TUESDAY, Oct. 2 (HealthDay News) -- Postmenopausal women who've had at least one panic attack may be at greater risk for heart disease, stroke and even death, new research suggests.

The study found that older women with a history of panic attacks were four times more likely to have heart disease than women who hadn't had a panic attack.

"Women who reported at least one panic attack were at higher risk of having cardiovascular illness and death after an average of five years of follow-up. Even after controlling for other risk factors, a panic attack remained an independent risk factor on its own," said study author Dr. Jordan Smoller, an associate professor of psychiatry at Harvard Medical School.

Symptoms of a panic attack include a sudden feeling of fear, anxiety or extreme discomfort that's out of proportion to your current situation. Panic attacks may also be accompanied by a rapid or irregular heartbeat, sweating, hot flashes, chills, chest pain, difficulty breathing, shaking, dizziness and a feeling that you might die. About one in 10 postmenopausal women has had at least one panic attack, according to the study.

The research, published in the October issue of the Archives of General Psychiatry, included 3,369 postmenopausal women between the ages of 51 and 83. All of the women completed questionnaires about the occurrence of panic attacks in the previous six months. A full-blown panic attack was one in which sudden fear was accompanied by at least four other panic attack symptoms. A limited panic attack was one in which fear was accompanied by one to three additional symptoms.

After an average 5.3 years of follow-up, the researchers collected information on heart disease, stroke and death from any cause. The researchers also adjusted the data to account for other known cardiovascular disease risk factors, such as weight, alcohol use, hormone use, high cholesterol, high blood pressure, age, diabetes and smoking history.

After adjusting for all those factors, the researchers found that full-blown panic attacks were associated with a fourfold higher risk of heart disease, nearly twice the risk of stroke, and a 75 percent increase in risk of death from any cause, compared to women who'd experienced no panic attacks. Women who'd had limited panic attacks fared somewhat better. The adjusted risk of heart disease was 65 percent higher, stroke risk was more than doubled, and all-cause mortality was increased by 34 percent.

"Negative emotional states and psychiatric symptoms can be related to adverse medical outcomes," said Smoller, who's also assistant vice chairman of the department of psychiatry at Massachusetts General Hospital.

"Panic attacks may be having a direct effect on cardiovascular health -- anxiety, panic and other negative emotional states have been related to changes in heart rhythm and changes in cardiac blood flow in previous studies. It may be that stress hormones and other components of the 'fight-or-flight' reactions that accompany panic directly impact the cardiovascular system," he said.

"Or," he added, "it could be that panic attacks are simply a marker for increased risk that is due to something other than the panic attacks themselves. It might be that the women who were experiencing panic might have been experiencing some other unrecognized cardiovascular problem."

Dr. Stephen Siegel, a cardiologist at New York University Medical Center, said the study definitely raises some interesting questions, but more research needs to be done to establish a definite link between panic attacks and cardiovascular health.

In the meantime, Siegel recommended that all women do whatever they can to reduce their cardiovascular disease risk factors. "Control all the known risk factors out there -- hypertension, cigarette smoking, diabetes, elevated cholesterol. We can make changes in these factors and we know they make a difference," he said.

Exercise is another great -- and proven -- option, Siegel said. Not only does it improve your heart health by lowering blood sugar, blood pressure and cholesterol, but exercise can also help ease anxiety and depression, providing both a physical and psychological benefit.

More information

To learn more about panic attacks and panic disorder, visit the American Psychological Association  .

MONDAY, Oct. 1 (HealthDay News) -- While lower cholesterol is generally considered a good thing, new research suggests that very low cholesterol levels in pregnant women may harm the health of the fetus.

Expectant mothers whose total cholesterol levels were under 159 milligrams per deciliter (mg/dL) gave birth -- on average -- to babies weighing about one-third of a pound less than babies born to mothers whose cholesterol levels exceeded 159 mg/dL, the researchers found.

Additionally, 12.7 percent of white women with low cholesterol levels gave birth prematurely, compared to just five percent of those with higher cholesterol levels. No such association was found in black women, however.

"To our surprise, we found that white women with very low cholesterol also have a significant risk of having babies born prematurely," said Dr. Max Muenke, chief of medical genetics at the U.S. National Human Genome Research Institute in Bethesda, Md.

Results of the study are in the October issue of Pediatrics.

"At this point, it's not even clear if it's the low cholesterol itself, or another lipid," he said, adding that more research is needed to confirm these findings.

"This study intuitively makes some sense," said Dr. Robert Welch, chair and program director for obstetrics and gynecology at St. John Health's Providence Hospital in Southfield, Mich. "Cholesterol is a building block for membranes, hormones and proteins, so it makes sense that if you have low cholesterol, your baby won't have the substrate it needs to grow."

Each year, more than half a million babies are born prematurely in the United States, according to the March of Dimes. Medical advances have brought down the incidence rates for many diseases and conditions, but that's not been the case with premature or low birth weight babies.

In 1994, 11 percent of babies were born prematurely, and 7.3 percent were considered low birth weight. In 2004, those numbers were 12.5 percent and 8.1 percent, respectively. A preterm birth is one that occurs before 37 weeks, and a baby under five and a half pounds is considered to have a low birth weight.

According to Muenke, because previous studies have shown that high cholesterol levels -- over 300 mg/dL -- may lead to premature birth, the researchers wanted to know if very low levels could also have an effect.

The researchers recruited more than 1,000 women from prenatal clinics in South Carolina. The women were between 21 and 34 years old, didn't smoke, didn't have diabetes and were only pregnant with one baby. Cholesterol levels were measured at about the 17th or 18th week of pregnancy.

Overall, 118 of the women had low cholesterol levels mid-pregnancy and 940 women had levels higher than 159 mg/dL.

The study found that white women had five times higher odds of delivering prematurely if they had low cholesterol. There was no association between cholesterol levels and preterm delivery in black women, according to the study.

However, for both races, babies weighed an average of 150 grams less (about one-third of a pound) when born to mothers with low cholesterol. Additionally, babies born to mothers with low cholesterol levels were about twice as likely to have a small head circumference.

Muenke said the low cholesterol levels are likely caused by a combination of genetics and nutrition. According to the study authors, the low cholesterol levels may stem from poor diet and nutritional deficiencies. What isn't yet known is if raising cholesterol levels in these women would have a positive effect on the baby's health.

"I wouldn't recommend routine screening for cholesterol in pregnant women right now," cautioned Welch. "It would increase health care expenditures tremendously without a known benefit. This was a first study; others need to done. We also need to find some explanation of why it's taking place only in white women and not in black women."

"What this study does suggest is that diet in pregnancy is important, and that not paying attention to nutrition could be harmful," said Welch.

Muenke agreed, adding that, "At this point, the message is really to 'stay tuned' for a repeat study. In the meantime, talk with your obstetrician about a healthy lifestyle, including exercise and healthy nutrition."

More information

To learn more about proper prenatal nutrition, visit the National Women's Health Information Center.

TUESDAY, Sept. 25 (HealthDay News) -- Breast cancer death rates continue to decline more than 2 percent annually, a long-running trend that can be traced to early detection and better treatments, according to a new American Cancer Society report.

However, the death rates are not declining as quickly among black women as among white and Hispanic women.

In 2007, about 178,480 new cases of invasive breast cancer will be diagnosed in American women, and another 62,030 cases of localized breast cancer will be found. About 40,460 women are expected to die from the disease this year, second only to lung cancer, the report said.

The decline in overall reported breast cancer cases, beginning in 2000, is believed to be related to two factors. One is the decreased use of hormone replacement therapy, which has been linked to a multitude of health risks, including breast cancer.

The other factor could be potentially troubling, experts say: A decrease in mammography screening, resulting in fewer cancers being detected. While 70 percent of women aged 40 and older said they had had a mammogram within the past two years in 2000, just 66 percent did in 2005.

Aside from skin cancer, breast cancer is the most frequently diagnosed cancer among U.S. women, accounting for more than one in four malignancies detected in women, said the report. It has been published every two years since 1996.

Among other findings in the report, titled Breast Cancer Facts & Figures 2007-2008:

• From 1995-2004, the drop in breast cancer death rates was highest in whites and Hispanics/Latinas, at 2.4 percent per year, but lower in blacks, at 1.6 percent annually. It remained unchanged among other racial and ethnic groups, including Asian-Americans/Pacific Islanders and American Indians/Alaska Natives.
• Breast cancer incidence rates have been declining sharply since 2001, by nearly 5 percent annually, in women aged 50 and older, partly due to the drop in use of hormone replacement therapy. Incidence rates in younger women, however, have remained stable since 1986.
• Although breast cancer in men is rare, the incidence in males increased 1 percent a year between 1975 and 2004. The cause is not known.

"For women concerned about the risk of developing and dying from breast cancer, probably still the most important advice is to get regular mammograms as recommended by the American Cancer Society," said Elizabeth Ward, director of surveillance research for the cancer society, and a contributor to the report.

Other preventive measures, said Ward: "If you have a family history, you should be talking about that history with your doctor. It may be recommended to begin screening sooner [than age 40]. Women should try to maintain a healthy weight all through their life. Women should consume no more than one alcoholic beverage a day. Exercise is also a good way to decrease risk. Physical activity has a small protective effect."

Dr. Eric P. Winer, director of the breast oncology center at the Dana-Farber Cancer Institute in Boston, and chief scientific advisor for Susan G. Komen for the Cure, said the new report contains "both good and bad news."

"It is clear that we have new diagnostic tools that have the potential to allow us to detect breast cancer at even earlier stages," Winer said. "Perhaps more importantly, we also have many new treatment strategies. These treatments, particularly if properly applied, will save lives and reduce suffering. There has been, and continues to be, a decline in death from breast cancer."

Still, Winer added, the report contains some troubling news, including the divergence in breast cancer rates between white and black women. It's a trend, he said, that "almost certainly relates to access to care and access to the best possible care."

"In spite of our best efforts, a substantial minority of women continue to be diagnosed when the disease has advanced to stage IV and is no longer curable. Again, this is a small minority, but it still represents a significant number of women," he said.

"In some cases, the cause of this is that women did not have access to health care. In other cases, it is because breast cancer can, at times, be quite aggressive and simply cannot be caught before it has spread. To combat this problem, we need greater access to care for all Americans and we need better treatment approaches."

More information

To learn more about the report, visit the American Cancer Society  .

FRIDAY, Sept. 21 (HealthDay News) -- Most women are unaware of the results of a large-scale study, released in 2002, that found significant cancer and heart risks associated with long-term hormone replacement therapy (HRT).

That study, called the Women's Health Initiative, generated massive amounts of publicity immediately after it was released. Its data caused many American women to abandon HRT altogether.

But just two years later, in June 2004, fewer than a third of women surveyed by Stanford University researchers said they knew about the findings.

"I was quite surprised by that. Other research had indicated that up to half had heard about it," said senior researcher Dr. Randall Stafford, associate professor of medicine, Stanford Prevention Research Center, Stanford University, Stanford, Calif., and the senior author of the study.

His team's study is published in the September/October issue of the journal Menopause.

When Stafford and his colleagues interviewed 781 women between the ages of 40 and 60, only 29 percent knew about the study. The question was posed this way: "Have you heard or read anything about the results of the Women's Health Initiative (WHI), a major research study in the U.S. suggesting the health risks of taking hormone therapy outweigh the benefits for most women?"

Those polled included 252 women who had not yet entered menopause, 88 classified as perimenopausal (having irregular menstrual cycles, but at least one period in the past 12 months), 227 women who were in or past menopause, and 196 who had surgically induced menopause after having undergone hysterectomy. For 18 women, menopausal status wasn't known due to missing data.

Next, the researchers ask whether HRT increases, decreases or has no impact on the risk of seven health conditions, including memory loss, heart disease, blood clots, stroke, osteoporosis, breast cancer and colorectal cancer.

Only 40 percent of the women answered more of these questions correctly than incorrectly. While 64 percent knew that hormones were thought to increase breast cancer risk, for example, only 9 percent knew the supplemental hormone regimen increased memory loss risk. Just 34 percent understood that HRT might boost their cardiovascular risk.

When asked if they had talked about hormone therapy with their doctors, the researchers found that 36 percent of women aware of the WHI findings had talked about it with their physicians. But only 15 percent of those who didn't know about the study results did.

"We need to do a better job of disseminating information," Stafford said, referring to the health care system.

But another expert familiar with the study viewed the results a bit differently. Some of the women may not have been even thinking yet about menopause, since the survey included women as young as 40, for whom menopause is typically 5 to 10 years away, noted Dr. William Parker, staff gynecologist and past chair of obstetrics and gynecology at Santa Monica-UCLA Medical Center and the Orthopaedic Hospital, Santa Monica, Calif.

"The unanswered question is, 'How many women who need to know the information now do not have it?' " said Parker, who is also clinical professor of ob-gyn, University of California, Los Angeles, School of Medicine.

If a woman is not at the point where she has to make a decision about hormone therapy, he said, it would not jeopardize her care if she was unaware of the study and its findings and didn't have a conversation with her physician.

In his own practice, Parker said, "If a woman is, say, age 48, and comes in, says she is having occasional hot flashes but is still having periods, I tell her, 'Let's have a conversation when you need it, because this information changes so quickly.' " Since the original WHI results were released in 2002, numerous re-analyses have been done of the study to confirm or negate the original findings, he noted.

Unless a woman needs the information immediately, Parker reasoned, the office visit time would probably be better spent on other concerns or preventive health.

The study was funded by the National Heart, Lung, and Blood Institute and GlaxoSmithKline Consumer Healthcare. The pharmaceutical company was interested in the data due to its black cohosh product for menopausal symptom relief, Stafford said.

More information

To learn more about the Women's Health Initiative, visit the National Heart, Lung, and Blood Institute.