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Jewish World Review Feb 18, 2005 / 9 Adar I, 5765
By Robert A. Wascher, M.D., F.A.C.S.
http://www.NewsAndOpinion.com |
Circulation: Previous research has suggested that poor dental hygiene might be associated with an increased risk of cardiovascular disease. However, the precise mechanisms whereby poor oral health may cause cardiovascular disease have been difficult to identify so far. Preliminary research studies looking at bacteria-like organisms as possible causative agents have, so far, failed to find any evidence of chronic infections of blood vessels in the heart or other organs. A new study evaluated 657 volunteers with an average age of 69 years, none of whom had any medical history of prior stroke or heart attack. A total of 4,561 samples of oral plaque were obtained from these 657 volunteers, and these samples were then assessed for bacteria associated with gingivitis (chronic inflammation of the gums). Each volunteer also underwent extensive testing for evidence of asymptomatic cardiovascular disease, including blood studies (white blood cell counts and C-reactive protein levels) and multiple ultrasound examinations of the carotid arteries.
After adjusting for differences in age, ethnicity, gender, socioeconomic factors, weight, smoking history, diabetes, high blood pressure, and blood cholesterol levels, carotid artery thickness, a measure of atherosclerosis, was correlated with the oral bacterial levels of each study volunteer. This study revealed that increasing levels of bacterial growth in the gums of study participants were associated with increasing carotid artery wall thickness, as well as increasing white blood cell counts.
Interestingly, there was no association found between oral bacterial burden and C-reactive protein (CRP) levels. This latter finding is especially intriguing (and puzzling), as CRP has emerged as a powerful predictor of cardiovascular disease risk. Indeed, elevated CRP levels in the blood have repeatedly been shown to more predictive of heart disease and stroke than cholesterol levels. In fact, previous research seeking to explain the relationship between poor oral health and cardiovascular disease have theorized that oral bacteria are able to somehow damage the lining of critical arteries throughout the body, either by directly infecting these arteries, or by causing low levels of sustained inflammation throughout the body. Because CRP levels are thought to be a sensitive indicator of systemic inflammation, and because CRP has been shown to be an accurate marker of cardiovascular disease risk, this study's finding that oral bacterial burden correlated with increasing carotid artery thickness, but not with CRP levels, raises as many questions as it answers. Still, this study goes a long way towards linking poor oral health with an increased risk of cardiovascular disease.
COSMETIC BREAST IMPLANTS & SUICIDE
Archives of Internal Medicine: Breast augmentation is the second most commonly performed cosmetic procedure in the US. Among the estimated 7 million cosmetic surgeries performed in the US in 2002, approximately 250,000 were for breast enlargement. (Liposuction edged-out breast augmentation for the number one position, with an estimated 375,000 patients undergoing liposuction in 2002.) Based upon comprehensive data from 2002, 88 percent of cosmetic surgery patients are women, and people aged 35 to 50 years undergo 44 percent of all cosmetic procedures. Caucasians represent 80 percent of patients undergoing cosmetic surgery, with Hispanic-American, African-American and Asian-American patients making up the remaining 20 percent.
One could fill an entire library with books written about the pros and cons of cosmetic surgery. However, there can be no debate about the growing popularity of such procedures in the US and, indeed, throughout much of the world. (Multiple mainstream travel and vacation guides now list luxury vacation packages centered around cosmetic surgery procedures performed at resorts in Europe, the Caribbean, Central and South America, and in Asia.) The continued explosive growth of cosmetic surgery in the US has given rise to endless psychological, sociodemographic, cultural and ethnic studies, and the self-indulgent Baby Boomers have been the target of many such studies (disclaimer: I am a card-carrying Baby Boomer). Doubtless, different factors motivate different people to submit themselves to the risks and discomforts of surgery in order to change their appearance, and it is unwise to paint all cosmetic surgery patients with too broad a brush. At the same time, there is considerable evidence that certain personality traits tend to be more common in people who seek cosmetic procedures. With this in mind, a new study from Denmark provides a sobering look at the incidence of suicide and psychological illness among women who had previously undergone cosmetic breast augmentation with implants.
This study evaluated 2,671 women who had undergone breast augmentation with implants, 7,071 women who had undergone breast reduction surgery, and 1,736 women who had undergone cosmetic surgery other than breast augmentation or breast reduction. All of these women underwent their operations between 1973 and 1995. The incidence and causes of death among this group of women were then extracted from Denmark's public statistics bureau. Interestingly, the study's authors were also able to review information about this group of women that was archived at the Danish Psychiatric Central Register prior to their cosmetic surgeries.
After analyzing the data, this study found that women who had undergone cosmetic breast augmentation with implants had a 50 percent increase in the relative risk of overall death when compared to the general population. Death from non-cancer lung diseases was 240 percent higher relative to the general population for these same women, while the risk of death due to suicide was 210 percent higher than for women in the general population. In contrast, women who underwent breast reduction surgery were 30 percent less likely to die, overall, when compared to women in the general population. Particularly interesting was the finding that the risk of dying from breast cancer was reduced by 60 percent, relative to the general population, among the women who had undergone breast reduction surgery. At the same time, this same group of women experienced a slight increase in the risk of death by suicide, with a 60 percent increased risk of successful suicide relative to women in the general population.
When the study's authors looked at psychiatric admissions prior to cosmetic surgery, they found that 8 percent of the women undergoing breast implant surgery had been previously admitted to a hospital with a psychiatric illness, as compared to 4.7 percent of the women who underwent breast reduction, and 5.5 percent of the women who underwent non-breast cosmetic surgery. Based upon this data, this study reports that women who had undergone breast augmentation with implants were about 70 percent more likely to have had a prior history of admission to a psychiatric facility compared with the other women who participated in this study.
Although this study was not designed to identify cause-and-effect mechanisms to explain its findings, its findings are nonetheless very intriguing and somewhat worrisome. I am neither a psychologist nor a cosmetic surgeon, but the findings of this study do seem to make sense, at least intuitively. While it may not be the case for all women (or men, for that matter) who undergo cosmetic surgery, it is likely that at least some women who choose to undergo breast augmentation with implants may be doing so to assuage negative self-image concerns. For at least some of these women, it is undoubtedly the case that the underlying causes of their negative self-impressions are not alleviated by breast augmentation surgery. In discussing the findings of this study with my plastic surgery colleagues, none of them were surprised. The three-fold increase in the risk of suicide among women who have undergone breast augmentation for cosmetic purposes, as identified by this study, is concerning, and suggests that additional screening for psychological illnesses should be considered as a routine part of the evaluation of patients seeking cosmetic breast augmentation surgery. Doubtless, the majority of such women will be free of any serious mental illnesses. However, based upon the results of this study, a significant proportion of such women may have significant psychological illnesses.
HORMONE REPLACEMENT THERAPY & THE RISK OF OVARIAN CANCER
Archives of Internal Medicine: The news about hormone replacement therapy (HRT) just keeps on getting worse. The landmark HERS-II and WHI studies have conclusively shown that the combination of estrogenic and progestational hormones, as taken by millions of women to alleviate the symptoms of menopause, do not reduce the risk of heart disease, but that they do increase the risk of breast cancer, heart attack, stroke, and dementia. More recent studies have also called into the question the safety of estrogen-only HRT, finding an increased risk of cardiovascular disease with this form of HRT. In my forthcoming book, The Great Hormone Replacement Therapy (HRT) Debate: What Every Woman (and Man) Should Know About HRT, I make the case, based upon more than 50 years of research (much of it buried or disparaged by the pharmaceutical industry), that HRT, in all commonly prescribed forms, has always been associated with significant health risks. Moreover, a certain "HRT Mythology" has been erected by the manufacturers of HRTs, over the past five decades, and which has depicted menopause as a pathological state of decay and disability, rather than the natural progression out of the reproductive phase of her life that every single woman on the planet will pass through. In addition to this "diseasification" of menopause, the drug companies and their allied proponents of HRT have not been satisfied with claiming that HRT medications alleviate the symptoms of menopause (they do so very effectively) alone, but have also further fleshed out the "HRT Mythology" by claiming that, among other benefits, HRT reduces the risks of cardiovascular disease and dementia. This "HRT Mythology" has recently suffered enormous setbacks in the face of overwhelming evidence, collected within enormous studies that utilize the highest level of experimental design, that only a very small percentage of women will have prolonged and disabling symptoms due to menopause, and that HRT causes some of the very life-threatening diseases that it was claimed, by its proponents, to prevent!
A new study has added yet another spike through the heart of the HRT monster, although the monster continues to live and breathe (hence, my new book). Previous studies looking at HRT and the risk of ovarian cancer have yielded inconclusive results. A nationwide population-based case-control study was performed in Denmark, a Westernized country with a superb public health data repository and a socialized healthcare system that captures high-quality healthcare data on the entire population. The study looked at women in Denmark between the ages of 35 and 79 years who had been diagnosed with ovarian cancer between 1995 and 1999, and compared these women with age-matched women without ovarian cancer. A total of 376 women who had been diagnosed with ovarian cancer were identified, and were compared with 1,111 age-matched women without ovarian cancer. The history of HRT usage for all of these women was then carefully collected and analyzed.
This study found that the risk of ovarian cancer increased with the cumulative intake of estrogen (but not with the intake of progestational hormones among those women taking combined estrogenic and progestational HRT). A simple and highly reproducible correlation between the total grams of estrogen intake and the risk of ovarian cancer was identified in this study. For every 5 grams of estrogen consumed, the relative risk of ovarian cancer reliably increased by 31 percent (the average prescription pill for HRT contains 0.625 mg of estrogens, or 0.000625 grams). Most importantly, this study found that the total cumulative consumption of estrogen was more significantly associated with an increased risk of ovarian cancer than was the duration of estrogen HRT intake. Therefore, the authors concluded that women who insist upon continuing HRT should take the smallest daily dose that alleviates their symptoms, in order to reduce their risk of ovarian cancer.
As my book nears its publication date, I will continue to update readers on further developments in HRT research.
JWR contributor Dr. Robert Wascher is an oncologic surgeon, professor of surgery, oncology research scientist, and author. He lives in Honolulu with his wife and two daughters.
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Protect yourself from cardiovascular disease — floss your teeth!; suicides and cosmetic surgery; hormone replacement therapy & the risk of ovarian cancer
