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Hormone Replacement Is Effective for Older Women Too

August 20, 2001|THOMAS H. MAUGH II | TIMES MEDICAL WRITER

Hormone replacement ther-apy is a proven way of protecting bone density in post-menopausal women, especially during the first five to seven post-menopausal years, when women undergo 20% or more of their lifetime bone loss. Now a study suggests that the therapy is also valuable in older women.

Dr. Dennis T. Villareal and his colleagues at Washington University School of Medicine in St. Louis studied 67 frail women age 75 or older. Forty-five were randomly assigned to receive either Premarin or Prempro and 22 received a placebo. The team reported in the Aug. 15 Journal of the American Medical Assn. that women receiving either of the hormones had a 3.9% increase in bone density in the lumbar spine after only nine months and a 1.8% increase in density in their femurs.

The researchers did not study whether the treatment decreased the incidence of bone fractures in the women, a major problem. According to the National Osteoporosis Foundation, 24% of elderly women who suffer hip fractures die within a year and one in four of the remainder never live independently again. The study was sponsored by the National Institutes of Health and by Wyeth-Ayerst Pharmaceuticals, which manufactures the hormones used.

Hormone therapy had not previously been studied in older women because they were not thought to be good candidates.

High Blood Pressure Is Often Mismanaged

An estimated 42 million Americans have high blood pressure--a major contributor to heart disease and strokes--but only 10 million are successfully treating it. Health authorities have attributed this poor record to poverty and lack of access to health care, but a new study finds that the vast majority of those with hypertension have health insurance and have visited a physician recently.

Dr. David Hyman and his colleagues at the Baylor College of Medicine in Houston studied data on 16,095 patients covered by the federal government's third National Health and Nutrition Examination Survey. They reported in the Aug. 16 issue of the New England Journal of Medicine (http://www.nejm.org) that 92% of the adults with untreated or unsuccessfully treated hypertension have health insurance and 72% of them had visited a physician during the previous year.

The researchers blamed the problem, at least in part, on the reluctance of many doctors to treat patients aggressively enough, especially elderly patients who often don't respond well.

The Baylor team found that most cases of unsuccessfully treated hypertension occurred in patients 65 or older. Doctors fear that lowering blood pressure too much will inhibit blood flow to the brain and reduce mental capacity, they said.

Iron Doses May Lessen ACE-Inhibitor Cough

Small doses of iron may reduce the coughing that is often a side effect of ACE inhibitors, a family of drugs widely used for treating cardiovascular disease, Korean researchers have found.

According to published reports, 5% to 39% of people taking the drugs develop a dry cough. Although the cough is not medically significant, its discomfort is the primary reason many patients stop taking the drugs.

Dr. Kyung Pyo Hong and his colleagues at Sungkyunkwan University School of Medicine in Seoul studied 19 patients who developed a persistent dry cough while taking ACE inhibitors. The six men and 13 women were 60 years old, on average.

The researchers said the cough "subsided within seven days after discontinuation of the drug and reappeared in 48 hours after reintroduction of the drug."

The team monitored the coughs during a two-week observation period, rating them on a standard scale, then gave the patients either a daily tablet of 256 milligrams of ferrous sulfate or a placebo. The researchers reported in the Aug. 16 Hypertension: Journal of the American Heart Assn. (http://hyper.ahajournals.org) that eight of the 10 patients receiving iron supplements showed a significant improvement in cough scores, compared with only one in nine of those receiving placebo. Three of those receiving iron showed a near complete end to their coughing.

The researchers do not know why the iron supplements worked, but iron has been reported to decrease the production of nitric oxide, which is known to have inflammatory effects on bronchial cells in the lungs.

HIV Transmission via Oral Sex Found Rare

HIV can be contracted by receptive oral sex, but it is a rare event, according to a UC San Francisco study.

Epidemiologist Kimberly Page Shafer and her colleagues studied 198 homosexuals, 98% of them male, who had participated in oral sex with an HIV-positive partner over the previous six months. They reported at an AIDS meeting in Atlanta last week that none of the participants became infected as a result of the exposures.

"The probability of acquiring HIV through that specific sexual activity is very, very low," Shafer said.

TB Test Needed for Arthritis Drug Recipients

Rheumatoid arthritis patients who wish to begin taking the promising drug Remicade must first have a tuberculosis test, the drug's manufacturer and the government said Wednesday.

The mandate comes on the heels of the discovery that patients taking the drug are four times as likely to develop TB as those not taking it.

Remicade suppresses the user's immune system in an effort to control the autoimmune attack that produces arthritis. If the user suffers from a dormant infection by the TB mycobacterium, the immune suppression may be enough to trigger an active infection.

The warning was issued because TB can be deadly and is easily spread to family and friends.

The Food and Drug Administration said there have been 88 TB cases among the estimated 170,000 people who have taken Remicade.

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Times medical writer Thomas H. Maugh II can be reached via e-mail at thomas.maugh@latimes.com.

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