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A new analysis comparing angioplasty with clot-busting drugs in female and male heart attack patients finds that women may benefit more from angioplasty than men. Part of the reason is that women were found to have higher rates of cerebral hemorrhage when treated with clot-busting drugs than men, says a Columbia University Medical Center doctor who helped lead the research.

Dr. Jacqueline E. Tamis-Holland, assistant professor of clinical medicine and first author of the study, says the results could help women get more appropriate treatments. "These findings should help physicians make better decisions when a woman with a heart attack comes into the emergency room," she says. "Studies like ours are pointing out the different risks that men and women face." In general, women heart attack patients are at higher risk for additional cardiovascular problems such as hemorrhage, stroke, and more heart attacks, than men.

She and colleagues at CHR de la Citadelle in Belgium, the Cleveland Clinic, Duke University, and New York University analyzed data from previously published research on 877 men and 260 women. Heart attack patients received either angioplasty or clot-dissolving drugs. Researchers collected demographic and medical data on the patients when they were hospitalized and at 30 days and six months afterwards.

The women were older than the men, more likely to have diabetes, high blood pressure, and a history of congestive heart failure but were less likely to have ever smoked cigarettes. The study, which appeared in the January issue of the American Heart Journal, analyzed data from a 1997 New England Journal of Medicine study – the Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes (GUSTO II-B) Angioplasty Substudy.

—Matthew Dougherty

Studies have shown that adolescent smoking patterns differ according to ethnic and racial groups. But it has been unclear whether the factors that lead youths to start smoking and draw them into daily smoking are similar across races and ethnicities.

Now, a study by researchers at Columbia University Medical Center and the New York State Psychiatric Institute indicates that for the most part, similar factors are at work for black, Hispanic, and white adolescents.

Predictors of smoking across racial and ethnic groups were peer smoking, delinquency, being part of a single-parent family, being older (in late teenage years), and absence of a ban on cigarette vending machines in locations accessible to young people, says Dr. Denise Kandel, professor of sociomedical science and psychiatry at CUMC and chief of epidemiology at NYSPI. Frequency of smoking, parental and peer smoking, and low parent-child closeness were common predictors of progression to daily smoking.

The researchers also found that individual factors, such as peer smoking, were more important predictors of smoking behavior than were school and overall policy factors, such as cigarette taxation and bans on cigarette advertising near schools.

The researchers analyzed data from a national study, the National Longitudinal Study of Adolescent Health (also known as Add Health), that surveyed and interviewed youngsters in grades 7 to 12, tracking them between 1994 and 1996. Following adolescents over time enabled the researchers to identify factors that predict who is likely to start smoking and to move to more frequent smoking before these transitions, Dr. Kandel says.

"Universal prevention and intervention techniques, such as reducing peer pressure, targeting parents, and reducing access to cigarettes, would be most beneficial in limiting adolescent smoking," Dr. Kandel says. "Most smokers start before the age of 18 so it is important to direct prevention strategies at young people and their parents." The paper appeared in the January issue of the American Journal of Public Health.

The research was supported by grants from the National Institute on Drug Abuse and the National Institute of Mental Health.

—Matthew Dougherty

A type of communication that goes on inside cells may be linked to schizophrenia, according to researchers at Columbia University Medical Center and Rockefeller University. Although scientists do not know what causes schizophrenia, they have known for many years that many different genes and environmental factors play a role. It has only been during the past two years, however, that some of these genes have been convincingly linked to the disease.

The new study suggests that malfunction and lack of communication between two key regulatory proteins inside the cells of people with schizophrenia are also involved. This results in impairment of a pathway that plays an important role in cell survival and synaptic plasticity of the central nervous system. The study was published Jan. 26 on the Nature Genetics Web site.

"The challenge now for schizophrenia researchers is to understand how genes that increase the risk for schizophrenia interact with each other to cause disease," says one of the study's senior authors, Dr. Joseph Gogos, assistant professor of physiology and cellular biophysics. "My lab is actively working toward this goal."

This research was supported by the Rockefeller Brothers Fund, New York City Council Speaker's Fund, and the EJLB Foundation (a Canadian foundation supporting research in schizophrenia and enviornmental protection).

—Susan Conova

In recent years, a number of studies have looked at the relationship between hormone levels and Alzheimer's disease, with inconsistent results. Now, researchers at Columbia University Medical Center may have uncovered a critical piece of this puzzle, observing elevated levels of sex-hormone binding globulin (SHBG), a protein strongly associated with estrogen transport, in menopausal women with Alzheimer's disease. The study appears in the February issue of the journal Neurobiology of Aging.

The researchers, led by Dr. Richard Mayeux, Gertrude H. Sergievsky Professor of Neurology, Psychiatry, and Epidemiology at P&S and the Mailman School of Public Health, measured levels of seven different hormones in 576 post-menopausal women, a number of whom had received a diagnosis of Alzheimer's disease. The investigators noted significant differences between patients with Alzheimer's and their healthy counterparts only in levels of SHBG, which was 20 percent higher in Alzheimer's patients.

"This finding is noteworthy because we would expect SHBG levels to decrease along with estrogen levels in menopause," says Dr. Mayeux. "The fact that only the women with Alzheimer's demonstrated elevated SHBG levels – with no accompanying increase in estrogen – suggests an abnormality and a possible link between SHBG and Alzheimer's. The role of SHBG during the aging process, however, needs further investigation."

—Leslie Boen