Sleep Apnea May Boost Risk of Sudden Cardiac Death

Study findings bolster suspected link between sleep disorder and heart-related death

By Kathleen Doheny

HealthDay Reporter

TUESDAY, June 11 (HealthDay News) -- Sleep apnea raises the risk of sudden cardiac death, according to a long-term study that strengthens a link doctors have suspected.

"The presence and severity of sleep apnea are associated with a significantly increased risk of sudden cardiac death," said study leader Dr. Apoor Gami, a cardiac electrophysiologist at Midwest Heart Specialists-Advocate Medical Group in Elmhurst, Ill.

The new research is published online June 11 in the Journal of the American College of Cardiology.

Sleep apnea -- in which a person stops breathing frequently during sleep -- affects about 12 million American adults, although many are not diagnosed. The diagnosis is made after sleep tests determine that a person stops breathing for 10 seconds or more at least five times hourly while sleeping.

Some research suggests that sleep apnea is on the rise, in part because of the current obesity epidemic.

Sudden cardiac death kills 450,000 people a year in the United States, according to study background information. It occurs when the heart unexpectedly and suddenly stops beating due to problems with the heart's electrical system. Those problems cause irregular heartbeats. The condition must be treated within minutes if the person is to survive.

Electrophysiologists are cardiologists who treat these heart rhythm problems.

In earlier research, Gami and his team had found that patients with sleep apnea who suffered sudden cardiac death often did so at night, a completely opposite pattern than found in others without sleep apnea who had sudden cardiac death.

"That was the first direct link [found] between sudden cardiac death and sleep apnea," Gami said.

In the new study, the researchers tracked more than 10,000 men and women, average age 53, who were referred for sleep studies at the Mayo Clinic Sleep Disorders Center, mostly due to suspected sleep apnea, from 1987 through 2003. After sleep tests, 78 percent were found to have sleep apnea.

During the follow-up of up to 15 years, they found that 142 had sudden cardiac arrest, either fatal or resuscitated.

Three measures strongly predicted the risk of sudden cardiac death, Gami said. These include being 60 or older, having 20 apnea episodes an hour or having low blood levels of oxygen.

This "oxygen saturation" drops when air doesn't flow into the lungs. "If the lowest oxygen saturation was 78 percent, or less, their risk of [sudden cardiac death] increased by 80 percent," Gami said. In a healthy person, 95 percent to 100 percent is normal.

Having 20 events an hour would be termed moderate sleep apnea, Gami said.

Gami found a link, not a cause-and-effect relationship, between sleep apnea and sudden cardiac death. He can't explain the connection with certainty, but said there are several possible explanations. For example, sleep apnea is related to the type of heart rhythm problem that causes sudden cardiac death, he said.

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Restless Legs Syndrome Tied to Earlier Death Risk

Older men with condition have 39 percent increase in mortality, study suggests

By Serena Gordon

HealthDay Reporter

WEDNESDAY, June 12 (HealthDay News) -- Men with restless legs syndrome now have another health concern: New research has just linked the condition to an increased risk of dying early.

In a study of nearly 20,000 men, Harvard researchers found that men with restless legs syndrome had a 39 percent higher risk of an early death than did men without the condition.

"This study suggests that individuals with restless legs syndrome are more likely to die early than other people," said study author Dr. Xiang Gao, an assistant professor at Harvard Medical School and an associate epidemiologist at Brigham and Women's Hospital in Boston. "This association was independent of other known risk factors."

"[However], this is an observational study," Gao said of the findings, which were published online June 12 in the journal Neurology. "We can only see an association that suggests a possible causal relationship."

Restless legs syndrome is a common condition that causes people to feel an uncomfortable sensation in their legs when lying down, according to the U.S. National Institute of Neurological Disorders and Stroke (NINDS). The feeling may be a throbbing, pulling or creeping sensation. Restless legs syndrome makes it hard to fall asleep and stay asleep.

The exact cause of restless legs syndrome is unknown. It does seem to run in families, suggesting a genetic component to the condition, according to the NINDS. Restless legs syndrome has also been linked to some medical conditions, such as kidney disease and the nerve disorder peripheral neuropathy. It's also associated with the use of certain medications, and may occur during pregnancy.

Gao said many people with restless legs syndrome have low iron levels, and taking iron supplements often can alleviate the symptoms of restless legs syndrome. But, he cautioned, too much iron can be dangerous, so be sure to have your doctor check your iron levels before taking any supplements.

The current study included nearly 18,500 American men who were followed for eight years. At the start of the study, none of the men had diabetes, arthritis or kidney failure. The average age at the start of the study was 67.

Almost 4 percent (690 men) of the study group was diagnosed with restless legs syndrome. Men with restless legs syndrome were more likely to take antidepressant drugs and have high blood pressure, cardiovascular disease or Parkinson's disease. Not surprisingly, men with restless legs syndrome had more frequent complaints of insomnia.

During the study follow-up, nearly 2,800 men died.

When the researchers compared those with restless legs syndrome to those without, they found that men who had the condition were 39 percent more likely to die during the study period than men without the condition. When they controlled for factors such as body mass, lifestyle factors, chronic conditions and sleep duration, the mortality risk for men with restless legs syndrome dropped to 30 percent.

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Radiation Therapy May Raise Future Death Risk From Heart Surgery

THURSDAY, April 11 (HealthDay News) -- Cancer survivors who had chest radiation therapy have a nearly twofold increased risk of dying in the years after having major heart surgery, a new study finds.

Researchers looked at 173 people who had chest radiation treatment for cancer an average of 18 years before they required heart surgery. These patients were compared to 305 people who underwent similar heart surgeries but had no history of radiation therapy.

The death risk in the first 30 days after heart surgery was about the same for both groups. But during an average follow-up of nearly eight years, 55 percent of the patients in the radiation group died, compared with 28 percent of those in the nonradiation group, the investigators found.

The study was published April 8 in the journal Circulation.

"These findings tell us that if you had radiation, your likelihood of dying after major cardiac surgery is high," study author Dr. Milind Desai, an associate professor of medicine at the Cleveland Clinic, said in a journal news release.

"That's despite going into the surgery with a relatively low risk score. In patients who have had prior [chest] radiation, we need to develop better strategies of identifying appropriate patients that would benefit from surgical intervention. Alternatively, some patients might be better suited for [nonsurgical] procedures," Desai said.

"While radiation treatments done on children and adults in the late 1960s, '70s and '80s played an important role in cancer survival, the treatment often takes a toll on the heart," Desai explained.

"Survivors are at greater risk than people who do not have radiation to develop progressive coronary artery disease, aggressive valvular disease, as well as pericardial diseases, which affect the heart's surrounding structures," he said. "These conditions often require major cardiac surgery."

While the study found an association between chest radiation therapy for cancer and future risk of death after heart surgery, it did not establish a cause-and-effect relationship.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Circulation, news release, April 8, 2013

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Gene May Boost Death Risk From Most Common Thyroid Cancer

FRIDAY, April 12 (HealthDay News) -- Researchers have pinpointed a genetic mutation that is strongly associated with an increased risk of death in people with thyroid cancer.

The investigators followed more than 1,800 patients after their initial treatment for papillary thyroid cancer, which accounts for 85 percent to 90 percent of all thyroid cancers.

After an average follow-up period of 33 months, 5 percent of those with the BRAF V600E mutation had died, compared with 1 percent of those without the mutation, according to the study in the April 10 issue of the Journal of the American Medical Association.

However, the link between this mutation and increased risk of death was not independent of tumor characteristics, the study authors noted in a journal news release.

This, and the fact that the overall death rate from papillary thyroid cancer is low, means that it is unclear how to use these findings to reduce death risk in patients with this type of cancer, said Dr. Mingzhao Xing, of the Johns Hopkins University School of Medicine, and colleagues.

The overall five-year survival rate for patients with papillary thyroid cancer is 95 percent to 97 percent. It's a challenge to distinguish patients who require aggressive treatment in order to reduce their risk of death from patients who do not, the researchers explained.

Even so, the authors of an accompanying editorial pointed out that the study provided important insight.

According to the editorialists, Dr. Anne Cappola and Dr. Susan Mandel of the University of Pennsylvania, "Although these findings do not support widespread BRAF V600E testing, they do support the need for additional study of how BRAF testing can be used to improve the already excellent prognosis of patients with papillary thyroid cancer."

While the study found an association between the gene mutation and thyroid cancer survival, it did not establish a cause-and-effect relationship.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Journal of the American Medical Association, news release, April 9, 2013

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Teen's Death From Chickenpox Highlights Need for Vaccination, CDC Reports

THURSDAY, April 11 (HealthDay News) -- The death from chickenpox of an otherwise healthy 15-year-old Ohio girl should remind parents of the importance of vaccination against the disease, U.S. health officials reported Thursday.

The teenager was admitted to the hospital with severe chickenpox, also known as varicella, and died three weeks later because of serious complications, according to a case study provided by the U.S. Centers for Disease Control and Prevention.

"Varicella can be deadly, even in seemingly normal individuals," said Dr. Kenneth Bromberg, director of the Vaccine Research Center and chairman of pediatrics at the Brooklyn Hospital Center in New York City.

"It is likely that death would have been prevented with prior vaccination," he said.

Chickenpox, which is highly contagious, is usually a mild illness characterized by an uncomfortable, itchy rash. But it sometimes leads to serious illness and death, as this 2009 case demonstrated.

Infants, adults and people with weakened immune systems are at increased risk for severe chickenpox, but most chickenpox-related hospitalizations and deaths occurred among healthy people younger than 20 before the chickenpox vaccine was introduced in 1995, the CDC report said.

"One of the reasons for death is bacterial superinfection of skin lesions with Streptococcus pyogenes [group A strep]," said Bromberg. "The other is disseminated viral infection, which seems to have happened in this case."

The teenager had no underlying conditions that might have raised the odds for severe chickenpox, according to the report.

The article, published in the April 12 issue of the CDC's Morbidity and Mortality Weekly Report, noted that the chickenpox vaccine is safe and more than 95 percent effective at preventing severe illness and death.

Since the vaccine became available, the number of chickenpox cases, hospitalizations and deaths in the United States has decreased substantially.

The 15-year-old's death demonstrates the importance of routine chickenpox vaccination, as well as catch-up vaccination of older children and teens to prevent chickenpox and its complications later in life when the disease may be more severe, the authors added.

Before chickenpox vaccination was included in routine childhood immunization, the disease caused about 11,000 hospitalizations and 100 to 150 deaths in the United States each year. The two dose-vaccine has led to declines of more than 95 percent in chickenpox-related illnesses, hospitalizations and deaths among people who have received routine vaccinations.

The CDC recommends children get the first dose of chickenpox vaccine at age 12 to 15 months and the second dose at age 4 to 6 years. Children, teens and adults who have not had a second dose -- and have not had chickenpox -- should get the catch-up vaccine.

Experts say adult vaccination is critical.

"The varicella vaccine is especially important for healthcare professionals, child care workers, teachers, residents and staff in nursing homes and people who care for or are around others with weakened immune systems," said Dr. Roya Samuels, a pediatrician at Cohen Children's Medical Center in New Hyde Park, N.Y.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Kenneth Bromberg, M.D., F.A.A.P., F.I.D.S., director, Vaccine Research Center, and chairman, pediatrics, the Brooklyn Hospital Center, New York City; Roya Samuels, M.D., pediatrician, Cohen Children's Medical Center, New Hyde Park, N.Y.; U.S. Centers for Disease Control and Prevention, news release, April 11, 2013

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Isolation, Loneliness May Raise Death Risk for Elderly

Study found lack of social contact a bigger predictor of early death than just feeling alone

By Steven Reinberg

HealthDay Reporter

MONDAY, March 25 (HealthDay News) -- Elderly people who are socially isolated and lonely may be at greater risk of early death, British researchers report.

Lack of social contact might be an even bigger risk factor than loneliness, they added. Why, however, isolation is such a powerful predictor of death isn't clear.

"Social contact is a fundamental aspect of human existence. The scientific evidence is that being socially isolated is probably bad for your health, and may lead to the development of serious illness and a reduced life span," said lead researcher Andrew Steptoe, director of the Institute of Epidemiology and Health Care at University College London.

There is also research suggesting that loneliness has similar associations with poor health, he said.

"In many ways, social isolation and loneliness are two sides of the same coin. Social isolation indicates a lack of contact with friends, relatives and organizations, while loneliness is a subjective experience of lack of companionship and social contact," Steptoe said.

The investigators found that social isolation was a more consistent predictor of not surviving than was loneliness, and was related to greater risk of dying even after age and background health were taken into account, he said.

One expert said the findings were a little unexpected.

"You would think that loneliness would compound the risk for mortality, as opposed to just isolation -- it's a bit of a surprise," said Dr. Bryan Bruno, acting chair of psychiatry at Lenox Hill Hospital in New York City, who was not involved with the study.

However, Steptoe explained, "Knowing about how lonely participants felt did not add to our ability to predict future mortality. This is not to say that loneliness is unimportant, or that we should not strive to reduce loneliness in older men and women," he said.

"But, we need to keep an eye on the social connections of older people, since maintaining social contacts among seniors and reducing isolation may be particularly important for their future survival," Steptoe added.

Bruno agreed that isolation is a significant factor in both reduced quality of life and mortality. "It is a difficult, challenging problem," he said.

"For my elderly patients, I often do a lot of education about the risk associated with being isolated and encourage them to spend as much time with other people as possible, whether it be family, friends or joining groups, community organizations or doing volunteer work," Bruno noted.

The report was published March 25 in the online edition of the Proceedings of the National Academy of Sciences.

To look at the risks of loneliness and social isolation on dying, Steptoe's team collected data on 6,500 men and women aged 52 and older who took part in the English Longitudinal Study of Aging in 2004.

People who had limited contact with family or friends or community were classified as socially isolated. The researchers used a questionnaire to assess loneliness, which was described in background information in the study as a person's "dissatisfaction with the frequency and closeness of their social contacts, or the discrepancy between the relationships they have and the relationships they would like to have."

During nearly eight years of follow-up, 918 people died and social isolation and loneliness both predicted an early death.

Social isolation, however, increased the risk of dying regardless of one's health and other factors, while loneliness increased the risk of dying only among those with underlying mental or physical problems, the researchers found.

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Anxiety, Depression May Triple Risk of Death for Heart Patients: Study

Researcher recommends stress-reducing measures

By Steven Reinberg

HealthDay Reporter

TUESDAY, March 19 (HealthDay News) -- Anxiety and depression coupled with heart disease triples the risk of death compared to cardiac trouble alone, researchers have found.

Among heart patients, anxiety can double the risk of dying from any cause, the study authors noted, and depression further raises those odds.

"Patients with heart disease who experience high anxiety during the stressors of everyday life may benefit from treatments designed to reduce anxiety, such as medications targeting anxiety or stress management," said lead researcher Lana Watkins, an associate professor of psychiatry and behavioral sciences at Duke University Medical Center in Durham, N.C.

"Benefits from stress-reducing interventions would potentially be greatest in patients where anxiety is found in combination with depression," she added.

Previous studies have shown that depression is about three times more common in heart attack patients than in others. But few studies have looked at anxiety's effect or the combination of the two on heart disease patients.

One expert, Dr. Gregg Fonarow, a spokesman for the American Heart Association and a professor of cardiology at the University of California, Los Angeles, agreed anxiety and depression are most lethal when they co-exist.

"Depression and anxiety have both been individually associated with a higher risk of developing cardiovascular disease, and in patients with cardiovascular disease [they are] associated with higher risk of recurrent cardiovascular events and death," Fonarow said.

This new study finds that anxiety, particularly when accompanying depression, independently increased risk of dying, he added.

The report was published March 19 in the Journal of the American Heart Association.

Anxiety is a common mental health problem, with about one-third of U.S. adults experiencing an anxiety disorder in their lifetime, the researchers noted. And heart disease is the leading cause of death in the United States.

For the study, more than 900 heart disease patients, average age 62, answered a questionnaire measuring their level of anxiety and depression right before or just after coronary angiography, which can be a stressful cardiac procedure. The test uses special X-rays and dyes to view the coronary arteries.

The investigators found that 90 patients had anxiety, 65 had depression and 99 suffered from both.

Of the 133 patients who died over the three years of follow-up, 55 suffered from anxiety, depression or both, the researchers reported. Most of these deaths (93) were related to heart disease, they noted.

Patients who are highly anxious during a stressful life experience, such as a cardiac hospitalization, are at an increased risk of dying, and this risk is independent of the severity of their heart disease and also of depression, Watkins said.

According to the researchers, anxiety can increase inflammation and blood pressure. Fatigue or feelings of worthlessness associated with depression may cause people to ignore their treatment for heart disease.

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Skipping Aspirin Before Artery Procedure May Boost Death Rates

Title: Skipping Aspirin Before Artery Procedure May Boost Death Rates
Category: Health News
Created: 3/7/2013 12:36:00 PM
Last Editorial Review: 3/8/2013 12:00:00 AM

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Processed Meat May Play a Part in Early Death: Study

It found those who ate the most increased their risk of dying prematurely by 44 percent

By Steven Reinberg

HealthDay Reporter

WEDNESDAY, March 6 (HealthDay News) -- Grilled hot dogs and sausages may be tasty treats at ball games and picnics, but a new study of nearly 450,000 people finds that eating too much processed meat might shave years off your life.

Those who ate the most processed meat increased their risk of dying early by 44 percent. In broader terms, if people ate less processed meat, the number of premature deaths overall would drop by almost 3 percent, Swiss researchers reported.

"Our recommendation is to limit processed meat intake to less than an ounce a day," said study author Sabine Rohrmann, head of the division of cancer epidemiology and prevention at the Institute of Social and Preventive Medicine at the University of Zurich.

The researchers could only show an association between eating processed meat and an increased risk of dying early, and not a cause-and-effect link. There are, however, some reasons to believe the association may be real, the scientists said.

"We know of some potential mechanisms that probably all contribute," Rohrmann said. "Meat is rich in cholesterol and saturated fat, which may be the link with coronary heart disease."

Processed meat is also treated with nitrates to improve durability, color and taste. "However, it also causes the formation of carcinogens. These are linked to the risk of colorectal and stomach cancer," Rohrmann said.

In addition, high iron intake from meat may lead to an increased risk for cancer, she said.

Another expert noted that previous research supports the link between processed meat and health problems.

"A wide array of studies have linked meat intake to higher rates of chronic disease," said Dr. David Katz, director of the Yale University Prevention Research Center in New Haven, Conn.

Eating relatively more meat likely means eating fewer plant foods, which protect against chronic disease, he said.

"The case for us eating mostly plants is strong," Katz said. "But those inclined can eat meat without harming their health, provided they choose wisely and steer clear of bologna."

For the study, which was published online March 6 in the journal BMC Medicine, Rohrmann and an international team of investigators collected data on nearly 450,000 men and women. At the start of the study, none of the participants had had cancer, a heart attack or stroke. The researchers also collected data on diet, smoking, exercise and weight.

By the middle of 2009, more than 26,000 of those in the study had died.

"Mortality is increased when we compare those participants who eat more than 40 grams per day of processed meat to those who have 10 to 20 grams per day," Rohrmann said.

The higher the consumption, the higher the risk. "For the highest consumption group (those who consume at least 160 grams of processed meat per day) mortality was 44 percent higher compared with those who eat little meat (10 to 20 grams a day)," she said.

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Bradley Cooper opens up about father’s death

Bradley Cooper has spoken about how watching his father die two years ago dramatically changed his life.

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Mother's Drinking Increases Risk of Infant's Death: Study

By Kathleen Doheny

HealthDay Reporter

TUESDAY, Feb. 26 (HealthDay News) -- Children of women who are diagnosed with an alcohol disorder during pregnancy or within a year after giving birth have a three-fold higher risk of dying from SIDS -- sudden infant death syndrome -- compared to babies whose mothers do not have alcohol issues, according to a new Australian study.

In the study, a mother's problem drinking was implicated in about one out of every six SIDS deaths, according to the researchers. Alcohol abuse by the mothers was also linked with about 3 percent of the deaths caused by something other than SIDS, the researchers found.

"Maternal alcohol-use disorder is a significant risk factor for SIDS and infant mortality excluding SIDS," wrote researcher Colleen O'Leary, of Curtin University in Perth, and colleagues.

The study was published online Feb. 25 and in the March print issue of the journal Pediatrics

SIDS is defined as the sudden death of an infant less than 1 year old that can't be explained after thoroughly investigating, according to the U.S. Centers for Disease Control and Prevention.

Overall, SIDS deaths have dropped by more than half since 1990, the CDC noted. Even so, it is still the leading cause of death among U.S. babies aged 1 month to 1 year.

In 2009, about 2,200 U.S. children died from SIDS. The rate is still disproportionately high among some groups, including American Indians, Alaskan natives and blacks, the Australian researchers said.

Australia has a higher-than-average infant death rate, with more than four of every 1,000 live births affected, according to study background information.

Experts have known that certain risk factors increase the chances of SIDS, including bed sharing, maternal smoking and putting a baby to sleep on their stomach. Prevention guidelines recommend positioning babies on their backs.

More recently, researchers have focused on alcohol.

The new study findings did not surprise David P. Phillips, a professor of sociology at the University of California, San Diego, who also has reported a link between parental alcohol intake and SIDS deaths. As alcohol consumption rises -- such as on New Year's and weekends -- so do the number of SIDS deaths, he found.

"We know that when people are under the influence of alcohol, they perform tasks much more poorly, including parenting," he said.

For the new study, the Australian researchers evaluated nearly 78,000 live births from 1983 to 2005. They found nearly 22,000 of the mothers had an alcohol diagnosis such as acute alcohol intoxication or dependence. About 56,000 did not.

In all, more than 300 children died from SIDS and nearly 600 others died of other causes.

Although the study found an association between infant death and maternal drinking, it didn't establish a cause-and-effect relationship. The researchers can't explain exactly why alcohol abuse and SIDS are linked. They speculate that the alcohol has a bad effect on the development of the brainstem during pregnancy.

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Sibling's Death May Boost Your Own Risk of Dying From Heart Attack: Study

By Steven Reinberg

HealthDay Reporter

WEDNESDAY, Feb. 27 (HealthDay News) -- When a brother or sister dies -- especially from a heart attack -- the risk of a surviving sibling also dying from a heart attack increases sharply in the following years, a large new study from Sweden suggests.

Chronic stress or lifestyle choices like drinking, smoking, unhealthy diet and lack of exercise may follow the loss of a sibling, increasing the risk of a heart attack over time, the researchers said.

"Health care providers should follow bereaved siblings to help recognize signs of acute or chronic psychosocial stress mechanisms that could lead to heart attack," said lead researcher Mikael Rostila, an associate professor at Stockholm University and the Karolinska Institute.

"We might be able to prevent heart attacks and other heart-related conditions by treating these siblings early on and recommending stress management," he added.

Reasons for the association between a sibling's death and the death of a brother or sister years later aren't clear, Rostila noted. And although the study showed an association between a sibling's heart attack death and heightened death risk, it did not establish a cause-and-effect relationship.

"More detailed information from medical records, shared childhood social environment and family characteristics, and data on personal and relational characteristics is needed to uncover the mechanisms causing the association between sibling death and heart attack," Rostila said.

The report was published in the Feb. 27 issue of the Journal of the American Heart Association.

To see the effect of a sibling's death on their other siblings, Rostila's team collected data on more than 1.6 million people in Sweden, aged 40 to 69.

They found the risk of dying from a heart attack increased 25 percent among surviving sisters and 15 percent among surviving brothers compared to people who had not lost a sibling. If their brother or sister died of a heart attack, risk of also dying from a heart attack in the following years increased by 62 percent among women and 98 percent among men, Rostila's team found.

Death from a heart attack was not likely to happen immediately after siblings died, the researchers said. Rather, the risk rose in the four to six years after a sibling's death among women and in the two to six years afterward among men, they found.

"This is a red flag for families," said Dr. Stephen Green, associate chairman of the department of cardiology at North Shore University Hospital, in Manhasset, N.Y. "We know that heart disease is genetic and environmental and typically siblings and family members share the same gene pool, but also share the same bad habits."

Many siblings whose brother or sister died from a heart attack have undiagnosed heart disease, Green said.

If you -- or someone you know -- has a family member with a history of heart disease or heart attack, or a family member who died from heart disease, it is important to talk with your primary care doctor or a cardiologist to make sure it doesn't happen to you, Green said.

More information

To learn more about heart attacks, visit the American Heart Association.

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Dialysis Catheters Tied to Higher Risk for Infection, Death, Study Finds

By Mary Elizabeth Dallas

HealthDay Reporter

THURSDAY, Feb. 21 (HealthDay News) -- Dialysis patients using catheters have a higher risk for death, infection and heart problems than patients using other procedures to access the blood, according to a new analysis.

Researchers examined 67 studies involving nearly 600,000 dialysis patients to compare the risks associated with three procedures used to access the blood: arteriovenous fistula, arteriovenous graft and central venous catheter.

An arteriovenous fistula is formed when a patient's vein and artery are connected to form a site through which blood can be removed and returned. An arteriovenous graft is a plastic channel between an artery and a vein. A third option for dialysis patients is a catheter, which patients often use to avoid surgery or needles or because of declining health.

Because of kidney failure, more than 1.5 million people around the world are treated with hemodialysis. The procedure involves filtering the blood to remove wastes, extra salt and water.

In conducting the study, the researchers assessed the link between these three types of vascular access and death, infection and major heart problems, such as heart attack and stroke.

The study, published Feb. 21 in the Journal of the American Society of Nephrology , revealed that patients using catheters had a 38 percent greater risk for a major heart problem, a 53 percent higher risk of dying and more than double the risk of developing a fatal infection than patients with fistulas.

Grafts also had an 18 percent higher risk of death and a 36 percent greater risk of serious infections than fistulas. But the researchers noted that patients with grafts did not have a greater risk for a major heart problem than those with fistulas.

Assuming patients on dialysis were of similar health, the researchers concluded that catheters used for hemodialysis have the highest risks for death, infections and heart trouble, while fistulas are the least risky.

"Our findings are reflected in current clinical practice guidelines, which promote fistulas as the preferred form of bloodstream access in hemodialysis patients," Dr. Pietro Ravani, of the University of Calgary, in Canada, said in a journal news release.

The study's authors noted that patients involved in the study who were using catheters were probably sicker than those using fistulas. They concluded that more research is needed to determine individual patient risk and assess the safety of the various types of blood access used for hemodialysis.

More information

The U.S. National Kidney and Urologic Diseases Information Clearninghouse provides more information on hemodialysis.

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Calcium Supplements May Raise Odds of Heart Death in Women

By Steven Reinberg

HealthDay Reporter

TUESDAY, Feb. 12 (HealthDay News) -- Women eating a high-calcium diet and taking calcium supplements adding up to more than 1,400 milligrams a day may be running nearly twice the risk of dying from heart disease, a large Swedish study suggests.

Both men and women take calcium supplements to prevent bone loss. The new findings come on the heels of another recent study that found a similar increased risk of death related to calcium intake among men.

"Many older adults increase dietary intake of calcium or take calcium supplements to prevent bone loss and there had been speculation that increased calcium intake with or without vitamin D could improve cardiovascular health," said Dr. Gregg Fonarow, an American Heart Association spokesman who wasn't involved in the study.

However, a number of recent studies have suggested that higher dietary intake or calcium supplementation may not only not improve cardiovascular health -- they may be associated with increased risk for cardiovascular events and mortality, said Fonarow, a professor of cardiology at University of California, Los Angeles.

The new report was published in the Feb. 12 online edition of the BMJ.

To see if calcium supplements raised the risk of dying from heart disease, a team led by Dr. Karl Michaelsson, a clinical professor in the department of orthopedic surgical sciences at Uppsala University in Sweden, analyzed data collected on more than 61,000 women enrolled in a study on mammograms.

Over 19 years of follow-up, nearly 12,000 women died -- almost 4,000 dying from cardiovascular disease, about 1,900 from heart disease and 1,100 from stroke, the researchers found.

The highest rates of death were seen among women whose calcium intake was higher than 1,400 milligrams a day, the researchers noted. On the other hand, women who took less than 600 milligrams of calcium a day were also at an increased risk of death.

Moreover, women taking 1,400 milligrams of calcium a day and also using a supplement had even a higher risk of dying than women not using supplements, Michaelsson's group found.

All in all, women getting more than 1,400 milligrams of calcium a day were more than twice as likely to die than women getting 600 to 999 milligrams a day, the researchers said.

The U.S. Office of Dietary Supplements recommends 1,000 to 1,200 milligrams of calcium a day for most adults.

According to the study authors, diets very low or very high in calcium can override normal control by the body, causing changes in blood levels of calcium.

Rather than worry about increasing calcium intake of those getting enough through their diet, emphasis should be placed on people with a low intake of calcium, the authors suggest.

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Calcium Supplements May Raise Men's Death Risk From Heart Disease

By Steven Reinberg

HealthDay Reporter

MONDAY, Feb. 4 (HealthDay News) -- Men taking calcium supplements may be running a nearly 20 percent increased risk of dying from cardiovascular disease, a new study suggests.

Both men and women take calcium supplements to prevent bone loss. In this study of calcium intake, the risk of dying from heart disease was higher for men but not for women.

"Increasing evidence indicates that too much supplemental calcium might increase the risk of cardiovascular disease," said Susanna Larsson, an associate professor at the Institute of Environmental Medicine at the Karolinska Institute, in Stockholm.

Larsson, who was not part of the study but wrote an accompanying journal editorial, added that "the paradigm 'the more the better' seems invalid for calcium supplementation."

The report was published in the Feb. 4 online edition of the journal JAMA Internal Medicine.

To find out if calcium supplements were associated with an increased risk of dying from cardiovascular disease, a team of scientists led by Qian Xiao, of the U.S. National Cancer Institute, collected data on more than 388,000 men and women, aged 50 to 71 years old. They took part in a study on diet and health conducted by the U.S. National Institutes of Health and the AARP from 1995 to 1996.

Over an average 12 years of follow-up, about 7,900 men died from cardiovascular disease, as did nearly 4,000 women. Among those who died, 51 percent of men and 70 percent of women were taking calcium supplements, the researchers found.

Xiao's group calculated that men taking 1,000 milligrams a day of a calcium supplement had a 20 percent increased risk of dying from heart disease. Men also had a 14 percent increased risk of dying from a stroke, but this was not statistically significant, the researchers said.

Among women, however, calcium supplements were not linked to an increased risk of dying from cardiovascular disease. And, calcium from diet didn't increase the risk of dying from cardiovascular disease for either sex, the researchers found.

The study authors said more research is needed to determine whether there is difference between men and women in the cardiovascular effects of calcium supplements.

"Given the extensive use of calcium supplements in the population[often for osteoporosis], it is of great importance to assess the effect of supplemental calcium use beyond bone health," the investigators concluded in the study.

Taylor Wallace, a representative of the supplement industry, faulted this and other studies because, he said, they were not specifically meant to address calcium supplements and heart disease.

Wallace, who is senior director for Scientific & Regulatory Affairs at the Council for Responsible Nutrition, said most studies of calcium supplements show no effects on the heart.

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Smoking Doubles Women’s Sudden Death Risk

Dec. 11, 2012 -- Smoking cigarettes may more than double a woman’s risk of sudden cardiac death. But quitting can reduce that risk significantly over time, according to a new study.

Sudden cardiac death is a sudden, unexpected death caused by loss of heart function. It is the leading cause of heart-related deaths in the U.S. and is responsible for up to 400,000 deaths per year.

Researchers found that women who were current smokers were two-and-a-half times more likely to suffer sudden cardiac death than nonsmokers. The risk of sudden cardiac death was even higher among heavy and lifetime smokers.

“We found the more that you smoke, the higher the risk of sudden cardiac death,” says researcher Roopinder Sandhu, MD, MPH, assistant professor of medicine at the University of Alberta in Alberta, Canada. “But the important thing is that this risk can be eliminated after smoking cessation.”

The study showed that quitting smoking had an almost immediate effect in reducing the risk of sudden cardiac death within five years among women without any symptoms of heart disease.

For women already diagnosed with heart disease, the benefits of quitting smoking took much longer to take effect.

Researchers say for many women, sudden cardiac death is the first sign of heart disease.

Although smoking is a known risk factor for sudden cardiac death, researchers say few studies have looked at the nature of this relationship in a large number of women both with and without heart disease.

This study looked at the impact of smoking and smoking cessation on the risk of sudden cardiac death among 101,018 women who took part in the Nurses’ Health Study. The results appear in Circulation: Arrhythmia & Electrophysiology.

During 30 years of follow-up, 351 cases of sudden cardiac death were reported.

Researchers found the amount and duration of cigarette smoking was strongly associated with the women’s risk of sudden cardiac death.

“Even with a very small amount, one to 14 cigarettes per day, women’s risk of sudden cardiac death was almost two-fold higher compared to women who did not smoke,” says Sandhu, who conducted the study as a visiting scientist at Brigham and Women’s Hospital in Boston.

Overall, the study showed:

The risk of sudden cardiac death increased by 8% for every five years a woman smoked.Heavy smokers who smoked 25 cigarettes a day or more had more than three times the risk of sudden cardiac death than women who didn’t smoke.Women who smoked for more than 35 years had a 2.5 times higher risk of sudden cardiac death than never smokers.

“This is an important study because it links smoking to sudden cardiac death in those unfortunate women who don’t make it to the hospital,” says Nieca Goldberg, MD, medical director of the women's heart program at New York University’s Langone Medical Center.

“The study shows that even modest levels of smoking can increase the risk of sudden cardiac death,” says Goldberg, a spokesperson for the American Heart Association. “People should know that just one cigarette is too much.”

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