TUESDAY, Aug. 24 (HealthDay News) -- People who suffer migraines with aura are at increased risk of dying from heart disease and stroke, but the individual risk for a migraine sufferer is low, two new studies show.

Auras -- temporary visual or sensory disturbances that occur before or during a migraine headache -- affect about one in five migraine sufferers, according to the U.S. National Women's Health Information Center.

Both studies were published in the Aug. 25 online edition of the BMJ.

In one study, Larus Gudmundsson from the University of Iceland and colleagues examined the impact of mid-life migraines in 18,725 men and women born between 1907 and 1935 who took part in research (the Reykjavik Study) that was launched in 1967 to study heart disease in Iceland.

Based on their analysis of a 26-year follow-up of the study participants, Gudmundsson's team concluded that men and women who suffered migraine with aura were at increased risk of dying from heart disease and stroke, as well as all other causes. Those with migraine without aura were not at increased risk.

In addition, the researchers found that women with migraine with aura are also at increased risk of dying from causes other than cardiovascular disease or cancer.

The individual risk faced by migraine sufferers with aura is low and efforts to reduce their risk of heart disease-related death should focus on eliminating conventional risk factors, including high blood pressure, smoking and high cholesterol, the study authors said.

Additional research is needed to learn more about the link between migraine with aura and increased risk of death from cardiovascular disease and other causes, the team stated in a news release from the journal's publisher.

"Finally, studies are needed to determine if reducing the frequency of attacks with migraine preventive treatment might reduce the risk of cardiovascular disease," Gudmundsson and colleagues concluded.

The second study found that women who have migraines with aura are at increased risk for hemorrhagic stroke (bleeding in the brain). Hemorrhagic strokes account for about 20 percent of all strokes. However, Dr. Tobias Kurth and colleagues at the National Institute of Health and Medical Research in France said the risk remains low and further research is required to confirm their findings.

It's unclear whether doctors should inform patients about the increased risk of death associated with migraine with aura, Dr. Klaus Berger, of the University of Muenster in Germany, wrote in an editorial accompanying the first study.

Berger believes that "for many people the information will cause an unwarranted amount of anxiety, although others may use the opportunity to modify their lifestyle and risk factors accordingly."

Doctors "must carefully weigh the decision whether or not to discuss the risks related to this condition," Berger concluded.

More information

The U.S. National Women's Health Information Center has more about migraine.

MONDAY, Aug. 9 (HealthDay News) -- Many stroke patients stop taking their medications while many heart failure patients are never prescribed recommended medications in the first place, new research shows.

In one report, researchers found that 25 percent of stroke patients stopped taking one or more of their stroke prevention medications within three months after their stroke.

"Providers should spend more time teaching stroke patients and caregivers when new risk factors are diagnosed and new medications are prescribed, such as blood pressure or cholesterol medications prior to discharge, while keeping the regimen as streamlined as possible," said lead researcher Dr. Cheryl D. Bushnell, an associate professor of neurology and associate director of the Women's Health Center of Excellence at Wake Forest University Health Sciences.

In addition, those patients with more severe disability and those without insurance are at risk of not continuing medications, she said.

"Most importantly, these results show that some patients require more teaching regarding their medications, including why a medication is prescribed and how to refill it," Bushnell said. "Hopefully, we as providers can improve patients' medication compliance through better communication and by being aware of the factors associated with medication discontinuation."

The report is published in the Aug. 9 online edition of the Archives of Neurology.

For the study, Bushnell and colleagues collected data on 2,598 patients who had been seen in 106 U.S. hospitals with a stroke or a transient ischemic attack (TIA).

Among these patients, 75.5 percent consistently took all the medications prescribed by their doctor.

However, 20 percent of patients were only taking at least half of their medications, and 3.5 percent weren't taking any of their medications three months after their stoke, the researchers found.

Patients who kept taking their medications typically did so for a variety of reasons -- they were suffering from other serious health problems, had adequate health insurance, or they had fewer medications and understood why they were taking them, Bushnell's group noted.

"This is something we have known, that long-term compliance is a problem and unless you target it, people sort of fall off the curve," said Dr. Steven R. Levine, vice chair of neurology at State University of New York, Brooklyn, and chief of neurology at University Hospital Brooklyn.

What is needed is more patient education and follow-up programs for stroke patients, he said. "Physicians can put patients in behavioral modification programs, get them to see physician assistance, nurse practitioners, nutritionists, to work on their risk factors," he said.

Patients need more education and better stroke support systems, Levine added.

"There are very few stroke prevention centers, despite stroke being the number one killer and disabler," Levine said.

In the second report, published in the Aug. 9/23 online edition of the Archives of Internal Medicine, researchers from the Stanford University School of Medicine found that doctors are not prescribing two medications known to be effective in managing heart failure as much as they once did.

"We expect that, over time, recommended therapies for conditions such as heart failure will continue to increase," Dr. Dipanjan Banerjee, a clinical instructor in cardiovascular medicine said. Banerjee, along with Dr. Randall Stafford, an associate professor of medicine, conducted the study.

However, they found while the use of medications such as ACE inhibitors and beta blockers was increasing, the increase was not to the level where it should be, Banerjee added.

"What is concerning to us, when we took another look at the data, [was] we saw there was a plateau and, in some cases, a decrease in the use of these medications," he said.

The team found that use of the ACE inhibitors and angiotensin receptor blockers increased from 34 percent in 1994 to 45 percent in 2002, but decreased to 32 percent by 2009.

With beta blockers, use went from 11 percent in 1998 to 44 percent in 2006, but dropped to 37 percent by 2009.

This suggests doctors may be getting tired of prescribing the same old drugs, which are available as generics, in favor of newer, more expensive ones, Banerjee said.

Dr. Gregg C. Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center at the University of California, Los Angeles, said that "heart failure results in substantial mortality, morbidity and costs. It is thus essential that evidence-based, guideline-recommended therapies be provided to all heart failure patients who are eligible."

This study suggests that from 1994 to 2009, there has been very little improvement in the use of medical therapies demonstrated to improve outcomes in outpatients with heart failure and substantial opportunities to improve heart failure care, he explained.

"However, it is important to note the limitation that these heart failure medications are only demonstrated to benefit about 50 percent of heart failure patients, whereas the data reported in this study are all patients with heart failure," Fonarow said.

The results of a recent study suggest that new evidence-based approaches can result in substantial improvements in the use of drugs, such as ACE inhibitors, angiotensin receptor blockers, beta blockers, aldosterone antagonists and other therapies for heart failure, he said.

"Thus, an important and highly effective solution to the heart failure treatment gaps highlighted in this present study has been identified," Fonarow said.

More information

For more information on stroke and heart disease, visit the American Heart Association  .

MONDAY, July 12 (HealthDay News) -- Patients who have a heart attack and undergo procedures to open blocked arteries are getting proven treatments in U.S. hospitals faster and more safely than ever before, according to the results of a large-scale study.

Data on more than 131,000 heart attack patients treated at about 250 hospitals from January 2007 through June 2009 also showed that the patients themselves have become more aware of the signs of heart attack and are showing up at hospitals faster for help.

Lead researcher Dr. Matthew T. Roe, an associate professor of medicine at Duke University Medical Center and the Duke Clinical Research Institute, thinks a combination of improved treatment guidelines and the ability of hospitals to gather data on the quality of their care accounts for many of the improvements the researchers found.

"We are in an era of health care reform where we shouldn't be accepting inferior quality of care for any condition," Roe noted.

"Patients should be aware that we are trying to be on the leading edge of making rapid improvements in care and sustaining those," he added. "Patients should also be aware that the U.S. is on the leading front of cardiovascular care worldwide."

The report is published in the July 20 issue of the Journal of the American College of Cardiology.

Roe's team, using data from two large registry programs of the American College of Cardiology Foundation's National Cardiovascular Data Registry, found there were significant improvements in a number of areas in heart attack care:

• An increase from 90.8 percent to 93.8 percent in the use of treatments to clear blocked blood vessels.
• An increase from 64.5 percent to 88 percent in the number of patients given angioplasty within 90 minutes of arriving at the hospital.
• An improvement from 89.6 percent to 92.3 percent in performance scores that measure timeliness and appropriateness of therapy.
• Better prescribing of blood thinners.
• A significant drop in hospital death rates among heart patients.
• Improvement in prescribing necessary medications, including aspirin, anti-platelet drugs, statins, beta blockers, angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers.
• Improvement in counseling patients to quit smoking and referring patients to cardiac rehabilitation.

In addition, patients were more aware of the signs of heart attack and the time from the onset of the attack until patients arrived at the hospital was cut from an average 1.7 hours to 1.5 hours, the researchers found.

Roe's group also found that for patients undergoing an angioplasty:

• There was an increase in the complexity of the procedure, including more patients with more challenging conditions.
• There were reductions in complications, including bleeding or injury to the arteries.
• There were changes in medications to prevent blood clots, which reflect the results of clinical trials and recommendations in new clinical practice guidelines.
• And there was a reduction in the use of older drug-eluting stents, but an increase in the use of new types of drug-eluting stents.

Despite all the good news, Roe's team said there was still room for improvement in care, particularly in ways to reduce the risk of bleeding that is present with even the most advanced treatments.

"We need to do ongoing and regular surveillance of care patterns" Roe said.

Dr. Gregg C. Fonarow, a cardiology professor at the University of California, Los Angeles, commented that "national clinical registries provide valuable data to characterize recent trends in the treatment and in-hospital clinical outcomes for patients hospitalized with cardiovascular disease or those undergoing cardiovascular procedures."

This new report demonstrates improvements in the speed in which reperfusion is offered in heart attack patients, better use of guideline-recommended medications in heart attack patients, and decreases in complications in patients undergoing coronary procedures, Fonarow said.

"These findings show the substantial efforts to provide physicians and hospitals with detailed feedback on performance coupled with targeted quality improvement efforts are producing measurable and meaningful benefits to cardiovascular disease patients," Fonarow added.

However, he said, there are further opportunities to improve care and clinical outcomes for patients with heart attacks and those undergoing cardiovascular procedures. Because "not all U.S. hospitals are participating in these voluntary clinical registries, there is a very important need to expand hospital participation," Fonarow noted. Fonarow is the unpaid chair of the Get With The Guidelines committee of the American College of Cardiology ACTION registry.

More information

For more information on heart attacks, visit the American Heart Association  .

FRIDAY, July 23 (HealthDay News) -- People concerned about heart disease rightfully fret about their cholesterol, blood pressure and blood sugar levels, but there's another overarching problem that could eclipse all those risk factors.

The nation's obesity epidemic has put more and more people at risk for developing heart disease, both on its own and by exacerbating other risk factors, experts say.

"Obesity plays a role in almost all the coronary risk factors," said Dr. Vincent Bufalino, president and chief executive of Midwest Heart Specialists, medical director of Edward Heart Hospital in Naperville, Ill., and a spokesman for the American Heart Association.

Obesity can boost your levels of bad cholesterol, raise your blood pressure and increase your chances of acquiring diabetes, Bufalino said. In other words, obesity ties directly into the three biggest risk factors for heart disease.

Rising obesity rates also threaten to undermine progress that has been made in controlling those risk factors.

A study presented at the American Heart Association's annual meeting reported that blood pressure and blood sugar levels continue to rise in adults, mainly fueled by increases in obesity. Those increases are such that they overwhelm improving heart-health trends, such as a drop in "bad" cholesterol levels and lower smoking rates.

And given the rise in childhood obesity, experts believe that things will only get worse. One of every three children and teens in the United States is now obese, according to the U.S. Centers for Disease Control and Prevention. Those children are more likely to develop heart disease later in life.

"The problem exists that the world is getting more and more obese," said Dr. Gerald Fletcher, a cardiovascular physician with the Mayo Clinic in Jacksonville, Fla. "Obesity is a major risk factor for heart disease, cancer and many other acquired diseases."

The definition of obesity and overweight depends on body mass index, or BMI, an estimate of a person's body fat. People with a BMI of 30 to 39.9 are considered obese, according to the U.S. National Institutes of Health, and those with a BMI of 25 to 29.9 are considered overweight. A BMI of 40 or more indicates morbid obesity.

Doctors know that obesity plays a role in the three big risk factors, based on extensive research, but Bufalino said there's common-sense proof available, too. People who lose weight and keep it off, he points out, always see across-the-board improvements in those risk factors.

"In all three categories -- cholesterol, blood pressure and blood glucose -- sustained weight loss will improve those numbers," Bufalino said.

People who lose weight experience a decrease in their high blood pressure, and their levels of "bad" cholesterol (LDL, or low-density lipoprotein) drop, according to the American Heart Association. They also tend to experience an increase in "good" cholesterol (HDL, or high-density lipoprotein), which lowers risk for heart disease and stroke by helping clear the blood vessels of bad cholesterol.

Losing weight also is considered one of the best ways to bring diabetes under control, or to avoid it altogether if a person has high blood sugar levels that indicate pre-diabetes.

People become obese by taking in more calories than they can burn off over the course of a day, according to the American Heart Association. They compound the problem by eating foods rich in fat, which contain more than twice the calories gram-for-gram of either protein or carbohydrates, and by eating foods loaded with sugar, which provides "empty" calories that have no nutritional value but drastically affect the body's blood glucose levels.

"People take care of their cars: They change the oil, they buy new tires," Fletcher said. "But there's only one body, and if we don't take care of it, we can't expect the health-care system to do it for us. You can buy another car, but you can't buy another body."

The answer, then, is a simple one: To reduce the chances that you'll develop heart disease, you need to control your calorie intake and exercise regularly.

A healthy diet involves watching everything you eat and counting the calories, Bufalino and Fletcher said. General tips include:

• Eat more vegetables and fruits.
• Select leaner cuts of meat, and try to eat fish more often.
• Choose whole-grain breads and pastas over those made with white flour. The same goes for brown rice over white rice.
• Cut out sugary soft drinks and fruit juices. Instead, drink water or diet beverages.

Dieting can help you lose weight, but you also need to exercise. "Reducing your calorie intake is what gets it started, and exercise provides the maintenance that keeps the weight off," Bufalino said.

NIH experts recommend that people who are out of shape start off slowly, performing moderate exercise -- walking for a half-hour three times a week, for instance -- and then build up from there.

Healthy weight loss is gradual, about one or two pounds a week, according to the CDC. Keep in mind that one pound equals about 3,500 calories, so to lose that pound in a week, each day you have to burn 500 more calories than you take in.

Bufalino said he encourages people to lose 10 pounds in six months, which is an attainable goal that keeps them from becoming frustrated. They then can build on their success.

"If you can get a 10 percent weight loss, that's a successful effort to control your weight problem," he said. For example, someone who is 220 pounds should try to ultimately lose 22 pounds if they want to see their heart-healthy numbers improve.

More information

The U.S. Centers for Disease Control and Prevention has more about the risk factors for heart disease.

For more on life-saving weight loss, read about one woman's story.