Levitra ED medication

Doctors should prescribe oral phosphodiesterase type 5 (PDE-5) inhibitor drugs, such as Viagra, Cialis and Levitra, for men with erectile dysfunction, unless the patient is on nitrate therapy, according to a clinical practice guideline issued by the American College of Physicians.

The type of erectile dysfunction (ED) drug prescribed should be based on the individual preferences of patients, including cost of medication, ease of use and types of side effects, the authors noted.

“The evidence is insufficient to compare the effectiveness or adverse effects of different PDE-5 inhibitors for the treatment of ED because there were only a few head-to-head trials,” guideline lead author Dr. Amir Qaseem, senior medical associate with the ACP, said in a news release.

Qaseem and colleagues analyzed the findings of 130 studies that evaluated PDE-5 inhibitors alone or combined. They found that treatment with the drugs led to statistically significant and clinically relevant improvements in sexual intercourse and erectile function in men with ED, regardless of the cause (e.g., diabetes, depression, prostate cancer) or ED severity at the start of the study.

Overall, PDE-5 inhibitors were relatively well-tolerated and associated with only mild or moderate side effects, such as headaches, flushing, upset stomach and runny nose, the authors found.

The guideline is published in the Oct. 20 issue of the journal Annals of Internal Medicine.

Because there is no conclusive evidence about the effectiveness of hormonal blood tests or treatment in patients with low testosterone levels, the ACP doesn’t recommend for or against routine use of the tests in ED patients. The college says doctors should make decisions to measure hormone levels based on an individual patient’s clinical symptoms (decreased libido, premature ejaculation, fatigue, etc.) and physical signs (such as testicular or muscle atrophy) that suggest hormone problems.

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.

Just weeks after quitting smoking, women show major reductions in several markers of inflammation associated with heart disease risk, new research shows.

The findings point the way to a strategy for encouraging people at risk of heart disease to kick the habit, the study’s authors say.

Smoking is known to promote inflammation, while quitting cuts the risk of developing and dying from heart and lung disease, Dr. Christine N. Metz of the Feinstein Institute for Medical Research in Manhasset, New York, and her colleagues write in the medical journal Chest. However, it’s unknown whether benefits are seen immediately after a person quits.

To investigate, they performed blood tests for several markers of inflammation, including C-reactive protein (CRP), tumor necrosis factor (TNF), and other substances, in 36 women participating in a smoking cessation program. The women were tested four times over 6 to 7 weeks.

Levels of TNF and two related substances fell steadily through the course of the study, the researchers found. Levels of CRP and interleukin-6 also fell.

Informing people about the “age and health” of their lungs is known to help encourage them to quit smoking, Metz and her team note, and using markers of inflammation like those measured in the current study could provide similar information on cardiovascular health.

“Quantifiable information reflecting cardiovascular health may act as positive reinforcement for those trying to quit and remain smoke free,” they add.

“We propose the identification of a panel of inflammatory biomarkers that could be used as measurable milestones for persons quitting smoking in a smoking cessation program focused on improving cardiovascular health for smokers who are at risk,” they conclude.

Parents who try to battle the childhood obesity epidemic by forbidding their kids to eat certain foods are not going to keep them from gaining weight and may actually be making the situation worse, researchers say.

Parents play a critical role in helping children make food choices that will allow them to maintain a healthy weight, according to doctors and experts. But success depends on using the right approach.

A child’s inhibitory control, which is similar to self-control, is the key factor in controlling weight. The concept is explored in an article published online in advance of release in an upcoming print issue of the Journal of Pediatrics.

In the study, Stephanie Anzman and Leann Birch, of the Center for Childhood Obesity Research at Pennsylvania State University, focused on 197 non-Hispanic white girls.

They collected information from the girls and their parents over 10 years, starting when the children were 5 years old. The researchers recorded the parents’ income and education level, and the body-mass index (BMI) of children and parents, and asked the children if their parents restricted certain foods. Mothers also were asked to describe their child’s level of self-control.

According to the study authors, girls deemed to have less self-control had higher BMIs and gained more weight compared with their peers who were better at self-regulation. They also noted that girls who lacked self-control were about twice as likely to be overweight by 15.

The researchers found that, among the study participants, the girls at the highest risk for weight gain were those with high levels of perceived parental food restrictions and low self-control.

“Parental attempts to help children with lower self-control by restricting their access to favorite snack foods can make the forbidden foods more attractive, thereby exacerbating the problem,” Anzman said in a news release from the journal’s publisher.

A better idea for parents is to help their children learn some control by allowing them to choose between healthy options. And it is better to not keep restricted foods in the house, she added.

The longer you live, the happier you’re likely to be, a growing body of research shows.

Researchers who spoke at the recently concluded annual convention of the American Psychological Association in Toronto said that mental health generally improves with age. Given that the world population of people over 65 is expected to nearly triple by 2050, according to U.S. officials, this should come as good news.

Reporting on several studies of aging and mental health, Susan Turk Charles, a professor at the University of California, Irvine, said the findings indicate that happiness and emotional well-being improve with time.

Older adults exert greater emotional control, said Charles. Studies show they learn to avoid or limit stressful situations and are less likely than younger adults to let negative comments or criticism bother them.

Charles added that “we know that older people are increasingly aware that the time they have left in life is growing shorter. They want to make the best of it so they avoid engaging in situations that will make them unhappy. They have also had more time to learn and understand the intentions of others, which helps them to avoid these stressful situations.”

Another study conducted over a 23-year period examined three groups of people at three different life stages and concluded that emotional happiness grew with age, she said.

These findings may not apply to older adults who feel trapped in distressing situations and those with forms of dementia, Charles said. “We know that older adults who are dealing with chronic stressors, such as caregiving, report high rates of physical symptoms and emotional distress,” she added.

In separate reports, Charles and Laura Carstensen, a psychology professor at Stanford University, also noted that social relationships — or lack of them — influence how older people respond to stress. Carstensen cited a Swedish study that concluded that people with strong social connections were less likely to suffer cognitive impairment than others. It seems social relationships influence the way that the brain processes information, she said. “These changes have a profound impact on health outcomes,” Carstensen said.

To make the most of the coming years, Carstensen offered these tips:
Think of ways to enjoy the time ahead and try to imagine living 100, healthy, happy years.
Provide daily routines that reinforce your goals, both in your home and in your social life.
Develop new activities and relationships, and don’t invest all of your emotional energy in a job or a single relationship.

A new hormone treatment to prevent brain damage in oxygen-deprived newborns shows promise, a study has found.

Currently, immediate cooling is the only way to reduce the risk of brain damage in newborns who suffered oxygen deprivation during delivery. The new method, which can be started as late as two days after birth, involves a two-week course of injections of erythropoietin, a hormone that stimulates red blood cell formation, the researchers explained.

The new study included more than 150 newborns with moderate to severe hypoxic-ischemic encephalopathy (HIE) at birth. About half of them received small doses of erythropoietin every other day. The neurological condition of all the children was assessed when they were 18 months old.

“Only half as many of the children treated with erythropoietin had developed a severe neurological functional disability or had died of their injuries. Thus the hormone treatment improves the prognosis considerably in the longer perspective,” Klas Blomgren, professor of pediatrics at the Sahlgrenska Academy at the University of Gothenburg and Sahlgrenska University Hospital in Sweden, said in a university news release.

But only children with moderate HIE benefited from the hormone treatment, according to the study in the August issue of the journal Pediatrics.

“We believe that erythropoietin has a regenerative and stimulating effect on recovery and on brain development following the injury,” Blomgren said. “This appears to be a safe treatment, almost without side effects, and it is also cheaper and technically simpler to administer in comparison with cooling. This means that the treatment can be given a wide distribution, and can be used even in developing countries.”

Most people reach their sexual peak at a time when, to put it charitably, they don’t always make the best use of their libido.

My patient Dan, a 53-year-old in perfect physical health, refers to this as biology’s cruel joke, meaning now that he really knows what he wants in life, he would love to recapture some of his youthful sexual vigor and put it to good use.

After years of psychotherapy, he had never felt more satisfied: he was at his pinnacle professionally and had a wife and three children whom he clearly adored. One day in therapy he asked me, “Do you think I could get some Viagra?”

I don’t consider myself the least bit puritanical, but I’m usually in the business of making the sick better, not making the normal better than well. When I asked him why, he admitted there was no problem; he just wanted to jazz things up.

“Is your wife complaining about sex?” I asked.

“Oh, no, she seems very happy with the status quo. We have sex about once a week and maybe more on vacation,” he said. “Besides, what’s the harm? So many of my friends use Viagra for a security blanket or a boost.”

The session ended without resolution, and he did not bring up the subject until a month later. Smiling, he told me that he had gotten a Viagra prescription from his internist. He assumed I would disapprove. I didn’t; I was just curious if there was a problem in his relationship that sent him in search of sexual enhancement.

It turns out that there wasn’t. What bothered Dan was “just” the normal decline in sexual performance with age.

Several months later, he came in complaining that he and his wife had been fighting — the first time in years. Apparently, she felt he had become more sexually demanding, something she did not welcome.

He was stunned. After all, he had simply taken a pill to make sex better and who could argue with that? What he had not taken into account was that his newfound sexual vigor had changed his relationship with his wife.

She was perfectly happy with her affectionate, laid-back, middle-aged husband; she had no desire for a sexual athlete as a partner at this point in her life. Viagra had become an intruder in their intimate life.

My patient is nothing if not persistent, so he went on a crusade to see if he could find a female equivalent of Viagra, thinking that it would level the playing field and set things right.

Even if his wife had shared this goal — she did not — there is nothing that medicine yet has to offer women that even comes close to Viagra and its ilk. The pharmaceutical industry has invested heavily in drugs like Viagra and Levitra for men with sexual dysfunction — or for enhancement, as many actually use them.

With the exception of estrogen, a hormone with some potentially serious adverse effects, there are few drugs that can increase female sexual function.

In fact, most drugs that address female reproductive biology restrain it, in the form of birth control.

And while Viagra and drugs like it do not directly increase libido, they can indirectly encourage it by improving erectile function.

Dan was loath to give up his new vigor. If he couldn’t get her a remedy, he just hoped that with time his wife would adjust to her rejuvenated husband.

Dead wrong. His exhausted wife finally lost her patience and told him that he had to stop the Viagra if he cared about their marriage.

I admit that I was surprised at how disruptive this little blue pill had become. As a psychiatrist and psychopharmacologist, I’m well aware of the side effects that drugs can cause in my patients.

Who would have imagined that a drug that most consider so helpful, if not harmless, could stir up such trouble in a relationship? I certainly hadn’t.

When last I saw Dan, he ruefully told me that he had not renewed his Viagra prescription.