Generic Levitra (Vardenafil)

Medicines used to treat Parkinson’s disease may increase the risk of impulse control disorders, such as problem gambling, compulsive shopping and binge eating, researchers warn.

In a new study that included 3,090 patients being treated for Parkinson’s at 46 movement disorder centers in the United States and Canada, the researchers found that 13.6 percent of the patients had impulse control disorders. These impulse disorders included gambling (5 percent), compulsive sexual behavior (3.5 percent), compulsive shopping (5.7 percent) and binge eating (4.3 percent), and nearly 4 percent of the patients had two or more of these disorders.

Impulse control disorders were more common among patients taking dopamine agonist medications (17.1 percent) than in those not taking the drugs (6.9 percent), the study authors found. Other factors associated with impulse control disorders were: use of levodopa (another treatment for Parkinson’s); living in the United States; being younger or unmarried; smoking cigarettes; and having a family history of gambling problems.

“Dopamine agonist treatment in Parkinson’s disease is associated with 2- to 3.5-fold increased odds of having an impulse control disorder,” wrote Dr. Daniel Weintraub, of the University of Pennsylvania, Philadelphia, and Philadelphia VA Medical Center, and colleagues. “This association represents a drug class relationship across impulse control disorders. The association of other demographic and clinical variables with impulse control disorders suggests a complex relationship that requires additional investigation to optimize prevention and treatment strategies.”

The researchers noted that dopamine agonists are increasingly being used to treat other conditions, such as fibromyalgia and restless legs syndrome.

“Larger . . . studies in these other populations are needed to examine the possible relationships between dopamine agonist treatment, other clinical features and impulse control disorders,” the authors concluded.

The study is published in the May issue of the journal Archives of Neurology.

SOURCE: JAMA/Archives journals, news release.

People who’ve had a stent implanted to keep a coronary artery open face an increased risk for heart complications and death if they have non-cardiac surgery in subsequent weeks, a new Scottish study has found.

“We looked at the risks connected to four and six weeks after surgery,” said study author Nicholas L.M. Cruden, a former cardiology lecturer at the University of Edinburgh and now a consultant for the National Health Service in Scotland. “Most of the risk was in the first six weeks. Between six weeks and one year, the risk was somewhat reduced, but still higher than expected.”

The study, published online May 4 in Circulation: Cardiovascular Interventions, found that 42 percent of people undergoing non-cardiac surgery within six weeks of stent implantation were more likely to have such complications as decreased blood flow to the heart and heart attacks or to die. These outcomes were found in just 13 percent of those whose surgery was done more than six weeks after stent implantation.

The risk of heart problems after non-cardiac surgery was even greater for the 65 percent of people whose stents were inserted because of a recent heart attack, compared with those had stable but chronic heart disease when they were given stents, the study found.

There are no formal British guidelines about surgery after stent implantation, Cruden said, but in France, he said, guidelines recommend that such surgery be postponed at least for a year.

Guidelines issued by the American Heart Association and other organizations in the United States recommend delaying surgery for at least a year after a stent implant, said Dr. Charles W. Hogue Jr., associate professor of anesthesiology at Johns Hopkins University School of Medicine.

The pros and cons of using clot-preventing drugs such as Plavix after stent implants have been debated for years, Hogue said. “The guidelines set antiplatelet therapy for a year or maybe indefinitely,” he said. “If you stop, you run the risk of stenosis [artery blockage]. But what happens if you have a tendency to bleed? That can cause all kinds of problems, particularly for the brain or the eye.”

Use of clot-preventing medication has to be decided patient by patient, Hogue said. “You have to judge risk vs. benefit on an individual basis,” he said. “This is a big public health issue because a lot of stents are being implanted.”

About 1.3 million artery-opening procedures are performed annually in the United States, Hogue said.

The Scottish study is the largest done to date on the effects of surgery after stent implants, Cruden said. The study shows a 50 percent increase in the risk for bleeding in such cases but no impact on surgical mortality, he said.

SOURCES: Nicholas L. M. Cruden, Ph.D., consultant, National Health Service, Glasgow, Scotland; Charles W. Hogue Jr., M.D., associate professor, anesthesiology, Johns Hopkins University School of Medicine, Baltimore;

Poor people are more likely to die within five to 10 years after heart surgery than more affluent people, U.S. researchers report.

They followed 15,156 white men, 6,932 white women, 678 black men and 564 black women who had heart bypass or valve surgery between 1995 and 2005 and found that the poorest patients were 19 to 26 percent more likely to die within five years of surgery than the wealthiest patients, regardless of race or gender.

“We were surprised that consistently and pervasively, through every way of looking at the data, it turns out this isn’t about skin color or gender. It’s about being poor,” study author Colleen G. Koch, a cardiac anesthesiologist and vice chair for research and education in the department of cardiothoracic anesthesia at the Cleveland Clinic, said in a news release.

However, the researchers did find that poor patients were significantly more likely to be black and female.

Koch and colleagues also found that poorer patients had more atherosclerosis, serious cardiovascular disease, prior heart attacks, left ventricular dysfunction, heart failure, high blood pressure, prior stroke, peripheral artery disease, treated diabetes, and chronic obstructive pulmonary disease. They were also more likely to be smokers.

The study appears in the current issue of the journal Circulation: Cardiovascular Quality and Outcomes.

Poorer patients didn’t have a significantly higher death rate while in hospital immediately after surgery. Factors such as financial problems, educational barriers, and lack of referrals to cardiac rehabilitation programs may contribute to increased risk of death among poor patients in the years after heart surgery, Koch said.

Their survival rates might increase through improved access to primary prevention, earlier identification of risk factors, better access to long-term interventions, and enrollment in cardiac rehab programs, Koch said. Cardiac rehab typically includes monitored exercise, nutritional counseling, emotional support, and education.