Thursday, December 3, 2009

Pregnancy Ups Risk of Restless Leg Syndrome

Pregnancy increases the risk for the occurrence, or worsening, of restless legs syndrome, says an Italian study in the Sept. 28 issue of Neurology.

The study of 606 women found that at least one in four pregnant women experience the syndrome, a movement disorder characterized by an urge to move the legs, generally accompanied by numbness, tingling or burning sensations.

The women were assessed during pregnancy and six months after the birth of their babies. Of the 606 women in the study, 161 (26.6 percent) reported experiencing the problem during pregnancy. For 101 of the women, it was the first time they had experienced RLS. About 25 percent of the women experienced symptoms at least once a week, and 15 percent at least three times a week.

In general, symptoms appeared or worsened around the sixth month of pregnancy and reached a peak during the seventh and eighth months of pregnancy. Rates of restless leg syndrome among the women dropped dramatically around the time of delivery and affected 5 percent to 6 percent of the women six months after delivery.

"The pregnant women most affected by the [restless leg syndrome] were older, had lower values of iron storage indicators, a higher prevalence of insomnia, and snored more than the unaffected group," researcher Dr. Mauro Manconi said in a prepared statement.

This is the first study to show a significant correlation between low iron indicator values and restless leg syndrome risk.

Stress Tests Can Predict Heart Ills in Healthy Men

A treadmill stress test can predict heart attacks or other serious heart disease even in men without symptoms, U.S. researchers reported.

The findings, published in the journal Circulation, suggest that exercise tests may be able to help predict which men who already appear to have a moderate to high risk of heart disease really need to take care.

One of the two studies showed exercise tests may be used to judge who would receive an implanted pacemaker-like device called a defibrillator, researchers said.

In one study two measurements -- a change in electrocardiogram or ECG tracing called ST-segment depression and an inability to reach target heart rate -- more than doubled the 10-year risk of coronary events such as heart attacks.
Men who did well on the stress test had a lower-than-expected rate of heart attack and serious heart disease in the 10 years following.

"Our results suggest that exercise testing may be of benefit in asymptomatic men with intermediate to high risk," said Dr. Gary Balady, a professor of medicine at Boston University School of Medicine.
His team tested women, too, but so few women developed heart attacks or serious heart disease that they could not decide if the test was a good predictor for women.
The 1,431 men and 1,612 women were taking part in a bigger study called the Framingham Heart Study. They were 45 years old at the start on average and had been followed for more than 18 years.

The volunteers got a battery of tests when they began the study that included the stress test. In the 10 years following 224 men, or 15.7 percent, had chest pain, a heart attack or died from coronary heart disease.
Overall, there was a 9.6 percent risk of heart attack, chest pain or other serious heart disease for the 3,000 people in the study over 10 years.

The men who had the highest predicted risk anyway, based on cholesterol levels, high blood pressure, family history and other factors, were the most likely to have serious heart disease if they also did poorly on the stress tests, the researchers found.
They said such patients should get aggressive care, including drugs to lower blood pressure and cholesterol.

A second study in Circulation, done at Columbia University Medical Center, found that an exercise test looking for a certain heartbeat pattern, called a Microvolt T-Wave Alternanscan or MTWA, also shows who may benefit from an implantable defibrillator device.

"It's an exercise test with a smart computer," said Dr. Thomas Bigger, who led the study.
Every year 300,000 to 400,000 people in the United States die suddenly when the heart's rhythm is suddenly disrupted.
But there is controversy over how to decide who needs defibrillators implanted to prevent this, and debate over whether Medicare and other insurers should use certain tests to qualify patients for payment.

Medicare only pays if patients have an abnormal QRS test, but the Columbia team say the MTWA test is more accurate.

They tested 177 patients and followed them for an average of 20 months.
Three percent of patients identified as high-risk by the MTWA died during that time, compared with 12 percent identified as low-risk by the QRS test.
The researchers noted that the test could also show who would not be helped by a defibrillator, potentially saving money and trouble.

Arteries Already Stiff in Obese 7-Year-Olds

Obese children as young as 7 already have the beginnings of artery disease, Italian and U.S. researchers reported.

They found signs that the carotid arteries of 100 obese children were already becoming thick and stiff, as well as indications that the children may have a higher risk of diabetes.

"You can see vascular changes already this early in really obese children," said Dr. Maurizio Trevisan of the University at Buffalo in New York, who led the study.
"We know that obesity in childhood increases the risk of atherosclerosis and death in adulthood," he added. "It is important for parents of obese children to help their children control their weight and get early treatment for these obesity-associated risk factors."

Trevisan, Dr. Archangelo Iannuzzi of Cava de' Tirreni Hospital in Salerno, Italy, and colleagues report their findings in the October issue of Diabetes Care.
For their study they screened 100 children aged 6 to 14 brought to a clinic in Naples because they were overweight. They compared those children to 47 of normal weight.
On average the obese children had higher insulin resistance -- a measure of tendency to diabetes -- than children of normal weight.

They also had higher blood pressure and cholesterol. For instance, the obese children had an average blood pressure of 120/76 while the normal weight children had an average pressure of 98/65.

Importantly, ultrasound scans showed the obese children had thicker and stiffer carotid arteries, the researchers said. The carotid arteries carry blood to the head.
"In adults, arterial thickening has been shown to be a precursor of arterial narrowing and to predict clinical coronary artery disease," said Trevisan.
An estimated 15 percent of U.S. children are overweight or obese and children in many European countries are catching up.

The study shows that obesity acts quickly to damage the arteries of children and that parents and doctors need to act quickly to protect them, the researchers said.
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