Women more likely to have 'broken heart syndrome' (AP)

ORLANDO, Fla. � A woman's heart breaks more easily than a man's.

Females are seven to nine times more likely to suffer "broken heart syndrome," when sudden or prolonged stress like an emotional breakup or death causes overwhelming heart failure or heart attack-like symptoms, the first nationwide study of this finds. Usually patients recover with no lasting damage.

The classic case is "a woman who has just lost her husband," said Dr. Mariell Jessup, a University of Pennsylvania heart failure specialist who has treated many such cases.

Cyndy Bizon feared that was happening when her husband, Joel, suffered a massive heart attack in 2005. "May God work through your hands," the Maine woman told the surgeon as her husband was wheeled past her into the operating room. She later collapsed at a nurse's station from "broken heart syndrome" and wound up in coronary care with him. Both survived.

Japanese doctors first recognized this syndrome around 1990 and named it Takotsubo cardiomyopathy; tako tsubo are octopus traps that resemble the unusual pot-like shape of the stricken heart.

It happens when a big shock, even a good one like winning the lottery, triggers a rush of adrenaline and other stress hormones that cause the heart's main pumping chamber to balloon suddenly and not work right. Tests show dramatic changes in rhythm and blood substances typical of a heart attack, but no artery blockages that typically cause one. Most victims recover within weeks, but in rare cases it proves fatal.

Dr. Abhishek Deshmukh of the University of Arkansas had treated some of these cases.

"I was very curious why only women were having this," he said, so he did the first large study of the problem and reported results Wednesday at an American Heart Association conference in Florida.

Using a federal database with about 1,000 hospitals, Deshmukh found 6,229 cases in 2007. Only 671 involved men. After adjusting for high blood pressure, smoking and other factors that can affect heart problems, women seemed 7.5 times more likely to suffer the syndrome than men.

It was three times more common in women over 55 than in younger women. And women younger than 55 were 9.5 times more likely to suffer it than men of that age.

No one knows why, said Dr. Abhiram Prasad, a Mayo Clinic cardiologist who presented other research on this syndrome at the conference.

"It's the only cardiac condition where there's such a female preponderance," he said.

One theory is that hormones play a role. Another is that men have more adrenaline receptors on cells in their hearts than women do, "so maybe men are able to handle stress better" and the chemical surge it releases, Deshmukh said.

Bizon was 57 when her attack occurred; she's now 63. She and her husband are pharmacists and live in Scarborough, Maine.

"I remember grabbing the counter and a black curtain coming down before my eyes," she said in a telephone interview. Her attack was so severe that she went into full cardiac arrest and had to have her heart shocked back into a normal rhythm. Although most such attacks resolve without permanent damage, she later needed to have a defibrillator implanted.

About 1 percent of such cases prove fatal, the new study shows.

"In the old days, we'd say someone was scared to death," said Prasad.

About 10 percent of victims will have a second episode sometime in their lives. And although heart attacks happen more in winter, broken heart syndrome is more common in summer.

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Online:

Heart Association, http://www.americanheart.org

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Blood type may affect stroke risk, study finds (AP)

ORLANDO, Fla. � Your blood type might affect your risk for stroke. People with AB and women with B were a little more likely to suffer one than people with O blood � the most common type, a study found.

The research can't prove such a link. But it fits with other work tying A, B and AB to more risk of blood clots in the legs and heart attacks. Blood type O also has been tied to an increased risk of bleeding, which implies less chance of clots, the cause of most strokes.

"There's increasing evidence that blood type might influence risk of chronic disease," said one of the study leaders, Dr. JoAnn Manson, chief of preventive medicine at Harvard's Brigham and Women's Hospital.

"It's not at the level where we want to alarm people and we want to make that clear. But it's one more element of risk that people would want to know about," and it could give them one more reason to keep blood pressure and cholesterol in line, she said.

The study, led by Brigham's Dr. Lu Qi, was presented Wednesday at an American Heart Association conference. It involved 90,000 men and women in two observational health studies that have gone on for more than 20 years.

Looking at the 2,901 strokes that have occurred and taking into account other things that can cause them, such as high blood pressure, researchers found:

_Men and women with AB had a 26 percent increased risk of stroke compared to those with type O.

_Women but not men with B blood had a 15 percent greater risk compared to those with O.

What's the explanation?

Blood type depends on proteins on the surface of red blood cells. A pattern of immune system responses forms early in life based on them. Certain blood types may make red cells more likely to clump together and stick to the lining of blood vessels, setting the stage for a blood clot, Manson said.

"You can't change it, and we don't know if it's the blood type per se or other genes that track with it" that actually confers risk, said Dr. Larry Goldstein, director of Duke University's stroke center.

"There are other things that are more important" than blood type for stroke risk, such as smoking, drinking too much and exercising too little, he said.

About 45 percent of whites, 51 percent of blacks, 57 percent of Hispanics and 40 percent of Asians have blood type O, according to the American Red Cross. Such people are called "universal donors" because their blood can safely be used for transfusions to any other blood type.

AB blood type is the least common type, present in 4 percent of whites and blacks, 2 percent of Hispanics and 7 percent of Asians.

B is second least common overall, in 11 percent of whites, 19 percent of blacks, 10 percent of Hispanics and 25 percent of Asians.

A is in 40 percent of whites, 26 percent of blacks, 31 percent of Hispanics and 28 percent of Asians.

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Online:

Heart Association: http://www.americanheart.org

Blood types: http://www.redcrossblood.org/learn-about-blood/blood-types

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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UK doctors call for ban on smoking in cars (AP)

LONDON � The British Medical Association is calling on the government to ban smoking at all times in cars, a step that would go beyond regulations elsewhere.

In research released on Wednesday, the group that represents U.K. doctors said the confined environment in cars exposes drivers and passengers to 23 times more toxins than a smoky bar. Children are particularly vulnerable to second-hand smoke since they absorb more pollutants. Smoke can linger in cars long after cigarettes have been smoked.

In countries including Australia, Canada, and parts of the U.S., smoking in cars is banned when children are present. In the U.K., smoking in public vehicles like buses and trains is banned but there is no law against smoking in private cars.

Dr. Vivienne Nathanson of the association said Wednesday that the government should now take a "bold and courageous step."

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Giffords faces long road, wants to return to Hill (AP)

WASHINGTON � Debating opponents. Negotiating compromises. Raising money. The demands of Congress are great for anyone, much less someone recovering from a gunshot to the head like Rep. Gabrielle Giffords.

Giffords' first televised interview showed a lively woman making good progress in recovering from a devastating brain injury, yet still struggling mightily to pull out the words she wants. Only 10 months after her injury, brain specialists unconnected with Giffords' care say she'll almost certainly continue to improve. But no one can predict how much or how fast.

How the brain rewires itself after trauma � making new connections or recruiting an undamaged area to compensate for a damaged one � is largely a mystery. But most people with severe brain injuries never emerge as exactly the same person they were before, and lingering impairment could make a return to Congress a difficult decision for Giffords and her family.

The stress of the job should get consideration, said Dr. Jordan Grafman, director of the Traumatic Brain Injury Research Laboratory at the Kessler Foundation Research Center in West Orange, N.J.

"A little stress makes us sharp. A lot of stress kills neurons," said Grafman, who has long studied penetrating brain injuries but hasn't examined Giffords. After a severe brain injury, "I really don't think you'd want to be exposed to the level of stress that you'd be exposed to in Congress. I wouldn't want to."

Monday's interview on ABC was the first opportunity for the public to get a detailed look beyond the reassurances of Giffords' friends and physicians about how she's fared since being shot on Jan. 8. It was a chance to see what someone who's making a recovery often called miraculous or remarkable really looks like.

Giffords appeared determined and confident, but she struggled to form multiple-word sentences, much less string them together for a detailed conversation. With the help of her husband, Mark Kelly, she said she wouldn't return to Congress until she was "better." The filing deadline to run to for re-election to her House seat is May 30.

On Tuesday, Giffords' staff released on her Facebook page a more complex, minute-long recording made last week, two weeks after the ABC interview. In it, she says wants to get back to work.

"I'm getting stronger. I'm getting better," Giffords says still somewhat haltingly. She adds, "There is a lot to say. I will speak better."

Giffords read a script for the recording, which required multiple takes "until she was happy with it," said spokesman Mark Kimble.

To independent brain specialists, Giffords' speech thus far is good, considering the bullet passed right by an important speech region in the brain's left side.

"I think she's way ahead of the curve," said Dr. Ross Bullock, chief of neurotrauma at the University of Miami and Jackson Memorial Hospital. "Just as people's faces are different and personalities are different, just where those collections of really important cells are located varies from person to person," making it impossible to say how much her speech region was damaged.

Indeed, video taken by Kelly of his wife's hard slog through rehabilitation showed a hugely common frustration: People with all kinds of brain injuries recall, once they can speak again, that they knew what word they wanted but a completely unrelated one popped out from their brain's tangled wiring. "Spoon," Giffords kept saying to a therapist early on, instead of "chair."

Recovery from a brain injury is most dramatic in the first year, especially in the first three to six months. Much of that early improvement is spontaneous as the brain's networks reorganize themselves, said Dr. Robert Laureno, neurology chairman at Washington Hospital Center.

The recovery can continue for two years although more slowly, the kinds of changes more noticeable to people you don't see often, Grafman said. Rehab helps to spur the brain's continued rewiring, what scientists call plasticity. Giffords' adaptable personality and motivation give her an obvious advantage, he added.

People can return successfully to high-profile jobs after serious brain injuries. Sen. Tim Johnson, D-S.D., suffered a brain hemorrhage in December 2006 and returned to the Senate the following fall. His speech was a bit slurred, and sometimes he used a scooter to get around. He later won re-election and chairs the Banking Committee.

Grafman says patients must adapt to lingering impairments, with the help of families who are best able to tell if they're making good judgments. For Giffords, a supportive congressional staff can do a lot of the work. But at some point, he noted, "people are going to ask hard questions. How is she going to handle them?"

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Associated Press writer Kevin Freking contributed to this report.

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Study finds many patients shun free heart drugs (AP)

ORLANDO, Fla. � Give people free prescription drugs and many of them still won't bother to take their medicine.

Doctors were stunned to see that happen in a major study involving heart attack survivors. The patients were offered well-established drugs to prevent a recurrence of heart trouble, including cholesterol-lowering statins and medicines that slow the heart and help it pump more effectively.

"My God, we gave these people the medicines for free and only half took it," said one of the study's authors, Dr. Elliott Antman of Harvard-affiliated Brigham and Women's Hospital in Boston.

In fact, the researchers couldn't even give the stuff away: They had trouble just signing up patients to take part in the study.

Nevertheless, Aetna, the insurance company that footed the bill, thinks this approach will save money in the long run and plans to start offering certain heart drugs free to some patients. In the study, patients offered medicines at no cost suffered fewer heart problems and saved $500 on average over roughly a year.

It is no secret many Americans don't follow their doctors' instructions. In one survey, one-third said they didn't fill a prescription or used less medicine than they should because of cost. The researchers in this study wanted to see what would happen if they took cost out of the equation.

The results were disheartening.

"Adherence in America is miserable," lamented Dr. Eric Peterson of Duke University, who had no role in the study. He noted that only 10 percent of the patients were taking all the medicines they should one year after a heart attack.

The study was led by Dr. Niteesh Choudhry of Brigham and Women's, who presented the findings Monday at an American Heart Association conference in Florida. They also were published online by The New England Journal of Medicine.

The study did not examine why people didn't take their medications. But doctors know that some forget. Most of these drugs mean three pills a day or more, for the rest of a patient's life. Also, some of these medicines carry side effects such as fatigue, lightheadedness, muscle pains, cough, even sexual difficulties for men.

Still, heart attack survivors like Joan Ferraro, 53, of Freehold, N.J., said they can't imagine not taking prescribed medicines, though she sometimes forgets her pills over a weekend.

"Why would you want to go through something like that again? It was the most horrific experience of my life. I would never want another one," she said.

The study enrolled 5,855 Aetna members who had a drug plan as part of their benefits and were going home from the hospital after a heart attack. They were 53 years old on average, and three-fourths were men.

The researchers had hoped to recruit 7,500 patients but scaled back when so few signed on.

Preventive medicines were offered free to 2,845 patients and prescribed with the usual copayments for the rest. Copays for these drugs run around $50 a month.

Roughly a year later, the share of patients who filled their prescriptions ranged from 36 percent to 49 percent in the copay group, depending on the drug, and was only 4 to 6 percentage points higher in the group that had no copays.

Providing these medicines for free had a "distressingly modest" effect on patients' willingness to take them, Dr. Lee Goldman of Columbia University and Dr. Arnold Epstein of the Harvard School of Public Health wrote in an editorial in the medical journal.

The Commonwealth Fund, a foundation devoted to improving the health care system, helped pay for the study, and some of authors consult for insurance companies.

In the study, the total number of heart attacks, strokes, cases of chest pain or heart failure and other such problems was significantly lower in the group offered free medicine.

That meant that an additional 2 of every 100 people were spared such problems because they were offered free medicines. Doctors suspect the difference between the groups would have been greater if more people had actually filled their prescriptions.

Costs dropped 26 percent for patients in the free drug group compared with the others, partly because of fewer doctor visits, lab tests and hospitalizations.

After about a year, total medical costs for the insurer, including follow-ups, hospitalizations and doctor's appointments, averaged $69,997 for those with the usual coverage and $64,726 for those offered free medicines. That was not considered a significant difference statistically, but insurers looking at the bottom line would still view it as worthwhile.

Dr. Lonny Reisman, an author of the study and chief medical officer for Aetna, said the company plans to offer some of these drugs free or with a reduced copay to some heart attack survivors and is considering doing do so for other chronic conditions such as diabetes and chronic lung disease.

The study may persuade other insurers to do the same, Goldman and Epstein said.

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Online:

Heart Association: http://www.americanheart.org

New England Journal: http://www.nejm.org

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Free drugs can help prevent repeat heart attacks (AP)

ORLANDO, Fla. � A study finds that offering people free medicines after a heart attack can help cut the chances they will suffer another one. It also saves them about $500 for health care over the next year without raising costs for insurers.

However, doctors were shocked that only about half of these patients filled their prescriptions even though they got them for free.

Insurance company Aetna says it soon will start offering certain heart medicines such as cholesterol-lowering statin drugs for free or with a reduced copay to some heart attack survivors because of these results. Aetna helped sponsor the study,

The research was discussed Monday at an American Heart Association conference in Florida.

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Online:

Heart Association: http://www.americanheart.org

New England Journal: http://www.nejm.org

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