Recovery Similar for

Heart Attack Therapies

In a study colliding with established practice, recovery from small heart attacks went just as well when doctors gave drugs time to work as when they favored quick vessel-clearing procedures.

The Dutch finding raises perplexing questions about how to handle the estimated 1.5 million Americans a year who have small heart attacks -- the most common kind. Most previous studies support the aggressive approach.

Under American and European guidelines, patients with small heart attacks are supposed to be rushed to a hospital laboratory to test for coronary-artery blockages. Then, they are usually given bypass operations or angioplasties to clear the clog.

The latest findings were laid out in today's issue of the New England Journal of Medicine. The Dutch team, led by Robbert J. de Winter of the University of Amsterdam, focused on 1,200 heart attack patients for a year.

In the group treated aggressively, 23 percent died, suffered another heart attack or went back to the hospital with chest pain. Only 21 percent did in the conservatively treated group -- a statistical tie.

Investments Can Have

Environmental Returns

Spending to protect the environment, from coral reefs to forests, can bring big returns to aid a global assault on poverty, a U.N.-backed report said yesterday.

The study, coinciding with a summit of world leaders in New York, suggested that forests may be more valuable when left standing rather than being cleared for crops because trees can absorb heat-trapping gases linked to global warming.

"The environment . . . is not a luxury good, only affordable when all other problems have been solved," said Klaus Toepfer, head of the U.N. Environment Program, which was among 30 international groups behind the report.

The study estimated that annual investments of $60 billion to $90 billion in the environment over the next 10 to 15 years would reach a world goal of halving the proportion of humanity living on less than a dollar a day, currently more than a billion people.

A further $80 billion a year was needed to limit global warming over the next 50 years.

It said that every dollar spent on clean water and sanitation in the Third World could bring $14 in benefits ranging from lower health care costs to higher work productivity and school attendance.

Hurricane Evacuees

To Get Flu Vaccines

Federal health officials are pressing forward with plans to ensure flu vaccinations this fall for hurricane evacuees in shelters as well as all people in nursing homes, populations they say are particularly at risk while living in tight quarters.

Julie L. Gerberding, director of the Centers for Disease Control and Prevention, said yesterday that elderly evacuees, as well as those of all ages at shelters, will be among the first to receive flu shots.

Federal stocks of all vaccines are being made available to evacuee children, Gerberding said at a news conference.

Federal officials want high-risk groups to get their flu shots and are asking doctors to hold off on giving the shots to healthy adults until Oct. 24 at the earliest.

High-risk groups include: people 65 and older; people in long-term care facilities; people with asthma, diabetes and other chronic conditions; children between 6 months and 23 months; pregnant women; and health care workers who come in direct contact with patients.

-- From News Services