Harvard Health Blog

High cholesterol is a key culprit in the development of cardiovascular disease, the leading cause of death in the United States and many other developed countries. We know that lowering cholesterol helps prevent heart attacks and strokes. But an unanswered question remains: how low should you go? New research published online today in The New England Journal of Medicine suggests that lower is better. In a large clinical trial, participants who took a cholesterol-lowering statin plus ezetimibe, a different type of cholesterol-lowering drug, had lower levels of harmful LDL cholesterol and experienced fewer heart attacks and strokes than participants taking a statin alone. The new findings provide a strong rationale for using ezetimibe when a statin alone isn’t enough.

Doctors use vital signs as a relatively straightforward way to detect an illness or monitor a person’s health. Key ones include blood pressure, body temperature, breathing rate, and heart rate. A report from the newly christened National Academy of Medicine (formerly the Institute of Medicine) proposes using 15 “vital signs” to track how health care in the United States measures up. These include life expectancy, well-being, access to care, patient safety, evidence-based care, and others. Why bother creating such a list? Health care costs in the U.S. are the highest in the world, yet people in many countries that spend less on health care are in better health overall and have better health care outcomes. In order to improve the performance of health care, we need to measure how it is doing in a logical, sustainable way. These vital signs will help us answer questions about what we are doing well and where we must improve.

Hospice care improves quality of life in the dire circumstances of a person’s last days. It can enable the dying to spend this time in peace, surrounded by family and friends, and in little pain. Studies confirm what many know intuitively. Family members are likely to experience major depression following the loss of a loved one. A recent study published in today’s online JAMA Internal Medicine looked at whether hospice care reduces the severity of bereavement-related depression in people who had recently lost a spouse. While the researchers saw no difference between spouses whose partners were enrolled in hospice and those how weren’t, major depression was less common in spouses who received support from a hospice program.

For the past 25 years, US News and World Report has been listing the “best hospitals” in the United States. In a Viewpoint article in this week’s JAMA, the magazine’s top health analysts describe how they are expanding and changing the way they rate hospitals. The current ratings aren’t designed for use by patients in need of typical hospital care. That’s changing. The US News team has spent more than a year analyzing more than 5 million patient records regarding more than a dozen common procedures and medical conditions from more than 4,300 hospitals. Ratings for five of these — hip replacement, knee replacement, coronary artery bypass surgery chronic obstructive pulmonary disease, congestive heart failure — were published online today. The new ratings use only performance measures such as patient safety, technology, and survival rates after admission. Keep in mind that ratings like these can help, but they’re mostly limited to data, and aren’t the whole picture. Other organizations also provide hospital rankings and ratings.

A strong or weak hand grip carries more than just social cues. It may also help measure an individual’s risk for having a heart attack or stroke, or dying from cardiovascular disease. As part of the international Prospective Urban and Rural Epidemiological (PURE) study, researchers measured grip strength in nearly 140,000 adults in 17 countries and followed their health for an average of four years. Each 11-pound decrease in grip strength over the course of the study was linked to a 16% higher risk of dying from any cause, a 17% higher risk of dying from heart disease, a 9% higher risk of stroke, and a 7% higher risk of heart attack. Interestingly, grip strength was a better predictor of death or cardiovascular disease than blood pressure. What’s the connection? It’s possible that grip strength measures biological age.

The release of new guidelines on mammography never fails to renew the heated controversy over the potential benefits and harms of this procedure. The latest draft guidelines from the U.S. Preventive Services Task Force (USPSTF) are no exception. The USPSTF recommends that women begin having mammograms at age 50 and stop at age 75. (The American Cancer Society and other medical organizations recommend that women begin getting regular mammograms at age 40.) The draft recommendations say there isn’t enough evidence to recommend or discourage the use of a new technique called 3-D mammography for screening, and also say there isn’t enough evidence to recommend that women with dense breasts, who are at higher risk of breast cancer, should have an ultrasound or MRI in addition to screening mammography. Comments can be made on the USPSTF draft until 8:00 pm Easter Time today. A final version of the recommendations is expected to be released in the fall of 2015.

When appendicitis strikes, an operation to remove the appendix has long been the route to recovery. But a new strategy called “antibiotics first” could help some people avoid surgery for appendicitis. A clinical practice article in today’s New England Journal of Medicine explores the idea of antibiotics first for appendicitis. The main advantage is that it could eliminate the need for surgery in some people with appendicitis. The drawbacks are that it leaves open the possibility of repeat bouts of appendicitis, with an appendectomy still down the road. It could also lead to lingering symptoms and a sense of uncertainty that could affect quality of life. Although immediate surgery is the standard of care for appendicitis, an antibiotics first approach could be appropriate now for individuals who prefer not to have surgery, aren’t healthy enough for surgery, or aren’t near a medical center that routinely does laparoscopic appendectomy.

Can a Mediterranean-type diet with extra servings of nuts and extra-virgin olive oil help protect memory and thinking skills with age? A study in this week’s JAMA Internal Medicine suggests that it might. The findings come from a small substudy done as part of the PREDIMED trial, which showed that a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced heart attacks, strokes, and other cardiovascular problems among people at high risk for them. Although the results of the new PREDIMED study are promising, its small size and the fact that it wasn’t designed to look at connections between diet and brain health mean the results need to be taken with a grain of salt. That said, since there’s no downside to following a Mediterranean diet, an added bonus beyond great taste could be protecting memory and thinking skills.

Environmentally friendly asthma inhalers may be good for the atmosphere, but they have nearly doubled what people with asthma are paying out of pocket for their inhalers. That’s the take-home message from a study led by Dr. Anupam Jena, an assistant professor of health care policy and medicine at Harvard Medical School and an internist at Massachusetts General Hospital. The findings were published online today in JAMA Internal Medicine. In 2008, the FDA banned a class of asthma inhalers that contained ozone-depleting propellants called chlorofluorocarbons (CFCs). The switch to CFC-free inhalers has led to an average increase of $10 per inhaler prescription, which has effectively doubled their cost.

Each year, several million people with neck or back pain get injections of anti-inflammatory steroid medications. When they work (they don’t always), such injections can bring profound relief. But injecting these medications into the spine can cause partial or total paralysis, brain damage, stroke, and even death. Case reports beginning in 2002 highlighted serious problems linked to spinal steroid injections. In 2014, the FDA started requiring a warning on the labels of injectable steroids. A Viewpoint article in this week’s Journal of the American Medical Association spotlights new safety recommendations to help prevent these rare but real problems. The new recommendations are part of the FDA’s Safe Use Initiative.

Pets can provide their owners with more than companionship. A new study, published online in the journal PLoS One, shows that pets can also help create human-to-human friendships and social support, both of which are good for long-term health. The effect isn’t limited to dogs. Other kinds of pets, including cats, rabbits, and snakes, can also be catalysts for making friends and finding social support. In a survey of residents of four cities, being a pet owner was the third most common way that respondents said they met people in their neighborhoods. Pet owners were 60% more likely than non–pet owners to get to know people in their neighborhoods they hadn’t known before. They were also more likely to have reported befriending someone they met through a pet-related connection or getting social support from them. As described in Get Healthy, Get a Dog, a Special Health Report from Harvard Medical School, pet ownership has many direct physical and mental health benefits.

If you had chickenpox as a child, the virus that caused it can re-emerge later in life —to cause shingles. This condition, also known as herpes zoster, consists of a rash on one side of the body, often accompanied by excruciating pain. The rash typically goes away in about a month, but in some people, the pain lingers for weeks, months, or even years. This chronic pain is called post-herpetic neuralgia. A vaccine called Zostavax can help prevent shingles. It is recommended for people ages 60 and older. The vaccine is produced by treating live varicella-zoster virus in ways that weaken it but don’t kill it. Though Zostavax works reasonably well to prevent shingles, it tends to be less effective in older people. And because it contains live virus, it should not be given to people with weak immune systems. An experimental new vaccine which goes by the name HZ/su, just described in The New England Journal of Medicine, seems to get around these problems. In the international Zoster Efficacy Study in Adults 50 Years of Age or Older (ZOE-50), the new vaccine appeared to be effective even in older people. It may, however, cause more pain at the injection site and also more frequent muscle pain and headache than the current vaccine. Even if the new vaccine performs well in future tests, FDA approval would still be a few years away.

Calorie counts adorn the exterior of cans and bottles of sodas, juices, sports drinks, and many other beverages. Should alcoholic beverages and drinks also come with calorie counts? Yes, argues Dr. Fiona Sim, chair of the United Kingdom’s Royal Society for Public Health, in an editorial in The BMJ. She explores well-supported links between alcohol drinking and obesity. Beginning in December 2015, alcohol-related calorie counts will be available in the United States to some people who dine out. The Food and Drug Administration is requiring restaurant chains with 20 or more outlets to provide calorie information for food and some alcoholic drinks. The calorie counts may come as a wake-up call for drinkers who are accustomed to thinking of an average drink as containing 100 to 150 calories. That figure may be true for the standard 1.5-ounce shot of distilled spirits, 12-ounce bottle of beer, or 5-ounce glass of wine, but the “generous pour” at many bars and restaurants often doubles the amount. Moreover, concoctions containing syrups, liqueurs, juices, cream, and other ingredients can send the calories soaring.

Switching from a “Western” diet with lots of fat and meat to a fiber-rich diet for just two weeks makes conditions in the large intestine less favorable to the development of colon cancer. The opposite switch may promote the formation of cancer. That’s the conclusion from a small but elegant study done in urban Pittsburgh and rural KwaZulu-Natal, South Africa. In the study, 20 volunteers from each area switched diets. For two weeks, the Americans ate a traditional high-fiber African diet rich in fruits, vegetables, nuts, and beans, while the Africans ate a Western diet with more fat, protein, and meat. In just two weeks, significant changes occurred in the lining of the colon and in its chemical and bacterial make-up in both groups, but in different directions. Those following the African diet showed improvements in colon health likely to protect against colon cancer, while those following the Western diet showed changes that could lead to colon cancer.

Atrial fibrillation is a heart rhythm disorder that affects millions of people. It can lead to potentially disabling or deadly strokes. Researchers from Johns Hopkins University School of Medicine adding motion-tracking software to standard MRI heart scans of 149 men and women with atrial fibrillation. The scans revealed specific changes in the muscles of the left atrium that increased stroke risk in some of the volunteers. These changes were not associated with age or other risk factors for stroke. This could help many people with this condition to avoid taking warfarin or other clot-preventing medications for life. But it is much too early to include MRI as part of the standard evaluation of people with atrial fibrillation — not to mention that such scans would significantly increase the cost of these evaluations. For now, doctors will continue to use standard tools to help determine stroke risk.

Men with locally advanced prostate cancer who combine hormone therapy with a course of radiation therapy tend to live longer than men who only take hormone therapy.

Each year, an alarming number of babies born in the United States spend their first few days withdrawing from drugs, often prescription painkillers their mothers took during their pregnancies. This problem, called neonatal abstinence syndrome (NAS), has increased fourfold since 2004, according to a report published online yesterday in The New England Journal of Medicine. NAS occurs in many babies whose mothers took a type of medication called an opioid during pregnancy. (Two commonly used opioids are OxyContin and Vicodin.) These drugs easily pass from the mother’s bloodstream to the baby’s. In effect, NAS is a baby’s withdrawal from opioids. With medication and time, babies with NAS get better, but they have to spend time in the hospital. In short, they get a rough start on life that can set them back and possibly have long-term repercussions. With so many safe options for pain control, women who are pregnant should use opioids only if these medications are absolutely necessary.

Fibroids are noncancerous tumors that grow in the uterus. They may be smaller than a seed or bigger than a grapefruit. Depending on their size, number, and location, fibroids can cause heavy bleeding and long menstrual periods (which can, in turn, cause anemia), pelvic pain, frequent urination, or constipation. Fibroids can also cause infertility and repeated miscarriages. About 7 in 10 women will develop this condition at some point. Given how common uterine fibroids are, it’s surprising how few randomized trials have been done to compare treatment options. A clinical practice article in today’s New England Journal of Medicine lays out the options for treating uterine fibroids and discusses the factors women and their doctors should consider when making treatment decisions.

Fainting can be alarming. Sometimes it’s a signal of a heart or other problem that needs to be fixed. But sometimes it is nothing to worry about, caused by not eating, having blood drawn, or even laughing too hard. Up to one-third of people at low risk for serious short-term problems after fainting end up being hospitalized. A research letter in this week’s JAMA Internal Medicine points out that hospitalization for low-risk fainting can do more harm than good. Just because you’re in the emergency department after fainting doesn’t mean you need to be admitted to the hospital. Ask your physician if you’re at risk for a worse event if you go home, and make sure that if you’re admitted it’s because there’s a potential serious cause for your fainting that can’t be fully assessed in the emergency department.

On Marathon Monday, thousands of runners will start in Hopkinton, Mass., and finish in Copley Square. Some will glide along, some will lope, and others will shuffle. No matter how they run, or how fast they run, running the Boston Marathon is something special. Here are a few tips to make the Boston Marathon your marathon. 1) Never wear something on marathon day you haven’t worn for a distance run before. 2) If family or friends will be watching you along the route, try to know in advance where they will be. 3. “The wall” is real so have a plan. 4. Try to take in the atmosphere. 5. Enjoy the camaraderie.

Standard biopsies of the prostate gland often miss potentially aggressive prostate cancer. Adding MRI images to standard biopsies improves the detection of prostate cancer.

Yoga is good for the muscles and the mind. New research suggests that it may also be good for the heart. A review of yoga and cardiovascular disease published in the European Journal of Preventive Cardiology indicates that yoga may help lower heart disease risk as much as conventional exercise, such as brisk walking. It can help people lose weight, lower blood pressure and cholesterol, and ease stress. Each of those changes works to prevent heart disease, and can help people who already have cardiovascular problems.

The tragic story of copilot Andreas Lubitz, the man who apparently crashed Germanwings flight 9525 into the Alps in an act of suicide and murder, demonstrates the opaqueness of mental illness. It is difficult to know when a person is struggling with private psychological and emotional pain that might lead to dangerous or destructive behavior. All of us tend to keep our thoughts, especially our most disturbing ones, to ourselves. Even when encouraged to speak those thoughts aloud — to a mental health professional, for example — it is very difficult to do so. This tragedy will likely spark calls for increased scrutiny of pilots. That’s not necessarily a bad thing, but it could lead to the unintended and undesirable consequence that pilots will become even more wary of seeking help. To honor the lives lost will require policies that protect the public while not being punitive to pilots.