• 38 percent said they will continue to

recommend HRT for women with

no preexisting cardiac or breast can-

cer risks

• 80 percent said they will continue to

prescribe HRT for controlling vaso-

motor symptoms (such as potential-

ly disabling hot flashes)

• 6 percent said they will continue to

prescribe HRT as they had in the

past

• 4 percent said they will discontinue

use of HRT

To see the full study, go to www.

medpanel.com.

Drug Trial in Women WithProgressing AdvancedBreast Cancer Presented

Results from two, Phase II Breast

Cancer trials studying Iressa®

(ZD1839), a cancer drug being devel-

oped by AstraZeneca, were presented

in mid-December at the San Antonio

Breast Cancer Symposium. Additional

clinical trials investigating the use of

Iressa in advanced breast cancer are

under way.

The results of the trial provide jus-

tification of continued study for Iressa

in the treatment of advanced-stage

breast cancer, presenters noted. In the

February | March 2003 AWHONN Lifelines 19

More women are surviving

heart failure than ever before.

In fact, survival after a heart failure

diagnosis has greatly improved over

the past 50 years, according to a

study from the National Heart,

Lung, and Blood Institute (NHLBI),

part of the National Institutes of

Health. The study, which analyzed

data from the NHLBI’s landmark

Framingham Heart Study (FHS),

found that the risk of dying after

being diagnosed with heart failure

had dropped by about a third in

men and women during that period.

The study, which appears in the

October 31, 2002, issue of The New

England Journal of Medicine, also

found that new cases of heart failure

had dropped by about a third for

women during the same period.

However, the number of new cases for

men remained unchanged.

About 4.8 million Americans have

heart failure, with about 550,000 new

cases being diagnosed each year.

Heart failure contributes to about

287,000 deaths a year.

In the new study, researchers ana-

lyzed data on 10,317 FHS participants

drawn from the original enrollees and

the offspring generation, including

their spouses. The study had equal

numbers of men and women, and

particular findings include,

• From 1950 to 1999, there were 1,075

cases of heart failure—about equal-

ly divided between men and women

• In 1950-69, 70 percent of men died

within five years of being diagnosed

with heart failure; in 1990-99, that

rate dropped to 59 percent

• In 1950-69, 57 percent of women

died within five years of heart fail-

ure diagnosis; in 1990-99, that rate

dropped to 45 percent

• For women, the number of new cas-

es dropped by a third from 1950 to

1979, with no additional change from

1980 to 1999. For men, there was

no significant change in the num-

ber of new cases from 1950 to 1999

• Deaths from heart failure decreased

on average by 12 percent per decade

for women and men

“The reason that new cases are on the

decrease for women but not men may

have to do with a gender difference in

the causes,” researchers said. Although

high blood pressure and heart attack

are important causes of heart failure

in both men and women, uncon-

trolled hypertension is more promi-

nent as a risk factor for the disease in

women, while heart attack plays a

greater role in men. Because the find-

ings are based on one, mostly white

study, more research must be done to

check trends on the survival and

number of new cases in other racial

and ethnic groups.

Improved SurvivalRates Among WomenWith Heart Failure

first study, Iressa, 500 mg (single daily

oral dose), was administered in a non-

randomized, open-label Phase II study

to 63 women with metastatic advanced

breast cancer, ages 34 to 80 years old,

who had continued to progress follow-

ing multiple breast cancer treatments.

Overall, the vast majority of trial par-

ticipants had tried all major treatment

options for advanced breast cancer and

their disease was actively progressing

when they entered the trial. Following

treatment with Iressa, one patient

achieved a partial response lasting five

months and eight women experienced

stabilization of their disease. Despite

active progression of disease at the

time of study entry, 15 percent of the

study population remained on Iressa

for four to eight months or longer. In

addition, others noted marked reduc-

tion in bone pain and several were able

to stop all pain medications.

In the second study, early data were

presented from a study of 22 women

where Iressa was administered in a

nonrandomized, open-label Phase II

study in patients with breast cancer

who became clinically resistant to

tamoxifen or were inappropriate for

tamoxifen treatment. At four weeks, 10

patients (46 percent) had not pro-

gressed, two patients (9 percent)

demonstrated a partial response and

five patients (23 percent) had progres-

sive disease. One patient with stable

disease has been treated beyond six

months to date.

All study patients were given 500

mg/day of Iressa. The median patient

age was 61 years old (range 32 to 85

years old). Side effects were experi-

enced by 59 percent of study patients.

Eight patients (36 percent) had a sig-

nificant facial rash, and four patients

(18 percent) each had nausea, vomit-

ing, alopecia and diarrhea. Eight

patients (36 percent) had a dose inter-

ruption followed by a dose reduction.

SIDS Risks IdentifiedAmong American IndianInfants

Astudy of Northern Plains Indi-

ans found that infants were less

likely to die of sudden infant death

syndrome (SIDS) if their mothers

received visits from public health nurs-

es before and after giving birth.

The Aberdeen Area Infant

Mortality Study, which appeared in the

December 4, 2002, edition of the

Journal of the American Medical

Association, also found that binge

drinking (five or more drinks at a

time) during the mother’s first

trimester of pregnancy made it eight

times more likely that her infant would

die of SIDS. Any maternal alcohol use

during the periconceptional period

20 AWHONN Lifelines Volume 7 Issue 1

Reports from a recent state of

the science conference pre-

sented on lupus by the Lupus Foun-

dation of America in conjunction

with health care providers and

researchers demonstrate that signifi-

cant progress has been made in the

research and treatment of lupus in

recent years. Lupus, a devastating

autoimmune disease, affects an esti-

mated 1 million people in the U.S.

and Europe, 90 percent of whom are

women. Through the presentations

the following facts emerged:

• Lupus affects mostly women: 90

percent of lupus patients are

women

• Lupus disproportionately affects

women who are Asian, Hispanic

or African American: the inci-

dence of lupus is two to three

times more prevalent among

these patient populations

• Lupus can be life threaten-

ing: Over a 20-year period,

the death rate in older

African American women

with lupus has increased

by 70 percent. Deaths in

lupus are typically related to

renal failure and opportunistic

infections that occur with the

use of the immunosuppressant

drugs that are often used to treat

the disease

• Patients with lupus can suffer a

very low quality of life: Pain,

lifestyle changes and emotional

problems were cited in a survey as

the most difficult factors for cop-

ing with the disease

Additionally, progress is being made

in the treatment of lupus: two

experimental new drugs for the

treatment of lupus are in late-stage

clinical testing. A drug for lupus-

related bone loss being developed by

Genelabs Technologies, Inc., and a

drug for lupus renal disease being

developed by La Jolla Pharmaceutical

are currently undergoing Phase III

clinical trials. These drug candidates

may be the first treatments for lupus

developed in more than 30 years.

For more information, go

to www.lupus.org.

Lupus: State of the Science Presented