Issue Date: March 7, 2004

In this article: Cholesterol zapper Regenerating heart muscles Sparking sex lives Relief for Alzheimer's patients Diabetes buster Pre-emptive strike against RA Understanding depression's effect on disease Painless skin cancer diagnosis Beefing up bones Sight-saving telescope Dr. Tedd's advice By the numbers: Statistics on aging Resources: More information

A SPECIAL REPORT FROM USA WEEKEND AND "AARP THE MAGAZINE"

Good news about bad things that happen to your parents

10 exciting new developments to help Mom and Dad live longer, healthier lives.

Cholesterol zapper

All through 2004, USA WEEKEND brings you today's most compelling health reporting, through partnerships with America's finest magazines. This week, we collaborate with AARP THE MAGAZINE, the No. 1 publication aimed at people 50 and over, for this must-read report on looking out for your parents' well-being. Next up: our special issue with Men's Health, later this spring.

Scientists have yet to develop self-cleaning arteries, but they may have found the next best thing: a synthetic form of HDL (the body's "good" cholesterol) that can melt away fatty plaque. The unclog-your-arteries tests occurred at the Cleveland Clinic, where cardiologist Steven Nissen, M.D., gave patients five weekly HDL injections, then measured their plaque deposits in the sixth week. "I was quite skeptical," Nissen says. "But what we saw was that plaque had actually been removed from arteries."

Even better, the HDL seemed to seek out the worst deposits. "It's the Holy Grail of heart disease treatment to go beyond slowing its progress to actually reversing it," he says.

Nissen knows large-scale studies are needed to confirm the results, but with luck, he predicts, the therapy could be available within three or four years. Not crazy about injections? No problem: Scientists are testing an oral HDL raiser, too.

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Regenerating heart muscles
Had a major heart attack? In the not-too-distant future, doctors may be able to use stem cells to regenerate damaged heart muscle. And here's the exciting part: They can do it using stem cells that aren't extracted from human embryos.

Stem cells are the body's cellular repair team, replenishing other cells and making new ones. Embryonic stem cells have two main benefits over adult stem cells: They can reproduce indefinitely, and they can turn into any type of cell. But given the controversy over harvesting cells from embryos, doctors have been exploring other possibilities. The payoff: A team from the University of Texas M.D. Anderson Cancer Center in Houston recently repaired heart muscles in animals by injecting them with stem cells extracted from human blood. It's the stem-cell equivalent of Columbus reaching America: Not only would cells harvested from one's own body eliminate the risk that they would be rejected, but obtaining them would be a simple, painless proposition.

"This work gives us a way to get the cells that's as easy as giving a blood sample," says Edward Yeh, M.D., lead author of the study. The real mind boggler is what the stem cells might mean to the 1.2 million Americans who suffer heart attacks each year. "Stem cells won't necessarily repair all the damage from a heart attack," Yeh says, "but our evidence shows that they can regenerate muscle."

Yeh is currently designing studies to test blood-harvested stem cells on heart patients, but the Food and Drug Administration has not determined whether to let stem cells be implanted in human hearts. The FDA is concerned that tissue generated by stem cells could run amok and cause serious complications, such as heart arrhythmias. With similar work progressing in other nations, Yeh remains optimistic. As for the FDA, an advisory committee will meet later this month to discuss possible clinical trials for cellular cardiac disease therapies.

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Sparking sex lives
Since 1998, doctors have written an astounding 177 million prescriptions for the little blue pill known as Viagra. But now the king of the pharmacy has some major competition: Levitra and Cialis. Although comparable in effectiveness and side effects, the newcomers tout at least one appealing advantage: more staying power. Levitra lasts up to 24 hours; Cialis, up to 36 (hence its nickname, "the weekender").

But a huge potential customer base in the sex-drug wars goes largely untapped: the estimated 43% of women with sexual dysfunction. One solution may be -- surprise -- Viagra. A 2002 study found the drug increased sensation and sexual enjoyment in some postmenopausal women, although it did little for women with lowered sexual desire. "In impotent men, the problem is usually that they want to have sex, but can't," says Irwin Goldstein, M.D., director of the Boston University School of Medicine's Institute for Sexual Medicine. "With women, we find a different issue: They lack the desire for sex."

Understanding female sexual desire is more complicated than understanding male physiology. For now, treatment focuses on addressing psychological causes and correcting imbalances in both female hormones -- via drugs and topical estrogen creams -- and male hormones. In fact, the treatment with the most potential for women may be testosterone; Goldstein found that three out of four women he treats for lack of desire have shortages of male hormones. The first step is more research, but eventually women may have as many sex-boosting options as men have.

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Relief for Alzheimer's patients
For the first time, there's a drug that attacks Alzheimer's disease not just early on, but in its ravenous late stages as well. Memantine, the first of a new class of drugs, targets a neurotransmitter called glutamate that, in high amounts, appears to damage and kill brain cells. Alzheimer's patients who've taken the drug show significant improvement in brainpower (including memory), daily living (dressing, talking on the phone) and behavior (a reduction in delusions, hallucinations and agitation).

"Basically, it stabilizes or improves symptoms," says Martin Farlow, M.D., professor of neurology at Indiana University School of Medicine. "For patients, that translates into a longer period of time they can stay at home, in the care of their families. And for families, it means their loved ones are more like themselves again."

How much time memantine buys is unclear. Current data suggest the most marked improvements persist over a year, although Farlow believes that benefits may be seen for two to three years.

That time could prove valuable. Researchers are working plenty of other angles to help Alzheimer's patients, from developing drugs to reduce plaque-forming protein in Alzheimer's-affected brains to using well-known weapons in new ways, such as anti-inflammatory drugs (ibuprofen, aspirin), statins and even vitamin E. Other experts are working to refine an Alzheimer's vaccine (an early attempt at making one failed).

"Patients are clearly benefiting from what we've learned in 10 short years," Farlow says. "I think that well within the next 10, we'll move Alzheimer's into the realm of highly treatable diseases."

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Diabetes buster
Insulin is the cellular equivalent of a nagging mother: Just as Mom ordered you to eat your veggies, insulin instructs fat and muscle cells to use glucose, one of their primary sources of fuel. But for the 17 million Americans with type 2 diabetes, there's a problem: Either the body doesn't produce enough of the insulin hormone, or the cells simply ignore it. Both scenarios can cause a buildup of glucose in the blood, and at high levels it acts almost like a poison, damaging the heart, kidneys, blood vessels and nerves.

"In people with type 2 diabetes, we often find a paradox," says Harvey Lodish, a member of the Whitehead Institute for Biomedical Research in Cambridge, Mass. "They have plenty of insulin, but they still have high blood sugar. Our goal is to find out why the insulin isn't doing its job." One possible clue: a newly identified protein called TUG, which acts like a microscopic puppeteer, controlling the movement of other proteins that carry glucose into cells. A drug that acts on TUG might enhance the ability of insulin to do its job, says Yale University researcher Jonathan Bogan, M.D. His team also hopes TUG will lead them to other proteins, to help them develop new, more effective diabetes treatments.

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Pre-emptive strike against RA
For anyone who has suffered the debilitating pain of rheumatoid arthritis (RA), a vaccine for this autoimmune disease, which causes the immune system to launch an attack on joint linings, is a potential dream treatment. University of Tennessee researchers think the instigator may be collagen, the primary supportive protein in joints. More specifically, it's collagen gone bad: an altered form of the protein that the immune system thinks is a foreign invader.

Although a human vaccine is still years away, early results are encouraging: Researchers have reduced both the onset and severity of RA in mice by injecting them with a synthetic collagen vaccine. Meanwhile, the best new bet is a test that could let doctors identify and treat RA years before the disease can cause damage. Researchers found that subjects with RA had significantly elevated blood levels of a particular antibody up to nine years before symptoms developed. By screening for the antibody (as easy as checking a blood sample), doctors could check patients periodically and start treatment before problems begin. "It's not hard to envision the day when we could find the patients who are poised to develop RA," says John H. Klippel, M.D., president and CEO of the Arthritis Foundation, "and put their disease into remission before it's done any damage."

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Understanding depression's effect on disease

Depression magnifies other health problems. But 80% of clinically depressed people can be successfully treated with drugs, therapy or a combination.

Depression isn't just about emotions: Doctors are gaining a new understanding of how it magnifies major health concerns. That includes increased rates of bone loss and hip fractures; poorer control of blood pressure; increased risk of type 2 diabetes; and higher incidence of and death rates from stroke, heart attacks and cancer. Using this knowledge, doctors are finding that aggressively treating depression can be good medicine. University of Iowa researchers found that depressed patients who received antidepressants for three months after a stroke were twice as likely to be alive seven years later than patients who did not receive treatment. A recent study published in the Journal of the American Medical Association found that treating elderly patients for depression eased their arthritis symptoms as well.

"Many people assume that depression is a normal part of aging. That's simply not true," says Joel Streim, M.D., president of the American Association for Geriatric Psychiatry. Yes, aging can present challenges that lead to downshifts in mood, from changes in living situations to physical disabilities to the loss of loved ones. But symptoms such as persistent sadness, changes in sleep patterns or appetite, flagging concentration, anxiety and irritability are all red flags in older people.

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Painless skin cancer diagnosis
Skin cancer is America's most common cancer, but it doesn't have to be. Dermatologists estimate that up to 80% of cases can be prevented through sun-safe strategies (like wearing sunscreen and limiting exposure to intense rays between 10 a.m. and 4 p.m.). Older Americans, who didn't get the SPF message until late in life, are especially vulnerable: In the past 30 years, death rates for melanoma, the most serious skin cancer, have risen by more than 50% in women over 65 and a whopping 157% in men over 65.

Here's the ray of hope: If caught early, 95% of melanoma cases can be cured. And now an emerging technology may help doctors catch melanoma before it kills. One of the prototypes is a device called MelaFind. It's a hand-held probe (don't worry -- it's painless) that captures images of a suspicious mole or skin spot, then transmits them to a computer that analyzes the cell's physical changes. In clinical studies, the machine has had more success than human experts in identifying melanoma. And because it can measure the depth of a malignancy, its use could simplify treatments.

"It's conceivable MelaFind could find a melanoma, and if it is localized in the epidermis, the physician could safely remove it in a single visit," says Marek Elbaum, who helped develop the device and is a founder of Electro-Optical Sciences, the company that hopes to bring it to market. Similar devices are being developed in Europe and Australia, although MelaFind may be the first to hit the U.S. market: Its makers hope to submit the necessary data for FDA approval within six months.

What about people whose melanoma already has reached a life-threatening stage? Researchers at Penn State's Milton S. Hershey Medical Center have identified a gene called PTEN that may play a role in up to 60% of malignant melanomas. Animal experiments have shown that by inserting a chromosome containing PTEN from healthy cells into melanoma cells, they can temporarily stop tumors' spread.

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Beefing up bones
Although science has given those with osteoporosis a second chance with new drugs (Fosamax, Actonel, Evista, Miacalcin), these drugs aren't enough for those who suffer most from the disease: patients who have lost so much bone mass that saving what they have isn't sufficient to fight fractures and disability. "For patients with severe osteoporosis, the goal has always been to go beyond preserving bone and give them back some of what they've lost," says Ethel Siris, M.D., a professor at Columbia University. Forteo, a drug rolled out in 2003, gives doctors the first way to do just that. "Forteo talks to cells that form bone, telling them to move along faster and do their job better," Siris says.

Apparently, the cells listen: Clinical trials found that women who took Forteo after suffering at least one vertebral fracture saw a 65% decline in spine-fracture risk and a 53% drop in non-spine fracture risk over 19 months. "The fact that thousands of women have discontinued estrogen therapy [hormone replacement therapy] means they're now at heightened bone-loss risk," Siris says. Researchers are seeking a way around the HRT obstacle. Scientists at the University of Arkansas for Medical Sciences are using animal models to test a new class of synthetic compounds called ANGELS (activators of non-genomic estrogen-like signaling) and recently found that one in particular, estren, preserved bone mass in much the same way as the body's natural hormones, without the serious side effects associated with HRT. But for now, if Mom has gone off HRT, a bone density test is a vital first step.

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Sight-saving telescope
If a telescope surgically implanted in your eye sounds like some astronomer's weird fantasy, guess again. It's a new treatment for age-related macular degeneration (AMD), the leading cause of vision loss among people over age 55. The most devastating form, called wet AMD, occurs when abnormal blood vessels grow beneath the retina, sabotaging central vision -- the kind that controls the ability to read, drive, recognize faces and see fine details. Eventually, scars build up and cause holes in your field of vision. The brightest hope for help is that tiny telescope: two high-powered lenses in a glass cylinder implanted behind the iris. In the straightforward 45-minute procedure, the telescope is put into one eye, which is used for central vision; the other eye remains as is and is used for peripheral vision.

No quick LASIK-type fix here: Learning to see with it takes three to six months, but in initial studies 77% of patients had enough improvement in vision to let them complete tasks such as reading a menu and balancing a checkbook. Clinical trials underway at 28 research centers nationwide could lead to FDA approval within the next two years.

The implant isn't the only AMD advancement in the works. New drug treatments include the already approved Visudyne, which can destroy the unwanted blood vessels that cause AMD. Two others -- Macugen and Lucentis -- may be ready by 2005.

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BY THE NUMBERS

• Time you need to walk each week to reduce your risk of diabetes: 2.5 hours.
• Number of Americans with diagnosed diabetes: 13 million. Undiagnosed cases (estimated): 5.2 million.
• Number of Americans with arthritis: 70 million. In 1985: 35 million.
• Percentage of medical schools that offer a course in pain management: 7.
• Annual national cost of caring for people with Alzheimer's disease: $100 billion.
• Percentage of men in their 50s who have sex at least once a week: 33. Percentage of women: 17.
• Among women ages 40 to 69 who date, percentage who are dating a younger man: 34.
• Calories burned per minute during a passionate kiss: 6.4.
• Number of Americans with macular degeneration: 10 million. Foods that may delay or reduce the severity of age-related macular degeneration: fruits and dark green leafy vegetables.
• How often older Americans should have their cholesterol tested: once every 5 years.
• Number of women with osteoporosis: 8 million. Number of men: 2 million.
• Days it takes to cut your risk of a heart attack once you quit smoking: 1.
• Top killer of U.S. women: heart disease. Percentage of women who believe it's their top health risk: 10 to 15.
• Percentage of melanoma cases that can be cured if caught early: 95.

For the sources of information in this chart, visit usaweekend.com.

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FOR MORE INFORMATION

Alzheimer's Association
225 N. Michigan Ave., Suite 1700
Chicago, Ill. 60601
800-272-3900
www.alz.org

American Foundation for Urologic Disease
1000 Corporate Blvd., Suite 410
Linthicum, Md. 21090
800-828-7866
afud.org

National Osteoporosis Foundation
1232 22nd St. N.W.
Washington, D.C. 20037
nof.org

Macular Degeneration Partnership
8733 Beverly Blvd., Suite 201
Los Angeles, Calif. 90048
888-430-9898
amd.org

Skin Cancer Foundation
245 Fifth Ave., Suite 1403
New York, N.Y. 10016
800-754-6490
skincancer.org

Arthritis Foundation
P.O. Box 7669
Atlanta, Ga. 30357
800-283-7800
arthritis.org

American Diabetes Association
1701 N. Beauregard St.
Alexandria, Va. 22311
800-342-2383
http://www.diabetes.org/home.jsp

American Association for Geriatric Psychiatry
7910 Woodmont Ave., Suite 1050
Bethesda, Md. 20814
aagponline.org

American Heart Association
7272 Greenville Ave.
Dallas, Texas 75231
americanheart.org

Association of American Medical Colleges
http://www.aamc.org/
National Heart, Lung and Blood Institute
http://www.nhlbi.nih.gov/
American Macular Degeneration Foundation
http://www.macular.org/
Schepens Eye Research Institute
http://www.eri.harvard.edu/
National Osteoporosis Foundation
http://www.nof.org/
American Lung Association
http://www.lungusa.org/
Alzheimer's Association
http://www.alz.org/
Journal of the American Medical Association
http://jama.ama-assn.org
Kinsey Institute
http://kinseyinstitute.org or http://www.indiana.edu/~kinsey/

The editorial content of this special report was produced by a team of AARP THE MAGAZINE editors at the invitation of USA WEEKEND. AARP THE MAGAZINE and AARP are not responsible for the advertising in this magazine. To subscribe to AARP THE MAGAZINE and become a member of AARP, call 888-687-2277 or visit aarp.org.