Blockages in the heart’s arteries commonly cause chest pains called angina. Cardiologists possess ever-improving invasive tools for restoring blood flow, including angioplasty (blowing up balloons to expand the artery at sites of plaque), stenting (insertion of cylindrical props of metal mesh), and bypass surgery, increasingly through very small incisions.

But while these invasive treatments decisively relieve symptoms in most patients, they actually prevent heart attacks and deaths only in special circumstances — notably, when patients are treated within a few hours of an acute heart attack. At the same time, we now have several effective classes of drugs that reduce the heart’s workload, improve blood flow by dilating arteries, and increasingly target the diseased artery itself.

So the question that patients and their physicians now confront is when to turn to the invasive strategies that have long been a mainstay of angina management. A recent analysis of data from pivotal clinical trial called COURAGE provides some important new insights.

In this study, over 2,000 patients with stable angina were randomized into groups receiving aggressive drug therapy with or without additional angioplasty and stenting. The primary results, published in 2007, showed no additional benefit to invasive treatments with regard to heart attack or deaths in the group during 4.6 years of follow-up. - See Managing Angina Without Surgery

Older women who regularly sleep too little or too much are up to 70 percent more likely to have a stroke, a study found.

Postmenopausal women who regularly slept nine hours or more were 70 percent more likely to have a stroke, compared with women who slept seven hours a night, according to a study of 93,676 women published today in the journal Stroke. Those who slept five hours or less were 14 percent more likely to have a stroke.

As many as 70 million people in the U.S. suffer from chronic sleep loss and sleep disorders, which are associated with obesity, depression, heavy drinking and smoking, according to the U.S. Centers for Disease Control and Prevention. Today's study found that women's sleep time affected stroke risk, even when researchers accounted for common risk factors, among them age, race, income, employment, smoking, depression, exercise, high blood pressure, diabetes and high cholesterol.

``The duration of sleep needed for optimal health probably differs for various population groups,'' said Jiu-Chiuan Chen, lead author of the study and assistant professor of epidemiology at the University of North Carolina's School of Public Health in Chapel Hill, in a statement. ``This study provides additional evidence that habitual sleep patterns in postmenopausal women could be important for determining the risk of ischemic stroke.'' - See Sleeping Too Much Or Too Little May Boost Stroke Risk in Women for the full report.

Patients with moderate-to-severe rheumatoid arthritis benefited from combining the drugs methotrexate and Enbrel (etanercept), new research found.

The combination improved both remission and radiographic non-progression rates within one year compared with the standard treatment of methotrexate alone.

Patients on this regimen were also more likely to stay employed, according to a study in the current issue ofThe Lancet. The study was funded by Wyeth, the maker of Enbrel.

According to the Arthritis Foundation, some 1.3 million Americans live with rheumatoid arthritis, thought to be an autoimmune disease. The disease involves inflammation of the joints which can lead to both pain and disability. There is no cure for the condition, although several drugs can provide relief.

More than 500 outpatients who had not previously tried methotrexate, a chemotherapy drug, were randomly selected to receive either methotrexate alone (with the dosage increasing regularly) or methotrexate plus 50 milligrams a week of Enbrel.

Half of the patients receiving both drugs went into remission, while 94 percent had a "good/moderate" response. Only 28 percent on methotrexate alone went into remission, according to the study. - See Drug Combo Improves Remission of Rheumatoid Arthritis for the complete report.

Amgen Inc.'s Enbrel anti- inflammatory drug reduces the symptoms of rheumatoid arthritis when given with a standard therapy early in the disease, a study found.

Treatment with Enbrel and the generic drug methotrexate led to disease remission in about 50 percent of patients with moderate-to-severe arthritis after a year, compared with 28 percent of patients given the older drug alone, a study published in The Lancet said. The treatment also increased the ability of patients to remain employed, the study, dubbed COMET, found.

Enbrel, which was the world's fifth best-selling drug last year with $5.3 billion in sales, was introduced in 1998. The medicine, sold with Wyeth, won approval as a therapy for the skin disorder psoriasis in 2004. The medicine, also known as etanercept, belongs to a class of drugs that block TNF, a substance linked to inflammatory diseases such as rheumatoid arthritis, psoriasis and the bowel disorder Crohn's disease.

``The results of the COMET trial suggest that remission is an achievable goal in patients with early severe RA within the first year of therapy,'' researchers led by Paul Emery, a professor at the Leeds Institute of Molecular Medicine in the U.K., said in the study. ``Patients who received combination therapy have a nearly threefold reduction in work stoppage compared with those who took high-dose methotrexate alone.'' - See Amgen's Enbrel Drug Works in Early-Stage Arthritis, Study Finds for the complete article.

People with Alzheimer's who exercise regularly had less brain damage, a finding researchers said may one day lead to development of a treatment to slow the disease.

Physically fit patients with mild cognitive impairment had less brain shrinkage than those who weren't so well conditioned, according to a study released today in the journal Neurology. Brain function declines as the disease progressively kills nerve cells, causing the organ to lose volume, researchers said.

Previous studies showed exercise improves thinking and memory, in people with normal brain activity, by boosting blood flow and elevating growth hormones, the scientists said. The new findings extend this connection to people with Alzheimer's. Understanding how exercise affects the brain could help scientists find a new target for drugs, the researchers said.

``Until now, there was no data to suggest people with Alzheimer's may benefit from regular exercise,'' said the study's lead author, Jeffrey Burns, in a telephone interview on July 11. - See Physical Fitness Linked to Brain Health, Alzheimer's Study Says for the complete article.

Drinking less alcohol, eating more vegetables and exercising can prevent or delay the onset of diabetes, researchers said on Friday in a study showing that lifestyle changes can make a big difference.

Diet and exercise reduced the incidence of diabetes by about 43 percent over 20 years among 577 high-risk Chinese adults, the researchers reported in the journal Lancet.

At the end of the 20 years, 80 percent of those who changed what they ate and exercised more had diabetes, compared with 93 percent who made no changes, said Guangwei Li of the China-Japan Friendship Hospital in Beijing and Ping Zhang at the U.S. Centres for Disease Control and Prevention.

The findings came as part of a series of studies addressing new research about diabetes, which affects 246 million adults worldwide, and accounts for 6 percent of all global deaths.

"The challenge is to translate research findings into substantial clinical improvements for patients. Although prospects are hopeful, they are not assured," the Lancet wrote in a commentary.

Type 2 diabetes accounts for about 90 percent of all diabetes cases and is closely linked to obesity and physical inactivity. Type 1 diabetes is an auto-immune disease often diagnosed at an early age. - See Diet and exercise can delay diabetes for years for the full report.

Breast cancer patients with lower levels of vitamin D were far more likely to die and far more likely to have their cancer spread than women with normal levels, Canadian researchers reported on Thursday.

Women deficient in the "sunshine vitamin" when they were diagnosed with breast cancer were 94 percent more likely to have their cancer spread and were 73 percent more likely to die than women with adequate vitamin D levels, the researchers said.

More than three-quarters of women with breast cancer had a vitamin D deficiency, the researchers reported to an upcoming meeting of the American Society of Clinical Oncology.

"The women with the lowest vitamin D levels had the highest risk of death from breast cancer," Dr. Richard Schilsky, of the University of Chicago and president-elect of ASCO, told Reuters in an interview.

"We are seeing an association. It is possible that vitamin D is simply a marker for healthy lifestyle. We don't think that is the case," said Dr. Pamela Goodwin of Mount Sinai Hospital in Toronto, who led the study. - See Vitamin D may lower breast cancer risk for the full report.

Heavy drinking causes high blood pressure, stiff arteries and rigid heart muscles in men and enlarged hearts in women, boosting their risk of having heart attacks and strokes, researchers said on Wednesday.

They defined heavy drinking as more than 21 drinks a week for men and more than 14 per week for women.

"We definitely see quite a deleterious effect," said Dr. Azra Mahmud of St. James Hospital in Dublin, who presented her findings at a meeting of the American Society of Hypertension in New Orleans.

"The most worrisome aspect is in women. It has a direct toxic effect," Mahmud said in a telephone interview. "Basically, women are not able to cope with high alcohol consumption. It is going directly to the heart and damaging it."

Once a heart becomes enlarged -- a sign it has been overtaxed -- it is difficult to reverse. Mahmud said prior studies have suggested that people with enlarged hearts are five to six times more likely to have heart attacks. - See Too much alcohol damages heart and arteries for the full report.

Problems with maintaining an erection may foretell heart trouble ahead for men with type 2 diabetes, two new studies show.

A number of past studies have found a connection between erectile dysfunction (ED) and heart disease. But the new findings, published in the Journal of the American College of Cardiology, confirm that ED often precedes and predicts heart trouble.

This, say researchers, suggests that men with ED should be especially vigilant about controlling heart disease risk factors.

In one study, Italian researchers found that among 291 men with type 2 diabetes, those who also had ED had twice the risk of suffering a heart attack, stroke or other cardiovascular complication over the next four years.

At the start of the study, all of the men had had evidence of "silent" heart disease -- meaning they had plaque buildup in their arteries on imaging tests, but no heart disease symptoms, such as chest pain. Having ED seemed to pinpoint those men who were at particular risk of a complication.

There was some good news as well, however: Taking cholesterol-lowering statins appeared to reduce the risks associated with ED, according to the researchers, led by Dr. Carmine Gazzaruso of the Clinical Institute "Beato Matteo" in Vigevano, Italy. - See Erectile dysfunction predicts heart problems: study for the complete article.

Breast density, which is increasingly used as a marker of breast cancer risk, is associated with the use of multivitamins, a new study shows.

The report, published this month in The American Journal of Clinical Nutrition, raises questions about advice routinely given to women to take a multivitamin. However, because the study is not a randomized clinical trial, it’s not clear if multivitamin use contributes to a woman’s breast density. It may be that the type of woman who takes multivitamins is more likely to have other risks factors linked to dense breasts.

Breast density describes the relative amount of different tissues present in the breast. A dense breast has less fat than glandular and connective tissue. On a mammogram, a dense breast looks mostly white, whereas a fatty breast looks dark gray.

Numerous studies have shown that breast density is an important breast cancer risk factor, and women with extreme density may have a two- to six-fold increased risk of breast cancer. In addition to its role in breast cancer risk, breast density makes it difficult to identify cancer on a mammogram, potentially increasing the risk that cancer will be diagnosed at a later stage. - See Multivitamins Linked With Breast Density for the complete article.