Shorter chemotherapy intervals may increase survival rates.
* THE QUESTION Does changing the time between chemotherapy cycles affect survival?
* PAST STUDIES have shown that, for women being treated for breast cancer, three-week cycles of chemotherapy allow recovery of blood counts after they plummet as a result of the drugs. Researchers have suggested that using filgastrim, a blood factor that aids the recovery of white blood cells, may allow shorter cycles that would prove to be more effective.
* THIS STUDY compared 1,973 women who were randomly assigned to receive either a common chemotherapy regimen in a three-week cycle or a two-week cycle accompanied with filgastrim after surgical removal of tumors that had spread from the breast to the lymph nodes. Eighty-two percent of those who received chemotherapy every two weeks survived without relapse for three years, compared with 75 percent of those in the three-week group.
* WHO MAY BE AFFECTED BY THESE FINDINGS? Women whose breast cancer has spread to lymph nodes.
* CAVEATS The results may not apply to other chemotherapy regimens. In addition, the researchers did not distinguish between patients who were estrogen-receptor positive and negative. Finally, the results need to be verified in more people and for a longer period.
* BOTTOM LINE Women may wish to consult their physician about having two-week cycles of chemotherapy after surgery for breast cancer.
* FIND THIS STUDY Feb. 13 issue of early release articles from the Journal of Clinical Oncology; abstract online at www.jco.org/early_release/.
A newer clot-buster may cause less bleeding than heparin.
* THE QUESTION Does bivalirudin prevent clots as effectively as heparin -- while also causing less bleeding -- during procedures to open clogged heart arteries ?
* PAST STUDIES have shown that bivalirudin (Angiomax), which was approved for clinical use about two years ago, may prevent dangerous blood clots and reduce bleeding better than the heparin, the standard clot-buster for more than 25 years. But these studies were limited to certain procedures and involved patients who also had unstable angina.
* THIS STUDY involved a broader patient population undergoing a variety of procedures that open up clogged heart arteries, such as balloon angioplasty and stent placement. The researchers randomly assigned 6,010 patients to receive one of the clot-busters. Those who took heparin also received glycoprotein inhibitors, which prevent blood platelets from sticking to each other. About 7 percent of the patients who received bi-valirudin also received glycoprotein inhibitors. Similar proportions of patients -- again, about 7 percent -- in both groups experienced complications or death within a month. Those assigned to bivalirudin had less bleeding while hospitalized than those assigned to heparin (2.4 percent vs. 4.1 percent). The bivalirudin patients had slightly more heart attacks, but this difference -- 0.5 percent -- was not considered statistically significant.
* WHO MAY BE AFFECTED BY THESE FINDINGS? People needing procedures to open clogged heart arteries.
* CAVEATS The Medicines Co., the manufacturer of Angiomax, funded the study. In addition, the results need to be verified in more people who receive bivalirudin combined with glycoprotein inhibitors.
* BOTTOM LINE People undergoing procedures for clogged heart arteries may wish to consult their physician about the clot-buster medications to be used. Those at elevated risk of excess bleeding may especially prefer bivalirudin to heparin.
* FIND THIS STUDY Feb. 19 issue of the Journal of the American Medical Association; online at http://jama.ama-assn.org/issues/v289n7/rfull/joc22311.html.
Autoimmune disease may increase heart attack risk.
* THE QUESTION Does rheumatoid arthritis -- an autoimmune disease that affects 2.1 million people in the United States, 1.5 million of them women -- affect the risk of heart attack?
* PAST STUDIES have found that inflammation of the lining of joints, one characteristic of rheumatoid arthritis, may also lead to fatty buildup in blood vessels, which can be dangerous to the heart.
* THIS STUDY examined the risk of heart attack in 114,342 women. The 527 who developed rheumatoid arthritis during 20 years of follow-up had twice the risk of having a heart attack as those who did not. Those who had the disease for at least 10 years had three times the risk of heart attack as those without the disease.
* WHO MAY BE AFFECTED BY THESE FINDINGS? Women with rheumatoid arthritis.
* CAVEATS Merck, a manufacturer of drugs for rheumatoid arthritis and heart disease, supported the study. In addition, the results are not based on a randomized trial. Finally, the findings may not apply to men.
* BOTTOM LINE Women with rheumatoid arthritis may wish to consult their physician about aggressive monitoring and treatment of heart disease risk factors such as blood pressure and blood cholesterol levels.
* FIND THIS STUDY Feb. 17 issue of rapid access Circulation; abstract online at http://circ.ahajournals.org/rapidaccess.shtml.
-- Haleh V. Samiei