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By Barbara Ficarra, RN, BSN, MPA
Sharecare.com launched yesterday in San Francisco at the Health services conference and while I was unable to attend this exciting event, I followed the live twitter feed (# health2con) and it almost felt like I was there.Having attended the Health 2.0 conferences in the past, the excitement and energy that [...]

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People who snore loudly, have difficulty falling asleep or often wake up tired may be at risk of developing heart disease. People who reported feeling snoring loudly were more likely to have metabolic syndrome
Sleep problems are "a big deal," an ear, nose and throat specialist said
Sleep problems could contribute directly to risk factors for heart disease and diabetes

(Health.com)--people who snore loudly, have difficulty falling asleep or wake up often feel fatigue may have more to worry about from dozing at work. A new study suggests may also be at increased risk of developing heart disease and other health problems down the road.

The study, researchers at the University of Pittsburgh asked more than 800 persons aged between 45 and 74 regarding quality of sleep. Three years later, people mentioned snoring loudly was more than twice as likely as quiet sleepers have metabolic syndrome--a cluster of risk factors for heart disease, diabetes and stroke including high blood pressure, high blood sugar, low ' good ' cholesterol, high triglycerides and belly excess fat.

Health.com 7 tips for the best sleep ever

People who have trouble falling asleep or that I woke up feeling unrefreshed at least three times per week was around 80 percent and 70 percent more likely than their peers, respectively, to develop three or more of these risk factors, the study found. (Someone must have three of the five risk factors to obtain a diagnosis of metabolic syndrome.)

Sleep problems are "a big deal," says Jordan Josephson, M.D., an ear, nose and throat specialist at Lenox Hill Hospital in New York. "It is bad for the heart, bad for diabetes, and lead to heart attacks and stroke. ... It can shorten your life. " (Josephson was not involved in the new survey).

Health.com: Surprise cardiac risks

Overall, 14 percent of study participants developed metabolic syndrome. African Americans were more sensitive than white, as were sedentary people as compared with those who were physically active.

Sleep news on the chart, the CNN health and medical blog

The findings, appearing in the journal sleep, echo previous studies have shown a link between sleep difficulties and health problems such as obesity and high blood pressure. But this is the first study to follow people with sleep problems over time to see if they develop metabolic syndrome, according to the authors.

Virend Somers, M.D., Professor of medicine at the Mayo Clinic in Rochester, Minnesota, says that sleep deprivation is "epidemic" which is "almost in parallel with the epidemic of obesity and widespread increase, risk factors for heart disease and diabetes. The links between obesity and metabolic syndrome are known, but the role that sleep plays was less clear, Somers says.

Health.com: How much sleep really need?

The new study I cannot prove that snoring or any other sleep problem actually cause metabolic syndrome affects approximately 25 percent of adults in the US and although researchers did controlling for race, physical activity, alcohol consumption and other factors, it is likely that obesity is partly responsible for linking problems sleep and metabolic syndrome.

However, sleep problems could contribute directly to risk factors for heart disease and diabetes. "Chronic sleep disorders may generate high levels of stress hormones and overstated cardiovascular responses, which could lead to changes in blood pressure, glucose metabolism and weight," says the study's lead author, Wendy Troxel, Ph. d., Assistant Professor of Psychiatry and psychology at the University of Pittsburgh. Troxel physics of snoring itself could be even to blame, he says. Experiments have suggested that body vibrations caused by snoring can increase potentially damaging inflammation in the lining of the arteries, it explains.

Health.com: snoring Is why am I getting out of control?

Hormoz Ashtyani, M.D., Medical Director of the Institute for sleep Wake disorders at Hackensack University Medical Center, in New Jersey, says doctors should begin by asking patients about their quality of sleep in order to assess their risk for heart disease and diabetes. "If you see a new patient, you always ask if smoke [them], [] have heart disease and so on," says Ashtyani. "Snoring and poor sleep also should be increased."Enter to win a monthly contest Makeover room from MyHomeIdeas. comCopyright Magazine health 2010

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A new study suggests women who are stressed out rather than other women, a heart attack at work or to have other forms of heart disease.

The findings at a meeting of the American Heart Association in Chicago, Nov.15 presented were based on data from 17,415 otherwise healthy women the middle age with the in the women's health study, sponsored by the national heart, lung and blood attended Institute.

The researchers found that a 40 percent increase in cardiovascular disease on all and one facing women load reported high job 88 percent at risk for heart attacks alone.("Burden" has been defined as demanding work with little power or ability to use the creativity and abilities).

Women concerned experienced an increase in heart disease about to lose a job, but you were more than women with high job security to be overweight or risk factors for heart disease have high blood pressure or high cholesterol.

Previous research on chronic job stress and heart disease in women had mixed results, although studies of predominantly male subjects have found a clear mapping between the two senior study author, Dr. Michelle A. said Albert, a cardiologist at the Brigham and women's Hospital in Boston and associate professor at Harvard Medical School.

"Cant get rid of stress, but can manage" said

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Instead, Nelson launched into his favorite subject, football. His friend, Jets fullback Tony Richardson, plays against Cincinnati on Thursday, and Nelson wondered how Bengals receiver Terrell Owens would react to cornerback Darrelle Revis labeling him a “slouch” last season.

The Jets captured each of their last three games in the final seconds, but while Richardson is employed by the N.F.L.’s most dramatic team, he understands the gulf between the game and real life. Nelson affirmed that recently, as he waits for the transplants he would eventually die without.

“This is real serious,” Richardson said this week at his locker. “Tyler is my little brother. We’re that close.”

They met through the Make-a-Wish Foundation at an event in Tampa, Fla., before the Super Bowl in February 2009. Of the dozen children there, Richardson met Nelson first, and he was struck by Nelson’s vast knowledge of football strategy and statistics, by Nelson’s boisterous laugh and wide smile.

Richardson called their connection instant. He knew he was supposed to work the room, but he struggled to pull himself away from Nelson.

Nelson lives in the Dallas suburb of Grand Prairie, and since Richardson had N.F.L. Players Association business there, he took Nelson out to dinner soon after their initial meeting. Thus began their friendship.

Richardson knew little of Nelson’s suffering, mainly because Nelson never complained or wallowed. His mother, Cynthia Nevels, a financial and business consultant, said doctors diagnosed cystic fibrosis two days after her son’s birth.

At age 13, Nelson’s condition worsened. Forced from competitive sports, he developed diabetes and weighed less than 100 pounds. Doctors said Nelson’s liver was cirrhotic, his lungs damaged, his spleen the size of a football. His nose bled constantly. He coughed blood. He spent weeks in the hospital. He took 17 medications daily.

Nelson answered pain with a smile on his face and laughter in his belly, and an outlook that remained positive. Only once in 16 years did his mother see frustration fill his face.

Richardson sent text messages or called every other day. On Nelson’s last two birthdays, Richardson visited. Two years ago, that meant spending the day with Nelson in the hospital, where they ate cake and talked about girls and played video games. Nelson explained his preferred profession: pilot.

Mostly, football was their bond. Nelson loves the Dallas Cowboys, and he rattled off the statistics of his favorite players, like Emmitt Smith and Terence Newman, and now Dez Bryant. Nelson taught Richardson to play the video game Madden NFL, where Nelson destroyed him.

“He needed tips,” Nelson said. “When he came down here, I kind of blew him out. He’s not the only one.”

In October, concerned with Nelson’s internal bleeding, doctors sent the family to the transplant hospital in Houston. Nevels leased her home near Dallas and sold most of her possessions to help cover medical costs. When she did not feel overwhelmed or scared, she felt numb.

From Oct. 22 to Nov. 15, the family waited, uncertain of the status of transplants for Nelson, uncertain of his future. Nevels projected calm that masked her inner turbulence.

“On the inside, I’m thinking, how is he going to make it?” she said. “There are no guarantees here. I was afraid. I still am.”

She taught Tyler yoga to help with breathing. She flew one brother, Jeremy, a senior football standout at South Grand Prairie High School, to Houston, and that alone improved Tyler’s condition. On Nov. 15, the family learned that the hospital’s medical board had approved his transplants, which he will receive at the same time, from the same donor.

The hospital gave him a pager. He sent a photo of him holding it, smiling, to Richardson.

Even with Dr. Marc Schecter, the hospital’s medical director of the pediatric lung transplant program, Nelson remained all football, all the time. In fact, after the Jets’ comeback victory last Sunday against Schecter’s favorite team, the Houston Texans, Nelson entered the hospital in Jets gear.

On average, Schecter said, patients wait 81 days for transplants. Because Nelson needs two organs, his wait could be longer.

In the interim, Nelson and his family stay at the Ronald McDonald House in Houston, where he attends a nearby school and tries to maintain as normal a life as possible.

“The hardest part is the waiting,” Schecter said. “We could call him tonight. We could call him in six weeks.”

Through his contacts with the Jets and Nike, Richardson sent three boxes of hats, shirts, jackets and shorts to Nelson. He also reached out to the N.F.L. and the players union and asked teammates Dustin Keller, Mark Sanchez and Nick Mangold to spread the word via their Twitter accounts.

Next week, Nelson will undergo an operation designed to divert the heavy bleeding from his intestines, stomach and esophagus around his damaged liver, toward the heart. He hopes his story will inspire more to donate organs (find out at giftstotyler.org). He also hopes the Cowboys will hire Bill Cowher or Tony Dungy as coach next season.

“Tony will never know how much inspiration he provided,” Nevels said. “Human beings don’t do something like he did. He makes Tyler happy. He gives Tyler hope.”

Richardson would like to hold a mirror to that notion. Because he sees the same thing, the other way around.

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Medical experts say the results, presented Sunday at the American Heart Association meeting, show there is a lesson to be learned about the effectiveness of small studies over all.

The drug, nesiritide, brand name Natrecor, was approved after small studies in carefully selected patients. It seemed to soothe a terrible heart-failure symptom — patients’ lungs fill with fluid and they feel as if they are drowning.

But the large study, with real-world patients, found no significant effect on that symptom.

A few years after its approval, nesiritide fell out of use because small studies seemed to indicate an increased risk of kidney problems and an increased death rate.

The large study showed those risks, too, were wrong.

“Once again, small studies give us the wrong answers,” said Dr. Robert M. Califf, a Duke cardiologist who directed the large study. “There was no safety issue at all.”

“To me, the really important message is that the drug got very widely used for reasons that are incorrect, and then it got bashed for reasons that are incorrect,” Dr. Califf said. “Unless we do these kinds of large clinical trials we are engaged in a comedy of errors,” he added.

The question of how to evaluate rare side effects that seem to arise in small studies plagues medical researchers. Most drug studies are not designed to assess rare effects, but as more drugs are sold to huge numbers of people who often take them for years, the question has become increasingly pressing.

The nesiritide story began in 2005, four years after the drug was approved. At first it was popular, but then researchers, in two analyses, asked if it was really safe. They had lumped together data from several nesiritide studies. One analysis reported damage to kidney functions, and the other found increased death rates. Sales plummeted.

Johnson & Johnson, the drug’s maker, put together an expert panel that said the only way to answer the safety question was to do a large study. That led to the study that Dr. Califf directed, which enrolled anyone who came to any of 450 participating hospitals around the world with heart failure and complaining of difficulty breathing. Participants were randomly assigned to get an infusion of nesiritide or saline. Researchers asked two main questions: Were the patients still alive a month later? And were they readmitted to the hospital?

The study’s executive committee is still debating what to conclude, Dr. Califf said. No one thinks the drug should be pulled from the market, he added, because some patients may get breathing relief even though the drug was not effective for the participants as a whole.

“But the major message is that if you don’t do the right studies you just don’t know” about risks and benefits, Dr. Califf said. “And you are at risk of making serious errors.”

Cardiologists have similar questions about the effectiveness of Zetia, an eight-year-old cholesterol drug that Dr. Califf is also studying. It has been beset by doubts about whether it improves heart health.

The Food and Drug Administration approved Zetia, which lowers LDL, or “bad” cholesterol, in 2002. In 2004, the agency approved a related drug called Vytorin, which combines Zetia and a statin called simvastatin.

Both are made by Merck. Together, they have had worldwide sales of $26.8 billion, according to IMS Health, a firm that tracks drug sales, and have been taken by millions of Americans.

But eight years after Zetia came on the market, many cardiologists say they still don’t know whether taking Vytorin is better for the heart than using a statin alone.

That is because statins like Crestor, which work by blocking the production of cholesterol in the liver, have proven to cut the risk of cardiovascular problems. Zetia, however, acts differently; it works in the gut, where it inhibits the absorption of cholesterol from food. Zetia alone modestly reduces bad cholesterol, and the combination pill significantly reduces LDL.

But studies so far have failed to demonstrate a cardiac benefit to the drugs. Now there is a new Zetia study, due to be presented this week at a kidney conference in Denver, which looked at whether the combined pill reduces heart attacks and strokes in patients with kidney disease, who are at high risk for heart problems.

But the study is unlikely to resolve the Zetia question because it did not involve a group of patients taking a statin alone. Doctors still won’t know whether the combined pill works better than statins, which are available as inexpensive generics.

To try to answer the health-benefit question, Merck has sponsored one of the largest clinical trials ever conducted on cholesterol drugs. The trial, which started in 2005 and is due to be completed in 2013, involves about 18,000 patients at 1,046 sites around the world. It is taking years to complete because researchers set a goal of tallying 5,200 major cardiovascular problems in order for the project to end, said Dr. Luciano Rossetti, the head of global scientific strategy at Merck Research Laboratories.

“I don’t see a problem with the timing considering what it takes to do a trial like this,” Dr. Rossetti said. “I think it is great that we are committed to finding out that answer.”

Dr. Califf, who is one of two principal investigators on the Zetia trial, said it was common for the main outcomes study to lag years behind the approval of a drug, but he said the practice was a problem for doctors who practice evidence-based medicine.

“F.D.A. by mandate could require studies, but that wouldn’t be necessary if clinical trialists and academic medical centers stuck to their guns and demanded the evidence before they used the drugs on a wide scale,” he said, referring to both Zetia and nesiritide.

Drug makers also bear a responsibility to conduct rigorous studies before they start widely promoting medications, he added.

“Huge amounts are spent on marketing that could have been spent on a clinical trial,” he said.

This article has been revised to reflect the following correction:

Correction: November 15, 2010

???An earlier version of this article misstated the number of trial sites in Merck's study of cholesterol drugs. It is 1,046, not 380.

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His death was confirmed by his son John.

Dr. Bing, who earned his medical degree in Germany but emigrated soon after Hitler rose to power, did groundbreaking research on the physiology of the heart and kidneys for more than half a century.

In the 1950s, his research made it possible to measure blood flow to the heart and determine its mechanical efficiency. In the 1960s, he developed an early version of the PET scan. His work on congenital heart disease led to the identification of a variety of cardiac malformations that surgeons were then able to treat.

When not engaged in medical research, Dr. Bing drew on his early conservatory training in piano and composition, and a close relationship with the composer Carl Orff, to write more than 300 works for chamber ensemble, orchestra and chorus that have been performed around the world. He also wrote several published works of fiction.

Dr. Bing first gained prominence at the Johns Hopkins School of Medicine, where he, the cardiac surgeon Alfred Blalock and the cardiologist Helen B. Taussig established the first cardiac catheterization laboratory dedicated to congenital heart disease.

There, Dr. Bing developed a technique that made it possible to measure the mechanical efficiency of the heart by inserting a catheter into a vein in the arm and from there into the main blood vessel that carries deoxygenated blood away from the heart muscle.

“It opened a whole new era for understanding how the heart functions as a pump and what goes wrong when it fails to pump efficiently,” said Dr. Heinrich Taegtmeyer, a professor of medicine at the University of Texas Health Science Center in Houston. “It also opened a new field, cardiac metabolism, that is still very much alive and well.”

Dr. Bing’s research on congenital heart disease included the identification of Taussig-Bing syndrome, a rare congenital deformation of the heart.

In the 1960s, working with the physicist George W. Clark of the Massachusetts Institute of Technology and aided by computers from the Ford Motor Company, Dr. Bing developed the use of radioactive tracers to measure cardiac blood flow and produce images of the heart. This laid the foundation for modern PET, or positron emission tomography, scanning, which produces three-dimensional images of bodily functions.

The citation accompanying his honorary doctorate from Johns Hopkins, awarded in 2000, characterized him as “one of the great cardiologists of our time.”

Richard Bing, who used the middle name John in the United States, was born on Oct. 12, 1909, in Nuremberg. His father was a hops merchant. His mother, a professional singer with a specialty in Bach’s cantatas, passed along a keen interest in music. After studying at the Nuremberg Conservatory, he pursued premedical studies in Frankfurt, Vienna, Berlin and Munich. For a time, he wavered between music and medicine.

Seeking advice, he auditioned for the composer Richard Strauss, who was late for a card game and rushed off without offering an opinion. The perplexed Mr. Bing opted for medicine after reading “Arrowsmith,” Sinclair Lewis’s portrait of an idealistic doctor.

He earned a medical degree from the University of Munich in 1934. After he and the rest of his family, which was Jewish, left Germany, he earned a second medical degree from the University of Bern the following year.

While on a fellowship at the Carlsberg Biological Institute in Copenhagen, he collaborated with the surgeon Alexis Carrel, a Nobel laureate for his work on organ transplants, and the aviator Charles Lindbergh.

The two men were visiting the institute to demonstrate an experimental pump to supply nutrient fluid to organs so they could survive outside the body during surgery, and they arranged for Dr. Bing to study perfusion, as the technique was known, at the Rockefeller Institute in New York.

After immigrating to the United States in 1936, he accepted a post in physiology at the College of Physicians and Surgeons at Columbia University, where, under Dr. Allen O. Whipple, he conducted research on vasopressor peptides secreted by the kidneys, work that laid the foundation for studying renal hypertension and renal failure caused by crushing injuries.

In 1938 he married Dr. Whipple’s daughter, Mary. She died in 1990. In addition to his son John, of Ewing, N.J., he is survived by another son, William, of Altadena, Calif.; a daughter, Judy Tasker of Thousand Oaks, Calif.; six grandchildren; and eight great-grandchildren.

In 1943, he enlisted as a lieutenant in the Army Medical Corps. After leaving the Army in 1945, he became an assistant professor of surgery at Johns Hopkins.

While doing research at the Johns Hopkins catheterization laboratory, Dr. Bing accidentally inserted a catheter into the coronary sinus, the vessel that delivers deoxygenated blood to the right atrium. He found that blood samples taken from the coronary sinus would allow him to measure cardiac metabolism in diseased and normal hearts.

“For the first time, it will be possible to measure accurately the effect of various chemical compounds on the human heart muscle and to study the effects of new drugs,” he told the New York Heart Association in 1951, announcing the technique.

In 1969, after continuing his work on cardiac metabolism at Washington University in St. Louis and serving as chairman of the department of medicine at Wayne State University in Detroit, Dr. Bing moved his laboratory to the Huntington Medical Research Institutes in Pasadena, Calif. There he helped develop high-speed cinematography of coronary vessels and carried out studies on the chemistry of the heart after a heart attack. In his 80s and 90s, he introduced a technique for measuring cardiac blood flow using nitric oxide.

Dr. Bing helped found the research group that in 1976 became the International Society for Heart Research, which appointed him its life president. With Lionel H. Opie, he founded the society’s principal publication, the Journal of Molecular and Cellular Cardiology.

In addition to publishing about 500 papers and books on medicine, Dr. Bing published several works of fiction, including “The Bisquit Principle” (2007), a satire on scientific inquiry.

A short documentary on his life, “Para Fuera” — the title is a Spanish expression meaning “away with it” — was shown at the Sundance Film Festival in January.

This article has been revised to reflect the following correction:

Correction: November 16, 2010

An obituary on Sunday about the cardiologist Richard J. Bing referred incorrectly to the coronary sinus, which figured in his research. It delivers deoxygenated blood to the right atrium, not to the right ventricle.

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Women who have jobs that require them to work "too hard" or "very fast" is 88 more likely to have a heart attack. Women with demanding jobs twice as likely to have a heart attack as peers with easier jobs they strain with a lot of work was more likely to need heart surgeryWomen worried about losing their jobs at 43 percent percent more likely to be physically inactiveWomen are at greater risk than men to experience work strain

(Health.com)--women with very demanding jobs is almost twice as likely to have a heart attack with their peers in looser professions, suggests a new study.

Researchers at Harvard Medical School analyzed 10 years of research and medical data to more than 17,000 women in the health profession. women, who were enrolled in a study visas for heart disease, were all in their 20s or early 30s when the study began.

Women who said their job requires them to work "too hard" or "very fast", but have little say over the day-to-day duties--a combination is known as "job strain"--was 88 percent more likely than those in less stressful jobs can have a heart attack.

He was also a 43 percent more likely to have heart surgery, according to the study, which was presented Sunday at an annual meeting of the American hearts in Chicago.

Health.com: Job killing you?8 types of stress at work

In addition, women who were stressed by job--or are worried about losing their jobs--was more likely than those with stable employment is physically inactive and to have high cholesterol.(Job insecurity in itself does not appear, you can increase the risk of heart attack, however.)

"This is one of the most important to emerge in recent years regarding the relationship between job strain and cardiovascular health," says Peter Kaufmann, Ph. d., researcher at the national heart, Lung and Blood Institute designed mental health and heart disease, but has not taken part in the new survey.

Doctors and other experts in the sector must do more to help the people who manage stress at work, adds Kaufmann. findings "stress that urgent progress in this arena," he says.

Health.com: Head-to-toe solutions for stress

The increased risk of heart attack seen in study cannot be attributed solely to the health and socioeconomic factors; work to zero on Manager, researchers controlled for age, race, education, and income, and blood pressure, body weight and cholesterol.

And even if all women in the study were health professionals, was a "very socioeconomically diverse group that includes doctors, nurses, dietitians, and researchers, says the study's lead author, Dr. Michelle Albert, M.D., a cardiologist at Brigham and women's Hospital in Boston.

A large proportion of investigations date in job stress and heart health has become men but women are more likely than men to experience job strain, not to mention the stress associated with home and family demands, says Paul Landsbergis, Ph. d., Associate Professor of environmental and occupational health Sciences at SUNY Downstate Medical Center in Brooklyn.

Health.com: I was too busy heart disease--until almost killed me

"The results certainly implies that we must do more to healthier jobs," says Landsbergis. one way to accomplish this, he adds, can be given individual workers more control over their jobs through collective bargaining and other types of organisation.

For its part, Albert recommends some simple steps to help women reduce the effects of stress at work: exercise regularly, try to leave your work at the workplace, and to take 10 to 15 minutes a day to relax and concentrate on your physical health, mental and emotional; it is also important that you have a network with family and friends to help you cope, says.

Health.com: 25 ways to relax really this season

"We will never be able to relax--some stress is positive, indeed," says Albert. "The negative aspects of stress we are going to need to learn how you can manage. "

The AHA annual meeting scientific sessions indicate the last heart-related research and treatment developments. Unlike the studies published in medical journals, the research presented at the meeting has not been checked by independent experts in the field.Enter to win a monthly contest Makeover room from MyHomeIdeas. comCopyright Magazine health 2010

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