Top Health Risks for Young Adults

Accidents Are the Leading Cause of Death; Long-Term Health Risks Include Smoking, Obesity, Inactivity

By Miranda Hitti
WebMD Health News

Reviewed By Louise Chang, MD

Feb. 18, 2009 -- Youth is often painted as a time of picture-perfect health, but that's not necessarily reality, a new CDC report shows.

The CDC today released its latest roundup of U.S. health statistics, with a special focus on young adults 18-29.

Highlights of the findings on young adults include:

• Top cause of death: Unintentional injuries, which killed about 40 per 100,000 young adults in 2005.
• Smoking: 29% of men and 21% of women 18-29 smoke cigarettes as of 2006.
• Obesity: 24% of young adults are obese, and 28% more are overweight but not obese as of 2005-2006. Obesity rates for young adults tripled between 1971-1974 and 2005-2006.
• Regular physical activity: Only 36% of young adults get regular physical activity in their spare time as of 2005-2006. That's better than the rate for older adults but below national goals.
• Strength training at least twice per week: Done by only 26% of young adults in 2005-2006.
• No health insurance: About a third of young adults 20-24 were uninsured in 2006.

The new CDC report, which is more than 600 pages long, isn't only about young adults. Here's a quick look at some of the health stats for the nation as a whole:

• Life expectancy is up. As the CDC first reported last year, life expectancy for babies born in 2006 is 78.1 years, a record high. Life expectancy is still lower for men than for women and for African-Americans than for whites, but those gaps are narrowing. And among 37 countries and territories that submitted life expectancy data in 2004, the U.S. ranked 23rd for men and 25th for women (Hong Kong was No. 1 for men and Japan was No. 1 for women.)
• Top causes of death: Deaths from heart disease, stroke, and cancer continue to drop but are still the nation's top three causes of death.
• Obesity: Still rising, but more slowly than in past decades. More than one-third of adults aged 20 and older are obese as of 2005-2006.
• Aging: People aged 75 and older made up 6% of the national population in 2006 and their ranks will double by 2050, the CDC predicts.

SOURCES: CDC: "Health, United States, 2008." News release, CDC.

©2009 WebMD, LLC. All Rights Reserved.

Heart Attack Care: Drugs vs. Stents

Analysis Shows Drugs After Heart Attack Are Effective and Reduce Costs

By Salynn Boyles
WebMD Health News

Reviewed By Elizabeth Klodas, MD, FACC

Feb. 18, 2009 -- Opening blocked arteries with balloon angioplasty and stents can save lives during a heart attack, but the invasive treatment offers little added value over heart drugs alone in patients first treated days and even weeks later.

Now a new analysis shows that avoiding stenting in stable late-presenting patients could result in a yearly savings of around $700 million in health care costs.

"What we have here is one of those cases where less is more," says researcher Daniel B. Mark, MD, MPH, of Duke University Medical Center.

Stents Most Useful Early

Clearing blocked arteries in the early stages of a heart attack can restore blood flow before heart muscle is permanently damaged.

But as many as a third of the roughly 1 million Americans who have heart attacks each year are treated more than 12 hours after their first symptoms appear, when heart damage is likely to have already occurred, Mark tells WebMD.

Clot-busting drugs are not an option when treatment is delayed, but bare metal or drug-coated metal stents were often implanted to prop open and clear blocked arteries in late-presenting patients, even when they had no angina (chest pain) or other physical symptoms.

In the Occluded Artery Trial (OAT), a major, federally funded study published two years ago, Mark and colleagues reported that late-presenting heart attack patients with blocked arteries had no better long-term outcomes when they were treated with balloon angioplasty and stents than when treated with drugs alone. These results led to major changes in the management of such patients by many cardiologists.

All of the patients enrolled in OAT were clinically stable with no chest pain, and all received appropriate medical treatment with drugs like aspirin, beta-blockers, ACE inhibitors, and statins.

Quality of Life and Treatment Costs

In a new report, published in the Feb. 19 issue of the New England Journal of Medicine, Mark and colleagues further analyzed the OAT data.

They examined quality-of-life measurements and treatment costs among the two treatment groups.

Quality of life was determined through standardized questionnaires administered either face-to-face or by telephone at enrollment and at 4, 12, and 24 months.

Four months after enrollment, the stent patients did report less chest pain and scored higher on quality-of-life assessments. But the differences were small and they had disappeared altogether within a year, Mark says.

"We saw no discernable differences in what patients said they were able to do or in any other major measure of quality of life and well-being," he says.

The average cost of hospital and physician care during the first 30 days of treatment was calculated to be $22,859 per patient treated with balloon angioplasty and stenting vs. $12,683 for the medical therapy group.

Over two years of treatment, medical costs among patients treated with angioplasty and stents were an average of $7,000 higher than patients who did not get angioplasty and stents.

It should be emphasized again that the patients enrolled in the OAT trial were all stable and without symptoms. Balloon angioplasty and stenting "does not appear beneficial for this highly selected group ... but that doesn't mean that patients who are very impaired or have poor quality of life and angina will not benefit," study researcher Judith S. Hochman, MD, of New York University School of Medicine, tells WebMD.

National Heart Lung and Blood Institute senior cardiologist George Sopko, MD, tells WebMD that the OAT trial highlights the importance of seeking treatment early when heart attack symptoms occur.

"When someone is having a heart attack, time is of the essence," he says. "We know that if we can reopen blocked arteries and provide adequate blood flow within the first hour or so the patient will usually have minimal damage."

SOURCES: Mark, D.B. New England Journal of Medicine, Feb. 19, 2009; manuscript received ahead of print. Daniel B. Mark, MD, MPH, director, Outcomes Research Group, Duke University Medical Center, Durham, N.C. Judith S. Hochman, MD, New York University School of Medicine. George Sopko, MD, MPH, senior cardiologist, National Heart Lung and Blood Institute.

©2009 WebMD, LLC. All Rights Reserved.

Smokers Have Rapid Aging Defect

By Daniel J. DeNoon
WebMD Health News

Reviewed By Louise Chang, MD

Feb. 6, 2009 -- Cigarette smoke causes the same cellular defect seen in people with Werner's syndrome -- a rare genetic disease that makes people age very fast.

Smoking speeds the aging process, causing smokers to die about 10 years before their time. Now researchers may have found a clue to this process, giving them unexpected new paths to treatment.

The clue comes from the observation that smokers aren't the only people who age too fast. In their 20s, people with a rare genetic disorder called Werner's syndrome get gray hair, thin skin, and hoarse voices.

They soon develop cataracts, diabetes, hardening of the arteries, and weak bones. In their 40s or 50s, they tend to die of heart disease and cancer.

Smokers also age prematurely and tend to die of heart disease and cancer. Might there be a link?

Yes, say University of Iowa researchers Toru Nyunoya, MD, and colleagues.

Werner's syndrome is caused by a mutation in a gene called WRN. The gene makes the WRN protein that protects and repairs DNA in every cell of the body.

Nyunoya and colleagues collected lung cells from smokers with emphysema. Sure enough, the cells had too little WRN protein. The smokers' WRN genes were normal, but something was keeping them from making enough WRN.

When the researchers cultured lung cells in the laboratory, they found that cigarette smoke extract decreased the cell's WRN production -- and made the cells age more quickly. Cells genetically engineered to make too much WRN were not as strongly affected by the smoke extract.

"Our study may support efforts to target Werner's syndrome protein for use in developing treatments for smoking-related conditions such as emphysema," Nyunoya said in a news release.

The findings appear in the Feb. 6 issue of the American Journal of Respiratory and Critical Care Medicine.

SOURCES: Nyunoya, T. American Journal of Respiratory and Critical Care Medicine, Feb. 6, 2009; vol 179: pp 279-287. News release, University of Iowa. News release, American Thoracic Society. National Library of Medicine Genetics Home Reference, "Werner Syndrome," accessed online Feb. 5, 2009.

©2009 WebMD, LLC. All Rights Reserved.