Oct. 1, 2005
A new study provides information about how much exercise women need to prevent heart disease.

Exercise Guidelines To Prevent Heart Disease for Women

A new study provides information about how much exercise women need to prevent heart disease. Based on the results of a longitudinal study comparing a group of 5,721 asymptomatic women with a group of 4,471 women with heart disease symptoms, women with less than 85 percent of exercise capacity were twice as likely to die within eight years as women above 85 percent. The study used METs or the amount of energy or oxygen used to sit quietly for a minute. Walking burns about three to six METS per minute and jogging expends more than six METs. The abstract for the published article is below, with lead author cardiologist Dr. Martha Gulati suggesting that fitness assessments be used for routine clinical evaluation for heart disease for women.

SOURCE: Gulati M, et al. The prognostic value of a nomogram for exercise capacity in women. New England J of Med Aug 4, 2005; 353:5:468-475.

Background: Recent studies have demonstrated that exercise capacityis an independent predictor of mortality in women. Normativevalues of exercise capacity for age in women have not been well-established. Our objectives were to construct a nomogram topermit determination of predicted exercise capacity for age in women and to assess the predictive value of the nomogram with respect to survival.

Methods: A total of 5,721 asymptomatic women underwent a symptom-limited maximal stress test. Exercise capacity was measured in metabolic equivalents (MET). Linear regression was used to estimate the mean MET achieved for age. A nomogram was established to allowthe percentage of predicted exercise capacity to be estimatedon the basis of age and the exercise capacity achieved. Thenomogram was then used to determine the percentage of predictedexercise capacity for both the original cohort and a referralpopulation of 4,471 women with cardiovascular symptoms who underwenta symptom-limited stress test. Survival data were obtained forboth cohorts, and Cox survival analysis was used to estimatethe rates of death from any cause and from cardiac causes in each group.

Results: The linear regression equation for predicted exercisecapacity (in MET) on the basis of age in the cohort of asymptomaticwomen was as follows: predicted MET = 14.7 - (0.13 x age).The risk of death among asymptomatic women whose exercise capacitywas less than 85 percent of the predicted value for age wastwice that among women whose exercise capacity was at least85 percent of the age-predicted value (P<0.001). Resultswere similar in the cohort of symptomatic women.

Conclusions: We have established a nomogram for predicted exercisecapacity on the basis of age that is predictive of survivalamong both asymptomatic and symptomatic women. These findingscould be incorporated into the interpretation of exercise stresstests, providing additional prognostic information for riskstratification.

New Bacteria Detected From Cosmetic Infections and Nail Salons

Four new isolates of a rapidly growing Mycobacterium species have been identified, with three isolated from footbath drains and a sink at a nail salon located in Atlanta,Ga., and the fourth from a granulomatous subdermallesion of a female patient in Venezuela who was undergoing mesotherapy.The strains produced a pale-yellow pigment when grown in thedark at the optimal temperature of 35°C. The isolates grew on MacConkey agar withoutcrystal violet. For treatment, these strains were susceptible to ciprofloxacin, doxycycline, sulfamethoxazole, imipenem, and other antibiotics. The new bacteria is named Mycobacterium cosmeticum sp. nov., with two strains, LTA-388T (=ATCCBAA-878T=CIP 108170T) (the type strain) and 2003-11-06 (=ATCCBAA-879=CIP 108169) designated, respectively, forthe strains of the patient in Venezuela and from the nail salonin Atlanta.

SOURCE: Robert C. Cooksey et al. Mycobacterium cosmeticum sp. nov., a novel rapidly growing species isolated from a cosmetic infection and from a nail salon. Int J Syst Evol Microbiol 54 2004; 2385-2391; DOI 10.1099/ijs.0.63238-0.

Oral Health Disparities

New summaries about the status of oral health in the United States are available from the National Health and Nutrition Examination Survey (NHANES). These provide estimated epidemiologic data about oral health conditions, including improved status of dental caries among children and adolescents, declining edentulism among older adults, and increased use of dental sealants among children.

The NHANES data from surveys in 1988 to 1994 and 1999 to 2002 were compared in these representative samples of the civilian, noninstitutionalized U.S. population over 2 years old. For the period 1991, 2002, 41 percent of children ages 2 to 11 had dental caries in their primary teeth. For the same period, 42 percent of children ages 6 to 19 had caries and 32 percent had received dental sealants. About 90 percent of adults had had dental caries in their permanent teeth, retaining a mean of 24 of 28 natural teeth, with only 8 percent edentulous. Among those who were 6 to 39 years old, 23 percent had very mild or greater enamel fluorosis. Disparities were noticed across all age groups, among racial/ethnic groups, persons with lower education and income, and by smoking status.

This report reaffirmed the declining status of dental caries prevalence and severity in the U.S. population since the 1988 to 1994 survey. However, the results reaffirm the fact that these improvements in oral health status are not uniform. The disparities in oral health conditions among certain racial and ethnic populations in the U.S. remain.

SOURCE: Surveillance for dental caries, dental sealants, tooth retention, edentulism, and enamel fluorosis. MMWR Aug. 26, 2005; Vol. 54:SS-3. http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5403a1.htm.

Dental Implants Market to Reach 3.5 Billion by 2010

Across the developed world, it is estimated that more than 40 percent of people in the developed world lack one or more teeth, with about 9 million edentulous persons over the age of 65 in the United States alone. By 2010, the worldwide market for dental implants will approach $3.5 billion, according to new estimates from Kalorama Information. The growth of the dental implant market is expected to grow faster than other dental products worldwide, according to estimates from the analysis, “Implant-Based Dental Reconstruction: The Worldwide Implant and Bone Graft Market,” by Anne Anscomb.

Much of the growth is due to the aging of the population in the developed world and increased expectations among the elderly for optimal oral health. The report contains a complete analysis of currently available dental implant and bone graft products, profiling 15 specific products. In addition, the report thoroughly reviews clinical, demographic, and regulatory trends and profiles 15 key competitors. The report can be obtained from Kalorama Information by going to http://www.kaloramainformation.com/pub/1099235.html.

New Information About Health Savings Accounts

For a new option in health insurance for you and your employees, check with your accountant and financial advisor about newly available Health Savings Accounts (HSA). The money is put into a designated account each year, is tax deductible, and can accrue each year. There is a benefit for using this if you do not use the money for medical expenses, because it can accumulate tax-free for retirement.

HSAs don’t replace health insurance policies, but are designed to supplement certain insurance plans. To participate in an HSA, you must be enrolled in a high-deductible health plan (HDHP). HDHPs typically have the lowest premiums of all health plans. If you’re currently enrolled in an HMO or a PPO and you switch to an HDHP, you could be eligible to save one-third to one-half of your cost for coverage, and money can be withdrawn instantly for qualified medical expenses as needed. Any dollars remaining can be saved for spending in future years, or invested to accumulate savings for health needs after retirement. For more information, go to www.hsafinder.com.