Acne is a skin condition characterized by whiteheads, blackheads, and inflamed red pimples or “zits.”
Symptoms

* Blackheads
* Crusting of skin eruptions
* Cysts
* Inflammation around the skin eruptions
* Pustules
* Redness around the skin eruptions
* Scarring of the skin
* Whiteheads

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Take the following self-care steps to lessen the effects of acne:

* Clean your skin gently with a mild, non-drying soap (such as Dove, Neutrogena, or Basics). Remove all dirt or make-up. Wash once or twice a day, including after exercising. However, avoid excessive or repeated skin washing.
* Shampoo your hair daily, especially if it’s oily. Comb or pull your hair back to keep the hair out of your face. Avoid tight headbands.
* Try not to squeeze, scratch, pick, or rub the pimples. Although it might be tempting to do this, it can lead to scarring and skin infections.
* Avoid touching your face with your hands or fingers.
* Avoid greasy cosmetics or creams. Look for water-based or “non-comedogenic” formulas. Take make-up off at night.

If these steps do not clear up the blemishes to an acceptable level, try over-the-counter acne medications. These creams and lotions are applied directly to the skin. They may contain benzoyl peroxide, sulfur, resorcinol, or salicylic acid. They work by killing bacteria, drying up the oil, and causing your skin to peel.

If the pimples are still a problem, a dermatologist can prescribe stronger medications and discuss other options with you.

Prescription medicines include:

* Oral antibiotics (taken by mouth) such as minocycline, doxycycline, and tetracycline
* Topical antibiotics (applied to the skin) such as clindamycin or erythromycin
* Retinoic acid cream or gel (Retin-A) and isotretinoin pills (Accutane) — pregnant women and sexually active adolescent females should NOT take Accutane, as it causes severe birth defects; Women taking Accutane should use two forms of birth control before starting the drug
* Prescription formulas of benzoyl peroxide, sulfur, resorcinol, salicylic acid

Birth control pills can sometimes help clear up acne. (In some cases, though, they may make it worse.)

Your doctor may also suggest chemical skin peeling, removal of scars by dermabrasion, or removal or drainage of cysts.

A small amount of sun exposure may improve acne. However, excessive exposure to sunlight or ultraviolet rays is not recommended because it increases the risk of skin cancer.
Causes

Acne occurs when tiny holes on the surface of the skin, called pores, become clogged. Each pore is an opening to a canal called a follicle, which contains a hair and an oil gland. Normally, the oil glands help keep the skin lubricated and help remove old skin cells. When glands produce too much oil, the pores can become blocked, accumulating dirt, debris, and bacteria. The blockage is called a plug or comedone.

The top of the plug may be white (whitehead) or dark (blackhead). If it ruptures, the material inside, including oil and bacteria, can spread to the surrounding area and cause an inflammatory reaction. If the inflammation is deep in your skin, the pimples may enlarge to form firm, painful cysts.

Acne commonly appears on the face and shoulders, but may also occur on the trunk, arms, legs, and buttocks.

Acne is most common in teenagers, but it can happen at any age, even as an infant. Three out of four teenagers have acne to some extent, probably caused by hormonal changes that stimulate oil production. However, people in their 30s and 40s may also have acne.

Acne tends to run in families and can be triggered by:

* Hormonal changes related to menstrual periods, pregnancy, birth control pills, or stress
* Greasy or oily cosmetic and hair products
* Certain drugs (such as steroids, testosterone, estrogen, and phenytoin)
* High levels of humidity and sweating

Despite the popular belief that chocolate, nuts, and other foods cause acne, this does not seem to be true.
Tests & diagnosis

Your doctor can diagnose acne based on the appearance of the skin. Testing is usually not required.
Prognosis

Acne usually subsides after adolescence, but may last into middle age. The condition generally responds well to treatment after a few weeks, but may flare up from time to time. Scarring may occur if severe acne is not treated. Some people, especially teenagers, can become significantly depressed if acne is not treated.
Complications

Possible complications include:

* Changes in skin color
* Cysts
* Damage to self-esteem, confidence, personality, and social life
* Permanent facial scars
* Side effects of Accutane (including very dry skin and mucous membranes, high triglyceride levels, liver damage, and birth defects in an unborn baby; call your doctor right away if you become pregnant while taking this drug)
* Side effects of other medications

When to contact a doctor
Call your doctor or a dermatologist if:

* Self-care measures and over-the-counter medicine have not helped after several months
* Your acne is severe (for example, you have lots of redness around the pimples or you have cysts) or getting worse
* You develop scars as your acne clears up

Call your pediatrician if your baby has acne that does not clear up on its own within 3 months.

Oct. 6, 2009 — Here’s a surprise: Some of the healthiest foods may also be the most likely to cause food-borne illness.

That’s the conclusion in a report by the Center for Science in the Public Interest (CSPI). The report shows leafy greens, sprouts, and berries are among the most prone to carry infections or toxins.

“We don’t recommend that consumers change their eating habits,” says Caroline Smith DeWaal, the CSPI’s head of food safety programs. Instead, the group is trying to point out vulnerabilities in the nation’s food safety system as it lobbies Congress to beef up enforcement.

The group analyzed CDC data on food illness outbreaks dating back to 1990. They found that leafy greens were involved in 363 outbreaks and about 13,600 illnesses, mostly caused by norovirus, E. coli, and salmonella bacteria.

The rest of the top 10 list included:

* Eggs, involved in 352 outbreaks and 11,163 reported cases of illness.
* Tuna, involved in 268 outbreaks and 2,341 reported cases of illness.
* Oysters, involved in 132 outbreaks and 3,409 reported cases of illness.
* Potatoes, involved in 108 outbreaks and 3,659 reported cases of illness.
* Cheese, involved in 83 outbreaks and 2,761 reported cases of illness.
* Ice cream, involved in 74 outbreaks and 2,594 reported cases of illness.
* Tomatoes, involved in 31 outbreaks and 3,292 reported cases of illness.
* Sprouts, involved in 31 outbreaks and 2,022 reported cases of illness.
* Berries, involved in 25 outbreaks and 3,397 reported cases of illness.

It is unclear how many of the outbreaks can be blamed on the foods themselves. The CDC’s database can’t discriminate between outbreaks caused by tomatoes, for example, vs. those caused by other ingredients in a salad. Foods like potatoes are almost always consumed cooked, so it is unlikely that potatoes themselves caused 108 outbreaks.

Still, Smith DeWaal called the list “the tip of the iceberg” when it comes to food-borne illnesses in the U.S. Not all outbreaks are reported to public health authorities. In addition, the analysis focused only on foods regulated by the FDA; that leaves out beef, pork, poultry, and some egg products, which are policed by the U.S. Department of Agriculture.

“Consumers always want to know what they should do to avoid getting sick,” says Sarah Klein, lead author of the report. She recommends “defensive eating,” including keeping food cold and cooking it thoroughly, chilling oysters and avoiding them when raw, and avoiding raw eggs or using them in homemade ice cream.

Several bills that are circulating in Congress aim to crack down on food safety by requiring all food producers to keep written safety plans and giving the FDA more power to inspect plans and enforce rules.

“In a relative scale our food supply remains quite safe,” says Craig Hedberg, a professor of environmental and occupational health at the University of Minnesota School of Public Health. The CDC says 76 million Americans get sick from food-borne illnesses each year.

“Because most people don’t experience a bad outcome from a lapse in good behavior it’s difficult to enforce,” he says.

SOURCES:Center for Science in the Public Interest: “The Ten Riskiest Foods Regulated by the U.S. Food and Drug Administration,” Oct. 6, 2009.Caroline Smith DeWaal, director, food safety programs, Center for Science in the Public Interest.Sarah Klein, author, CSPI report.Craig Hedberg, professor of environmental and occupational health, University of Minnesota School of Public Health.CDC web site: “Food-Related Diseases.”

Oct. 13, 2009 — Cancer patients undergoing chemotherapy feel less exhausted if they enroll in an intense program that exercises the mind as well as the body, a Danish study finds.

Fatigue is one of the most troubling side effects of cancer chemotherapy. Patients don’t feel like doing anything, either physically or mentally. And the less they do, the weaker and more depression -prone they become.

Earlier studies showed that moderate exercise can help. So can psychosocial programs. Could both kinds of programs be combined — and intensified — for greater impact?

To find out, Lis Adamsen, PhD, and colleagues at Copenhagen University Hospital, Denmark, asked 269 adult cancer patients to enroll in a nine-hours-a-week exercise program for six weeks. Half the volunteers were randomly assigned to a control group and were asked to wait six weeks to join the program.

Although the program was designed to appeal to men and women, women were much more likely to volunteer. In the end, 196 women and 73 men volunteered for the study; 235 of them completed the program.

The program included:

* Monday, Wednesday, and Friday: High-intensity physical training (30 minutes of warmup, 45 minutes resistance training, and 15 minutes of cardiovascular training).
* Tuesdays: 90 minutes of body-awareness training (stretching on week 1, yoga breathing on weeks 2-3, and Pilates movement on weeks 4-6).
* Monday, Tuesday, Wednesday, and Friday: 30 minutes of relaxation training to follow physical training or body-awareness training.
* Monday and Friday: 30 minutes of massage

Patients weren’t allowed to pick and choose — they had to show up for the entire program, regardless of how they felt after their chemo treatments.

One patient with a brain tumor had a seizure after cardio training, so Adamsen and colleagues warn brain cancer patients not to try this kind of exercise. Ill effects were not seen in other patients.

Instead, those completing the program felt better. Although improvements were small to medium in size, the exercise program significantly reduced fatigue and increased patients’ sense of vitality. They felt fewer limits in their daily activities than did patients who did not exercise.

“The range of exercise components used … has been shown to be feasible, safe, and beneficial to various patients with cancer during chemotherapy — even patients with advanced disease,” Adamsen and colleagues conclude.

They note, however, that a program with more appeal to men needs to be developed.

The findings appear in the Online First edition of BMJ.

SOURCE:Adamsen, L. BMJ, Online First edition, Oct. 14, 2009.

Oct. 15, 2009 (Baltimore) — A diet rich in cruciferous and green leafy vegetables, nuts, fish, and tomatoes and low in red meat and high-fat dairy products may protect against Alzheimer’s disease, a study suggests.

Researcher Nikolaos Scarmeas, MD, associate professor of neurology at Columbia University in New York, tells WebMD that recommendations can’t be made on this study alone. “But in general, these foods are part of what we consider a healthy diet for other reasons, such as protection against heart disease . And they could help [your brain].”

The study was presented at the annual meeting of the American Neurological Association (ANA).

The research involved 1,691 people aged 65 and older with no signs of dementia when they entered the study. All filled out detailed questionnaires that asked about what foods they ate over the past year.

The researchers then studied various foods in the lab to determine which were rich in nutrients such as omega-3 fatty acids and vitamin E that have been linked to a lower risk of Alzheimer’s disease and which were low in nutrients such as saturated fatty acids that have been linked to a greater risk.

Based on the amounts of each nutrient in each food, “we discovered an Alzheimer’s-disease-protective dietary pattern that was characterized by a high consumption of nuts, fish, salad dressing, poultry, tomatoes, cruciferous, dark, and green leafy vegetables and fruits, and low in high-fat dairy, red meat, organ meat, and butter,” Scarmeas says. “Foods are not consumed in isolation, so studying the dietary pattern may offer substantial advantage.”

The 1,691 study participants were then divided into three groups according to how well they adhered to such a diet over the past year. Over the next four years, 211 of them were diagnosed with Alzheimer’s disease. Results showed that those in the top third were 38% less likely to develop Alzheimer’s four years later than those in the lowest third.

The analysis was adjusted for a variety of factors that could potentially explain the association, including age, smoking status, physical activity , body mass index, and caloric intake.

The fact that the researchers followed healthy people over time and that the analysis was adjusted to take into account factors such as physical activity that may also lower the risk of Alzheimer’s disease gives it strength, says Craig Blackstone, MD, PhD, of the National Institute of Neurological Disorders and Stroke.

“This is certainly a healthy diet to follow,” he says.

SOURCES:134th Annual Meeting of the American Neurological Association, Baltimore, Oct. 11-14, 2009.Nikolaos Scarmeas, MD, associate professor of neurology, Columbia University, New York.Craig Blackstone, MD, PhD, National Institute of Neurological Disorders and Stroke, Bethesda, Md.

By Daniel J. DeNoon
WebMD Medical News Reviewed by Louise Chang, MD

June 12, 2009 - There’s no shortcut to three years of difficult “chemical castration” hormone therapy for men receiving radiation treatment for locally advanced prostate cancer .

But there are silver linings to the finding, from European clinical trials led by Michel Bolla, MD, of the University of Grenoble, France.

Most men with newly diagnosed prostate cancer in the U.S. have an earlier stage of prostate cancer than the men in the Bolla study. If they need hormone therapy at all, they are likely to get by with a six-month treatment course.

Bolla explored whether this might work for men treated with radiation for what doctors call locally advanced prostate cancer — that is, prostate cancer that has spread beyond the inside of the prostate but not throughout the body.

In a study of 970 men, the researchers compared six months of hormone treatment — with additional treatment if men relapsed — to immediate assignment to three years of hormone treatment.

“The increase of overall survival in men given three years of treatment is superior,” Bolla tells WebMD.

Because hormone therapy blocks male hormones, it causes loss of sexual function and severe hot flashes. The good news, Bolla says, is that after three years, these side effects go away.

“We can see a modification of quality of life with respect to decrease of sexual activity during the three years of treatment,” he says. “But once the treatment is completed, the quality of life is like the quality of life prior to treatment.”

For most men in the U.S. — who, because of prostate-cancer screening have their cancers detected at an earlier stage than the men in the Bolla study — three years of hormone therapy would be “overkill,” says prostate cancer researcher Peter Albertsen, MD, of the University of Connecticut, Farmington.

“In many parts of the country, these men are automatically getting hormonal therapy just because doctors figure if it works for the more aggressive cancers it can work for the more localized cancers,” Albertsen tells WebMD. “The radiation therapy itself may be overkill — so then when you add three years of hormonal therapy, you are really overtreating these men.”

Unfortunately, it’s still not known for sure whether men with more limited disease than those in the Bolla study get a benefit from hormone therapy.

It’s not really an issue for many men whose prostate cancer is diagnosed before age 70. That’s because most such men in the U.S. opt for surgery to remove the prostate. At least for now, there’s no convincing evidence that men treated with prostatectomy benefit from hormone therapy.

“We are learning step by step when hormonal therapy seems to be effective and when it is not,” Albertsen says. “For men with relatively localized disease, we have no evidence that the additional hormonal therapy adds any value whether it is six months or three years or any permutation in between. That is because the radiation therapy may itself be sufficient.”

Bolla’s study — and editorial comments by Albertsen — appear in the June 11 issue of the New England Journal of Medicine.

SOURCES:Bolla, M. New England Journal of Medicine, June 11, 2009; vol 360: pp 2516-2527.Albertsen, P. New England Journal of Medicine, June 11, 2009; vol 360: pp 2572-2574.Peter C. Albertsen, MD, chairman, department of urology, University of Connecticut, Farmington.Michel Bolla, MD, head of radiotherapy, University of Grenoble, France; president, European Organization for Research and Treatment of Cancer (EORTC).

By Todd Zwillich
WebMD Medical News Reviewed by Louise Chang, MD

June 18, 2009 — A consumers group complained to regulators and threatened a lawsuit Thursday over what it calls a drug company’s misleading claims that two of its multivitamins reduce the risk of prostate cancer .

The Center for Science in the Public Interest is taking aim at One A Day Men’s 50+ Advantage and Men’s One A Day Men’s Health Formula multivitamins, both of which contain selenium . The group says widespread ads for the products claiming selenium helps reduce the risk of prostate cancer are false and not supported by major scientific studies.

Early studies suggested selenium, an antioxidant, could have some protective effect against cancer. But a major government-sponsored trial published in January, called SELECT (The Selenium and Vitamin E Cancer Prevention Trial), concluded that selenium “did not prevent prostate cancer” in a population of healthy men.

But the group complained that Bayer Healthcare LLC, which makes both products, continues to claim on packaging and in ads that they help reduce the risk of prostate cancer.

“A complete multivitamin plus selenium, which emerging research suggests may reduce the risk of prostate cancer,” Bayer’s ads state, according to the CSPI’s complaint to the Federal Trade Commission.

“We urge the Federal Trade Commission to take swift and strong action to get these deceptive Bayer ads off television, radio, and Internet and out of newspapers and magazines or wherever else they may be displayed,” states the CSPI’s complaint to the FTC.

The FTC in 2007 ordered Bayer to stop making unproven health claims for a One A Day weight loss product and told the company not to make any unsubstantiated claims for any vitamins in the One A Day product line.

In a statement, Bayer says “We are aware of CSPI’s complaint and are in the process of reviewing their allegations.”

“In the meantime, we stand behind all claims made in support of our products, including One A Day multivitamins. The claims made in support of selenium are based on an FDA-approved qualified health claim,” reads the statement, provided to WebMD.

The CSPI also threatened to sue Bayer if the company does not change its advertising for the One A Day multivitamins.

“Bayer is thumbing its nose at the Food and Drug Administration, the FTC, and any number of state consumer protection laws,” CSPI Litigation Director Steve Gardner says.

“FTC can sometimes take years. Because these ads are so bad we’ve threatened to sue Bayer within 30 days if they don’t stop running them,” David Schardt, CSPI senior nutritionist, tells WebMD.

The CSPI also notes that prostate cancer experts from across the U.S. have written to the FTC in support of the CSPI complaint against Bayer.

SOURCES:Journal of the american Medical Association, 2009; v 301: pp 39-51. Center for the Science in the Public Interest, letter to Federal Trade Commission, June 18, 2009.Statement, Bayer Healthcare LLC. Steve Gardner, CSPI litigation director.David Schardt, senior nutritionist, CSPI.

By Salynn Boyles
WebMD Medical News Reviewed by Louise Chang, MD

June 19, 2009 — Mayo Clinic researchers say an experimental treatment may have cured two patients whose prostate cancers were so advanced they had been considered inoperable.

Both patients were reportedly free of cancer after treatment with a combination of hormone therapy, an experimental immunotherapy, and surgery.

No one was more surprised than their doctors. “This is certainly not the way we thought it would go,” Mayo urologist and immunologist Eugene Kwon, MD, tells WebMD.

He adds that the point of the treatment had been to buy some time for patients whose cancers appeared to be incurable.

The two men were originally enrolled in a study designed to determine if treatment to suppress testosterone (known as androgen ablation), followed by treatment with an experimental immunotherapy called ipilimumab, could slow the progression of advanced prostate cancer .

“The goal was to see if we could modestly improve upon current treatments,” Kwon says.

The 85 patients in the study were not considered candidates for surgery, but several showed such dramatic regressions in their cancers that they left the trial in order to have it.

Kwon admits that this was done in the first patient not because the study investigators thought it was a good idea, but because the patient’s wife insisted.

“Even though this patient had remarkable reduction in disease, we still did not think surgery would be beneficial,” he says. “But in a two-hour, late-night phone conversation that became quite acrimonious, she demanded that we take her husband off the study and do surgery.”

More than a year and a half later, that patient shows no signs of prostate cancer, Kwon says.

One other patient who also left the study to have surgery also appears free of the cancer, and a third patient was operated on last week.

“This occurred not because we as physicians and scientists were so brilliant, but because a patient’s wife re-crafted our thinking about what was achievable,” he says.

Second Opinion

But just how promising is the treatment that Kwon and colleagues ended up with?

A prostate cancer specialist who spoke to WebMD says that remains to be seen.

“I think this is interesting information, but it is way too early to get excited,” says Derek Raghavan, MD, PhD, who directs the Cleveland Clinic’s Taussig Cancer Institute.

The study is ongoing and has yet to be published, but the researchers did present details on the patients who had the combination treatment and surgery in a poster presentation at a recent meeting of the American Society of Clinical Oncology.

Raghavan says prolonged androgen ablation is known to improve survival in locally advanced prostate cancer patients.

He adds that until more details of the trial are published, there is no way to independently assess the impact of ipilimumab on outcomes.

Ipilimumab is an experimental monoclonal antibody that targets a molecule on T-cells (a type of immune cell) that inhibits the immune system’s ability to fight cancer cells. It has mostly been studied in melanoma patients.

“We and others have shown remarkable responses after initial androgen ablation in this group of patients,” he says. “In this small, phase II study it is impossible to dissect out the impact of this … antibody.”

SOURCES:American Society of Clinical Oncology annual meeting, Orlando, Fla., May 29-June 2, 2009.Eugene Kwon, MD, urologist and immunologist, Mayo Clinic, Rochester, Minn.Derek Raghavan, MD, PhD, FACP, director, Cleveland Clinic Taussig Cancer Institute.

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Mesothelium derives from the embryonic mesoderm cell layer, that lines the coelom (body cavity) in the embryo. It develops into the layer of cells that covers and protects most of the internal organs of the body.
A layer of mesothelial cells grown in cell culture, featuring the typical “cobblestone” appearance

Structure

The mesothelium forms a monolayer of flattened squamous-like epithelial cells resting on a thin basement membrane supported by connective tissue. Cuboidal mesothelial cells may be found at areas of injury, the milky spots of the omentum, and the peritoneal side of the diaphragm overlaying the lymphatic lacunae. The luminal surface is covered with microvilli. The proteins and serosal fluid trapped by the microvilli provide a frictionless surface for internal organs to slide past one another.

Function

The mesothelium is composed of an extensive monolayer of specialized cells (mesothelial cells) that line the body’s serous cavities and internal organs. The main purpose of these cells is to produce a lubricating fluid that is released between layers, providing a slippery, non-adhesive and protective surface to facilitate intracoelomic movement.

The mesothelium is also implicated in the transport and movement of fluid and particulate matter across the serosal cavities, leukocyte migration in response to inflammatory mediators, synthesis of pro-inflammatory cytokines, growth factors and extracellular matrix proteins to aid in serosal repair, and the release of factors to promote the disposition and clearance of fibrin (such as plasminogen). It is an antigen presenting cell. Furthermore, the secretion of glycosaminoglycans and lubricants may protect the body against infection and tumor dissemination.

Role in disease

* Mesothelioma: (cancer of the mesothelium) is a disease in which cells of the mesothelium become abnormal and divide without control or order. They can invade and damage nearby tissues and organs. Cancer cells can also metastasize (spread) from their original site to other parts of the body. Most cases of mesothelioma begin in the pleura or peritoneum. More than 90% of mesothelioma cases are linked to asbestos exposure.

* Intra-abdominal adhesions: Normally, the mesothelium secretes plasminogen, which removes fibrin deposits. During surgical procedures, the mesothelium may be damaged. Its fibrinolytic capacity becomes insufficient and fibrin accumulates, causing fibrous adhesions between opposing surfaces. These adhesions cause intestinal obstruction and female infertility if it occurs in the abdomen, and may impair cardiac and lung function in the thorax.

* Ultrafiltration failure: The peritoneal mesothelium is implicated in the long-term development of ultrafiltration failure in peritoneal dialysis patients. The presence of supra-physiological glucose concentrations, acidity, and glucose degradation products in peritoneal dialysis fluids contribute to the fibrosis of the peritoneal mesothelium, either by epithelial-mesenchymal transition or increased proliferation of existing fibroblasts. A fibrosed peritoneum results in the increased passage of solutes across the peritoneum and ultrafiltration failure.

Sources

* Mesothelioma: Questions and Answers (National Cancer Institute).
* Histology at KUMC epithel-epith01 “Mesothelium”
* Histology at BU 00102loa - “Tissues, Layers, and Organs: transverse section of rat gut”
* Mutsaers SE. “Mesothelial cells: Their structure, function, and role in serosal repair.” Respirology 2002; 7:171-191

By Bill Hendrick
WebMD Medical News Reviewed by Elizabeth Klodas, MD,FACC

June 9, 2009 — Smoking , high blood pressure , excess weight, and diabetes are major risk factors for increasing the size of the heart’s left ventricle (the main pumping chamber) a new study shows. An increase in the size and thickness, or “mass,” of the left ventricle is a worrisome condition that can lead to heart failure .

Boston University researchers say that in a study of more than 4,200 people, those four risk factors were strongly correlated with greater left ventricle mass over the short term (four years), as well as over the long term (16 years).

The study is published in Circulation: Journal of the American Heart Association.

“Left ventricular mass has been associated in multiple studies with risk of cardiovascular disease, including risk of developing heart failure,” says Ramachandran S. Vasan, MD, senior investigator of the study and chief of the section of preventive medicine at Boston University School of Medicine. “These factors can be directly targeted for prevention and lowering these risk factors therefore could potentially lower the burden of heart failure.”

The scientists looked at the effect of risk factors on left ventricular mass by analyzing data from the Framingham Offspring Study, which encompasses the children and spouses of children of the original Framingham Heart Study participants.

The original Framingham Heart Study is a landmark observational data-gathering and analysis effort that started in 1948. It centered on a group of residents from Framingham, Mass., in whom heart disease risk factors and outcomes were tracked over time.

Measuring Heart Risk

For the present analysis, data were evaluated from heart ultrasound examinations obtained from 2,605 offspring in the 1970s and checkups through the late 1990s. Fifty-three percent of study participants were women; the average age was 45.

Participants were divided into low-, intermediate-, and high-risk-factor groups. The researchers say high blood pressure, excess weight, smoking, and diabetes strongly correlated with greater left ventricular mass, as did age and gender.

“People with fewer risk factors had almost no increase in [left ventricular] mass with age,” Vasan says in a news release. “People who had more risk factors had a steeper increase in [left ventricular] mass with age.”

The researchers also say that women, over a 16-year period, showed a greater and steeper rate of left ventricular mass increase as they aged. Also, people with diabetes, especially women, had a steep increase in muscle thickening over time.

In a separate study published in the same edition of Circulation, Vasan, Michael J. Pencina, PhD, also of Boston University, and colleagues describe a “calculator” they devised to predict an adult’s 30-year risk of experiencing or dying from a heart attack or stroke .

Analyzing data from 4,506 participants in the Offspring study, they concluded that women, on average, had a 7.6% 30-year risk of suffering a heart attack or stroke, compared to 18.3% for men. Although excessive weight was not a statistically significant indicator of cardiovascular events in the short term, that changed in the long-term, 30-year outlook.

The calculator “will enable physicians to enter patient data and obtain the 30-year risk estimates for their patients,” says Pencina, an associate professor of biostatistics at Boston University. “My hope would be that we can increase awareness of cardiovascular risk in younger people who may have lower 10-year risks but higher 30-year risks, and encourage them to take steps to maintain optimal levels of their risk factors.”

As an example, the researchers say a 25-year-old woman who smokes, has high blood pressure, and high cholesterol levels has a 1.4% risk, according to the calculator, of suffering a major cardiovascular event by age 35, but a 12% risk by age 55.

SOURCES:News release, American Heart Association.Pencina, M. Circulation: Journal of the American Heart Association, June 2009.

There’s research that suggests a connection between rheumatoid arthritis (RA) and diabetes . But the nature of that connection or even whether it’s actually real is unclear. “There are tantalizing links between the two diseases,” says Daniel Solomon, MD, MPH, an associate professor of medicine at Harvard Medical School and a rheumatologist at Brigham and Women’s Hospital in Boston. But “at this point they are mainly speculative.”

WebMD asked Solomon and Androniki Bili, MD, MPH, to explore the possible connection between RA and diabetes. Bili is an associate rheumatologist at Geisinger Health System in Danville, Pa. Here is what they had to say and how it might affect the way you manage RA.

RA/Diabetes Connection: What Are the links?

There are a number of theories about the connection between diabetes and rheumatoid arthritis. RA is an autoimmune disease. The immune system defends the body from invading organisms and substances that can cause damage. With RA, the body’s immune system attacks its own joints. The result of that attack is an ongoing inflammation, which is a hallmark of RA. Some research suggests that inflammation may also play a role in the onset of diabetes.

Solomon tells WebMD that there are links between inflammation and insulin resistance. “We know there is an increased risk of insulin resistance among people with RA,” he says. Insulin is produced in the pancreas and helps the body use glucose, or blood sugar, for energy. In people with insulin resistance, the body’s cells don’t respond to insulin in the correct way. That increases the risk of developing type 2 diabetes .

But inflammation is not the only potential link between RA and diabetes. Certain drugs that are used to treat RA, namely steroids, may actually increase the risk of diabetes . “We need to be very aware of RA patients’ glucose levels, especially if they are on corticosteroids,” says Solomon. “This drug is a risk factor for hyperglycemia or high blood sugar levels .”

The effects of RA may also increase the risk of diabetes. People with RA may lead sedentary lives due to pain and RA-related disabilities. When people are physically inactive, they are more likely to be overweight . Being overweight or obese is a known risk factor for diabetes. And according to the CDC, the inactivity caused by arthritis interferes with management of both RA and diabetes.

RA/Diabetes Connection: Can the Risk Be Lowered?

”If a patient has any modifiable risk factors for diabetes such as obesity,” Solomon says, “I want to be as proactive as possible.” This means encouraging the patient to eat a healthful diet and get regular exercise . Doing so will help lose weight and reduce the risk of diabetes.

And treating RA may also play a role in reducing the risk of diabetes. While steroids can increase diabetes risk, other rheumatoid arthritis medications may actually help lower the risk. For example, studies show that the antimalarial drug hydroxychloroquine is associated with a decreased risk of diabetes among people with RA.

In one study, people with RA who had ever taken hydroxychloroquine were 53% less likely to develop diabetes than their counterparts who had never taken it. In another study of patients with RA, researchers found that having ever taken hydroxychloroquine reduced the risk of diabetes by 38%. What’s more, people with RA who took hydroxychloroquine for more than four years were 77% less likely to report a new diabetes diagnosis than those who never took it.

“This is a safe and inexpensive drug and it has been consistently shown to decrease the risk of diabetes in RA,” says Bili, the author of the first study.

RA/Diabetes Connection: Making Informed Choices to Reduce the Risk

Does the effectiveness of hydroxychloroquine in reducing diabetes risk mean all people with RA and risk factors for diabetes should take it?

“It is a reasonable choice,” Bili says, “but it is a weaker treatment for RA. It may not achieve disease control.” Other drugs are more effective when it comes to treating the pain and inflammation of RA. “But, says Bili, “for people with mild RA who have risk factors for diabetes, it might be reasonable to start treatment with hydroxychloroquine. If they have more severe RA, she tells WebMD, hydroxychloroquine could be taken in combination with another arthritis drug.

It’s not clear why hydroxychloroquine is associated with lower diabetes risk among people with RA. It may allow the hormone insulin to remain in the body longer. This could improve insulin sensitivity and glucose tolerance and prevent diabetes.

Solomon says that what is known now is that insulin resistance is elevated in RA, but certain RA drugs such as TNF blockers, hydroxychloroquine, and methotrexate may improve insulin sensitivity. “Studies show that TNF antagonists taken for a month or a year improve insulin resistance,” Solomon says. “But we don’t know if this will lead to reduced diabetes risk.”

Many important questions remain about the link between diabetes and arthritis. “We don’t know whether tighter control of RA will reduce the risk of diabetes,” Solomon says. A study that looks at the effect of better RA control in reducing the risk of diabetes would, he says, “be a wonderful trial.”

In the meantime, it’s important to keep in mind that making healthy lifestyle choices involving exercise, diet, and not smoking is an important part of RA management. And those same choices are important in managing the risk of diabetes.

SOURCES:Daniel Solomon, MD, MPH, associate professor of medicine, Harvard Medical School; rheumatologist, division of pharmacoepidemiology, Brigham and Women’s Hospital, Boston.Androniki Bili, MD, MPH, associate rheumatologist, Geisinger Health System, Danville, Pa.Bolen, J. Morbidity and Mortality Weekly Report, 2008; vol 57: pp 486-489.American College of Rheumatology 2008 meeting; San Francisco, California; Oct. 28, 2008.Wasko, M. The Journal of the American Medical Association, July 11, 2007; vol 298: pp 187-193.

Reviewed by Louise Chang, MD on 6/12/2009