Short stature is associated with a 50% greater risk of coronary heart disease, according to Tuula Paajanen and colleagues, who reported their findings in the European Heart Journal.

To reach these conclusions, the scientists performed a meta-analysis on 52 relevant articles on the subject, which were found during a systematic search of MEDLINE, PREMEDLINE and All EBM reviews. Together, the studies included a bit more than 3 million individuals.

For the purposes of their study, the scientists defined “short” as being below 5’5″ in males and below 5’0″ in females. They defined “tall” as being above 5’10″ in men and above 5’6″ in women.

Analysis of the combined studies revealed that individuals in the shortest cohort had a 46% greater likelihood of sustaining a cardiovascular event than those in the tallest cohort.

The scientists concluded that since short children tend to become short adults, their findings might help physicians select shorter kids and teens for early intervention programs designed to reduce cardiovascular risk. 

The study is believed to be the first to confirm the association, which had been debated for at least 50 years. It must be remembered that this study has shown a correlation, but does not prove that short stature actually causes cardiovascular disease. Randomized controlled trials would be required to prove causality, but of course they are impractical in the current instance.

It’s at least as likely that our country will be hit by a major, crippling Pearl Harbor-like cyber attack as it is that San Francisco will be hit by a magnitude 8 earthquake. So maybe people should take note of  a new report which suggests that we are woefully prepared to defend ourselves against it, or respond effectively if it happens.

The report was released last week by the Inspector General of the Department of Homeland Security. Its overly optimistic title is, “U.S. Computer Emergency Readiness Team Makes Progress in Securing Cyberspace, but Challenges Remain.”

The report focuses on the US Computer Emergency Readiness Team, or CERT, which was created to coordinate the nation’s cyber-defense efforts. CERT is a division of the Department of Homeland Security (DHS) that is specifically tasked to analyze and reduce cyber threats and vulnerabilities, disseminate cyber threat warning information, and coordinate cyber incident response activities.

According to the report, CERT is barely functioning, 7 years after it was established. 

To begin with, CERT is understaffed. Only 45 of the 98 positions approved for the emergency readiness team are filled. As a result, it relies on contractors to carry out the most basic activites like updating operating procedures. It basically can do nothing except process data for anomalies and react to breaches after the fact.

Want more? CERT has no strategic plan, let alone performance measures on which to assess progress. It also lacks the authority to assure its safety recommendations are implemented, even by the federal agencies it is supposed to protect.

Then again, even if CERT somehow morphs into a highly effective organization, it’s well to remember that the vast majority of the networks that make up our country’s cyber infrastructure are privately owned, and therefore beyond its auspices.

At least we can say we were warned.

Allopurinol, for 40 years a mainstay in the treatment of gout, has been shown to work for angina too, according to scientists at the University of Dundee.

To reach this surprising conclusion, Awsan Noman and colleagues enrolled 65 patients with chronic stable angina pectoris and angiographically proven coronary artery disease into a randomized, controlled trial of high-dose allpurinol (600 mg per day) vs. placebo.

The scientists found that patients randomized to receive allopurinol increased the median time to ST depression (a sine qua none of coronary ischemia) from 232 seconds to 298 seconds, whereas in placebo-treated subjects that statistic increased from 232 seconds to 249 seconds, a significant difference.

Allopurinol also increased total exercise time and the time before onset of chest pain. There were no adverse treatment effects.
 
Noman’s group suspects the beneficial effects of Allopurinol are caused by its ability to inhibit an enzyme known as xanthine oxidase. This in turn reduces myocardial oxygen (energy) consumption for a particular stroke volume.
 
Next up for the scientists is to determine how best to use allopurinol in the management of chronic stable angina. They were optimistic in this regard, noting that compared with nitrates and beta blockers allopurinol does not reduce blood pressure or heart rate, or trigger headaches and tiredness, which commonly accompany standard drug treatments.

They also noted that allopurinol may be quite useful in developing countries where the incidence of coronary artery disease is exploding and access to more expensive drugs and invasive therapies is limited.

The article appears in Lancet.

America’s epidemic of overweight and obesity sets back private employers by nearly $45 billion per year in health care costs and diminished productivity. In response, nearly one-third of US companies either offer, or are considering financial incentives that motivate employees to lose weight or otherwise become healthier.

The incentives are quite diverse. Some companies simply reward employees for getting a check-up evaluation or pay the costs of diet classes. Others pay employees that achieve certain exercise targets. Still others cut health-insurance premiums.

IBM has long been considered a leader in such programs. Nearly half of its workforce earns upwards of $150 per year for participating. In one scheme, IBM pays employees for completing 3-month, Web-based health programs.

As another example, OhioHealth, a hospital chain, began paying employees for walking. The provider uses pedometers and pays up to $500 depending on the distance travelled. “We thought that would be a big enough number to help people think twice,” Lisa Meddock, OhioHealth’s benefits manager told the Wall Street Journal.

Nearly half of OhioHealth’s 9,000 employees participated, and the provider has paid out over $377,000 so far.

The literature contains few studies designed to assess the impact of employer-based health incentive programs like this. In one of the largest studies, Cornell University scientists examined 7 such programs and found that the average participant lost just over 1 pound.

The Cornell team did find, however that programs designed to put employees at risk for losing their own money were more effective than those designed to win money. In one such study featuring so-called “refundable bonds,” participants agreed to shed X pounds by Y date or forfeit the money they deposited. In this program, employees lost an average of 4 pounds.

Most people are born with 4 wisdom teeth, which normally descend below the gum line between the ages of 17 and 25. Wisdom teeth are believed to have been important to our hunter-gatherer ancestors, whose coarse diet caused teeth to grind down and wear out.

The jaws of our hunter-gatherer ancestors were much larger than ours however, and for many of us there isn’t enough room in our mouths to accommodate the late-comers.

In these cases, wisdom teeth can become impacted (trapped in the jawbone) or erupt through the gum line only partially—a situation that predisposes to bacterial infections of the jaw, periodontal disease and tooth decay.

Of course, most people experience none of these complications, and the prophylactic surgical procedure designed to remove these risks can cause complications of its own. These include infections, postoperative bleeding and even perforated sinuses or nerve damage.

So how does one decide whether to have wisdom teeth removed, even if they are causing no problems? It turns out the scientific literature contains almost no guidance on the matter.

The American Dental Association for example, has not published guidelines for dealing with wisdom teeth. It prefers to let care givers decide on a case-by-case basis.

Thankfully, the NIH recently launched a study that might shed light on the subject. The study, led by Greg Huang of the University of Washington, will record the reasons given by general dentists when they suggest either pulling or keeping wisdom teeth, and then track patient outcomes for 2 years.

Meanwhile, Chevy Chase dentist Steven Kahan, who has dealt with the problem for 40 years, told the Washington Post, “It is the kind of thing where all of us make a somewhat educated guess.”

In the absence of disease-modifying treatments, the cumulative costs of care for people with Alzheimer’s disease will exceed $20 trillion, in today’s dollars, over the next 40 years according to a new report from the Alzheimer’s Association.

The report, “Changing the Trajectory of Alzheimer’s Disease: A National Imperative” concludes that the number of Americans with the disease will jump from 5.1 million today to 13.5 million by 2050.
 
Driving the exploding costs of Alzheimer’s by 2050 is the fact that nearly half (48 percent) of the afflicted 13.5 million people will have an advanced form of the disease which is associated with expensive, intensive care.

The report also highlights the remarkable financial impact that even modest, incremental treatment improvements can have on this trend. For example, a treatment that delays onset of Alzheimer’s disease by five years would, if instituted now, decrease the number of Americans with Alzheimer’s from 5.6 million to 4 million by the end of the decade.

Annual Medicare savings by 2020 would be $33 billion, and would climb to $283 billion by 2050 in this scenario.

“Today, there are no treatments that can prevent, delay, slow or stop the progression of Alzheimer’s disease,” said Harry Johns, President and CEO of the Alzheimer’s Association in a press release. “While the ultimate goal is a treatment that can completely prevent or cure Alzheimer’s, we can now see that even modest improvements can have a huge impact.”
 
“Given the magnitude and the impact of this disease, the government’s response to this burgeoning crisis has been stunningly neglectful,” said Johns. “The federal government has sent a token response and has no plan. Immediate and substantial research investments are required to avoid an even more disastrous future for American families and already overwhelmed state and federal budgets.”

The National Institutes of Health has announced it intends to revise its policies governing financial conflicts of interest. The changes will increase disclosure responsibilities on institutions that receive funding from the agency,  increase transparency and accountability, and toughen-up rules it first promulgated in 1995.

“We cannot afford to take chances with the integrity of the research process,” NIH Director Francis Collins remarked at a press conference introducing the proposed changes. “We believe it is essential to tighten up this situation in order to be sure that we are obtaining and maintaining the public trust in the integrity of the scientific enterprise.”

Among the revisions, the NIH proposes to reduce the reporting threshold for conflicts from $10,000 to $5,000. In addition, the NIH wants to shift responsibility for deciding whether a particular relationship is in fact a conflict from the investigator to his or her institution. This would require institutions to establish review processes for potential conflicts and report such matters to the NIH.

The NIH is also proposing that for the first time, Phase 1 Small Business Innovation Research grants and the Small Business Technology Transfer Program would be covered under these policies.

The new rules do exclude income from teaching, lectures, seminars, or service on review or advisory committees review panels for institutions of higher learning or government agencies.

A further change would require grant receiving bodies to disclose on publicly accessible websites any significant financial interests involving their faculty or others related to the entities.

“The public may not always understand the intricacies of rigorous science, but most individuals quickly grasp the concept of bias,” wrote Collins in a commentary in JAMA. “Americans do not want financial conflicts of interest to influence the federally funded research.”