Jewish World Review Jan. 18, 2002 / 5 Shevat, 5762
By Robert A. Wascher, M.D., F.A.C.S.
http://www.NewsAndOpinion.com --
This week's New England Journal of Medicine features a study of cognitive
and academic outcomes in 242 adult survivors of premature birth. The
average birth weight of these pre-term birth survivors was 1179 grams (2.6
pounds), and all were delivered following pregnancies averaging 29.7 weeks
in length. The pre-term birth survivors were compared with 233 young adults
of similar age and socioeconomic background, all of whom had normal birth
weights.
This study's findings add to previous research that has linked very low
birth weights to an elevated risk of cognitive and academic problems later
in life. As compared with the normal birth weight group, the very low birth
weight group graduated from high school less frequently, scored lower on
standardized IQ and academic achievement tests, had a higher rate of
neurosensory impairments, and were shorter in stature. Men in the pre-term
birth group-but not women-were also less likely to enroll in college. At
the same time, the pre-term birth group reported less alcohol and drug use,
and had lower rates of pregnancy than the full-term birth group.
The effects of premature birth are not fully understood at this time.
However, it has become reasonably clear that lifelong brain development can
be adversely affected in babies with extremely low birth weights. Such
babies are also at increased risk of developing brain hemorrhage and other
complications at birth that can adversely impact on brain function and
development, although this was not factored into this study's design or
analysis.
While there is an increased risk of long-term complications in
babies with very low birth weights, not all pre-term babies will experience
delayed cognitive development, decreased academic potential, or short
stature. Each child, whether born early or "on time," is a unique
individual, and has a unique potential for development and accomplishment.
However, very low birth weight babies may require careful monitoring and
assistance, as they grow, in order to aid them in attaining their maximum
cognitive and academic potential in life.
SMOKERS UNDER THE KNIFE
Complications following surgery occurred in 18% of the patients in the
tobacco abstinence group versus 52% of the patients in the group of active
smokers. The most striking reductions in surgical complications among the
tobacco-abstaining patients occurred in the categories of surgical wound and
cardiovascular complications.
The results of this study confirm, once again, the significant health
benefits that derive from even relatively short periods of tobacco
abstinence. Quite apart from the disastrous health effects of tobacco that
arise after many years of smoking (and chronic exposure to the more than
2,000 carcinogens and toxins discovered to date in tobacco smoke), the
inhalation of tobacco smoke acutely impairs heart and blood vessel function,
reduces lung capacity and blood oxygen levels, and increases the risk of
abnormal blood clotting in blood vessels throughout the body. Each of these
deleterious effects of tobacco is capable of causing serious complications
in patients undergoing surgery, and sometimes with fatal results.
ASPIRIN AND CARDIOVASCULAR HEALTH
The evidence to date suggests that aspirin can significantly
reduce the risk of heart attacks, particularly in patients with multiple
risk factors for heart disease (these include age 60, high total
cholesterol or LDL cholesterol levels, low levels of HDL cholesterol,
tobacco use, the presence of high blood pressure or diabetes, male gender,
and a family history of cardiovascular disease). At the same time, aspirin
is known to increase the risk of gastrointestinal bleeding and hemorrhagic
strokes, particularly in people who are older.
The optimum dose of aspiring for cardiovascular disease prevention is not
clear. However, it appears that as little as 75 mg of aspirin (a "baby
aspirin" has 81 mg of aspirin) per day provides cardiovascular benefits
comparable to a 325 mg adult aspirin tablet, while simultaneously reducing
the risk of aspirin-induced complications (it should be noted that even
"enterically-coated" aspirin tablets are known to cause these same
complications).
In reviewing all studies to date, the USPSTF found that the use of daily
aspirin reduced the risk of heart attack by about 28%. At the same time,
aspirin increased the risk of gastrointestinal bleeding and, to a much
lesser extent, the risk of hemorrhagic stroke (aspirin's beneficial effect
on cardiovascular health is thought to be primarily due to its anti-clotting
action on the blood).
Based upon this analysis, if one looks at 1,000
patients known to be at increased risk of heart attack, the daily use of
aspirin over a five-year period would prevent 6 to 20 heart attacks, but
would also cause 2 to 4 major gastrointestinal hemorrhages and 0 to 2
hemorrhagic strokes. In patients with a lesser risk of heart attack,
aspirin's beneficial effects on heart attack risk decline, while the risk of
aspirin-induced complications remains the same.
With this in mind, the
USPSTF recommends that physicians carefully assess the cardiac disease risk
of their patients, as well as their susceptibility to aspirin's adverse side
effects, before recommending aspirin therapy. As it stands now, 1 or 2 baby
aspirin tablets per day appear to provide the same cardiovascular health
benefits as the 325 mg adult tablet, while somewhat reducing-but not
eliminating-the risks of gastrointestinal bleeding and, possibly,
hemorrhagic stroke. Bottom line: see your doctor before starting yourself
on daily aspirin
JWR contributor Dr. Robert A. Wascher is a senior research fellow in molecular & surgical oncology at
the John Wayne Cancer Institute in Santa Monica, CA.
Comment by clicking here.
Lifelong effects of premature birth
As a surgeon, I am all too aware of the increased risk of complications that
occurs in smokers undergoing surgery. An interesting study from Denmark in
this week's Lancet looks at the impact of temporary smoking cessation on
patients about to undergo hip or knee replacement surgery. Fifty-six
patients agreed to quit smoking 6-8 weeks before surgery, and 52 active
smokers volunteered to serve as controls in the study. The smoking
cessation group received counseling and nicotine supplements, and was
required to either abstain from smoking, or to reduce cigarette consumption
by at least 50%.
Over one million American will experience a new or recurrent heart attack
this year. The current issue of the Annals of Internal Medicine reviews the
impact of aspirin on the development of heart disease and heart attack,
based upon the recent findings of the U.S. Preventive Services Task Force
(USPSTF).
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