Giancarlo La Giorgia

TORONTO — Treating uterine fibroids may eventually be as simple as prescribing a pill, or zapping the benign growths with high-intensity focused ultrasound—two of several promising nonsurgical alternatives to the roughly 300,000 fibroid-related hysterectomies performed annually in the United States.

Hysterectomy “is the gold standard in fibroid treatment. … The problem is that it's a big operation, and the patient loses her uterus. For some women, that just is not an acceptable solution,” Dr. R. Torrance Andrews said in an interview after his presentation at the annual meeting of the Society of Interventional Radiology.

Uterine fibroids, or leiomyomas, may cause infertility or premature delivery and in rare cases may become malignant. They affect about 30% of reproductive-age women, most commonly between the ages of 35 and 45 years, and particularly African American women, whose incidence rate is up to nine times higher than that of white women.

Dr. Andrews, chief of vascular and interventional radiology at the University of Washington Medical Center, Seattle, discussed mainstream fibroid treatments such as hysterectomy, laparoscopic myomectomy, and uterine fibroid embolization (UFE), as well as emerging therapies like high-intensity focused ultrasound (HIFU), asoprisnil, and other methods.

In terms of recommending one treatment over the other, Dr. Andrews was frank: “I think it's a big mistake for interventional radiologists to tell patients authoritatively that they should have an embolization, instead of [a surgical] treatment. Similarly, unless a gynecologist is really well versed in embolization and patient selection, they should not tell patients that they are not embolization candidates. I think it needs to be a collaborative effort.”

HIFU is a form of highly focused acoustic energy, delivered transcutaneously (without puncturing the skin) via an array of ultrasound transistors onto a single point within the body measuring 3 mm by 8 mm—about the size of a grain of rice.

In MR-guided HIFU procedures (granted FDA approval in 2004), the uterine region is scanned for fibroids and divided into planes at different depths. All visible fibroid cells at a given depth are individually ablated before moving onto the next plane, and the process is repeated until the entire volume is treated.

“The beauty of HIFU is that it's completely noninvasive. It's the 'Star Trek' of medical intervention … and is going to have a very important role to play, not just for fibroids, but for all kinds of tumors,” Dr. Andrews said.

Despite its vaunted potential, Dr. Andrews said he knows of only a handful of U.S. centers offering HIFU treatment, and he attributes the scarcity to cost—about $1.5 million per unit—and to poor results to date.

“The published data on HIFU are terrible. The success rates are bad, partly because a quarter or more of patients drop out before they complete their treatment” he said, noting that not all patients will want to go through three or more 3-hour sessions inside a noisy, cramped MRI machine.

He also argued that the FDA's strict restrictions during trials—that investigators could not treat any fibroid within a centimeter and a half of normal uterine tissue—was “a guarantee for failure,” and the main reason for the treatment's paltry 14% fibroid volume reduction.

His department at the University of Washington, which recently acquired an ultrasound-guided machine (“faster than MR, but not yet FDA-approved”) for clinical study, has chosen not to offer HIFU treatments until more data are available.

Dr. Andrews noted the buzz surrounding asoprisnil, a selective progesterone-receptor modulator that has been shown to significantly shrink fibroids and reduce their symptoms with minimal side effects during phase III trials. However, a new drug application, expected in late 2005, has not yet been filed with the FDA.

He also briefly discussed various thermal ablation techniques, developed mainly between 2000 and 2003. The basis of each is a transfer of energy—either laser, radiofrequency, microwave, or cryotherapy—through a percutaneous or transvaginal probe. They offer highly targeted delivery, but as with myomectomy, they only treat fibroids that can be seen. Interest in most of these techniques has largely faded away, Dr. Andrews said.

TORONTO — Treating uterine fibroids may eventually be as simple as prescribing a pill, or zapping the benign growths with high-intensity focused ultrasound—two of several promising nonsurgical alternatives to the roughly 300,000 fibroid-related hysterectomies performed annually in the United States.

Hysterectomy “is the gold standard in fibroid treatment. … The problem is that it's a big operation, and the patient loses her uterus. For some women, that just is not an acceptable solution,” Dr. R. Torrance Andrews said in an interview after his presentation at the annual meeting of the Society of Interventional Radiology.

Uterine fibroids, or leiomyomas, may cause infertility or premature delivery and in rare cases may become malignant. They affect about 30% of reproductive-age women, most commonly between the ages of 35 and 45 years, and particularly African American women, whose incidence rate is up to nine times higher than that of white women.

Dr. Andrews, chief of vascular and interventional radiology at the University of Washington Medical Center, Seattle, discussed mainstream fibroid treatments such as hysterectomy, laparoscopic myomectomy, and uterine fibroid embolization (UFE), as well as emerging therapies like high-intensity focused ultrasound (HIFU), asoprisnil, and other methods.

In terms of recommending one treatment over the other, Dr. Andrews was frank: “I think it's a big mistake for interventional radiologists to tell patients authoritatively that they should have an embolization, instead of [a surgical] treatment. Similarly, unless a gynecologist is really well versed in embolization and patient selection, they should not tell patients that they are not embolization candidates. I think it needs to be a collaborative effort.”

HIFU is a form of highly focused acoustic energy, delivered transcutaneously (without puncturing the skin) via an array of ultrasound transistors onto a single point within the body measuring 3 mm by 8 mm—about the size of a grain of rice.

In MR-guided HIFU procedures (granted FDA approval in 2004), the uterine region is scanned for fibroids and divided into planes at different depths. All visible fibroid cells at a given depth are individually ablated before moving onto the next plane, and the process is repeated until the entire volume is treated.

“The beauty of HIFU is that it's completely noninvasive. It's the 'Star Trek' of medical intervention … and is going to have a very important role to play, not just for fibroids, but for all kinds of tumors,” Dr. Andrews said.

Despite its vaunted potential, Dr. Andrews said he knows of only a handful of U.S. centers offering HIFU treatment, and he attributes the scarcity to cost—about $1.5 million per unit—and to poor results to date.

“The published data on HIFU are terrible. The success rates are bad, partly because a quarter or more of patients drop out before they complete their treatment” he said, noting that not all patients will want to go through three or more 3-hour sessions inside a noisy, cramped MRI machine.

He also argued that the FDA's strict restrictions during trials—that investigators could not treat any fibroid within a centimeter and a half of normal uterine tissue—was “a guarantee for failure,” and the main reason for the treatment's paltry 14% fibroid volume reduction.

His department at the University of Washington, which recently acquired an ultrasound-guided machine (“faster than MR, but not yet FDA-approved”) for clinical study, has chosen not to offer HIFU treatments until more data are available.

Dr. Andrews noted the buzz surrounding asoprisnil, a selective progesterone-receptor modulator that has been shown to significantly shrink fibroids and reduce their symptoms with minimal side effects during phase III trials. However, a new drug application, expected in late 2005, has not yet been filed with the FDA.

He also briefly discussed various thermal ablation techniques, developed mainly between 2000 and 2003. The basis of each is a transfer of energy—either laser, radiofrequency, microwave, or cryotherapy—through a percutaneous or transvaginal probe. They offer highly targeted delivery, but as with myomectomy, they only treat fibroids that can be seen. Interest in most of these techniques has largely faded away, Dr. Andrews said.

TORONTO — Treating uterine fibroids may eventually be as simple as prescribing a pill, or zapping the benign growths with high-intensity focused ultrasound—two of several promising nonsurgical alternatives to the roughly 300,000 fibroid-related hysterectomies performed annually in the United States.

Hysterectomy “is the gold standard in fibroid treatment. … The problem is that it's a big operation, and the patient loses her uterus. For some women, that just is not an acceptable solution,” Dr. R. Torrance Andrews said in an interview after his presentation at the annual meeting of the Society of Interventional Radiology.

Uterine fibroids, or leiomyomas, may cause infertility or premature delivery and in rare cases may become malignant. They affect about 30% of reproductive-age women, most commonly between the ages of 35 and 45 years, and particularly African American women, whose incidence rate is up to nine times higher than that of white women.

Dr. Andrews, chief of vascular and interventional radiology at the University of Washington Medical Center, Seattle, discussed mainstream fibroid treatments such as hysterectomy, laparoscopic myomectomy, and uterine fibroid embolization (UFE), as well as emerging therapies like high-intensity focused ultrasound (HIFU), asoprisnil, and other methods.

In terms of recommending one treatment over the other, Dr. Andrews was frank: “I think it's a big mistake for interventional radiologists to tell patients authoritatively that they should have an embolization, instead of [a surgical] treatment. Similarly, unless a gynecologist is really well versed in embolization and patient selection, they should not tell patients that they are not embolization candidates. I think it needs to be a collaborative effort.”

HIFU is a form of highly focused acoustic energy, delivered transcutaneously (without puncturing the skin) via an array of ultrasound transistors onto a single point within the body measuring 3 mm by 8 mm—about the size of a grain of rice.

In MR-guided HIFU procedures (granted FDA approval in 2004), the uterine region is scanned for fibroids and divided into planes at different depths. All visible fibroid cells at a given depth are individually ablated before moving onto the next plane, and the process is repeated until the entire volume is treated.

“The beauty of HIFU is that it's completely noninvasive. It's the 'Star Trek' of medical intervention … and is going to have a very important role to play, not just for fibroids, but for all kinds of tumors,” Dr. Andrews said.

Despite its vaunted potential, Dr. Andrews said he knows of only a handful of U.S. centers offering HIFU treatment, and he attributes the scarcity to cost—about $1.5 million per unit—and to poor results to date.

“The published data on HIFU are terrible. The success rates are bad, partly because a quarter or more of patients drop out before they complete their treatment” he said, noting that not all patients will want to go through three or more 3-hour sessions inside a noisy, cramped MRI machine.

He also argued that the FDA's strict restrictions during trials—that investigators could not treat any fibroid within a centimeter and a half of normal uterine tissue—was “a guarantee for failure,” and the main reason for the treatment's paltry 14% fibroid volume reduction.

His department at the University of Washington, which recently acquired an ultrasound-guided machine (“faster than MR, but not yet FDA-approved”) for clinical study, has chosen not to offer HIFU treatments until more data are available.

Dr. Andrews noted the buzz surrounding asoprisnil, a selective progesterone-receptor modulator that has been shown to significantly shrink fibroids and reduce their symptoms with minimal side effects during phase III trials. However, a new drug application, expected in late 2005, has not yet been filed with the FDA.

He also briefly discussed various thermal ablation techniques, developed mainly between 2000 and 2003. The basis of each is a transfer of energy—either laser, radiofrequency, microwave, or cryotherapy—through a percutaneous or transvaginal probe. They offer highly targeted delivery, but as with myomectomy, they only treat fibroids that can be seen. Interest in most of these techniques has largely faded away, Dr. Andrews said.

TORONTO — Treating uterine fibroids may eventually be as simple as prescribing a pill, or zapping the benign growths with high-intensity focused ultrasound—two of several promising nonsurgical alternatives to the roughly 300,000 fibroid-related hysterectomies performed annually in the United States.

“[Hysterectomy] is the gold standard in fibroid treatment. … The problem is that it's a big operation, and the patient loses her uterus. For some women, that just is not an acceptable solution,” said Dr. R. Torrance Andrews in an interview after his presentation at the annual meeting of the Society of Interventional Radiology.

Uterine fibroids, or leiomyomas, may cause infertility or premature delivery and in rare cases may become malignant. They affect about 30% of reproductive-age women, most commonly between the ages of 35 and 45 years, and particularly African American women, whose incidence rate is up to nine times higher than that of white women.

Dr. Andrews, chief of vascular and interventional radiology at the University of Washington Medical Center, Seattle, discussed mainstream fibroid treatments like hysterectomy, laparoscopic myomectomy, and uterine fibroid embolization (UFE), as well as emerging therapies like high-intensity focused ultrasound (HIFU), asoprisnil, and other methods.

In terms of recommending one treatment over the other, Dr. Andrews was frank: “I think it's a big mistake for interventional radiologists to tell patients authoritatively that they should have an embolization, instead of [a surgical] treatment.

“Similarly, unless a gynecologist is really well versed in embolization and patient selection, they should not tell patients that they are not embolization candidates. I think it needs to be a collaborative effort.”

After hysterectomy, myomectomy and UFE are the main recommended fibroid therapies, both with their own benefits and disadvantages.

Myomectomy is a targeted, surgical procedure that removes all visible fibroids and the symptoms they cause. However, recovery takes several weeks, and any abnormal tissue not seen during the procedure can grow back. Half of all myomectomy patients have fibroid recurrence within 5 years.

Fibroid embolotherapy offers more diffused, long-lasting treatment, with a recurrence rate of about 15% after 5–7 years. Patients typically experience painful cramps immediately after UFE and may have to wait for as long as 6 months for their fibroids to shrink enough to provide significant symptom relief.

Nevertheless, the outpatient procedure allows patients to return to their regular routine within a week after treatment.

HIFU was the next-generation therapy Dr. Andrews discussed at greatest length. It is a form of highly focused acoustic energy, delivered transcutaneously (without puncturing the skin) via an array of ultrasound transistors onto a single point within the body measuring 3 mm by 8 mm—about the size of a grain of rice.

In MR-guided HIFU procedures (granted FDA approval in 2004), the uterine region is scanned for fibroids and divided into planes at different depths.

All visible fibroid cells at a given depth are individually ablated before moving on to the next plane, and the process is repeated until the entire volume has been treated.

“The beauty of HIFU is that it's completely noninvasive. It's the 'Star Trek' of medical intervention … and is going to have a very important role to play, not just for fibroids, but for all kinds of tumors,” Dr. Andrews said.

Despite its vaunted potential, Dr. Andrews said he knows of only a handful of U.S. centers offering HIFU treatment, and he attributes the scarcity to cost—about $1.5 million per unit—and to poor results to date.

“The published data on HIFU are terrible. The success rates are bad, partly because a quarter or more of patients drop out before they complete their treatment” he said, noting that not all patients will want to go through three or more 3-hour sessions inside a noisy, cramped MRI machine.

He also argued that the FDA's strict restrictions during trials—that investigators could not treat any fibroid within a centimeter and a half of normal uterine tissue—was “a guarantee for failure,” and the main reason for the treatment's paltry 14% fibroid volume reduction.

His department at the University of Washington, which recently acquired an ultrasound-guided machine (“faster than MR, but not yet FDA-approved”) for clinical study, has chosen not to offer any HIFU treatments until more data become available.

Dr. Andrews noted the buzz surrounding asoprisnil, a selective progesterone-receptor modulator that has been shown to significantly shrink fibroids and reduce their symptoms with minimal side effects during phase III trials. However, a new drug application, expected in late 2005, has not yet been filed with the FDA.

He also briefly discussed various thermal ablation techniques, developed mainly between 2000 and 2003. The basis of each is a transfer of energy—either laser, radiofrequency, microwave, or cryotherapy—through a percutaneous or transvaginal probe. They offer highly targeted delivery, but as with myomectomy, they only treat fibroids that can be seen. Dr. Andrews pointed out that interest in most of these techniques has largely faded away.

TORONTO — Treating uterine fibroids may eventually be as simple as prescribing a pill, or zapping the benign growths with high-intensity focused ultrasound—two of several promising nonsurgical alternatives to the roughly 300,000 fibroid-related hysterectomies performed annually in the United States.

“[Hysterectomy] is the gold standard in fibroid treatment. … The problem is that it's a big operation, and the patient loses her uterus. For some women, that just is not an acceptable solution,” said Dr. R. Torrance Andrews in an interview after his presentation at the annual meeting of the Society of Interventional Radiology.

Uterine fibroids, or leiomyomas, may cause infertility or premature delivery and in rare cases may become malignant. They affect about 30% of reproductive-age women, most commonly between the ages of 35 and 45 years, and particularly African American women, whose incidence rate is up to nine times higher than that of white women.

Dr. Andrews, chief of vascular and interventional radiology at the University of Washington Medical Center, Seattle, discussed mainstream fibroid treatments like hysterectomy, laparoscopic myomectomy, and uterine fibroid embolization (UFE), as well as emerging therapies like high-intensity focused ultrasound (HIFU), asoprisnil, and other methods.

In terms of recommending one treatment over the other, Dr. Andrews was frank: “I think it's a big mistake for interventional radiologists to tell patients authoritatively that they should have an embolization, instead of [a surgical] treatment.

“Similarly, unless a gynecologist is really well versed in embolization and patient selection, they should not tell patients that they are not embolization candidates. I think it needs to be a collaborative effort.”

After hysterectomy, myomectomy and UFE are the main recommended fibroid therapies, both with their own benefits and disadvantages.

Myomectomy is a targeted, surgical procedure that removes all visible fibroids and the symptoms they cause. However, recovery takes several weeks, and any abnormal tissue not seen during the procedure can grow back. Half of all myomectomy patients have fibroid recurrence within 5 years.

Fibroid embolotherapy offers more diffused, long-lasting treatment, with a recurrence rate of about 15% after 5–7 years. Patients typically experience painful cramps immediately after UFE and may have to wait for as long as 6 months for their fibroids to shrink enough to provide significant symptom relief.

Nevertheless, the outpatient procedure allows patients to return to their regular routine within a week after treatment.

HIFU was the next-generation therapy Dr. Andrews discussed at greatest length. It is a form of highly focused acoustic energy, delivered transcutaneously (without puncturing the skin) via an array of ultrasound transistors onto a single point within the body measuring 3 mm by 8 mm—about the size of a grain of rice.

In MR-guided HIFU procedures (granted FDA approval in 2004), the uterine region is scanned for fibroids and divided into planes at different depths.

All visible fibroid cells at a given depth are individually ablated before moving on to the next plane, and the process is repeated until the entire volume has been treated.

“The beauty of HIFU is that it's completely noninvasive. It's the 'Star Trek' of medical intervention … and is going to have a very important role to play, not just for fibroids, but for all kinds of tumors,” Dr. Andrews said.

Despite its vaunted potential, Dr. Andrews said he knows of only a handful of U.S. centers offering HIFU treatment, and he attributes the scarcity to cost—about $1.5 million per unit—and to poor results to date.

“The published data on HIFU are terrible. The success rates are bad, partly because a quarter or more of patients drop out before they complete their treatment” he said, noting that not all patients will want to go through three or more 3-hour sessions inside a noisy, cramped MRI machine.

He also argued that the FDA's strict restrictions during trials—that investigators could not treat any fibroid within a centimeter and a half of normal uterine tissue—was “a guarantee for failure,” and the main reason for the treatment's paltry 14% fibroid volume reduction.

His department at the University of Washington, which recently acquired an ultrasound-guided machine (“faster than MR, but not yet FDA-approved”) for clinical study, has chosen not to offer any HIFU treatments until more data become available.

Dr. Andrews noted the buzz surrounding asoprisnil, a selective progesterone-receptor modulator that has been shown to significantly shrink fibroids and reduce their symptoms with minimal side effects during phase III trials. However, a new drug application, expected in late 2005, has not yet been filed with the FDA.

He also briefly discussed various thermal ablation techniques, developed mainly between 2000 and 2003. The basis of each is a transfer of energy—either laser, radiofrequency, microwave, or cryotherapy—through a percutaneous or transvaginal probe. They offer highly targeted delivery, but as with myomectomy, they only treat fibroids that can be seen. Dr. Andrews pointed out that interest in most of these techniques has largely faded away.

TORONTO — Treating uterine fibroids may eventually be as simple as prescribing a pill, or zapping the benign growths with high-intensity focused ultrasound—two of several promising nonsurgical alternatives to the roughly 300,000 fibroid-related hysterectomies performed annually in the United States.

“[Hysterectomy] is the gold standard in fibroid treatment. … The problem is that it's a big operation, and the patient loses her uterus. For some women, that just is not an acceptable solution,” said Dr. R. Torrance Andrews in an interview after his presentation at the annual meeting of the Society of Interventional Radiology.

Uterine fibroids, or leiomyomas, may cause infertility or premature delivery and in rare cases may become malignant. They affect about 30% of reproductive-age women, most commonly between the ages of 35 and 45 years, and particularly African American women, whose incidence rate is up to nine times higher than that of white women.

Dr. Andrews, chief of vascular and interventional radiology at the University of Washington Medical Center, Seattle, discussed mainstream fibroid treatments like hysterectomy, laparoscopic myomectomy, and uterine fibroid embolization (UFE), as well as emerging therapies like high-intensity focused ultrasound (HIFU), asoprisnil, and other methods.

In terms of recommending one treatment over the other, Dr. Andrews was frank: “I think it's a big mistake for interventional radiologists to tell patients authoritatively that they should have an embolization, instead of [a surgical] treatment.

“Similarly, unless a gynecologist is really well versed in embolization and patient selection, they should not tell patients that they are not embolization candidates. I think it needs to be a collaborative effort.”

After hysterectomy, myomectomy and UFE are the main recommended fibroid therapies, both with their own benefits and disadvantages.

Myomectomy is a targeted, surgical procedure that removes all visible fibroids and the symptoms they cause. However, recovery takes several weeks, and any abnormal tissue not seen during the procedure can grow back. Half of all myomectomy patients have fibroid recurrence within 5 years.

Fibroid embolotherapy offers more diffused, long-lasting treatment, with a recurrence rate of about 15% after 5–7 years. Patients typically experience painful cramps immediately after UFE and may have to wait for as long as 6 months for their fibroids to shrink enough to provide significant symptom relief.

Nevertheless, the outpatient procedure allows patients to return to their regular routine within a week after treatment.

HIFU was the next-generation therapy Dr. Andrews discussed at greatest length. It is a form of highly focused acoustic energy, delivered transcutaneously (without puncturing the skin) via an array of ultrasound transistors onto a single point within the body measuring 3 mm by 8 mm—about the size of a grain of rice.

In MR-guided HIFU procedures (granted FDA approval in 2004), the uterine region is scanned for fibroids and divided into planes at different depths.

All visible fibroid cells at a given depth are individually ablated before moving on to the next plane, and the process is repeated until the entire volume has been treated.

“The beauty of HIFU is that it's completely noninvasive. It's the 'Star Trek' of medical intervention … and is going to have a very important role to play, not just for fibroids, but for all kinds of tumors,” Dr. Andrews said.

Despite its vaunted potential, Dr. Andrews said he knows of only a handful of U.S. centers offering HIFU treatment, and he attributes the scarcity to cost—about $1.5 million per unit—and to poor results to date.

“The published data on HIFU are terrible. The success rates are bad, partly because a quarter or more of patients drop out before they complete their treatment” he said, noting that not all patients will want to go through three or more 3-hour sessions inside a noisy, cramped MRI machine.

He also argued that the FDA's strict restrictions during trials—that investigators could not treat any fibroid within a centimeter and a half of normal uterine tissue—was “a guarantee for failure,” and the main reason for the treatment's paltry 14% fibroid volume reduction.

His department at the University of Washington, which recently acquired an ultrasound-guided machine (“faster than MR, but not yet FDA-approved”) for clinical study, has chosen not to offer any HIFU treatments until more data become available.

Dr. Andrews noted the buzz surrounding asoprisnil, a selective progesterone-receptor modulator that has been shown to significantly shrink fibroids and reduce their symptoms with minimal side effects during phase III trials. However, a new drug application, expected in late 2005, has not yet been filed with the FDA.

He also briefly discussed various thermal ablation techniques, developed mainly between 2000 and 2003. The basis of each is a transfer of energy—either laser, radiofrequency, microwave, or cryotherapy—through a percutaneous or transvaginal probe. They offer highly targeted delivery, but as with myomectomy, they only treat fibroids that can be seen. Dr. Andrews pointed out that interest in most of these techniques has largely faded away.

TORONTO — A combination of inherited and acquired risk factors puts certain women in danger of developing venous thromboembolism (VTE), said Dr. Susan R. Kahn at the annual meeting of the Society of Interventional Radiology.

The VTE incidence rate in women of child-bearing age with genetic thrombophilia who also take oral contraceptives is 2.85 per thousand—35 times higher than women of the same group with neither risk factor, whose incidence rate is a comparatively low 8 per 100,000.

“A woman between the ages of 28 and 45 with [genetic thrombophilia], such as the factor V Leiden mutation, and who also uses oral contraceptives has an increased risk of thrombosis, but she may ultimately manage to avoid having a thrombotic episode. However, if she happens to undergo knee surgery at age 35, the added risk factor may tip her over the thrombosis threshold, and she may develop clinical VTE,” said Dr. Kahn, a researcher of thromboembolic disorder epidemiology at McGill University, in Montreal.

The clinical complications from VTE—which is manifested as either deep-vein thrombosis (DVT) or pulmonary embolism (PE)—include death from PE, postphlebitic syndrome, and recurrent VTE. Some of the long-term complications include postthrombotic syndrome, which develops in 30%–40% of DVT patients despite treatment with anticoagulants, as well as chronic pulmonary hypertension, which develops in about 2% of PE patients.

Despite advances in thromboprophylaxis and treatment, the annualized incidence of VTE in the general population has remained one to two patients per 1,000 persons over the last 25 years. On average, a person can expect a 5% chance of developing VTE in their lifetime, and the incidence increases twofold with each decade of age. The incidence is also far greater in black and white populations than in those of Asian descent.

According to Dr. Kahn, understanding the etiology of VTE is essential in improving outcomes in high-risk patients. She pointed out the tendency of VTE risk factors to interact: “In oncology patients, cancer itself activates coagulation factors, the patient is often immobilized, and there may be a tumor obstructing or invading the veins, leading to a thrombotic episode.”

The multifactorial pathogenesis of VTE was first described by German pathologist Rudolf Virchow over a century ago as a combination of venous stasis (such as with iliac vein stenosis), blood vessel damage (during the replacement of a central venous catheter, for example) and hypercoagulation (due to hereditary causes, such as factor V Leiden, or acquired factors, such as the lupus anticoagulant or exposure to estrogen).

Dr. Kahn noted that much of the recent interest in VTE has focused on the inherited factors discovered in the last decade predisposing patients to venous thrombosis. Known generically as genetic thrombophilia, these relatively common factors occur through one or more biochemical defects. Genetic thrombophilia affect 8%–10% of the population, though in patients presenting with idiopathic VTE, incidence of genetic thrombophilia rises to 40%–50%.

The factor V Leiden mutation is the most common genetic thrombophilia: the heterozygous form, found in 5%–8% of the normal population, increases the risk of VTE five-fold, whereas the rarer homozygous form confers an 18-fold risk increase. The second most common genetic thrombophilia is the heterozygous form of the prothrombin 20210 mutation, affecting 2% of the population, and doubling the risk of VTE. Other, rarer thrombophilias—that arise from multiple genetic mutations that cause deficiencies in natural anticoagulant proteins, such as protein C, protein S, or antithrombin III—occur in less than 1% of the population, yet are associated with a much higher risk of VTE.

TORONTO — A combination of inherited and acquired risk factors puts certain women in danger of developing venous thromboembolism (VTE), said Dr. Susan R. Kahn at the annual meeting of the Society of Interventional Radiology.

The VTE incidence rate in women of child-bearing age with genetic thrombophilia who also take oral contraceptives is 2.85 per thousand—35 times higher than women of the same group with neither risk factor, whose incidence rate is a comparatively low 8 per 100,000.

“A woman between the ages of 28 and 45 with [genetic thrombophilia], such as the factor V Leiden mutation, and who also uses oral contraceptives has an increased risk of thrombosis, but she may ultimately manage to avoid having a thrombotic episode. However, if she happens to undergo knee surgery at age 35, the added risk factor may tip her over the thrombosis threshold, and she may develop clinical VTE,” said Dr. Kahn, a researcher of thromboembolic disorder epidemiology at McGill University, in Montreal.

The clinical complications from VTE—which is manifested as either deep-vein thrombosis (DVT) or pulmonary embolism (PE)—include death from PE, postphlebitic syndrome, and recurrent VTE. Some of the long-term complications include postthrombotic syndrome, which develops in 30%–40% of DVT patients despite treatment with anticoagulants, as well as chronic pulmonary hypertension, which develops in about 2% of PE patients.

Despite advances in thromboprophylaxis and treatment, the annualized incidence of VTE in the general population has remained one to two patients per 1,000 persons over the last 25 years. On average, a person can expect a 5% chance of developing VTE in their lifetime, and the incidence increases twofold with each decade of age. The incidence is also far greater in black and white populations than in those of Asian descent.

According to Dr. Kahn, understanding the etiology of VTE is essential in improving outcomes in high-risk patients. She pointed out the tendency of VTE risk factors to interact: “In oncology patients, cancer itself activates coagulation factors, the patient is often immobilized, and there may be a tumor obstructing or invading the veins, leading to a thrombotic episode.”

The multifactorial pathogenesis of VTE was first described by German pathologist Rudolf Virchow over a century ago as a combination of venous stasis (such as with iliac vein stenosis), blood vessel damage (during the replacement of a central venous catheter, for example) and hypercoagulation (due to hereditary causes, such as factor V Leiden, or acquired factors, such as the lupus anticoagulant or exposure to estrogen).

Dr. Kahn noted that much of the recent interest in VTE has focused on the inherited factors discovered in the last decade predisposing patients to venous thrombosis. Known generically as genetic thrombophilia, these relatively common factors occur through one or more biochemical defects. Genetic thrombophilia affect 8%–10% of the population, though in patients presenting with idiopathic VTE, incidence of genetic thrombophilia rises to 40%–50%.

The factor V Leiden mutation is the most common genetic thrombophilia: the heterozygous form, found in 5%–8% of the normal population, increases the risk of VTE five-fold, whereas the rarer homozygous form confers an 18-fold risk increase. The second most common genetic thrombophilia is the heterozygous form of the prothrombin 20210 mutation, affecting 2% of the population, and doubling the risk of VTE. Other, rarer thrombophilias—that arise from multiple genetic mutations that cause deficiencies in natural anticoagulant proteins, such as protein C, protein S, or antithrombin III—occur in less than 1% of the population, yet are associated with a much higher risk of VTE.

TORONTO — A combination of inherited and acquired risk factors puts certain women in danger of developing venous thromboembolism (VTE), said Dr. Susan R. Kahn at the annual meeting of the Society of Interventional Radiology.

The VTE incidence rate in women of child-bearing age with genetic thrombophilia who also take oral contraceptives is 2.85 per thousand—35 times higher than women of the same group with neither risk factor, whose incidence rate is a comparatively low 8 per 100,000.

“A woman between the ages of 28 and 45 with [genetic thrombophilia], such as the factor V Leiden mutation, and who also uses oral contraceptives has an increased risk of thrombosis, but she may ultimately manage to avoid having a thrombotic episode. However, if she happens to undergo knee surgery at age 35, the added risk factor may tip her over the thrombosis threshold, and she may develop clinical VTE,” said Dr. Kahn, a researcher of thromboembolic disorder epidemiology at McGill University, in Montreal.

The clinical complications from VTE—which is manifested as either deep-vein thrombosis (DVT) or pulmonary embolism (PE)—include death from PE, postphlebitic syndrome, and recurrent VTE. Some of the long-term complications include postthrombotic syndrome, which develops in 30%–40% of DVT patients despite treatment with anticoagulants, as well as chronic pulmonary hypertension, which develops in about 2% of PE patients.

Despite advances in thromboprophylaxis and treatment, the annualized incidence of VTE in the general population has remained one to two patients per 1,000 persons over the last 25 years. On average, a person can expect a 5% chance of developing VTE in their lifetime, and the incidence increases twofold with each decade of age. The incidence is also far greater in black and white populations than in those of Asian descent.

According to Dr. Kahn, understanding the etiology of VTE is essential in improving outcomes in high-risk patients. She pointed out the tendency of VTE risk factors to interact: “In oncology patients, cancer itself activates coagulation factors, the patient is often immobilized, and there may be a tumor obstructing or invading the veins, leading to a thrombotic episode.”

The multifactorial pathogenesis of VTE was first described by German pathologist Rudolf Virchow over a century ago as a combination of venous stasis (such as with iliac vein stenosis), blood vessel damage (during the replacement of a central venous catheter, for example) and hypercoagulation (due to hereditary causes, such as factor V Leiden, or acquired factors, such as the lupus anticoagulant or exposure to estrogen).

Dr. Kahn noted that much of the recent interest in VTE has focused on the inherited factors discovered in the last decade predisposing patients to venous thrombosis. Known generically as genetic thrombophilia, these relatively common factors occur through one or more biochemical defects. Genetic thrombophilia affect 8%–10% of the population, though in patients presenting with idiopathic VTE, incidence of genetic thrombophilia rises to 40%–50%.

The factor V Leiden mutation is the most common genetic thrombophilia: the heterozygous form, found in 5%–8% of the normal population, increases the risk of VTE five-fold, whereas the rarer homozygous form confers an 18-fold risk increase. The second most common genetic thrombophilia is the heterozygous form of the prothrombin 20210 mutation, affecting 2% of the population, and doubling the risk of VTE. Other, rarer thrombophilias—that arise from multiple genetic mutations that cause deficiencies in natural anticoagulant proteins, such as protein C, protein S, or antithrombin III—occur in less than 1% of the population, yet are associated with a much higher risk of VTE.

Statins Reduce Sepsis Risk

Statins may diminish the risk of sepsis in people with cardiovascular disease, according to the results of a large observational study.

Dr. Daniel G. Hackam of the University of Toronto and his colleagues found that the risk of sepsis was reduced by 19% in patients over the age of 65 years who used statins, compared with those who did not use the drugs (Lancet DOI:10.1016/S0140–6736[06]68041–0, published Jan. 25, 2006).

Statins, widely used as lipid-lowering agents, also exhibit anti-inflammatory and antioxidant effects and can improve endothelial function and modulate cellular immunity, all of which may help ward off the severe effects of sepsis, the authors wrote.

The researchers identified 173,410 patients at high risk of sepsis. The selection criteria were patients over 65 years who had been treated in a hospital in Ontario, Canada, between 1997 and 2002 for an acute cardiac event, ischemic stroke, or revascularization. Propensity-based matching produced a final cohort of 69,168 patients, of whom 34,584 were statin users and 34,584 were not.

Monitoring for each patient began on their index date and continued until the patient died or was admitted to the hospital for sepsis, or until the end of the study, if there were no events. In all, there were 1,218 cases of sepsis, of which 551 were in statin-using patients and 667 were in the nonstatin-using control group, a statistically significant difference. The development of severe or fatal sepsis was also less likely in the statin-using group, the authors noted.

Dr. Hackam and his colleagues recommended that statin treatment for patients with major infections who are already on the drug should be continued, although they should be monitored closely for potential toxic effects. Statins should be considered for patients with a high risk for sepsis, especially those with cardiovascular disease, they wrote.

Waist Size Predicts CVD Risk

Waist circumference of at least 35 inches correlated with major cardiovascular and metabolic risk factors in women, reported Dr. Lori Mosca, director of preventive cardiology at New York-Presbyterian Hospital/Columbia University Medical Center, and her associates.

This finding suggests that measuring the waist can serve as a simple way to identify women at risk for cardiovascular events “who might benefit from further evaluation and intervention,” the researchers said (J. Women's Health 2006;15:24–34).

They conducted a free, 1-day cardiovascular disease (CVD) screening program in 12 cities across the country; 6,938 women aged 18–93 years participated, and more than half were racial or ethnic minorities. The women were assessed for waist size, blood pressure, body mass index, and cholesterol and glucose levels.

Waist circumference of at least 35 inches was found in 52%; these women were significantly more likely than those with smaller waists to have high blood pressure, hypercholesterolemia, low HDL cholesterol, and impaired fasting glucose, even after the data were controlled for race and ethnicity, education level, and family history of CVD.

Thus a single, simple waist measurement, even if done by the woman herself, can be valuable in identifying those “who have a clustering of risk factors known to be synergistic with respect to CVD risk,” Dr. Mosca and her associates said.

High Fish Intake Cuts CHD Risk

For reducing the risk of coronary heart disease, a diet high in fish is better than a diet with a modest amount of fish, reported Dr. Hiroyasu Iso of the University of Tsukuba, Ibaraki-ken, Japan, and associates.

The investigators conducted a prospective study of healthy Japanese men (19,985) and women (21,593) aged 40–59 years at enrollment during 1990–1992. By follow-up in 2001, there had been 258 incident cases of CHD, including 198 definite MIs, 23 probable MIs, and 37 sudden cardiac deaths. This included 62 fatal and 196 nonfatal cardiac events (Circulation 2006;113:195–202).

CHD risk was 40% lower among people with the highest intake of fish (eight servings per week, or 180 g/day) than among those with the lowest intake (once per week, or 23 g/day). “This implies that a high intake of fish can further reduce the risk of initial coronary heart disease events compared with a moderate fish intake, which has never been tested by previous observational studies in Western countries,” Dr. Iso and associates said.

The reduced risk was confined to nonfatal events only, but that may have been because the low number of fatal MIs (62) and sudden cardiac deaths (37) failed to provide enough statistical power to detect an association with those types of events, they added.

Statins Reduce Sepsis Risk

Statins may diminish the risk of sepsis in people with cardiovascular disease, according to the results of a large observational study.

Dr. Daniel G. Hackam of the University of Toronto and his colleagues found that the risk of sepsis was reduced by 19% in patients over the age of 65 years who used statins, compared with those who did not use the drugs (Lancet DOI:10.1016/S0140–6736[06]68041–0, published Jan. 25, 2006).

Statins, widely used as lipid-lowering agents, also exhibit anti-inflammatory and antioxidant effects and can improve endothelial function and modulate cellular immunity, all of which may help ward off the severe effects of sepsis, the authors wrote.

The researchers identified 173,410 patients at high risk of sepsis. The selection criteria were patients over 65 years who had been treated in a hospital in Ontario, Canada, between 1997 and 2002 for an acute cardiac event, ischemic stroke, or revascularization. Propensity-based matching produced a final cohort of 69,168 patients, of whom 34,584 were statin users and 34,584 were not.

Monitoring for each patient began on their index date and continued until the patient died or was admitted to the hospital for sepsis, or until the end of the study, if there were no events. In all, there were 1,218 cases of sepsis, of which 551 were in statin-using patients and 667 were in the nonstatin-using control group, a statistically significant difference. The development of severe or fatal sepsis was also less likely in the statin-using group, the authors noted.

Dr. Hackam and his colleagues recommended that statin treatment for patients with major infections who are already on the drug should be continued, although they should be monitored closely for potential toxic effects. Statins should be considered for patients with a high risk for sepsis, especially those with cardiovascular disease, they wrote.

Waist Size Predicts CVD Risk

Waist circumference of at least 35 inches correlated with major cardiovascular and metabolic risk factors in women, reported Dr. Lori Mosca, director of preventive cardiology at New York-Presbyterian Hospital/Columbia University Medical Center, and her associates.

This finding suggests that measuring the waist can serve as a simple way to identify women at risk for cardiovascular events “who might benefit from further evaluation and intervention,” the researchers said (J. Women's Health 2006;15:24–34).

They conducted a free, 1-day cardiovascular disease (CVD) screening program in 12 cities across the country; 6,938 women aged 18–93 years participated, and more than half were racial or ethnic minorities. The women were assessed for waist size, blood pressure, body mass index, and cholesterol and glucose levels.

Waist circumference of at least 35 inches was found in 52%; these women were significantly more likely than those with smaller waists to have high blood pressure, hypercholesterolemia, low HDL cholesterol, and impaired fasting glucose, even after the data were controlled for race and ethnicity, education level, and family history of CVD.

Thus a single, simple waist measurement, even if done by the woman herself, can be valuable in identifying those “who have a clustering of risk factors known to be synergistic with respect to CVD risk,” Dr. Mosca and her associates said.

High Fish Intake Cuts CHD Risk

For reducing the risk of coronary heart disease, a diet high in fish is better than a diet with a modest amount of fish, reported Dr. Hiroyasu Iso of the University of Tsukuba, Ibaraki-ken, Japan, and associates.

The investigators conducted a prospective study of healthy Japanese men (19,985) and women (21,593) aged 40–59 years at enrollment during 1990–1992. By follow-up in 2001, there had been 258 incident cases of CHD, including 198 definite MIs, 23 probable MIs, and 37 sudden cardiac deaths. This included 62 fatal and 196 nonfatal cardiac events (Circulation 2006;113:195–202).

CHD risk was 40% lower among people with the highest intake of fish (eight servings per week, or 180 g/day) than among those with the lowest intake (once per week, or 23 g/day). “This implies that a high intake of fish can further reduce the risk of initial coronary heart disease events compared with a moderate fish intake, which has never been tested by previous observational studies in Western countries,” Dr. Iso and associates said.

The reduced risk was confined to nonfatal events only, but that may have been because the low number of fatal MIs (62) and sudden cardiac deaths (37) failed to provide enough statistical power to detect an association with those types of events, they added.

Statins Reduce Sepsis Risk

Statins may diminish the risk of sepsis in people with cardiovascular disease, according to the results of a large observational study.

Dr. Daniel G. Hackam of the University of Toronto and his colleagues found that the risk of sepsis was reduced by 19% in patients over the age of 65 years who used statins, compared with those who did not use the drugs (Lancet DOI:10.1016/S0140–6736[06]68041–0, published Jan. 25, 2006).

Statins, widely used as lipid-lowering agents, also exhibit anti-inflammatory and antioxidant effects and can improve endothelial function and modulate cellular immunity, all of which may help ward off the severe effects of sepsis, the authors wrote.

The researchers identified 173,410 patients at high risk of sepsis. The selection criteria were patients over 65 years who had been treated in a hospital in Ontario, Canada, between 1997 and 2002 for an acute cardiac event, ischemic stroke, or revascularization. Propensity-based matching produced a final cohort of 69,168 patients, of whom 34,584 were statin users and 34,584 were not.

Monitoring for each patient began on their index date and continued until the patient died or was admitted to the hospital for sepsis, or until the end of the study, if there were no events. In all, there were 1,218 cases of sepsis, of which 551 were in statin-using patients and 667 were in the nonstatin-using control group, a statistically significant difference. The development of severe or fatal sepsis was also less likely in the statin-using group, the authors noted.

Dr. Hackam and his colleagues recommended that statin treatment for patients with major infections who are already on the drug should be continued, although they should be monitored closely for potential toxic effects. Statins should be considered for patients with a high risk for sepsis, especially those with cardiovascular disease, they wrote.

Waist Size Predicts CVD Risk

Waist circumference of at least 35 inches correlated with major cardiovascular and metabolic risk factors in women, reported Dr. Lori Mosca, director of preventive cardiology at New York-Presbyterian Hospital/Columbia University Medical Center, and her associates.

This finding suggests that measuring the waist can serve as a simple way to identify women at risk for cardiovascular events “who might benefit from further evaluation and intervention,” the researchers said (J. Women's Health 2006;15:24–34).

They conducted a free, 1-day cardiovascular disease (CVD) screening program in 12 cities across the country; 6,938 women aged 18–93 years participated, and more than half were racial or ethnic minorities. The women were assessed for waist size, blood pressure, body mass index, and cholesterol and glucose levels.

Waist circumference of at least 35 inches was found in 52%; these women were significantly more likely than those with smaller waists to have high blood pressure, hypercholesterolemia, low HDL cholesterol, and impaired fasting glucose, even after the data were controlled for race and ethnicity, education level, and family history of CVD.

Thus a single, simple waist measurement, even if done by the woman herself, can be valuable in identifying those “who have a clustering of risk factors known to be synergistic with respect to CVD risk,” Dr. Mosca and her associates said.

High Fish Intake Cuts CHD Risk

For reducing the risk of coronary heart disease, a diet high in fish is better than a diet with a modest amount of fish, reported Dr. Hiroyasu Iso of the University of Tsukuba, Ibaraki-ken, Japan, and associates.

The investigators conducted a prospective study of healthy Japanese men (19,985) and women (21,593) aged 40–59 years at enrollment during 1990–1992. By follow-up in 2001, there had been 258 incident cases of CHD, including 198 definite MIs, 23 probable MIs, and 37 sudden cardiac deaths. This included 62 fatal and 196 nonfatal cardiac events (Circulation 2006;113:195–202).

CHD risk was 40% lower among people with the highest intake of fish (eight servings per week, or 180 g/day) than among those with the lowest intake (once per week, or 23 g/day). “This implies that a high intake of fish can further reduce the risk of initial coronary heart disease events compared with a moderate fish intake, which has never been tested by previous observational studies in Western countries,” Dr. Iso and associates said.

The reduced risk was confined to nonfatal events only, but that may have been because the low number of fatal MIs (62) and sudden cardiac deaths (37) failed to provide enough statistical power to detect an association with those types of events, they added.