Levitra ED medication

Localities that ban smoking in bars, restaurants and other public places witness a quick drop in heart attacks, two new studies show.

The research — which incorporated data from a total of 24 studies of smoking bans across the country — found at least a 17 percent reduction in heart attacks one year after the bans had been enacted.

“That’s when you lump all these studies together,” said Dr. David G. Meyers, a professor of cardiology and preventive medicine at the University of Kansas and lead author of a report that will appear in the Sept. 29 issue of the Journal of the American College of Cardiology.

“One thing we looked at was the effect of duration,” Meyers said. “The longer the study, the greater the beneficial effect. On average, after one year there was a 25 percent reduction in the risk of heart attack. The risk reduction got bigger the longer the ban was in effect.”

The other study, published in the Sept. 21 issue of Circulation, found a 17 percent drop in heart attack rates after one year and about a 36 percent drop three years after smoking restrictions had been enacted.

It incorporated data from 13 studies in the United States, Canada and Europe. Meyers’s research effort analyzed data from 11 studies of 10 public smoking bans in the same geographic regions.

Meyers said that the greatest benefit revealed in his study was seen in people younger than 50. Women seemed to benefit more than men, but for an unknown reason, he said.

Because the studies his group reviewed included localities with a total population of 22 million, “we can make a rather firm conclusion that smoking bans reduce the risk of heart attacks,” Meyers said.

The results indicate that a nationwide ban on smoking in public places would prevent 156,400 heart attacks a year in the United States, the report in the cardiology journal said.

One scenario in particular appears to clinch the case, Meyers said. When officials in Butte, Mont., banned smoking in public places, the incidence of heart attacks decreased by 45 percent. A judge reversed the banning ordinance, and the incidence of heart attacks returned to the previous level, he said.

Smoking increases the risk of heart attacks and other cardiovascular problems in a number of ways — by making artery-clogging blood clots more common, by reducing the amount of beneficial HDL cholesterol and by raising the possibility of dangerous heart rhythm abnormalities. Smokers double their risk for heart attacks, and secondhand smoke exposure increases the risk by 30 percent, the researchers said.

Smoking bans almost certainly decrease the risks for cardiovascular problems such as stroke and lung disorders such as emphysema, as well as lung cancer, said Dr. Steven A. Schroeder, director of the Smoking Cessation Leadership Center at the University of California, San Francisco, “but those decreases generally take a lot longer to take place.” He wrote an editorial that accompanied the publication of Meyers’s study.

Predictions that smoking bans will cause a disastrous drop in business for bars and restaurants generally don’t come through, Schroeder said. “A lot of people don’t like going into smoking restaurants and bars,” he said. “The last haven of smoking is in gambling casinos.”

And though many gamblers might not mind a smoky atmosphere, employees are inevitably exposed to the dangers of smoke, Schroeder said. A similar situation was faced by airline flight attendants in the 1970s and 1980s, he said. They eventually sued the airlines and won a settlement that has enabled them to establish a research institute on the dangers of smoking, Schroeder said.

New York City, which has had a smoking ban for several years, now proposes to extend that ban to city parks. Meyers said that seems like a good idea, though the immediate effect is uncertain.

“The dilutional effect of open air means there might not be enough smoke to make a difference,” he said. “But only a tiny exposure to cigarette smoke can be dangerous. I would like to see everyone stop smoking, and I think a smoking ban in parks would help, but there is no scientific evidence to show that it would help.”

Statins could be as beneficial for people with acceptable cholesterol readings but high levels of inflammation as they are for those with high cholesterol levels, a new analysis finds.

An earlier study of more than 17,000 participants, known as the JUPITER trial, found that rosuvastatin (Crestor) cut the risk for serious vascular problems in people whose cholesterol levels were not high while high-sensitivity C-reactive protein (hs-CRP) levels were.

CRP is a protein that increases during whole-body inflammation, and testing its levels has become an additional way to assess the risk of cardiovascular disease.

“The JUPITER trial demonstrated that rosuvastatin, when given to apparently healthy men and women with low cholesterol but increased hs-CRP, reduced heart attack by 55 percent, stroke by 48 percent, angioplasty and bypass surgery by 46 percent and all-cause mortality by 20 percent — all highly significant — and did so in the absence of major side effects,” said Dr. Paul Ridker, director of the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital in Boston and a member of the JUPITER Study Group. He is the lead author of the new analysis, which is published online Sept. 22 and in the November issue of Circulation: Cardiology Quality and Outcomes.

The new analysis takes the study results a step further, attempting to interpret them in practical terms — to evaluate whether the absolute risk reduction justifies wider prescribing of the statins.

Ridker and his colleagues calculated the absolute risk reduction and also used an epidemiological measure called “number needed to treat.” That measure looks at the number of people who would need to be treated to prevent one additional bad outcome.

The JUPITER participants all had acceptable LDL cholesterol (below 130 milligrams per deciliter) but an hs-CRP of 2 milligrams/liter or higher. According to the American Heart Association, an hs-CRP of less than 1 reflects a low risk of getting cardiovascular disease.

The researchers found that “the efficiency of treating elevated hs-CRP patients with statins is at least as good, if not better, than the efficiency of treating those with high cholesterol,” Ridker said.

The new analysis, he said, is expected to help clarify future guidelines about who should and should not be on statins.

JUPITER was funded by AstraZeneca, which makes Crestor.

And though the analysis was meant to help physicians and policymakers, it does have a take-home message for patients, one expert said.

It suggests there is a much broader population that may benefit from statins, said Dr. Gregg Fonarow, a cardiologist and professor of medicine at the University of California, Los Angeles. “Those who tend to be treated those who have very high cholesterol.”

Also, he said, some doctors test their patients who at risk for cardiovascular disease for CRP levels, but other do not. “You might want to ask your doctor if you should have a CRP test,” Fonarow said.

To assess cardiovascular risk, a doctor takes many factors into account, including age, blood pressure, cholesterol and family history — and the use of statins doesn’t negate the need for paying attention to lifestyle issues, Ridker and Fonarow agreed. They stressed the need to maintain a healthy weight and healthy cholesterol levels, to exercise regularly and to not smoke, or to stop if you do.

And not everyone should take statins, Fonarow added. People with active liver disease, for instance, should not be on the medications, he said, nor should those who have had an adverse reaction to them.

New research suggests that people who have successfully lost weight will activate certain parts of their brains when confronted with images of food.

While preliminary, the findings indicate that those who shed pounds — and keep them off — tap into regions of the brain related to control over urges.

“It may be that they actually recruit new brain regions to help with their weight loss,” said study author Jeanne McCaffery, an assistant professor of psychiatry and human behavior at Brown Medical School, in Providence, R.I.

McCaffery and her colleagues wanted to understand how people react to “food cues” — in this case, photos of food. “People make decisions about whether or not they’re going to eat food, and that decision-making usually comes when they first smell or see the food,” she said.

The researchers recruited several groups of participants: 18 people of normal weight, 16 fat people and 17 people who had successfully shed weight — at least 30 pounds from their maximum weight — and kept it off for at least three years.

The participants underwent brain scans as they looked at pictures of high-calorie and low-calorie foods. The MRI scans revealed that those who had successfully lost weight showed more activity in the parts of the brain that are associated with inhibition and in dealing with complex tasks, McCaffery said.

Those of normal weight didn’t show this pattern. This may be because “they’ve been of normal weight all of their lifetime. The successful weight losers have to put in more effort to avoid eating foods or to control their response to food.”

The findings appear in the October issue of the American Journal of Clinical Nutrition.

Ian McDonald, a professor of metabolic physiology who wrote a commentary accompanying the study, said questions remain.

For one, did the people who lost weight begin to have this brain response when they started shedding pounds or later? “Similarly, are the obese different from the non-obese because of an intrinsic difference or as a result of the inappropriate eating which has led to their obesity?” asked McDonald, a researcher at the University of Nottingham Medical School in England.

In other words, does inappropriate eating by heavy people lead to differences in the way their brains work when they look at food?

Also, McDonald said, future research needs to figure out what the differences in brain activity mean for the choices people make. “Similar measurements need to be made before, during and after weight loss,” he noted.

For now, McCaffery said the researchers would like to understand better how the brain works in people who have lost weight successfully.

In the future, she said, it’s possible that “we’ll be able to teach other people how to do that.”

Love your afternoon pick-me-up? A blended coffee beverage might hit the spot but pack on the pounds, a new study suggests.

A survey of about 3,000 purchases from 115 restaurant chains in New York City found that servings of brewed coffee or tea average about 63 calories, even when some include milk and sugar. But get a blended beverage and you’re looking at 239 calories on average — 89 more than you’re likely to find in a can of soda.

A large ice-blended beverage, meanwhile, can reach 750 calories or more. At one coffee chain, 8 percent of the customers interviewed bought the largest size of a blended drink, which can boast 860 calories.

“The popularity of blended coffee beverages has grown in recent years,” Dr. Thomas Farley, New York City’s health commissioner, said in a news release from the city’s Health Department. “Unfortunately, many of these drinks are loaded with calories. Your afternoon pick-me-up may be weighing you down.”

Research suggests that 17 percent of U.S. adults buy one of these blended drinks each day.

What to do? Beverages such as coffee and tea can have fewer than 10 calories, although you might need to studiously ignore those sugar packets, the health department suggests. Low-fat or skim milk can help, too, as can getting a “small” size if the drink is sugar-sweetened and flavoring it yourself.