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Less Reason for HRT

An accumulating body of credible information – some of the latest released just last week – finds no value in using hormone replacement therapy as a treatment for heart disease, fractures, depression and urinary incontinence – postmenopausal conditions for which it has been widely prescribed.

Last week's report by an international team of women's health experts further upends conventional clinical practice by questioning whether, given HRT's health risks, there aren't safer yet equally effective treatments available for postmenopausal symptoms such as hot flashes. The report, slated for publication in June, was financed by the National Institutes of Health and a private Italian science foundation.

Earlier this year a study in the Journal of the American Medical Association found that women who took hormones for three years experienced no less fatigue or depression than those who didn't take them.

According to surveys, 38 percent of U.S. women between the ages of 50 and 74 take hormone replacement therapy (HRT). In addition to relieving post-menopausal symptoms, HRT can reduce bone loss from osteoporosis – if it's taken continuously. However, HRT raises the risk of blood clots and uterine cancer; use for more than five years is also associated with a higher risk of breast cancer.

Recent studies have cast doubt on HRT's once-vaunted ability to confer protection against heart disease; last year, the American Heart Association advised against taking hormones for cardiovascular benefits.

Aerobic Weight Lifting

When seniors who pumped iron saw gains in muscle tone, few were surprised. Previous studies have shown it's never too late to benefit from resistance training. What startled observers was that participants' aerobic capacity also grew.

The 62 seniors – men and women ages 60 to 83 – who took part in a year-long strength training program saw significant improvements in their cardiovascular and respiratory fitness, according to Kevin Vincent, a third-year medical student at the University of Florida's College of Medicine in Gainesville and the study's principal investigator. Study results, including 20 percent to 24 percent gains in peak oxygen consumption, were published in the March issue of the Archives of Internal Medicine.

Contrary to expectations, turning up workout intensity didn't produce better results. Over time, those in a low-intensity workout group increased their time to exhaustion by 26 percent; the higher-intensity group raised its time to exhaustion by only 23 percent.

Seniors should consult their doctors before picking up a barbell, Vincent said. But he added that strength training appears to hold benefits for everyone, even those with health problems. "Think of strength as a way to improve your overall quality of life," Vincent said.

Be Nice to Your Reminder Pet

They're cute. They're cuddly. And they want you to take your blood pressure medicine. They're computerized "pill pets" devised by researchers at the Age Lab at the Massachusetts Institute of Technology to gently nudge people who sometimes forget to take their medications.

But these brightly colored creatures crave something in return: attention. Fail to push a button acknowledging that you've taken the pills as prescribed, and the pets sicken and eventually die.

"We are emotional animals, and . . . this plays on an emotional channel," said Joe Coughlin, the Age Lab's director. In testing so far, the Age Lab has found that elderly women became particularly attached to their "pets."

The Age Lab hopes to make the critters even more user-friendly down the road – perhaps by adding a smile or a frown to the small screens on the artificial animals. With corporate support, pill pets could be on the market in a couple of years, Coughlin said.

Eating With Alzheimer's in Mind

Eat right and you may be able to reduce your chances of developing Alzheimer's disease. That's the implication of a recent report in the New England Journal of Medicine that found a link between the age-related brain disease and high blood levels of an amino acid called homocysteine.

What's stirring particular interest in the study is that folic acid, a B vitamin found in grains, leafy green vegetables, dry beans and citrus, can reduce homocysteine levels. So, to a lesser degree, can vitamins B 6 and B 12, both commonly found in fortified breakfast cereals as well as other foods.

You can't exceed safe vitamin limits by eating food. But taking supplements is another story. Experts are divided on the wisdom of popping B-vitamin capsules without first consulting a physician. One expert at Tufts University in Boston warned that a folic acid supplement could tip a user over the 1-milligram-per-day safety limit and possibly disguise vitamin B 12 deficiency, which can lead to nerve damage. Another expert at George Washington University called folic acid supplementation harmless and said at least one test for B 12 deficiency was foolproof.

Researchers drew their findings from data in the Framingham Heart Study, involving several thousand Boston-area residents who have been tested every two years since 1948. The 30 percent of participants with the highest homocysteine levels showed twice as much risk of developing Alzheimer's as those with average levels.

But even mildly elevated homocysteine levels appeared to be associated with increased risk.

Homocysteine levels can be detected through blood tests, but these are not standardized or generally advised. Look for that to change, now that research has tied high homocysteine levels not just to Alzheimer's but to heart attack and stroke. In five years, predicted Mark Mattson, chief of the Laboratory of Neurosciences at the National Institute on Aging, homocysteine tests will be routine, and seniors with elevated readings will be urged to up their folic acid intake.

For Strong Bones, Take Yearly

If you could stave off osteoporosis – the brittle bone disease associated with aging – by taking medication once a day, once a week or once a year, which would you choose? That's why there's excitement about a report in the Feb. 28 issue of the New England Journal of Medicine, noting favorable findings from an osteoporosis trial involving intravenous infusions – months or even a year apart – of zoledronic acid in post-menopausal women.

For the 351 women in 10 countries who took part, bone mineral density results were comparable regardless of whether they took the once-a-year IV of zoledronic acid or daily or weekly doses of other bisphosphonates, which are commonly used to treat osteoporosis. Researchers said zoledronic acid was generally well tolerated, although some women experienced muscle pain and fever. Intravenous dosing bypassed stomach irritation – a problem for many who take oral bisphosphonates.

Women typically are more susceptible than men to osteoporosis. The National Osteoporosis Foundation estimates that 44 million Americans age 50 and older are at risk for osteoporosis and low bone mass. Fosamax leads a small group of marketed drugs that slow bone loss. Another drug, Forteo, which is awaiting approval by the Food and Drug Administration (FDA), stimulates bone growth.

The study was underwritten by Novartis Pharmaceuticals, which has received FDA approval to use zoledronic acid – marketed under the brand name Zometa and given in a different dose – in cancer treatments. In January the company launched a three-year osteoporosis trial involving 7,400 women ages 55 to 90, said company spokesman Gina Moran. The company says patients will find it easier to comply with an annual IV in a doctor's office rather than a daily or weekly pill regimen.

Cutting Heart Risk, Eastern Style

The idea that lifestyle measures alone – diet, exercise and stress reduction – can reduce cardiovascular disease is not new. A small study published in 1998 by diet evangelist and physician Dean Ornish showed that patients could reduce arterial blockage by such nonmedical means.

New support for that approach came this month from a less traditional source: the Maharishi Mahesh Yogi, leader of the Transcendental Meditation movement.

A study in the American Journal of Cardiology found that a "natural" regimen of diet, exercise, an herbal supplement and stress-reduction techniques advocated by Maharishi Vedic Medicine (MVM) outperformed two alternatives – a health education regimen involving diet, exercise and a multivitamin, and routine medical care with no added intervention – in reducing hardening of the arteries and arterial plaque. Both conditions can lead to heart attacks and strokes.

Fifty-seven seniors with an average age of 74 took part in the study. MVM patients saw their carotid intima-media thickness (IMT) readings decrease 10.6 percent, compared with a 5 percent average reduction for the other groups.

The study was funded by the Retirement Research Foundation and the National Institutes of Health's National Center for Complementary and Alternative Medicine.

James S. Gordon, a psychiatrist and director of the Center for Mind-Body Medicine in Washington, said he was impressed that the MVM study tested an "integrated" treatment approach rather than simply looking at meditation or diet or exercise by itself. While relaxation techniques are gaining recognition as an important component of cardiovascular treatment, said Gordon, who was chairman of the White House Commission on Complementary and Alternative Medicine Policy, it's unknown whether one form of relaxation is better than another.

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