Health news for You
WASHINGTON (AP) - The government is trying a more upbeat approach to getting Americans to eat right and watch their weight. Proposed new dietary guidelines call eating ``one of life's greatest pleasures'' and urge consumers to ``be flexible and adventurous'' in picking foods.
The guidelines, which were developed by a panel of 11 nutrition experts, don't make any major changes in recommendations from the existing version but include special sections for the first time on whole grains and food safety and expanded advice on weight control.
They also provide more specific choices of foods and ways to prepare them, while advising consumers not to ``overdo on fat (especially saturated fat), sugars, salt and alcohol.''
The guidelines were first published in 1980 and are revised every five years to reflect the latest developments in scientific research. Federally funded nutrition programs are required to adhere to the recommendations, and they are also widely used by professionals and dietitians in advising clients.
``They've done a really nice job of developing guidelines that are really user-friendly and correspond with what we know from the current literature,'' said Cyndi Thompson, a spokeswoman for the American Dietetic Association.
The departments of Agriculture and Health and Human Services are to take public comment on the revised version before making it final later this year.
The new guidelines include some subtle changes in wording meant to make it easier for consumers to adhere to the maximum recommended fat intake while emphasizing that consumers should cut down on the saturated fats found in meat and dairy products.
The current guidelines on fat recommend that people follow a diet that is low in total fat. The new recommendation is for a diet that is ``moderate in total fat,'' but low in saturated fat and cholesterol.
Research by the food industry indicates consumers are put off by the term low-fat and see a moderate-fat diet as easier to follow, even if the fat content is the same. The recommended maximum fat intake is still 30 percent of total calories, or 65 grams a day in a 2,000 calorie diet.
``What they're trying to do is come up with wording that is positive and has some degree of hope,'' said Thompson, a nutrition expert at the University of Arizona. ``They're trying to say: Be moderate, be sensible, that all foods can fit into a healthy diet, you just can't overconsume.''
The meat industry doesn't like the change in wording, fearing that it will put a stigma on beef and pork.
``We believe it's a real unfair implication,'' said Al Tank, chief executive officer of the National Pork Producers Council. ``The implication is that you should avoid all foods of animal origin.''
``Food choices should not be just about the amount of fat consumed,'' said Mary K. Young, executive director, nutrition, at the National Cattlemen's Beef Association. ``Food choices should take into account the important nutrients in foods that are needed for healthy diets.'' She said beef is a good source of iron, zinc, protein and B vitamins.
Groups representing vegetarians and racial minorities say the advisory committee that wrote the revision is biased toward the meat and dairy industries and filed suit to block the government from using the guidelines. A judge refused last week to block the committee's work from being released.
ATLANTA (AP) - The rate of salmonella from eating raw or undercooked eggs dropped by more than one-third between 1996 and 1998, according to government researchers who credited better safety measures.
The U.S. Centers for Disease Control and Prevention said safer egg production and preparation were behind the drop.
``We see this as a triumph of a collaborative effort between CDC, state health departments, industry, commercial food preparers and consumers,'' said Dr. David Swerdlow, a CDC epidemiologist.
For reasons not fully understood, the rate of a type of salmonella illness associated with raw or undercooked eggs soared in the 1980s and '90s from 0.6 cases per 100,000 people in 1976 to 3.6 in 1996. But the rate dropped to 2.2 per 100,000 from 1996 to 1998, the CDC said Thursday.
In the late 1980s, health officials began a push to educate people about the dangers of raw or undercooked eggs.
Symptoms of salmonella illness include nausea, diarrhea, fever, abdominal cramps and chills. The illness can be fatal for infants, the elderly and those with weakened immune systems.
The CDC estimates that 600 people die from the illness each year.
SAN FRANCISCO (Reuters) - When Bob tested positive for the AIDS virus, he could not believe it. Although he was gay he had not engaged in the classic risk factor, anal sex, in 20 years.
``I had tested negative exactly 20 times,'' he said. ``I was freaked ... I was known as super-careful. My friends all went flying to clinics. They said if it happened to me it could happen to anybody.''
But it did happen. Bob was one of eight men infected with HIV through oral sex in a study of 102 men by the Centers for Disease Control and Prevention (CDC) and the University of California San Francisco. This is a transmission rate of nearly 8 percent for something people thought was safe.
The study surprised researchers at a scientific meeting in San Francisco this week and stunned the gay community here -- a community very well-educated about the risks of HIV.
Frederick Hecht of UCSF and colleagues suspect that if the numbers are so high in San Francisco -- ground zero for the AIDS movement -- they may be even worse elsewhere. The study shows that even when people think they are doing the right thing they could be putting themselves into deadly danger.
Bob believes he is a classic example. His partner died of AIDS 7 years ago and he had taken part in several studies since then. He thought he knew just what the risks of oral sex were.
``I am an accountant. I read these statistics from the CDC which said there had been something like 6 cases in 500,000.''
The CDC says this about the risk of oral sex on its Web page : ``It is possible for you to become infected with HIV through performing oral sex. There have been a few cases of HIV transmission from performing oral sex on a person infected with HIV. While no one knows exactly what the degree of risk is, evidence suggests that the risk is less than that of unprotected anal or vaginal sex.''
But elsewhere it cites an Emory University study that says: ''Modeling risks estimate per-contact transmission risk and vary from one in 600,000 to more recent estimate of 0.3 percent.''
The latest study, presented at the 7th Conference on Retroviruses and Opportunistic Infections in San Francisco, suggests a much higher transmission rate.
Bob had gone to seminars where he was told the risk of infection from oral sex was equivalent to being abducted by aliens. Still, he was careful, but he made an exception with one man he had known for years.
``I thought that, because of these statistics, it was like being hit by lightning. I made a conscious decision to swallow. I had read stuff about how the stomach acid can kill the virus and I thought that if I spit it out it would have more of a chance to remain in my mouth.''
Bob said it does little good to realize that the overall risk of oral sex is less than the overall risk of unprotected anal or vaginal sex. ``Being hit by a truck is less risky than being hit by a Volkswagen but you still get killed,'' he said.
``I made a conscious decision. I am an accountant and I believe the statistics and this is where it got me.''
John also said he knew there was a risk but thought he could beat the odds. A professional in his mid-30s, he, too, felt he was pretty well-educated about HIV.
``I take responsibility for my own actions. I was aware that oral sex carried some risk with it,'' he said in a telephone interview. He was dating someone who he knew was HIV-positive and had oral sex with him but stopped before things got to the point where John thought they were dangerous.
``He didn't ejaculate in my mouth,'' John said. But something called pre-ejaculate may have been to blame. The HIV virus is carried in blood and semen as well as in vaginal secretions. Men often produce a fluid called pre-ejaculate before they climax, and this, too, can be infectious.
John will never know. ``I don't know actually how it happened,'' he said. But going back 10 to 14 days from when he first started showing symptoms -- the fevers, chills and rash -- he thinks it had to have been that episode of oral sex.
He goes back over and over that time period, trying to think of something else that could explain it. ``I always used a condom when I had anal sex,'' he said. ``I had some dental work done previously. Maybe my gums were messed up.''
He had a test done for HIV antibodies but it was negative, which is common because it takes the body so long to mount its defense against HIV. That is one of the reasons the virus is so successful.
He did not test positive for infection until 10 weeks later -- weeks that cost him vital time. Many doctors think patients do better if treated immediately after infection, before the virus can start its insidious attack on the immune system.
Another CDC study presented at the retrovirus meeting said people may be protected if they get immediate ``morning-after'' treatment. The researchers cannot know for sure, but of 400 people who took HIV drugs within a day and a half of a risky sexual intercourse, not a single one has become infected.
So knowing the dangers of something like oral sex can help people either avoid the behavior or seek immediate treatment if they do engage it in.
What surprises and upsets Bob is how unwilling other gay men are to accept the idea that oral sex can infect them. ``I have been called a liar. I have been called in denial. I have had people tell me I must have gotten it in 1975, the last time I had anal sex. They just don't want to believe it.''
Yet another study at the AIDS meeting supported Bob's idea. CDC researchers found that gay men and drug users felt that, because lifesaving drugs are available, they do not have to worry so much about the risks.
Bob knows better. ``I will be on these drugs for the rest of my life,'' he said.
He and John are angry because gay groups actively advocated oral sex as a safer alternative to anal sex. But they concede most people cannot or will not abstain completely from sex.
A third man, who does not wanted to be identified even with a made-up name, said it is hard to be careful all the time.
``People have to decide where they want to place their levels of protection. It is a hard balance. You can try to be celibate or you can try to be smart,'' he said.
John agreed. ``It is such a difficult decision for folks to make, particularly during sex. If you were to eliminate all the options, people would go crazy.''
TORONTO - Male infants feel pain during circumcision and they remember that pain six months later when they receive their routine vaccination, according to a study led by Hospital for Sick Children (HSC) researchers.
The results of this study, led by Dr. Gideon Koren, head of Clinical Pharmacology & Toxicology at HSC and a Professor of Paediatrics, Pharmacology, and Medicine at the University of Toronto, are reported in the March 1 issue of the British medical journal Lancet.
Earlier research led by Dr. Koren had indicated that male infants demonstrate a greater pain response to vaccination than female infants. The current study sought to determine whether there was a difference between circumcised and uncircumcised male infants in their pain response to vaccination, and whether pretreatment of circumcision pain with a topical anaesthetic affected the pain response to vaccination.
The study involved 87 male infants in three groups: 32 uncircumcised infants; 29 infants receiving a topical anaesthetic prior to circumcision; and 26 who were circumcised without pain relief. The infants were recruited to the study through Women's College Hospital. Between ages four and six months, the infants received routine diptheria-pertussis-tetanus (DPT) vaccinations from their primary care physician and their pain response to the vaccination was measured.
"What we discovered was that the infants who were uncircumcised demonstrated the least pain during vaccination," Dr. Koren explains. "The infants who were circumcised showed substantially more pain."
Pain response was measured by monitoring facial expression, duration of crying, blood pressure, and heart rate. In addition, parents and the primary care physician completed a questionnaire regarding their perception of the severity of pain the infant was experiencing.
"This study demonstrates two important findings," says Dr. Koren. "It shows that infants do in fact feel pain, and that their pain is not short-lived, as previously thought. Consequently, adequate pain relief should be routinely used during circumcision and any other medical and surgical procedures where pain is possible."
Washington - The link between cancer and electric and magnetic fields around power lines is slight, according to a six-year government and industry research project.
The congressional mandated research, conducted by the National Institute of Environmental Health Science, began in 1992 and cost $60 million. ``The scientific evidence suggesting that (electric and magnetic field) exposures pose any health risk is weak,'' said NIEHS director Kenneth Olden, who cautioned that unresolved scientific questions still mean that electric and magnetic forces ``cannot be recognized at this time as entirely safe.''
There is some limited scientific evidence that exposure may increase the incidence of leukemia, the report said, though that evidence isn't strong enough to warrant ``aggressive'' regulatory action to protect those who live near power lines.
Additional studies now under way may improve knowledge of whether power lines lead to childhood leukemia, the report said. The study was presented to Congress today. An interagency presidential committee will make a second report to Congress after reviewing the NIEHS report.
Eli Lilly & Co.'s new osteoporosis drug Evista reduced the risk of invasive breast cancer in older women by 76 percent after three years of treatment, according to a study in a leading medical journal. Researchers found 13 cases of invasive breast cancer among the 5,129 osteoporosis patients treated with Evista, compared with 27 among the 2,576 taking an inactive placebo, according to the study, published in tomorrow's Journal of the American Medical Association.
``Rarely do we see such dramatic prevention of a disease in medicine, and this is an exciting start,'' said Dr. Steven Cummings, the lead researcher, from the University of California at San Francisco. ``If it holds up, it could be one of the most important advances in women's health in a long time.'' Still, the results were not all good news for Evista, a drug Lilly needs to make into a blockbuster before 2003, when it loses patent protection on its top-seller, the $2.8-billion-a-year Prozac. In the study, more Evista users developed potentially fatal blood clots and diabetes than patients in a control group.
While the results were widely anticipated and presented in part at medical meetings during the past year, publication in one of the world's biggest medical journals could help Lilly boost Evista sales. Evista generated $144 million in 1998, its first year on the market -- about half the sales some analysts expected. If the findings are confirmed and Evista continues to reduce breast cancer risk, it may be preferable to the only drug approved to prevent breast cancer, AstraZeneca Plc's Nolvadex, which has been linked to endometrial cancer, the researchers said. While more and longer-term data are available on Nolvadex, the early Evista results appear even more promising, Cummings said.
More than 43,000 American women died of breast cancer in 1998, making it the second leading cause of cancer death among women. Analysts say Lilly likely won't be able to propel Evista, now approved to prevent thinning of bones in older women, into the blockbuster category of drugs with more than $1 billion in sales without a breast-cancer prevention claim.
Still, the drug is not without side effects. Patients taking Evista were three times more likely to develop a potentially fatal blood clot in their legs or lungs than those on placebo, the researchers found. Evista patients also reported new or worsening diabetes and suffered irritating side effects like hot flashes, flu-like symptoms and leg cramps. While Evista reduced the risk of vertebral fractures, it didn't have a significant impact on other fractures, the researchers found.
Some experts believe drugs like Evista and Nolvadex may better treat a range of ailments in postmenopausal women than hormone replacement therapy with estrogen, a market currently dominated by American Home Products Corp.'s Premarin. While estrogen can prevent osteoporosis, ease symptoms of menopause, and may protect the heart and ward off Alzheimer's disease, it has also been linked to breast and endometrial cancer.
The newer drugs, known as selective estrogen receptor modulators or SERMs, act like estrogen in some areas such as improving bone density while blocking the negative effects of estrogen elsewhere. ``Seeking to create the perfect SERM that will duplicate or improve on the beneficial effects of estrogen while protecting against its risks, the (Evista) findings provide solid encouragement,'' said Dr. Adele Franks from the Prudential Center for Health Care Research and Karen K. Steinberg from the Centers for Disease Control and Prevention in Atlanta. Evista ``should not be considered suitable for use by most women at this time, but its contributions to knowledge intensify the anticipation of finding something even better on this new frontier,'' they wrote in an editorial.
SPOKANE, Wash. (AP) -- The Federal Trade Commission is asking a judge to bar two Washington companies from making unsubstantiated claims for a dietary supplement advertised as a wonder drug that can cure diseases.
The FTC alleges the ``Vitamin O'' supplement is nothing more than bottled salt water sold for $10 an ounce. A federal court hearing is set for April 7.
The agency wants to force Kettle Falls-based Rose Creek Health Products Inc. and The Staff of Life Inc. to refund customers' money.
An ad that ran in USA Today claims Vitamin O ``has helped eliminate everything from breathing problems and lack of energy to life-threatening diseases'' such as cancer and heart disease.
A Food and Drug Administration lab analyzed the liquid and found it to be nothing more than salt water, said Eleanor Durham, an FTC attorney.
USA Today routinely screens ads for diet supplements to ensure that advertisers offer a money-back guarantee and include a phone number or address for consumers' questions, a spokesman for the Arlington-Va.-based newspaper said.
Steve Anderson said the five Vitamin O ads USA Today ran from November through February met those standards.
``We would have to take a long and hard look'' before approving any future Vitamin O ads, Anderson said.
Donald Smyth, owner of both Rose Creek and The Staff of Life, did not return a call Thursday.
The FTC has several pending complaints against producers of dietary supplements that purport to cure various ailments. Such products are frequently advertised in alternative medicine publications and can be sold without approval from the FDA. The Vitamin O case is unusual because the product has recently been promoted in newspapers.
WASHINGTON (AP) -- Alzheimer's disease is one of the scariest threats of old age, particularly frightening because so far there's no way doctors can protect people at risk.
That may be about to change.
Scientists have just discovered that a memory problem called ``mild cognitive impairment'' can be an early warning sign of Alzheimer's -- and they're beginning three huge studies to see if certain drugs could prevent those patients from ever getting Alzheimer's.
``It's very exciting,'' said Neil Buckholtz, chief of the dementia branch at the National Institute of Aging. But ``I don't think people are really aware of this concept'' of mild cognitive impairment.
The NIA is trying to get the word to people over age 55 that if they're getting abnormally forgetful, they should see a doctor.
We all have occasional lapses where we forget where we parked the car or can't recall someone's name. That's normal, particularly as people age or experience stress.
Depression also can cause memory lapses, and forgetfulness is a side effect of some drugs. Doctors can offer immediate help for those problems.
But mild cognitive impairment is a more persistent memory problem. A golf lover makes a tee time on Tuesday but by Thursday, he leaves his golfing buddies waiting in vain on the links.
A pattern of such forgetfulness can mean mild cognitive impairment -- as long as doctors rule out other dementia symptoms. The mildly cognitive impaired don't have such symptoms as difficulty completing normal daily activities, problems with reasoning or inability to communicate, Dr. Ronald Petersen of the Mayo Clinic reports this month in Archives of Neurology.
A final test is simple: Read a paragraph's worth of information and wait 30 minutes. Someone with healthy short-term memory usually can spout back the information, but the mildly cognitive impaired have trouble, Buckholtz explained.
Mild cognitive impairment doesn't mean you're definitely destined for Alzheimer's. But studies show that every year, 12 percent to 15 percent of those patients will progress to Alzheimer's -- in other words, up to 45 percent will have Alzheimer's within three years. In contrast, only 1 percent of healthy people over age 65 get Alzheimer's each year.
The cause of Alzheimer's is not known. But 4 million Americans have it, a number expected to jump as the baby boomers age. So neurologists want a way to at least delay Alzheimer's onset.
Three new studies are hunting such a therapy in patients diagnosed with mild cognitive impairment:
A National Institute on Aging-sponsored study will give 720 patients ages 55-90 either high-dose vitamin E, the current Alzheimer's medication Aricept or a dummy pill. Results are expected by 2003. For information, call 1-888-455-0655 or check the Internet at www.memorystudy.org. Study sites are in 28 states and Canada.
NIA-funded scientists discovered in 1997 that high-dose vitamin E can slow by about six months the progression of moderately severe Alzheimer's. Vitamin E is an antioxidant thought to limit damage from ``free radicals,'' molecular damage that has been found in Alzheimer's patients' brains.
Aricept inhibits the breakdown of acetylcholine, a brain chemical vital for nerve cells to communicate with each other. Also, test-tube studies suggest acetylcholine could decrease the buildup of Alzheimer's-related brain plaques.
Novartis Pharmaceuticals is enrolling 900 patients ages 55-85 in a three-year study comparing its experimental drug Exelon to a placebo. Exelon, which also inhibits the breakdown of acetylcholine, is awaiting government permission to sell in the United States as an Alzheimer's treatment. The new prevention study will be conducted at 50 sites worldwide. For information, call 1-877-554-HOPE.
Merck & Co. is enrolling more than 1,000 Americans over age 64 in a study comparing its experimental drug Vioxx to placebo. Vioxx is a novel painkiller awaiting government sales approval. But it works by inhibiting inflammation, considered another possible cause of Alzheimer's disease, so Merck now is studying its brain effects. For information, call 1-800-65-STUDY.
WALDPORT, OREGON -- Health officials have more questions than answers about two recent fatal cases of strep-throat in a coastal Lincoln County town They do know the four-year old boy and 37-year old woman died of virulent strains of streptococcus (strehp-toe-CAHK-us) that invaded other organs beyond the throat. But don't know if the same form killed both victims. The two have an indirect connection... the boy's father and the woman's husband are business partners. But the victims died a month apart, and Gaye Gruber with the county's health department says people usually develop symptoms within three days of being exposed to the bacteria. Gruber says one case of invasive strep is alarming, but in the town of Waldport two cases ``certain sent the red flags up.'' Tests are expected to provide more answers next week.
WASHINGTON (AP) -- Researchers have found that tears, saliva and pregnant women's urine contain proteins that are powerful killers of HIV, the virus that causes AIDS.
In a study published today in the Proceedings of the National Academy of Sciences, scientists found that a protein called lysozyme was able to kill the AIDS virus quickly in test-tube experiments.
Sylvia Lee-Huang of New York University, lead researcher in the study, said the protein could become an important drug against HIV because it is a natural compound that the body routinely makes in tears and saliva.
``It ought to be more tolerated and have fewer side effects than other HIV drugs,'' said Lee-Huang. ``It possibly could be used in combination with other drugs.''
It's not known how lysozyme kills HIV, but Lee-Huang speculated that it could work by breaking down the outer membrane of the virus.
The team also found that the urine of pregnant women contains another type of protein, called ribonucleases, that destroys the genetic material in the HIV virus.
Nava Sarver, an AIDS researcher at the National Institute of Allergy and Infectious Diseases, said the study was interesting but needs to be confirmed by other laboratories.
``A lot of work needs to be done to simulate the (laboratory) findings in a more relevant situation,'' said Sarver. Her agency, NIAID, is part of the National Institutes of Health.
The search for the anti-HIV protein was prompted, said Lee-Huang, when researchers realized the babies of women infected with HIV were somewhat protected from the virus.
Researchers earlier suspected that human chorionic gonadotropin, or HCG, a hormone produced during pregnancy, was responsible for protecting against HIV and other viruses.
Lee-Huang said she and her group purified HCG and found it had no effect on HIV. The researchers then spent two years isolating other proteins in urine and testing them against HIV. Eventually they found lysozyme and ribonucleases.
The researcher speculated that pregnancy prompts a woman's body to make more virus-killing proteins to protect the developing baby from viruses and bacteria. That suggests ``Mother Nature knows best how to protect the earliest stages of life,'' Lee-Huang said.
The proteins also were found in mother's milk, white blood cells and chicken egg whites.
The presence of lysozyme in saliva may be a factor in why HIV is not transmitted by casual kissing, said Lee-Huang.
The team is trying to determine exactly how lysozyme attacks HIV. That is a critical step in developing a new HIV drug based on the protein, she said.
INDIANAPOLIS, INDIANA -- Health food and nutrition stores are being swamped with requests for a new herbal product called ``Cellasene''... which is supposed to eliminate deposits of cellulite on the body. But an Indianapolis physician says be careful before you take this or any other herbal product. Doctor Allison Tomusk says the product contains fairly high levels of iodine and another item that causes blood thinning and that could be dangerous for some people. She says the best way to handle it is to consult with a physician who is knowledgeable about herbal products.
CHICAGO (AP) -- In a surprising shift from popular medical theory, researchers reported today that they found no evidence that a high-fat diet promotes breast cancer -- or that low-fat foods protect against the disease.
Researchers and other experts quickly noted that a low-fat diet is still good for the heart, and heart disease kills far more Americans -- women and men -- than any cancer.
`We should just accept that good scientists can't tell you yet what to eat to minimize your breast-cancer risk,'' said Dr. John Glaspy of the University of California at Los Angeles, who was not involved in the research.
Doctors have theorized that eating lots of fat increases breast-cancer risk. They have based their thinking on animal studies, international comparisons and studies of women who developed breast cancer and women who didn't.
Some experts have suggested that the key is the type of fat consumed, not the amount; that fish oil offers some protection from breast cancer; or that contaminants stored in fat trigger breast cancer.
The new study, published in today's Journal of the American Medical Association, tracked 88,795 women in the continuing Nurses' Health Study. The women, ages 30 to 55, completed detailed questionnaires about their eating habits every four years from 1980 to 1994.
Researchers compared the diets of the women without breast cancer and the 2,956 women whose breast cancer was discovered during the study.
Breast cancer was found to be no more common among women who ate lots of fat, or among those who ate a large proportion of animal fat, polyunsaturated fat (vegetable fat) or trans-unsaturated fat (partially hydrogenated oils, such as those used in margarine and to cook doughnuts and french fries).
Nor was breast cancer any less common in women who got a high proportion of their fats from fish oil or who got less than 20 percent of their total calories from fat.
``Our research indicates it's highly unlikely that women who consume a low-fat diet are protected against breast cancer,'' said the study's lead author, Dr. Michelle Holmes, an instructor of medicine at Harvard Medical School and Brigham and Women's Hospital. ``Equally, it appears a high-fat diet also poses no increased risk for the disease.''
Most surprisingly, women who ate the least fat appeared to have a 15 percent higher rate of breast cancer, the researchers
Holmes said she's not ready to conclude that a low-fat diet increases breast cancer risk because the finding was based on fewer than 1,000 women who ate less than 20 percent of calories as fat.
The theory that dietary fat is linked to breast cancer arose from the observation that breast-cancer rates are far lower in traditional Asian cultures, where diets are generally low in fat.
Compared with women in Western cultures, Asian women start menstruating later, give birth at a younger age and gain far less weight in adulthood -- all factors that decrease breast-cancer risk, Holmes said.
NEW ORLEANS (AP) -- A laser mounted on a tube the width of a cocktail straw can blast tiny holes in the walls of the heart, triggering the growth of blood vessels that substantially relieve crippling chest pain.
Lasers are already used as a last-ditch treatment of bad chest pain in some people, but an experimental new approach described Sunday appears much safer and can be used without open-heart surgery.
Experts say the promising results should help relieve many doctors' skepticism about laser therapy of the heart.
Heart lasers were approved by the U.S. Food and Drug Administration for routine use last year. However, the treatment requires opening the chest and carries a 6 percent to 10 percent risk of death.
The new approach involves threading the laser into the heart on a catheter, something that doctors do routinely for a variety of procedures, such as angioplasty.
If it works as well as data so far suggest, it could offer relief to many thousands of Americans whose heart pain cannot be treated with angioplasty or bypass surgery.
``This is for people with no options who are miserable with their angina,'' said Dr. Stephen N. Oesterle of Massachusetts General Hospital in Boston.
Oesterly presented the results of the largest study yet with this approach at a meeting of the American College of Cardiology.
In his study, doctors at 12 hospitals in the United States and England randomly assigned 221 patients to have either the laser therapy or routine medical care. All had severe angina, resulting from poor circulation to their heart muscle.
Angina is rated on a scale of 1 to 4. Before treatment, all were in stage 3 or 4, meaning they had chest pain will eating, brushing their teeth or even sitting perfectly still.
After laser treatment, two-thirds had improved at least two grades to stage 1 or 2. This meant they could walk about their homes comfortably, even though climbing stairs might still trigger pain.
``You can lead a normal life with class 2 angina,'' said Oesterle. ``You cannot with class 4 angina.''
The laser is threaded into the left ventricle, where doctors burn 10 to 15 tiny holes into the heart walls. None died during the procedure. Patients can be sent home the same day they are treated. When the approach was first proposed in the 1980s, doctors theorized that the holes acted as substitute blood vessels, carrying blood to oxygen-starved muscle. However, experts now know that the holes themselves quickly plug up, serving no purpose. Instead, it now appears that the laser damage somehow triggers the heart to grow tiny new arteries, a process called angiogenesis. These arteries feed the muscle that cannot be adequately nourished by the heart's clogged coronary arteries. Dr. Ben McCallister of Mid America Heart Institute in Kansas City said Oesterle's results will probably make physicians more open to the idea of using lasers to improve heart circulation. ``There has been a lot of skepticism about this,'' said McCallister. ``I think this very careful study will change the tide about how people think about this.'' Oesterle tested a laser system developed by CardioGenesis Corp., where he has been a consultant. Similar approaches are also being tested with lasers developed by Eclipse Surgical Technologies and Biosense, Inc.
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