Physicians Underestimate Women's Heart Disease Risk
Women are less likely than men to receive recommendations from their doctors for preventive therapies such as cholesterol-lowering drugs, aspirin therapy and cardiac rehabilitation to protect against heart attacks and death, according to a study by Lori Mosca, M.D., Ph.D., associate professor of medicine and director of the Columbia Center for Heart Disease Prevention.
The treatment gap results from doctors' misperceptions that a woman's risk is lower, even when her actual risk is calculated to be the same as a man's, according to the study, which asked 500 doctors to assess the risk of several hypothetical patients.
When the researchers adjusted for the differences in the perception of risk, the differences in treatment of women were resolved in most cases.
"The finding that differences in the perception of risk of heart disease accounted for differences in preventive care is critical," says Dr. Mosca. "These data suggest that if we educate physicians to more accurately assess risk in women, they will be more likely to receive appropriate preventive care. Preventive measures, including lifestyle and drug therapy, have been shown to save lives in both men and women."
The study, funded by the American Heart Association via a grant from KOS Pharmaceuticals, was published in the Feb. 1 issue of Circulation.
Long-Term Mortality Rises After Pre-eclampsia
Researchers from CUMC, Yale University, Hebrew University, and the Albert Einstein College of Medicine have found that women whose pregnancies are complicated by pre-eclampsia are three times as likely as other women to die in the third and fourth decades after the complication.
Pre-eclampsia's relationship to the mother's long-term mortality has been controversial, with some researchers finding an increase in deaths while others saying there is no change in risk, provided the complication affected only the first pregnancy. None of these studies, however, have followed women beyond 25 years after pregnancy.
The new study followed women into the third and fourth decades after pre-eclampsia and found a strong and time-dependent increase in risk of death starting at 20 years after delivery. Of the different causes of death, cardiovascular disease was the most strongly related to pre-eclampsia.
Susan Harlap, M.D., professor of clinical epidemiology in the Mailman School of Public Health, says the researchers don't know whether pre-eclampsia promotes vascular disease or if women at risk of cardiovascular disease have a greater chance of developing pre-eclampsia.
In either case, the researchers say practitioners should not be reassured once a woman with pre-eclampsia safely delivers her child; they encourage preventive measures to reduce cardiovascular risk.
The research was published in the March issue of Epidemiology and was supported by the NIH.
Reducing RAGE Regenerates Liver
Living donors can donate up to 70 percent of their livers, but that amount is sometimes not enough for the recipient. Donated liver tissue often fails to regenerate to its full size in patients who receive "small for size" donations, endangering the recipient's life.
Inflammation probably plays a big part in damaging a too-small liver, and now CUMC researchers have found that blocking a pro-inflammatory receptor allows the too-small liver to regenerate, at least in mice. The results suggest that a similar strategy to block the receptor, called RAGE, in people could increase the availability of live liver transplantations by making small-for-size liver donation more feasible.
The research was in the Feb. 7 Journal of Experimental Medicine by Jean Emond, M.D., the Thomas S. Zimmer Professor of Surgery and Clinical Vice Chair of Transplantation; Ann Marie Schmidt, M.D., Chief of Surgical Science; Guellue Cataldegirmen, M.D., postdoctoral fellow in the Division of Liver Diseases and Transplantation; and Shan Zeng, Ph.D., associate research scientist in the same division.
This research was funded by the Surgical Research Fund of P&S and the U.S. Public Health Service.
Mouthwash for Diabetes?
This summer, researchers in the School of Dental and Oral Surgery are starting a Phase II clinical trial to see if a mouthwash can help people with diabetes and periodontitis control their blood sugar.
If left untreated, people with diabetes are more susceptible to periodontitis, an infection of the gums that can destroy the bone, gums, and connective tissue that support the teeth. Periodontitis also makes it harder for diabetics to control their sugar.
In previous studies, Steven Engebretson, D.M.D., assistant professor of clinical dentistry, has found that reducing inflammation caused by periodontitis improves patients' sugar control. His new trial will determine if a product in development, Ketorolac Oral Rinse, can more conveniently reduce inflammation than current treatments, which include tartar scraping, root planing, and, sometimes, surgery.
In 2003, Procter & Gamble donated the product's patents to Columbia, along with a substantial restricted cash grant to support patent maintenance and to help Dr. Engebretson continue developing the rinse as a treatment for periodontitis.
Neurologists Advocate Change in Stroke Care
A close look at more than 500 CUMC stroke patients has prompted Columbia neurologists to change the way they treat a dangerous type of stroke and to call for other centers to follow suit.
Outcomes research has changed the way CUMC physicians treat strokes caused by bleeding between the brain and skull.
Subarachnoid hemorrhage, usually the result of a burst aneurysm between the skull and the brain, often killed patients 10 to 15 years ago if the aneurysm started bleeding again before being repaired. With today's more aggressive treatment aneurysms are usually fixed within 24 hours of admission many neurologists felt the re-bleeding problem had disappeared.
But Stephan Mayer, M.D., associate professor of clinical neurology, and his colleagues found re-bleeding still occurs in 6.7 percent of subarachnoid hemorrhage patients. The findings appeared in the March 2005 Archives of Neurology.
"That percentage is a lot higher than people expected and it's led to a change in our practice that we're trying to promote in other stroke centers," says Dr. Mayer.
To prevent rebleeding, Columbia neurologists are now treating newly arrived patients with antifibrinolytics for no more than three days. The use of antifibrinolytics is controversial because of dangerous side effects, but Dr. Mayer says the danger arises when the drugs are given continuously for weeks. He and his colleagues are now studying if antifibrinolytics reduce rebleeding and improve outcomes.
The research was supported by the American Heart Association.
Poor Patients with Bipolar Disorder Often Undiagnosed
Primary care doctors are getting better at identifying depressed patients but missing those with bipolar disorder, according to a study in the Feb. 23 JAMA by Myrna Weissman, Ph.D., professor of epidemiology and chief of clinical-genetic epidemiology at the New York State Psychiatric Institute, and colleagues.
In their survey of more than 1,000 low-income patients seeking primary care in a New York City clinic the researchers found that almost 10 percent reported symptoms of bipolar disorder during their lifetime.
Though the patients' physicians recorded evidence of depression in about half of these patients, none diagnosed bipolar disorder. Distinguishing between depression and bipolar disorder is important because treating bipolar disorder with antidepressants alone may induce manic episodes. Dr. Weissman says the detection of bipolar disorders among low-income patients could be improved if physicians ask patients with depression or substance abuse about past manic episodes.
"Because the poor tend to rely on primary care physicians for mental health treatment, these health professionals can play an important role in the assessment and management of bipolar disorders."
The research was supported by a grant from Eli Lilly & Co and a National Research Service Award Institutional Research Training Grant from NIMH.