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Duke Health News 919-660-1306

CAN HRT HURT?

For several years, women have been hearing how
hormone replacement therapy (HRT) may provide a buffer against the
onslaught of physical ailments, including heart disease, related to the
post-menopausal years. But researchers at Duke University Medical
Center say HRT may not be the magic tonic for women already suffering
from heart disease.

Their study, reported in March at the annual
meeting of the American College of Cardiology, is the second in a year
to find a link between new use of hormones in women who have heart
disease and the occurrence of a second cardiac "event," such as
unstable angina. Angina was defined as chest pain that becomes worse or
chest pain at night.

In a group of 1,857 post-menopausal women,
all of whom had had a heart attack, new users of HRT were found to be
at higher risk of developing unstable angina serious enough to require
hospitalization, according to cardiologist Dr. Karen Alexander. Of the
111 women who started using hormones after their heart attack, 32.5
percent were hospitalized for angina; of 413 who used hormones before
their heart attacks, 21 percent were hospitalized for angina. Only 17
percent of the remaining women, who had never taken HRT, were
hospitalized.

"While hormone use has benefits and may still be
cardioprotective in women without heart disease, women who have heart
disease should probably not start using it," said Alexander.

ON GUARD AGAINST DIABETES

That
middle-age spread can trigger a bigger problem than self-consciousness
for women. With age comes a higher chance of developing diabetes, and
while the threat faces both sexes, women tend to be at higher risk.

Type
2, or adult-onset, diabetes is "pretty much stratified by weight," says
Dr. Leslie Domalik, an endocrinologist at Duke. About 80 percent type 2
diabetics - who typically develop the disease after age 40 - are
overweight.

"The tendency is higher for women overall to develop
diabetes, because of how they carry their weight, viscerally, or in
their middle," Domalik says.

For women, the risk is heightened in
several ways, according to Domalik. First, insulin resistance increases
with age. Next comes weight gain common with age and less activity. And
finally, with menopause comes a change in fat distribution.

"With
many women, it's not so much actual weight gain, it's the distribution
and what happens relative to weight. The weight may not change but the
amount of visceral fat increases."

Even though many take oral
medication or inject insulin, the main treatment for type 2 diabetes is
diet and exercise. "In general, you want to make lifestyle changes
early on, rather than making the changes after developing diabetes,"
Domalik advises. Since the incidence of diabetes relates more to fat
intake than sugar consumption, she says, adopting a low-fat diet early
in adult life can help stave off not only diabetes, but also heart
disease.

PULLING KILLER CANCER OUT OF THE SHADOWS

Doctors
at Duke are fighting a shadowy killer that snatches life from more
women each year than breast, colon or cervical cancer. But catching the
stealthy disease -- lung cancer -- in its early stage continues to be a
problem.

Even though lung cancer strikes men more frequently, the
number of women developing lung cancer is on the rise. Doctors expect
to diagnose the disease in nearly 78,000 women this year, or in about
46 percent of the cases. Only about 15 percent of lung cancers are
detected before they spread, which reduces long-term survival to about
15 percent of the patients. But doctors say about half of lung cancer
patients could become five-year survivors if the disease were detected
in its initial stage.

"Yearly chest X-ray screening should be
recommended for smokers," said Dr. David Harpole, a Duke surgeon who
treats lung cancer patients. "About 80 percent of the lung cancer
patients we can cure are those whose cancer was caught before they had
symptoms, usually when they had an X-ray for another reason."

Even
if a smoker has quit the habit, the risk of developing lung cancer is
enough for Harpole to recommend yearly screening if she smoked for a
long period. He uses the 20-year, 20-a-day guideline - if you smoke a
pack a day now or did smoke a pack a day for 20 years, get screened.

Harpole
points to a Finnish study reported in December that showed a
significantly higher survival rate when lung cancer was detected
through screening of asymptomatic patients. There's no standard
screening for lung cancer currently recommended by the National
Institutes of Health, but that may change soon since the NIH has
screenings in trial now.

For those who worry about radiation
exposure, Harpole says a chest X-ray delivers a minute amount of
radiation, posing virtually no risk for patients.

BONING UP ON CALCIUM NEEDS

If
you think drinking a glass of milk daily is enough to keep your bones
strong, think again. Adult women need to down nearly a quart of milk
each day to get their minimum allotment of calcium, dietitians tell us.

More
than 20 million American women have osteoporosis, and while some
contributing factors (like gender, rage, age and genetics) can't be
changed, there's plenty women can do to ward off weakened bones.

Within
the past several years, National Institutes of Health research has
suggested that women aren't taking in enough calcium to prevent bone
loss. Pre-menopausal women need 1,000 mg calcium daily and
post-menopausal women over age 50 need 1,000-1,500, depending on
whether they're taking estrogen. As women age, they absorb less calcium
and make less vitamin D, which is essential for calcium absorption. And
as the estrogen level falls as menopause approaches, bone loss
accelerates.

How to get more calcium? Connie Ostrowski, a family
nurse practitioner and registered dietitian, recommends turning to
foods first. Dairy products are one of the richest sources, followed by
some leafy green vegetables and legumes (see table). And remember that
excessive protein - more than 5 to 6 oz. of meat per day - can result
in increased loss of calcium through urine.

Consider a supplement
if diet alone can't meet your calcium needs, Ostrowski says. Calcium
carbonate compounds (such as TUMS, Oscal or Caltrate) rate best for
absorption, though some women with sensitive stomachs may better
tolerate calcium phosphate and calcium citrate, she says. Your body can
absorb 750 mg of calcium at one time, so if you take 1,000 mg, divide
it into two doses. If you don't drink milk fortified in vitamin D, you
may need a supplement of 5 to 10 mg daily or take a multivitamin.

Foods High in Calcium

Plain Yogurt, 1 cup 400 mg

Milk, 1 cup 300 mg

Tofu set with calcium, cup 258 mg

Orange juice, 1 cup (calcium fortified) 240 mg

Cereal, 1 cup (calcium fortified) 200 mg

Mozzarella cheese, 1 oz. 183 mg

Canned salmon w/ bones, 3 oz. 181 mg

Collards, cup cooked 179 mg

Ricotta cheese, † cup 169 mg

Bread, 2 slices (calcium fortified) 160 mg Daily Calcium Needs

WOMEN

Teens 1,200-1,500 mg

Before menopause 1,000 mg

Pregnant or nursing 1,500 mg

Over 50 taking estrogen 1,000-1,200 mg

Over 50 not on estrogen 1,500 mg

MEN

25-65 1,000 mg

Over 65 1,500 mg

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