March 1999

Vitamin A And Maternal Survival
March 11, 1999

Being pregnant is 50 to 100 times likelier to kill women living in poor, underdeveloped countries than women in industrialized nations. It's a shocking statistic, but one that vitamin A can help bring down.

The evidence comes from a huge study of more than 44,000 women in Nepal, where most births occur at home and prenatal care is practically non-existent. Malnutrition is common. Johns Hopkins researchers have found that adding vitamin A or beta carotene to the diets of expecting women lowered their risk of death from pregnancy by as much as 40 percent. It was probably due to vitamin A's ability to reduce the risk of infection, says public health professor and study lead author Dr. Keith West.

"It is a very clear statement that we need to be paying attention to the nutritional health, to the diets of women in the developing world," explains West. "Especially as they enter and go through their child-bearing years."

As in many poor countries, good sources of vitamin A like fruits and vegetables are not always available year round in Nepal.

Study: Scary Films Stay With You
March 10, 1999

Still scared of the water all those years after "Jaws"? Researchers say you're not alone.

A survey of 150 students at the Universities of Michigan and Wisconsin found that one in four had some lingering "fright" effect from a movie or TV show they saw as a child or a teen-ager.

The younger children were when they were frightened, the longer the reaction lasted.

Some people who saw the 1975 thriller about a man-eating shark never went into the ocean again, said Kristen Harrison, a University of Michigan communications professor who co-wrote the study.

And what about "Psycho," the 1960 thriller with the deadly shower scene?

"There are people who shower with the door open, even though they're quite sure there isn't a killer in the house," Harrison said Tuesday.

Ninety percent said they were scared by a TV or movie from their childhood or adolescence; 26 percent said they still experience "residual anxiety."

Ranny Levy, president of the Coalition for Quality Children's Media in Santa Fe, N.M., said her own 27-year-old son was frightened of taking a swim in the sea a few years ago and blames it on seeing "Jaws" as a boy.

"He had to force himself. He really identified it with watching 'Jaws' when he was little," she said.

Cellulite Pill Hits U.S. Stores
March 10, 1999

An herbal supplement popular in Australia that claims to eliminate cellulite was launched in the U.S. market Tuesday, prompting a wave of media attention and medical skepticism.

The makers of Cellasene claim an eight-week course of three pills daily will eliminate the stubborn, lumpy fat known to plague women's thighs.

The pills, available at major drug and retail stores, cost about $40 for a two-week supply.

As with the scores of other dietary supplements promising everything from slowing aging to preventing cancer, Cellasene is not regulated by the federal Food and Drug Administration and its claims do not have to be substantiated.

Vitamin maker Rexall Sundown Inc. (Nasdaq:RXSD - news), based in Boca Raton, Fla., which has the U.S. distribution rights to Cellasene, said gingko biloba, sweet clover and grapeseed extracts and other ingredients in Cellasene work by increasing blood circulation, reducing fluid buildup, stimulating metabolism and reducing localized fats. The company's press kit and Web site offered no information on any tests done on the efficacy of Cellasene.

Doctors said the claims were unlikely and would require controlled medical trials to achieve any credibility.

"I would be very skeptical of any quick-fix pill one can ingest that would have any meaningful effect on the appearance of cellulite," said Dr. Seth Yellin, director of the Emory Center for facial aesthetics at Emory University in Atlanta.

"All of these things (ingredients) have been around for some time. Why all the sudden would putting them together this way create a miraculous cure for cellulite, a problem that has plagued women for forever?" he asked.

The pills have proved popular in Australia, where published reports said consumers had to be put on waiting lists because of a shortfall after Cellasene's debut last fall.

A warning on the label says those taking the pills may exceed the FDA's recommended daily allowance of iodine. It also warns that Cellasene should not be used by people with thyroid conditions, those being treated with blood thinners or those who are pregnant or nursing.

Sudden Death During Exertion Tied To Plaque Rupture
March 10, 1999

Acute exertion -- such as pushing a car, mowing the lawn, moving furniture, or having sexual intercourse -- appears to be a risk factor for sudden death in middle-aged men who have high cholesterol levels and significant coronary artery disease, according to a study published in The Journal of the American Medical Association.

In a study based on the autopsies of 141 men who died suddenly, Dr. Allen P. Burke of the Armed Forces Institute of Pathology in Washington, DC, and colleagues found that plaque rupture -- the sudden break-down of fatty plaques in the lining of coronary arteries -- caused death in 68% of the men who died while exerting themselves. In men who died while at rest, plaque rupture was the underlying cause in only 23%.

The men studied had significant coronary artery disease, with at least one heart artery blocked by 75% or more.

In addition, the men who died suddenly during exertion had significantly higher cholesterol levels than those who died at rest, and most were not in good physical condition.

Based on the autopsies and information from families of the dead men, the deaths were divided into two groups: those that occurred when a man was under stress, either physically or emotionally; and those that occurred while a man was at rest.

Among the 25 who died during exertion, 14 were previously sedentary men who were involved in sudden, strenuous activity such as carrying a heavy object, moving furniture, pushing a car, mowing a lawn, digging a ditch, playing basketball, having sexual intercourse, bicycling, or shoveling snow. Seven of the deaths occurred during emotionally stressful activities, such as a giving a speech, appearing at court, or during an argument.

Of the 116 deaths that occurred while the men were at rest, activities included sitting at home, sitting at work, or watching television.

"The current study indicates that acute exertion is an additional independent risk factor for plaque rupture in men, presumably by disruption of a vulnerable plaque," writes Burke's team. "Therefore, we suggest that acute exertion should be added as a potential risk factor for plaque rupture, along with elevated serum cholesterol level."

According to the report, "a proportion of sudden deaths in middle-aged men may be decreased if the potential danger of acute exertion in hypercholesterolemic men is avoided. To this end, it would seem prudent to incorporate serum cholesterol reduction as an integral component of an exercise program in those men with elevated serum cholesterol."

SOURCE: The Journal of the American Medical Association 1999;281:921-926.

Lots Of Coffee Can Mimic Stress State
March 5, 1999

Drinking four or five cups of coffee throughout the morning leads to a rise in blood pressure and increased secretion of stress hormones -- a response similar to one caused by chronic stress, US researchers said Thursday.

Presenting their findings at the annual meeting of the Society of Behavioral Medicine in San Diego, the research team from Duke University Medical Center in Durham, North Carolina, noted that this stress-like state caused by a high intake of morning coffee can last into the evening.

Principal investigator Dr. James Lane and colleagues asked 72 habitual coffee drinkers to take 250 milligrams (mg) of caffeine at 8 a.m. and another 250 mg at 12 noon during the first week of a 2-week study. On day 2, subjects took a placebo (dummy pill) at 8 a.m. and 12 noon. On both days, subjects abstained from any other caffeine intake. The investigators measured blood pressure four times an hour throughout both days.

The effects of caffeine on both blood pressure and heart rate "could be seen through 10 p.m.," Lane told Reuters Health. On average, caffeine caused a small increase -- about 3 mm Hg -- in both diastolic and systolic blood pressure, and increased levels of stress hormones in the blood, including a 32% increase in epinephrine and a 14% increase in norepinephrine levels.

The team noted that the study participants reported more stress and higher levels of activity on the day that they ingested caffeine.

"This is not a large effect (on blood pressure)," Lane said, and acknowledged that similar studies have shown more pronounced effects with caffeine intake. "But a 5 mm Hg increase in blood pressure is associated with a 34% increase in incidence of stroke and a 21% increase in incidence of heart disease," Lane noted. "Small increases in blood pressure can have a meaningful effect."

"Increases in adrenaline make the day feel more stressful," Lane said, and the participants' reports reflected this as well.

The researchers also note that while stress hormones help the body react quickly in times of stress, high levels of these hormones over time have been linked to heart damage.

"This is more evidence that caffeine is harmful to our health.... It may be that cutting back on caffeine may be a way to reduce hypertension and heart disease," Lane commented.

In the study, the investigators also looked at the effects of caffeine on women taking the oral contraceptive pill. Previous research suggested that women on the Pill may be more prone to the negative effects of caffeine. But Lane's team did not find such an effect. "In fact, women taking oral contraceptives showed slightly less of a stress response to caffeine than (women not taking the Pill)," according to a statement.

Avoiding Bad Cholesterol
March 5, 1999

A high blood cholesterol level puts you at risk for coronary heart disease -- the nation's number-one killer. Eating right, exercising, and losing weight (if necessary) are the keys to lowering a high blood cholesterol level.

To lower your "bad" or LDL cholesterol, you'll need to lower your intake of "saturated" fats. Saturated fat is found mostly in animal products: Fatty cuts of prime rib, ground beef, whole milk, and milk products such as cheese and ice cream. Unsaturated fats are more likely to be found in vegetable oils. If you're unsure of a product's fat content, check the nutrition label on the package.

You can begin to lower your cholesterol level by switching to lean meats, skim milk, nonfat yogurt, or lowfat ice cream and cheese. While a cup of whole milk has five grams of saturated fat, skim milk has none. Peel the fatty skin off poultry, and you cut the fat and saturated fat by half. Also, go easy on organ meats such as liver (not a stretch for most people) and processed meats like bacon, bologna, hot dogs, and sausage. Choose fish more often; it's a low-fat gold mine. Three ounces of haddock -- a piece about the size of a deck of cards -- has only a sprinkling of fat and saturated fat. (Remember: A person who eats roughly 2,000 calories a day should consume no more than 67 grams of total fat and 22 grams of saturated fat daily.) When it comes to cooking and baking, liquid vegetable oils such as corn, olive, soybean, and canola oil have more unsaturated than saturated fat. They're a good substitute for butter. However, they are not fat or calorie free. Most of these oils have about 120 calories and nearly 14 grams of fat per tablespoon. (Yes, that includes olive oil.) Use them modestly.

Spread plant-based margarine instead of animal-based butter on your morning toast. Although the two spreads have the same fat and calories -- 12 grams of fat and 100 calories per tablespoon -- butter has almost eight grams of artery-clogging saturated fat whereas margarine has only two. To choose the margarine with the least cholesterol-raising fat, look for the label that lists "liquid vegetable oil" ahead of "hydrogenated or partially hydrogenated vegetable oil." Better yet, choose light or low-fat margarine, which has fewer calories and less total fat, including cholesterol-raising fat, than butter or regular margarine.

One of the easiest ways to keep the cholesterol and saturated fat in your diet low is to keep your meat, poultry, and fish intake down to no more than about six ounces daily. Forget about buying a one-pound steak to feed two people. Have the supermarket butcher cut that amount in half, or freeze the second half of the steak for another dinner. Let's face it, the less you make, the less you'll eat.

Cigars Are Not A Safe Alternative To Cigarettes, Study Shows
March 8, 1999

Cigar aficionados who think they're averting the dangers of cigarette smoking actually may be slowly damaging their blood vessels, according to researchers.

Reporting here Sunday at the annual meeting of the American College of Cardiology, Dr. Minerva Santo-Tomas said that her team at Mount Sinai Medical Center in Miami has the first evidence that cigar smoking harms the lining of the blood vessels that serve the heart. The effects can be seen immediately after a few puffs on a stogie, she said.

The trendiness of cigars among young people has to do, in part, with the belief that cigars are a healthier alternative to cigarettes, Santo-Tomas noted. "But," she said, "cigars are not safe."

To see whether "the yuppie habit" constricts blood vessels, as cigarettes have been shown to do, the Miami researchers studied the brachial arteries in the arms of 22 nonsmokers ages 25 to 45. Twelve participants each smoked a cigar before the test, while ten did not. Using highly sensitive ultrasound testing, the researchers found that the nonsmokers' artery walls opened wider to let blood flow through. That is, the vessels of the nonsmokers dilated 10 percent in response to blood flow, while those of cigar smokers dilated only 2 percent.

The brachial artery, Santo-Tomas said, offers a non-invasive testing ground for researchers to observe what is likely going on in heart arteries. In the heart vessels, interference with dilation would hinder blood flow to the muscle.

Previous studies have shown that cigar smokers are at higher risk than nonsmokers for certain types of heart disease. This study, Santo-Tomas said, "goes one step further" in showing that the habit acts directly on blood-vessel lining. Dysfunction in heart-blood vessel lining, she noted, can be a precursor to the hardening and narrowing of vessels, a condition known as atherosclerosis.

These findings, noted Toledo, Ohio, cardiologist Christopher Cooper, are important in showing that "cigar smoking, in all likelihood, hurts normal heart function."

Another expert not involved in the study agreed that these artery observations are significant. "This is the first investigation to find that cigars cause abnormalities in [vessel] function," said Mount Sinai cardiologist David Paniagua. Cigarette smoking has been implicated in vessel-lining damage. Now, Paniagua said, it may be time for doctors to warn patients of the possible consequences of cigar smoking for heart arteries.

Next on her team's agenda, Santo-Tomas said, is to uncover the mechanism by which cigar smoking holds back blood-vessel dilation.

For now, the researchers can only speculate that the effects on blood vessels they observed can lead to atherosclerosis in the long run. Larger studies are needed to flesh out factors such as how often cigar smokers have to light up in order to inflict long-term damage.

Santo-Tomas said they do know that cigar smoking appears to compound the damage of cigarettes, upping smokers' risk for heart disease. Cigarette smokers who take up the cigar habit, she noted, are more likely to inhale cigar smoke deeply.

High Blood Pressure Shrinks Men's Brains
March 5, 1999

The amount a man's brain shrinks as he ages may depend on his blood pressure decades before, researchers report.

"High blood pressure accelerates brain aging," said neurologist Dr. Charles DeCarli of the University of Kansas in Kansas City, lead author of a study appearing in the latest issue of the journal Stroke.

DeCarli and colleagues from several sites nationwide examined the brains of 414 male twins, acquiring very precise pictures by using a technique known as magnetic resonance imaging (MRI). All of the men were surviving members of twin pairs first marked for study during army service in the 1940s. Since 1969, the National, Heart, Lung, and Blood Institute has tested their blood pressure regularly.

As the twins were all older men — average age 72 — many of them showed signs of illness. Almost one-third had symptoms of heart disease and 8 percent showed signs of stroke. Comparing the MRI pictures of their brains with their current health, the researchers found the higher a man's blood pressure now, the smaller his brain. Most importantly, though, DeCarli's team found a significant link between brain shrinkage and raised blood pressure levels at mid-life, when the men's average age was 47. Men with high blood pressure in middle age also had less white matter, which consists of nerve bundles that carry messages long distances between brain cells. "They were 70-year-old men with the brains of 80-year-olds," said DeCarli.

About 50 million people nationwide have high blood pressure. The disease causes more than 40,000 deaths annually and plays a part in many other problems including stroke, heart disease and kidney failure, according to the American Heart Association. In DeCarli's study, 132 men were receiving medication for the ailment. Despite this, they had less brain matter than men without any history of high blood pressure.

"We know all too little about how mid-life health conditions affect disease later in life," said Dr. Dennis Evans, a specialist in aging at Rush Medical College in Chicago.

DeCarli advised, "check your blood pressure when you are 40, even if you have no symptoms of a problem." He said that physicians should treat borderline high blood pressure even more aggressively when patients are middle-aged, in light of his team's findings. Overtreatment has some risk, but at the same time younger patients might withstand the side effects of blood pressure medications better, he said.

Subtle brain damage like that observed in the study may weaken brains so that they cannot cope with diseases like Alzheimer's, added Evans. It's one more reason to get patients to take blood pressure seriously, in his view. He said he would tell patients, "Get your blood pressure down or run the risk of your brain being less useful when you're older."

Stroke (1999;30:529-537)

Moderate Weight Gain Puts Men At Risk
March 5, 1999

Gaining even a moderate amount of weight after age 20 increases men's risk of having a heart attack and dying from coronary artery disease, according to a Swedish study.

Obesity is a known risk factor for heart disease, but the study by researches at Sahlgrenska University Hospital in Goteborg, Sweden, shows that moderate weight gain is also associated with an increased risk of death from diseased heart arteries, with the risk increasing as weight increases.

The researchers, led by Dr. A Rosengren, analyzed data from 6,874 men born between 1915 and 1925 who were first examined, weighed and measured in the early 1970s. The study participants were also asked how much they weighed when they were 20 years old. Based on how much weight they had gained since age 20, the men were divided into seven groups: those who had lost more than 4% of weight, those whose weight had remained stable, and those whose weight had increased by 4-10%, 10-15%, 15-25%, 25-35%, or more than 35%.

The men's health was then tracked for nearly 20 years. The average weight gain from age 20 to middle age was almost 10 kilograms or about 22 pounds. Only 922 of the men (13%) remained stable -- gaining or losing less that 4% of their weight since age 20. The remaining 79% gained more than 4% of their weight.

Compared with men who remained stable, those who had gained the most since their youth -- more than 35% -- had almost three times the risk of dying from coronary disease, even after adjusting for smoking habits, physical activity, cholesterol levels, blood pressure and diabetes. These men were also at increased risk for a nonfatal heart attack, note the researchers.

But men who gained between 4% and 10% also faced a relative risk of dying from heart disease that was 1.5 times that of men whose weight had remained stable, the authors add.

Previous studies in women have shown that even a small weight gain from age 18 to middle age resulted in a small but significant increase in coronary disease incidence, even in women with normal adult weight.

But the investigators note it is "unclear whether weight reduction in middle age will reduce risk."

"We do not know whether men who are young now will gain proportionately more or less weight as they grow older and what the effects will be in terms of mortality from coronary disease," Rosengren's team writes. "From a public health perspective, available data in both men and women indicate that preventing weight gain in young people is important."

SOURCE: European Heart Journal 1999;20:269-277.

Emergency Contraceptive Demand High
March 3, 1999

Just a few years ago, few women knew about the "morning-after" pills. Now, due largely to Preven, the first marketed emergency contraception kit, it is gradually becoming more mainstream.

At family-planning clinics, inner-city medical facilities and college health centers, doctors say the demand for emergency contraception has risen dramatically in the past year. Most women may not know the brand Preven, but they increasingly know that there's help available if they have unprotected sex.

Some obstetricians and gynecologists are even writing Preven prescriptions for patients to keep on hand — just in case.

In the three months that the $20 Preven kits were available in 1998, about 1.3 million were sold, according to IMS Health, a market data firm based in Plymouth Meeting, Pa.

Nationwide, Planned Parenthood clinics received 28,000 requests for emergency contraception last year, twice the number of 1997.

"There no question that the availability of a dedicated product raises everyone's consciousness level for emergency contraception," said Gloria Felt, president of Planned Parenthood of America.

At Penn State University's main campus in State College, Pa., requests for emergency contraception rose 57 percent last year to 148.

Preven is made by Barr Laboratories of Pomona , N.Y., and marketed by Gynetics Inc., a Somerville, N.J., company that is spending about $30 million this year to advertise Preven. Its marketing campaign includes full-page ads in most women's magazines with the slogan: "The condom broke. But her life stayed intact."

Preven pills are no different from other brand-name birth control pills that have been used as morning-after emergency contraception. But doctors say Preven is easier to use because it comes prepackaged in a kit that includes simple directions and a pregnancy test.

Studies show Preven is 75 percent effective at preventing pregnancy if the pills are taken within three days of sex. By contrast, regular birth control pills taken properly are 99 percent effective.

The morning-after pills are different from RU-486, the French abortion pill, which can end a pregnancy several weeks after it has begun. The morning-after pills delay or prevent ovulation, meaning no egg enters the uterus to be fertilized. If ovulation has already occurred, experts theorize that the morning-after pills may prevent fertilization or alter the uterine lining so that a fertilized egg doesn't implant and develop into an embryo.

Anti-abortion groups vigorously protest RU-486, though they have been far less vocal about the morning-after pills.

The National Right to Life Committee said in a statement that it takes no position on any drug or device that acts to prevent fertilization, though it opposes anything that acts after that point.

However, Judie Brown, president of the American Life League of Stafford, Va., said morning-after pills are "nothing more than an early abortion."

Although Preven debuted without much political fanfare, Gynetics has come under scrutiny for other reasons.

The Food and Drug Administration, which approved Preven on Sept. 2, accused Gynetics in January of using false and misleading advertising because the materials "imply that Preven is an alternative to regular contraceptive use."

Gynetics officials say they are in discussions with the agency about the ads' language.

The FDA also accused the company of minimizing the drug's side effects of nausea and vomiting. Gynetics is working on a second generation Preven that would reduce the nausea.

Another company, Women's Capital Corp., of Washington, D.C., last month applied to the FDA to get approval for its as yet unnamed emergency contraception. Women's Capital officials say its pill would have fewer side effects and be more effective than Preven.

The FDA, which is known for restricting drugs into the U.S. market, was a catalyst for Preven. In 1995, the agency joined several women's health groups in seeking a company to market emergency contraception.

For years, public health officials felt hindered in getting the message out about morning-after contraception as doctors worried about abortion politics, and patients did not know to ask for it.

Large drugmakers, such as Johnson and Johnson, parent of birth control pill manufacturer Ortho-McNeil Pharmaceutical, showed no interest. But Gynetics, which is headed by former Ortho President Roderick Mackenzie jumped at the opportunity.

Health officials were driven by one goal: Reducing the more than 2.7 million unintended pregnancies each year in the United States. About half are due to contraceptive failure.

Dr. Carolyn Westhoff, medical director of a women's clinic at New York Presbyterian Hospital, gives prescriptions for Preven to her patients even if they don't ask. "This way, patients are prepared in advance," she said.

Ultimately, emergency contraception may become as easy to buy as condoms.

A government project in Seattle that started last spring permits pharmacists to prescribe the pills directly to women. In nine months ended last December, more than 6,000 prescriptions were written.

B Vitamin Deficiency May Cause Hearing Loss
March 9, 1999

Deficiencies in vitamin B-12 or folic acid may lead to hearing loss in elderly women, according to US researchers.

``Poor vitamin B-12 and folate status may be associated with age-related auditory dysfunction,'' write Dr. Denise Houston and colleagues at the University of Georgia in Athens, Georgia. Their findings are published in the March issue of the American Journal of Clinical Nutrition.

Although hearing loss is common in elderly people, the biological mechanisms that cause age-related hearing impairment remain unknown.

In their study, Houston's team assessed hearing function as well as blood levels of both vitamin B-12 and folates in a group of 55 healthy women, aged 60 to 71.

The investigators found that ``women with impaired hearing had 38% lower (blood) vitamin B-12 and 31% lower red cell folate than women with normal hearing.''

Both of these nutrients play important roles in maintaining efficient blood flow and nervous system function. The researchers explain that hearing loss in the elderly may be due to changes in the cochlea, a tiny shell-shaped organ in the inner ear that translates sound into electrical impulses that can be read by the brain. The cochlea ``is supported by a single artery,'' the authors point out, making it especially vulnerable to restrictions in blood flow brought about by vitamin B-12 or folate deficiency.

Houston's group cautions that ``it is not known whether supplements of vitamin B-12 or folate would improve hearing function or slow the rate of hearing loss in elderly individuals.'' They write that in Cuba in 1992-1993, widespread vitamin deficiency was linked to hearing loss in many individuals. Cuban experts later reported that vitamin B supplementation ``produced 'rewarding results,' but they also noted that 'there was minimal return of hearing in response to treatment,''' Houston and colleagues explain.

SOURCE: American Journal of Clinical Nutrition 1999;69:564-571.

New Info Designed To Help Breast Cancer Patients
March 3, 1999

Breast cancer treatment guidelines designed for patients were released by the National Comprehensive Cancer Network (NCCN) and the American Cancer Society Monday at a cancer network conference in Fort Lauderdale, Florida.

The 24-page guidelines include general information on the physiology of the breast, types of breast cancer, and explanations of tests used to diagnose breast cancer. The guidelines also include flow-chart treatment algorithms for the different stages of breast cancer.

"These patient guidelines will help you better understand your cancer treatment and your doctor's counsel," the NCCN authors write in the guidelines, which were printed in InTouch magazine. "We urge you to discuss them with your physician."

The document advises patients to ask their physicians about disease stage, number of tumors, tumor grade, lymph-node involvement, estrogen- or progesterone-receptor status, and side effects of treatment.

The guidelines are available from the National Comprehensive Cancer Network at 1-888-909-NCCN or the American Cancer Society at 1-800-ACS-2345. Their websites are www.nccn.org and www.cancer.org.

Exercise, Not Diet, Is Key To Healthy Living, Study Says
March 5, 1999

Fitness, not fatness, may be key to health and longevity, according to a survey that followed nearly 22,000 men over an average eight-year period.

The study, published in the American Journal of Clinical Nutrition, found that men who were fit but obese had a lower death rate than those who were unfit but lean. Mortality rates also showed little difference between fit, obese men and fit, lean men.

Steven N. Blair and researchers from the Cooper Institute for Aerobics Research in Dallas and the department of health and human performance at the University of Houston studied medical evaluations of 21,925 men between the ages of 30 and 83. Their sizes were divided into three categories according to the average weight for their height: lean, normal and obese.

Total endurance time on an exercise treadmill as well as oxygen uptake were used as fitness indicators. Men in the lowest 20 percent of each age group for treadmill endurance time and those whose oxygen uptake fell within the lowest 25 percent were classified as unfit. The remainder were classified as fit.

There were 428 deaths in the follow-up period, including 144 from heart disease and 143 from cancer. Unfit, lean men had twice the risk of mortality from any cause as compared with fit, lean men. These results were similar after adjustment for smoking, alcohol intake and parental history of heart disease.

However, figures also showed that most lean people were fit. Among the 5,420 people who were lean, just 327 were classified as unfit.

Steven Blair said his study demonstrates that the "national obsession" with weight is misplaced.

"The take-home message to physicians is that they should get off the backs of their patients whose body mass index is higher than average but have normal blood pressure and cholesterol," he said.

Instead of telling obese patients to diet, he said, it would be better to encourage them to improve fitness by going for three 10-minute walks a day.

"Fitness, not weight, is what is really important in health. And that's good news because most people have more control over exercise than they do over their weight, which has a strong genetic component," he said.

Dr. Michael D. Jensen, professor of medicine at the Mayo Clinic in Rochester, Minn., said the study should be commended for highlighting the significance of exercise in maintaining good health.

"Exercise and diet are of equal importance, but if there's only one thing a patient can do, it's better they opt for exercise, because good exercise habits are usually maintained. Diets are not," he said.

Jensen cautioned people not to oversimplify the results of the study, noting that high blood pressure and high cholesterol levels can develop after several years of obesity.

"An obese man might be healthy at 35, but by the time he reaches his forties and fifties, we're more likely to see problems like high lipid levels and hypertension," he said.

Gary Hunter, a professor in human studies and nutrition sciences at the University of Alabama at Birmingham, said he disputed the study's conclusion that the benefits of leanness are limited to fit men.

"There are a number of studies which indicate that the presence of visceral [abdominal] fat is an independent risk factor in cardiovascular [heart] disease and insulin insensitivity, a precursor for diabetes," he noted.

Hunter also said that the length of time spent on a treadmill was not a true indicator of fitness "since an obese person probably runs less efficiently than a lean person.

"A very obese, very fit person is a rare phenomenon. It's possible that person has genetic characteristics which explain his robust health," he said.

T'ai Chi Lowers Blood Pressure
March 2, 1999

T'ai Chi -- the slow-motion form of exercise popular in China -- can reduce blood pressure in older adults as much as regular aerobic exercise, but without speeding up their heart rates, according to researchers.

These findings ``suggest that (exercise) intensity may be less important than other factors'' when it comes to lowering high blood pressure, conclude researchers led by Dr. Deborah Rohm Young of the Johns Hopkins Medical Institutions in Baltimore, Maryland. Their study is published in the March issue of the Journal of the American Geriatrics Society.

The researchers focused on a group of 62 overweight, hypertensive individuals over 60 years of age. Subjects were assigned to 3 months of either moderate aerobic workouts or T'ai Chi, with each regimen consisting of 30 to 45 minutes of exercise four to five times per week.

The authors chose the popular Yang style of T'ai Chi, which they describe as ``13 movements practiced in sequence in a slow, fluid and continuous manner.''

They report that at the end of the 3-month period, the T'ai Chi program ``reduced blood pressure to an extent similar to a program of moderate-intensity aerobic exercise.'' Systolic blood pressure (the first number in a reading) declined by an average of 8.4 mm Hg in the T'ai Chi group, and by 7.0 mm Hg in the aerobics group. Diastolic pressure (the second number in a reading) fell by an average of 3.2 mm Hg and 2.4 mm Hg, respectively.

According to Young's team, these results suggest that even low-intensity exercise can produce real health benefits for older individuals with high blood pressure. They point out that ''many older adults, particularly women, have had little or no experience with exercise and may find even moderate-intensity activity undesirable.'' T'ai Chi, which can be performed anywhere and requires no special clothing or gear, ``may be desirable to older adults who do not identify themselves as 'exercisers','' they conclude.

SOURCE: Journal of the American Geriatrics Society 1999;47:277-284.