Precaution is better than cure. 

                                       Edward Coke

WEDNESDAY, Nov. 16 (HealthDay News) -- Broken heart syndrome -- a temporary heart condition brought on by extreme physical or emotional stress -- occurs overwhelmingly in women compared to men, a new study suggests.

Whether preceded by the sudden death of a loved one, a frightening medical diagnosis, a car accident or even a surprise party, the phenomenon is 7.5 times more common in females, and women older than 55 are 2.9 times more likely to develop broken heart syndrome than younger women, the researchers found.

"We don't really know what causes it, but it's with people who present with symptoms of a heart attack that often occurs with a very stressful situation," said Dr. Stacey Rosen, associate chair of cardiology at the Long Island Jewish Medical Center in New Hyde Park, N.Y. "We know women get all forms of heart disease differently than men do. Whether this is an external effect on the heart muscle . . . or a difference in the way blood vessels behave is yet to be understood," said Rosen, who was not involved in the study.

University of Arkansas researchers were slated to present the study Wednesday at an American Heart Association (AHA) meeting in Orlando, Fla. Research presented at scientific meetings is preliminary and has not yet been peer-reviewed.

Known clinically as takotsubo cardiomyopathy, broken heart syndrome causes a temporary enlargement of part of the heart, while the rest of the organ functions normally or with more forceful contractions. Symptoms mimic a heart attack and trigger chest pain, shortness of breath, an irregular heartbeat and generalized weakness. The condition is treatable and typically resolves within a week, though it is fatal in rare cases.

The study analyzed records from a nationwide database in 2007 and found that of about 6,230 cases of broken heart syndrome, more than 89 percent were in women. About one-third of patients were between the ages of 50 and 65, while 58 percent were older than 65. In those aged 55 and older, the odds of developing broken heart syndrome were 9.5 times higher in females than males, the investigators found.

"It's the first time we have a tangible disease that shows the connection between the mind and heart," said Dr. Suzanne Steinbaum, director of women's health and heart disease at Lenox Hill Hospital in New York City.

"I don't think we should underestimate the effects of the mind on the heart," added Steinbaum, also an AHA spokeswoman. "Constant stress, which is so prevalent right now in our world, sort of gives us a window into the possibilities . . . of what our emotional state can have on our heart."

But experts are still trying to discern why women suffer so much more from broken heart syndrome. Hormonal differences between the sexes and variations in coronary arteries may be factors, Rosen and Steinbaum said, but more research is needed.

"There is a truth to women being more emotional and reacting more emotionally, though I'm not sure it's fair to men to say that if something is emotionally upsetting to men, they're not feeling it," Steinbaum said.

"This kind of research 10 or 15 years ago was pretty unusual," Rosen noted. "The fact that gender differences in the heart are being studied now is a pretty tremendous thing. Our understanding of this clinical entity goes hand in hand with this work."

More information

Johns Hopkins University has more about broken heart syndrome  .

WEDNESDAY, Nov. 16 (HealthDay News) -- People who are diligent about keeping their heart healthy have a good chance of staving off cancer as well, researchers report.

Individuals who don't smoke and who maintain a healthy body-mass index (BMI), normal blood pressure and two to four other "ideal" measures of heart health have a 38 percent lower risk of developing cancer, according to research scheduled for presentation Wednesday at the annual meeting of the American Heart Association in Orlando, Fla.

The study authors hope the score they've developed will help doctors drive home the message that prevention is key to both cancer and heart disease.

"Physicians need motivation to really push the issue of prevention with patients," said lead author Laura J. Rasmussen-Torvik, an assistant professor of preventive medicine at Northwestern University Feinberg School of Medicine in Chicago.

Other experts agreed.

"If we give patients a double whammy [message], in the ideal world, we might be preventing two of these biggest killers. It might be a stronger message," said Dr. Tara Narula, a cardiologist with Lenox Hill Hospital in New York City.

"People generally know that healthy behaviors prevent heart disease and cancer, but to [relate risk factors such as cholesterol] to cancer is novel," added Dr. Harmony Reynolds, associate director of the Cardiovascular Clinical Research Center at New York University Langone Medical Center in New York City. "It's very nice to have that crossover in practice. Sometimes I talk to patients about lowering their cholesterol and exercising, and they get very fatalistic saying that, in my family, cancer is the problem. It's very convenient to be able to say these things."

"Ideal" cardiovascular health is one of the American Heart Association's Strategic 2020 Goals, which aim to improve Americans' heart health by 20 percent and reduce deaths from heart disease and stroke by 20 percent.

For this study, researchers followed more than 13,000 healthy individuals for 13 years, measuring seven "metrics" of heart health at the start and tracking any cancer that developed. Those seven factors are: not smoking, normal BMI (a calculation based on weight and height), physical activity, healthy diet, and safe cholesterol, blood pressure and fasting blood glucose levels.

Between 1987 and 2006, the participants developed more than 1,800 new cancers, namely prostate, breast, lung and colon. But, the more "ideal" factors people had, the less likely they were to develop cancer.

Compared to people who had none of the seven factors, having just one reduced the risk of cancer by 20 percent. Three factors lowered the risk of cancer by 22 percent, and five to seven pushed the risk down 38 percent.

"If you lower yourself by one point [risk factor], that's a significant decrease in cancer risk and a lower risk of heart disease," said Dr. Christopher Cove, assistant director of the cardiac catheterization lab at the University of Rochester Medical Center in New York. "That's exciting."

When the researchers looked at the same participants but removed smoking from the measure, the association was no longer significant but the trend was still in the right direction.

"This says that, yes, smoking is really important but we still see the trend when smoking is taken out, so adhering to a healthy diet and having a low BMI are still important for cancer risk," said Rasmussen-Torvik.

The association might have been even clearer had the study had more participants and more cases of cancer, said Reynolds.

It's not clear why these associations exist, but Narula hypothesized they could relate to overall inflammation, which drives both heart disease and cancer.

The study authors said they hope to see more collaboration between the American Heart Association and cancer advocacy groups.

"I think the American public is very confused about conflicting health messages," said Rasmussen-Torvik. "If organizations like the American Heart Association, the American Cancer Society and the American Diabetes Association could work together to emphasize some core prevention goals, that could be beneficial to all groups."

Research presented at meetings should be considered preliminary until published in a peer-reviewed medical journal.

More information

The U.S. National Cancer Institute has more on cancer risk.

TUESDAY, Nov. 15 (HealthDay News) -- People with heart conditions who take vitamins may be less likely to take some of their other medications properly, according to a new study.

Researchers from the Intermountain Medical Center in Utah asked 100 people with an irregular heartbeat -- known as atrial fibrillation -- what they knew about warfarin (Coumadin), a commonly prescribed blood thinner. The patients were also asked how well they followed their prescription for the drug, and whether or not they also took vitamins or other supplements.

People taking warfarin need regular monitoring because too much of the drug can cause bleeding, and too little can allow blood clots to form, increasing the risk for stroke. In addition, diet also plays a role in warfarin's effectiveness.

The study, presented Monday at the American Heart Association's annual meeting in Orlando, Fla., found that 62 percent of patients who were prescribed warfarin took the drug with dietary supplements, potentially reducing its effectiveness. Of this group, 24 percent admitted that they even skipped doses of the anticoagulant drug, putting them at greater risk for stroke. Moreover, heart patients who took vitamins were 2 percent more likely to double their dose of warfarin, compared to those not taking supplements, which can increase their risk of bleeding.

The study also found that patients taking vitamins were less informed about potentially dangerous interactions between the supplements they were taking and warfarin. The researchers pointed out these patients had more episodes of unexplained bleeding, and needed more non-surgical transfusions.

The study's authors concluded that patients on prescription drugs should be more aware of the potentially negative side effects associated with taking dietary supplements.

"When you take a vitamin pill, you often are getting a much higher dose than you would by just eating a balanced diet. People don't realize that vitamins can be just as active as drugs, and, as we've seen here, mixing the two together can, in some cases, have adverse consequences for your health," said one of the study's authors, Dr. Jeffrey L. Anderson, director of cardiovascular research at Intermountain Medical Center's Heart Institute, in a news release from the medical center.

"This indicates to me that we physicians need to do a better job of educating our patients about vitamins and other supplements and how they interact with the medications we prescribe," Anderson added.

The study's authors cautioned that taking too many vitamins or too much of any one supplement could have negative health consequences.

"More and more studies are starting to show that excessive doses of some vitamins can increase the risk for serious diseases, including cancer," said Anderson. "As health care providers, we need to encourage caution when it comes to taking vitamins, as with any other medications."

Commenting on the study, Dr. Jack Ansell, chairman of the department of medicine at Lenox Hill Hospital in New York City, pointed out that about 3 million people in the United States take warfarin. "Because its effect on blood clotting is variable in response to diet and other drugs, it requires routine monitoring. In fact, vitamin K is an antidote to warfarin, and this may have been included in some of the supplements patients were taking in the study," Ansell explained.

"It is not clear who was managing the warfarin therapy in these patients, but anticoagulation clinics tend to provide expert education, whereas such education is less likely to occur in the individual physician's office. This study highlights the importance of such education regardless of who manages the warfarin therapy," Ansell said.

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

More information

The U.S. Food and Drug Administration has more about dietary supplements.

TUESDAY, Nov. 8 (HealthDay News) -- Doctors who own equipment for cardiac stress tests are more likely to perform the tests, even when guidelines don't recommend it.

The same was true if the doctor didn't necessarily own the equipment but did interpret the results in his or her own office, according to a study in the Nov. 9 issue of the Journal of the American Medical Association.

The authors of the study looked specifically at patients who had recently undergone revascularization procedures to open blocked arteries.

There are no recommendations to support routine testing of patients with no symptoms within two years of having a procedure such as balloon angioplasty or receiving stents, or within five years of having coronary artery bypass surgery.

It's well known that imaging has exploded in many areas of medicine, particularly cardiology. The trend has also been linked previously to physician reimbursement.

One recent study found that doctors are far more likely to refer patients complaining of lower back pain for an expensive MRI scan if they own or lease such imaging equipment.

The authors of the new study looked at data on nearly 18,000 patients enrolled in a national insurance plan, UnitedHealthcare, which also funded the study, who had undergone revascularization within the past several months.

The data only included procedures performed between 2004 and 2007. Guidelines for routine testing after such a procedure weren't introduced until 2007.

Two types of tests were looked at: nuclear stress testing (which uses radioactive material to see blood flow) and stress echocardiography (which uses ultrasound), but the authors reported results only on nuclear, which was the most common test in this group, according to study lead author Dr. Bimal R. Shah, an assistant professor of medicine at Duke University Medical Center.

Nuclear stress testing was about 2.3 times more common in physicians who charged both technical fees (for such things as equipment and overhead) and professional fees (largely for interpretation of the results) than in those who billed for neither, said Shah.

Nuclear testing rates were about 50 percent higher among physicians who just billed for professional services versus those who didn't bill for either, he added.

Testing did tend to be more common among patients who had symptoms, although up to 10 percent of patients in this study who underwent testing had no symptoms.

Shah acknowledged that more current data need to be obtained, given that guidelines as well as Medicare/Medicaid reimbursement have changed since the study was finished.

And some of the testing may indeed have been necessary, given that billing information can only reveal so much about a patient's overall status.

"There are certainly reasons that patients may be getting tested: patient reassurance, physician reassurance or [if an employer requires it] before returning to work," Shah said. But there were large variations, he noted.

"This has been a concern for a long time, [but] how important this is financially and from a risk perspective may be overemphasized," said Dr. Robert Hendel, a professor of medicine and radiology and director of cardiac imaging at the University of Miami School of Medicine. "We have made great strides [since 2007] to make people aware that we have to be much more concerned about how we utilize testing both in terms of risk and extent."

Regardless of the issue of reimbursement, though, "the bigger issue is that we want to discourage all inappropriate testing," Hendel said.

More information

The U.S. National Library of Medicine has more on nuclear stress testing.