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Hopkins News For You
This is a service for our friends around the world from Johns Hopkins International. To receive reports, please contact us at patientnewsletter@jhmi.edu.
October 2004
Merck Withdraws Rheumatoid Arthritis Drug Vioxx
More Frequent Monitoring Advised for People with Diabetes
Brother or Sister with Heart Disease Increases Your Own Risk
Anemia Drug May Help Patients with Transverse Myelitis
When Should Statins Be Used and How Much?
Fat and Cancer
: Johns Hopkins Medicine Video; Hopkins Doctors Separate Conjoined Twins; New website in Korean.
Merck Withdraws Rheumatoid Arthritis Drug Vioxx
Merck & Co., Inc. has announced a voluntary withdrawal of Vioxx (rofecoxib) from the U.S. and worldwide market due to safety concerns of an increased risk of heart attack and stroke in patients taking the drug. Vioxx is a prescription COX-2 selective, non-steroidal anti-inflammatory drug (NSAID) that was approved for use in the United States in 1999 for the relief of the signs and symptoms of osteoarthritis, for the management of acute pain in adults, and for the treatment of menstrual symptoms. Vioxx was later approved for the relief of the signs and symptoms of rheumatoid arthritis in adults and children.
While the individual risk to patients taking the drug is small, the U.S. Federal Drug Administration encourages people taking Vioxx to contact their doctor to discuss discontinuing use of Vioxx and to discuss alternative treatments. For more information, visit www.fda.gov/cder.
More Frequent Monitoring Advised for People with Diabetes
A Johns Hopkins study suggests that people with type I and type II diabetes should monitor their blood sugar levels more than the usual twice daily to make sure that levels are not elevated over 150 milligrams per deciliter for long periods. The research team has added new and detailed evidence of the link between elevated blood sugar levels in people with diabetes and increased risk of developing life-threatening forms of cardiovascular disease -- including coronary heart disease, stroke and peripheral artery disease.
Their findings suggest monitoring the level of glycated hemoglobin (also called glycosylated hemoglobin) and adding this measurement to regular monitoring of cholesterol levels and blood pressure. According to the study's senior author, endocrinologist Sherita Golden, M.D., the relationship between blood sugar levels in people with diabetes and their risk of developing heart disease has remained unclear until now, despite different studies that have found a link to specific types of cardiovascular problems.
Brother or Sister with Heart Disease Increases Your Own Risk
Researchers at Johns Hopkins have found that having a brother or sister with early heart disease is a better predictor of a person's chance of developing heart disease than parental history or how they score on traditional risk factors. "Family history has for years been recognized as a risk factor in predicting a person's chance for developing coronary heart disease early on in life -- separate from better-known risk factors, such as HDL and LDL cholesterol levels, blood pressure, smoking and age. But we never knew if there was a difference between sibling and parental histories of early heart disease in terms of an individual's risk of developing early atherosclerosis," said the study's senior author, cardiologist Roger Blumenthal, M.D.
The researchers' findings should make it easier for doctors to determine which patients may have early coronary heart disease and which, if any, require aggressive treatment, including dietary changes, increased exercise, stronger attempts at smoking cessation, aspirin therapy and/or cholesterol-lowering and blood pressure-lowering therapies.
Anemia Drug May Help Patients with Transverse Myelitis
A synthetic medication usually referred to by the acronym EPO is often used to treat anemia experienced by people with cancer or those undergoing chemotherapy. Now it turns out that EPO may help protect the brain from damage related to trauma or disease. Hopkins neurologist Sanjay Keswani is studying EPO to help patients with transverse myelitis.
According to the researcher, EPO protects the brain by preventing the nerve fibers from degenerating and nerve cells from dying. "The premise in using it in patients with acute transverse myelitis is that, in the inflammatory phase in these patients, often the nerve fibers or axons are damaged and often that damage is irreversible," says Dr. Keswani. The next target for EPO may well be multiple sclerosis, he adds.
When Should Statin Medications Be Used and How Much?
There’s no question that the class of drugs called statins help reduce cholesterol in the blood and the risk of heart disease, but many questions remain on the best way to use them. A study released in August by the American Medical Association seemed to raise even more issues, but cardiologist Roger Blumenthal, M.D., director of preventive cardiology at Johns Hopkins, says this study needs to be taken in the proper context. Although the study showed there was a trend that using statins at the higher dose and also starting them early was beneficial, it was not statistically significant.
"When you put this study in with all of the available evidence, it certainly tells us that we should aggressively treat people with vascular disease. If someone has had a recent episode of chest pain, we should aim for an LDL cholesterol of less than 70," says Dr. Blumenthal. LDL, or low-density lipoprotein, is the major cholesterol carrier in the blood. If too much LDL cholesterol circulates in the blood, it can slowly build up in the walls of the arteries feeding the heart and brain. Dr. Blumenthal emphasizes that the most important factor in reducing the risk of heart disease is lifestyle modification, and that diet, exercise and stopping smoking are just as important as medication.
Fat and Cancer
Add increased cancer risk to the long list of negative health effects of obesity, the American Cancer Society warns. Hopkins oncologist Arlene Forastiere, M.D., says the list of cancers to which obesity is linked is lengthy and growing.
"There is very good data to show that obesity substantially increases the risk for colon, endometrial, kidney and esophageal cancers and there is growing data linking it to pancreatic, liver and gall bladder cancers. We know that people who are overweight and obese tend to have diets that are disproportionate in fat and carbohydrate intake and they tend to have diets that are low in intake of fresh fruits and vegetables, which we know can reduce risk of cancer."
Obesity also hinders treatment, says Dr. Forastiere, and outcomes after cancer therapy are also significantly worse for people who are obese. The need to get your weight under control has never been clearer, she says.
****See a short video on Johns Hopkins Medicine: www.jhintl.net homepage
****Read about the operation, the surgical team led by Dr. Benjamin Carson, and the technology used in this dramatic procedure: Conjoined Twins
****Johns Hopkins International launches website in Korean: www.johnshopkinskorea.com
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