Removing ovaries seems to shorten a woman's life span.
* THE QUESTION A woman who needs a hysterectomy for a noncancerous reason such as fibroids or endometriosis usually has a quick conversation with her doctor about whether to have her ovaries removed at the same time. Unless she's younger than 40, most doctors advise it simply because the procedure, known as oophorectomy, eliminates any chance of ovarian cancer, a rare but deadly disease. Is that a wise choice for women who are not at high risk for this cancer?
* THIS STUDY used data from other studies to determine the life expectancy of women who did and did not have their ovaries removed when they had a hysterectomy. All of the women were considered at average risk for ovarian cancer. Using a statistical model, the information was analyzed by the women's age and other characteristics. Oophorectomy in women younger than 65 increased the estimated risk of dying from heart disease as well as the risk of death attributed to a fractured hip. Among women 50 to 54 years old who did not take estrogen therapy, 16 percent of those who had their ovaries removed would be expected to die of heart disease, compared with 8 percent of those who did not have an oophorectomy.
* WHO MAY BE AFFECTED BY THESE FINDINGS? Women considering whether to have their ovaries removed. More than 600,000 women have hysterectomies each year in the United States, 90 percent for noncancerous reasons. More than half of those women have an oophorectomy at the same time.
* CAVEATS The findings are estimates of how women would fare; the study used real data but inserted it into a statistical model and did not track actual women after they'd had a hysterectomy. The data came primarily from white women; whether the findings would apply to others is unclear. The results do not pertain to women at high risk for ovarian cancer.
* FIND THIS STUDY August issue of Obstetrics & Gynecology; abstract available online at www.greenjournal.org.
* LEARN MORE ABOUT oophorectomy at http://womenshealth.gov and www.mayoclinic.com.
Blood pressure may not need to be high to predict heart risk.
* THE QUESTION When blood pressure readings fall short of the numbers considered high, people may think they've dodged the problems that hypertension can bring. Is that relief justified, or should blood pressure that lurks on the edge of hypertension be seen as an early warning of cardiovascular trouble?
* THIS STUDY analyzed health data over an 18-year period on 8,986 participants in a nationwide nutrition study. Overall, people with blood pressure readings of 120 to 139 over 80 to 90 -- sometimes called pre-hypertensive -- were 32 percent more likely than those with normal (lower) readings to have a heart attack, stroke or heart failure. The risk increased some as readings approached the upper end of the range (so-called high-normal blood pressure).
* WHO MAY BE AFFECTED BY THESE FINDINGS? Anyone whose blood pressure measures 120 over 80 or higher. About one in three American adults has high blood pressure (140 over 90 or higher), which makes them more susceptible to heart disease and stroke. Some experts estimate that an equal number of adults are pre-hypertensive.
* CAVEATS People who are overweight, smoke or have high cholesterol may face a higher risk of cardiovascular problems, even if their blood pressure falls in the lower part of the pre-hypertensive range. Blood pressure was measured only at the start of the study.
* FIND THIS STUDY July/August issue of Annals of Family Medicine; abstract available online at www.annfammed.org.
* LEARN MORE ABOUT hypertension at www.nhlbi.nih.gov/health and www.americanheart.org.
Stay-awake drug may be of limited value for shift workers.
* THE QUESTION When people work all night and try to sleep during the day, some adjust but others never do. They're chronically sleepy on the job and experience daytime insomnia, a condition known as shift-work sleep disorder. Might such people benefit from modafinil, a drug shown to help people with narcolepsy and sleep apnea stay awake?
* THIS STUDY randomly assigned 204 adults who worked night shifts and had been diagnosed with shift-work sleep disorder to take modafinil (Provigil) or a placebo 30 to 60 minutes before starting work each night. Once a month, the participants spent a night at a sleep lab. After three months, 74 percent of the modafinil group reported at least minimal improvements, compared with 36 percent of the placebo group. When prompted in the nighttime lab sessions to fall asleep, it took them longer to do so (which was considered an improvement), from roughly two minutes to four minutes, while the time needed by the placebo group stayed about the same; they also had fewer attention lapses during their normal working hours, whereas the placebo group experienced more, and they had reported having fewer accidents or near-accidents while commuting home than the others. However, the modafinil group continued to be excessively sleepy and exhibit nighttime performance weaknesses. Neither the drug nor the placebo worsened daytime insomnia.
* WHO MAY BE AFFECTED BY THESE FINDINGS? The estimated 6 million people in the United States who work overnight shifts. Up to 10 percent of them are believed to exhibit symptoms of the disorder.
* CAVEATS The participants' actual on-the-job performance was not measured. Long-term safety and effectiveness of the drug were not tested. The study was funded by Cephalon, which makes Provigil; four of the 10 primary authors work for the pharmaceutical company, the others have received consultants' fees from it.
* FIND THIS STUDY Aug. 4 issue of the New England Journal of Medicine; abstract available online at www.nejm.org.
* LEARN MORE ABOUT shift work and sleep problems at www.sleepfoundation.org/sleeptionary and www.mayoclinic.com.
-- Linda Searing
The research described in Quick Study comes from credible, peer-reviewed journals. Nonetheless, conclusive evidence about a treatment's effectiveness is rarely found in a single study. Anyone considering changing or beginning treatment of any kind should consult with a physician.