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RAND study finds women with heart disease and diabetes less likely to receive proper care

Women with heart disease and diabetes are less likely to receive several types of routine outpatient medical care than men who have similar health problems, according to a RAND Corporation study issued today.While previous research has shown that women less frequently receive expensive medical care such as angioplasty for heart disease, few studies have evaluated gender disparities in managed care settings.

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1. Advance in understanding of blood pressure gene could lead to new treatments
   02-04-2007 · EurekAlert!
   Research by scientists at UCL (University College London) has clearly demonstrated for the first time the structure and function of a gene crucial to the regulation of blood pressure. The discovery could be important in the search for new treatments for illnesses such as heart disease, the UK's biggest killer. In a paper published online today in Nature Medicine, the team, led by Professor Patrick Vallance and Dr James Leiper, UCL Department of Medicine, reveal the role of the human gene dimethylarginine dimethylaminohydrolase (DDAH), showing that loss of DDAH activity disrupts nitric oxide (NO) production. NO is critical in the regulation of blood pressure, nervous system functions and the immune system. The role of DDAH is to break down modified amino acids (Asymmetric dimethylarginine (ADMA) and monomethyl arginine (L-NMMA)) that are produced by the body and have been shown to inhibit NO synthase. These molecules accumulate in various disease states including diabetes, renal failure and pulmonary and systemic hypertension, and their concentration in plasma (the fluid component of blood) is strongly predicative of cardiovascular disease and death. In a healthy human body, the majority of ADMA is eliminated through active metabolism by DDAH. Scientists have hypothesised that if DDAH function is impaired, NO production is reduced, and that this could be an important feature of increased cardiovascular risk. To examine this pathway in more detail, the researchers deleted the DDAH gene in mice. These mice went on to develop hypertension, or high blood pressure. They also designed specific inhibitors (small molecules) which bind to the active site of human DDAH. These small molecule inhibitors also induced hypertension in mice, confirming the importance of DDAH in the regulation of blood pressure. Dr Leiper, UCL Medicine, said: “These genetic and chemical approaches to disrupt DDAH showed remarkably consistent results, and provide compelling evidence that loss of DDAH function increases the concentration of ADMA and thereby disrupts vascular NO signalling. “There has been considerable scientific interest in this pathway and the role of ADMA as a novel risk factor, but so far there's been little evidence to support the idea that it's a cause of disease, rather than just a marker. Genes and their pathways are crucial to our understanding of cardiovascular disease and a better understanding of DDAH-1 could lead to important new treatments. “It could help us to establish if genetic variation predisposes certain people to these diseases, or whether environmental factors exert some of their effects through modulation of DDAH activity. “Our research also shows that this pathway could be harnessed therapeutically to limit production of NO in certain situations where too much nitric oxide is a bad thing; for example, hypotension and septic shock. These are some of the biggest problems in intensive care medicine and there is a huge unmet need for drug treatments.” The study, which was carried out at UCL's Rayne Institute, was funded by grants from the British Heart Foundation, the Wellcome Trust and the Medical Research Council. Professor Jeremy Pearson, Associate Medical Director of the British Heart Foundation, said: "The unexpected finding in the 1980s that a simple gas, nitric oxide (NO), is made by cells in the blood vessel wall and is a powerful control of blood vessel relaxation led to the award of the Nobel Prize in 1998 to its discoverers. "More recently, there has been increasing evidence that impairment of NO production is likely to be an important factor in the development of heart and circulatory disease, but the mechanisms responsible are not fully understood. "This study suggests for the first time that the loss of the activity of the enzyme DDAH-1 leads to reduced NO production and may cause heart and circulatory disease. These findings are likely to be important in the search for new ways to optimise the health of our blood vessels." ### Notes for Editors 1. For more information, please contact Ruth Metcalfe in the UCL Media Relations Office on tel: +44 (0)20 7679 9739, mobile: +44 (0)7990 675 947, out of hours: +44 (0)7917 271 364, e-mail: r.metcalfe@ucl.ac.uk2. 'Disruption of methylarginine metabolism impairs vascular homeostasis' is published in the February issue of the journal Nature Medicine. Advance online publication is embargoed to 18.00 GMT (13.00 US Eastern) Sunday 4 February 2007. Journalists can obtain copies of the paper by contacting the UCL Media Relations Office.3. The study was funded by the British Heart Foundation, the Wellcome Trust and the Medical Research Council. About UCL Founded in 1826, UCL was the first English university established after Oxford and Cambridge, the first to admit students regardless of race, class, religion or gender, and the first to provide systematic teaching of law, architecture and medicine. In the government's most recent Research Assessment Exercise, 59 UCL departments achieved top ratings of 5* and 5, indicating research quality of international excellence. UCL is the fourth-ranked UK university in the 2006 league table of the top 500 world universities produced by the Shanghai Jiao Tong University. UCL alumni include Mahatma Gandhi (Laws 1889, Indian political and spiritual leader); Jonathan Dimbleby (Philosophy 1969, writer and television presenter); Junichiro Koizumi (Economics 1969, Prime Minister of Japan); Lord Woolf (Laws 1954, Lord Chief Justice of England & Wales); Alexander Graham Bell (Phonetics 1860s, inventor of the telephone), and members of the band Coldplay.
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2. Screening for abdominal aortic aneurysms in women may save lives
   11-09-2007 · EurekAlert!
   In nine out of 10 cases, a burst abdominal aortic artery is quickly fatal for its most common victim: elderly males. A new study -- the largest yet performed -- now confirms that women over 65 with a history of smoking or heart disease are also at high risk for an abdominal aortic aneurysm -- supporting the notion that they should also receive ultrasound screening to help spot and correct the dangerous condition.
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3. Counseling for spouses keeps Alzheimer's patients out of nursing homes
   11-13-2006 · EurekAlert!
   Spouses of Alzheimer's disease patients are less likely to put their loved ones in a nursing home if they receive enhanced caregiver support and counseling. Researchers say their findings could potentially save millions of dollars in nursing home care costs, according to a study published in the Nov. 14, 2006, issue of Neurology, the scientific journal of the American Academy of Neurology.
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4. Women with high or increasing blood pressure are up to three times more likely to develop diabetes
   10-09-2007 · EurekAlert!
   One of the largest studies to investigate the relationship between blood pressure and type 2 diabetes has found that women who have high blood pressure levels are three times more likely to develop diabetes than women with low blood pressure levels. This effect was independent of body mass index and other conditions that are known to predispose people to cardiovascular disease and diabetes, researchers report in the European Heart Journal.
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5. RAND study finds asthma and lung disease patients receive half of recommended medical care
   11-13-2006 · EurekAlert!
   Patients around the United States with obstructive lung diseases receive half of the recommended medical care, with care varying based on individual conditions, according to a RAND Corp. study issued today.RAND estimates that increasing the number of chronic obstructive pulmonary disease patients who receive oxygen treatment at home could prevent 27,000 to 57,000 deaths annually and increasing the number of hospitalized asthmatic patients who receive systematic steroids could prevent nearly 2,000 deaths each year.
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6. Study finds women less likely than men to have their cholesterol controlled
   05-15-2007 · EurekAlert!
   Women are significantly less likely than men to have their LDL cholesterol controlled to recommended levels, according to a new study by the National Committee for Quality Assurance (NCQA). The study, to be published in the May/June edition of Women’s Health Issues, investigated gender differences in cardiovascular disease prevention, treatment and risk factors based on national health care quality data from commercial and Medicare managed care plans.
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7. Elderly Medicare, Medicaid patients not receiving quality care
   10-16-2007 · EurekAlert!
   Using quality-of-care measurements developed by the Assessing Care of Vulnerable Elders project, UCLA researchers found that vulnerable elderly patients received only 65 percent of the tests and other diagnostic evaluations and treatments recommended for a variety of illnesses and conditions, including diabetes and heart disease. The study findings appear in the October issue of the peer-reviewed journal Medical Care.
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8. Medical management of another condition may not lead to early cancer diagnosis
   06-02-2007 · EurekAlert!
   Being in regular contact with healthcare providers because of a chronic illness such as diabetes or heart disease doesn't necessarily mean a person is more likely to have a cancer detected early, according to a study led by Duke University Comprehensive Cancer Center researchers.
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9. Older blacks and Latinos still lag whites in controlling diabetes
   09-24-2007 · EurekAlert!
   Despite decades of advances in diabetes care, African-Americans and Latinos are still far less likely than whites to have their blood sugar under control, even with the help of medications, a new national study finds. That puts them at a much higher risk of blindness, heart attack, kidney failure and other long-term diabetes complications. But the study also suggests opportunities to decrease the disparities.
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10. Yearly mammograms protect breast cancer survivors
    07-20-2007 · EurekAlert!
    Older women with breast cancer often receive less care than do younger ones. Now a study in the July 20, 2007 Journal of Clinical Oncology shows older women who get yearly mammograms after treatment of early-stage breast cancer are less likely to die from breast cancer. Researchers examined five years of follow-up on 2,000 patients age 65 and older with early-stage breast cancer at six systems in the Cancer Research Network, including Group Health.
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