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The author of this paper set out to determine the extent to which potential "errors" in many early epidemiologic studies led to erroneous conclusions about an inverse association between moderate drinking and coronary heart disease (CHD). His analysis is based on prospective data for more than 124,000 persons interviewed in the U.S. National Health Interview Surveys of 1997 through 2000 and avoids the pitfalls of some earlier studies. He concludes that the so-called "errors" have not led to erroneous results, and that there is a strong protective effect of moderate drinking on CHD and all-cause mortality.

The results of this analysis support the vast majority of recent well-done prospective studies. In the present paper, non-drinkers had much higher risk of death than did almost all categories of subjects consuming alcohol. The author contends that these results lend credence to the argument that the relationship between alcohol and mortality is causal.

While some Forum reviewers felt that this analysis only replicates what has been shown in many other papers, it appears that erroneous information continues to be used by some policy groups in setting drinking guidelines. Thus, most reviewers believe that this new analysis provides important information on potential health effects of moderate drinking.

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A combination of calcium and vitamin D may cut the chance of melanoma in half for some women at high risk of developing this life-threatening skin cancer, according to a new study by Stanford University School of Medicine researchers.

Using existing data from a large clinical trial, the study zeroed in on women with a history of non-melanoma skin cancer, as people with this generally non-fatal disease are more likely to develop the more lethal illness -- melanoma. The researchers found that women who once had non-melanoma and took the calcium-vitamin D combination developed 57 percent fewer melanomas than women with similar histories who were not given the supplements. Non-melanoma skin cancers, such as basal cell or squamous cell cancers, are the most common forms of skin cancer.

"In preventive medicine, we want to target people most at risk for the disease," said dermatologist Jean Tang, MD, PhD, lead author of the study. "If you previously had a non-melanoma skin cancer, calcium plus vitamin D might reduce your risk of the more deadly melanoma."

Tang added a note of caution. The study found that a daily dose of 1,000 mg calcium plus 400 IU of vitamin D doesn't provide skin cancer protection for everybody. Women without a history of non-melanoma skin cancer who took the supplements did not see any reduction of risk compared with their placebo-group counterparts, according to the research.

The study will be published online on June 27 in the Journal of Clinical Oncology.

Vitamin D is well-known for its role in bone growth, but it also affects non-skeletal cells. In many parts of the body, including the skin, vitamin D controls how quickly cells replicate, a process that often goes awry in cancer. Reports from various institutions have suggested that vitamin D is associated with lower risks of colon, breast, prostate and other cancers. Nonetheless, the Institute of Medicine published a report last November saying that more research was needed on vitamin D and calcium, as the evidence was insufficient to prove their having a benefit for conditions other than bone health.

This study is the second to look at the effect of vitamin D supplementation on cancer risk with a randomized, controlled trial.

Tang and colleagues analyzed data from the Women's Health Initiative, a study that followed 36,000 women ages 50 to 79 for an average of seven years. Half of the women took the daily dose of calcium and vitamin D as part of the experiment; the other half took a placebo pill. The WHI calcium plus vitamin D trial was designed to look at the effects of the supplement on hip fractures and colorectal cancers, but its researchers collected data on many other health issues, including other cancers.

Tang and colleagues took advantage of the large and long-term data set provided by the WHI trial to explore whether vitamin D has a protective effect against skin cancer. "Our results include the first positive cancer-reducing effect seen from the calcium plus vitamin D trial," said Teresa Fu, MD, a co-author of the study and a recent graduate of the School of Medicine.

The lack of protective effect in women without a history of non-melanoma skin cancer may be due to the amount of vitamin D given to the patients in the WHI trial. "The patients in the Women's Health Initiative were given vitamin D at a very low dose, based on today's knowledge -- only 400 IU per day," said David Feldman, MD, professor emeritus of endocrinology and a co-author of the study. Furthermore, patients in the placebo group were allowed to take as much vitamin D as patients that were provided the calcium and vitamin D supplements, so the experimental difference between the two groups was small. In light of that small difference, "it's somewhat surprising that there was an effect on melanoma risk, and I think many potential benefits of vitamin D may not have been detected," said Feldman.

Because men were not included in the trial, the researchers cannot be certain whether the protective effect of the supplements would also apply to men with a history of non-melanoma skin cancer. Nonetheless, a 2010 study by Tang demonstrated that elderly men with higher blood levels of vitamin D have fewer non-melanoma skin cancers.

Even in a large study like the WHI, the low frequency of melanomas means that the absolute number of cancers was small. Out of the 36,000 participants, only 176 cases of melanoma were reported. "That just highlights how large a trial needs to be to capture cancer as relatively rare as melanoma," said Marcia Stefanick, PhD, the Stanford WHI principal investigator and senior author of this study.

"These results spur us to do more studies," said Tang. She is planning multiple lines of research to examine the potential relationship between vitamin D and cancer prevention, including a study that will compare blood levels of vitamin D with melanoma outcomes. Another line of research will examine the effect of larger doses of vitamin D on the behavior of skin cells in patients with high skin-cancer risk.

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Women who sit for long periods of time everyday are two to three times more likely to develop a life-threatening blood clot in their lungs than more active women, finds a study published on bmj.com today.

The new study is the first to prove that a sedentary lifestyle increases your risk of developing a pulmonary embolism – a common cause of heart disease.

An editorial published alongside the study says that, although the risk is small – equivalent to seven extra cases per 10,000 person years, and only slightly higher than seen in users of oral contraceptives or long haul airplane travel - the findings could have major health ramifications.

Pulmonary embolism develops when part, or all, of the blood clot travels through the bloodstream from the deep veins in the leg and up into the lungs. Symptoms include difficulty breathing, chest pain and coughing.

While other studies have explored the relationship between physical activity and pulmonary embolism, few data are available linking the condition with physical inactivity.

Dr Christopher Kabrhel and colleagues studied 69,950 female nurses over an 18-year period providing detailed information about their lifestyle habits by completing biennial questionnaires.

They found that the risk of pulmonary embolism is more than two times higher in women who spend most time sitting (more than 41 hours a week outside of work) compared with those who spend least time sitting (less than 10 hours a week outside of work).

The results remained conclusive after taking account of factors such as age, body mass index and smoking, adding to the evidence that physical inactivity is a major cause of this condition.

The study also shows that physical inactivity correlated with heart disease and hypertension and could be one of the hidden mechanisms that link arterial disease and venous disease.

The authors conclude that physical inactivity is associated with incident pulmonary embolism in women, and suggest that public health campaigns that discourage physical inactivity among the general population could reduce the incidence of pulmonary embolism.

In the accompanying editorial, researchers in Canada say the study "reinforces the notion that prolonged inactivity increases the risk of venous thromboembolism, and it shows how this occurs in everyday life." The findings also indirectly support the use of preventive interventions for at risk people with prolonged immobility, they conclude.

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While depression and anxiety have long been recognised as risk factors for heart disease, there is less certainty over the beneficial effects of a 'positive' psychological state, Now, following a study of almost 8000 British civil servants, researchers say that a satisfying life is indeed good for the heart.

The results of the study are published online today by the European Heart Journal.(1)

The civil servants - who were all members of the Whitehall II study cohort in the UK with an average age of 49 years (2) - were questioned about seven specific areas of their everyday lives: love relationships, leisure activities, standard of living, job, family, sex, and one's self. They were asked to rate their satisfaction in each domain on a scale of 1 ('very dissatisfied') to 7 ('very satisfied'). Ratings for each domain were also combined to provide an average satisfaction score for their overall lives.

The participants' health records were then examined for coronary related deaths, non-fatal heart attack, and clinically verified angina over a follow-up period of around six years.

Results of the investigation showed that higher levels of average life satisfaction were associated with a reduced (and statistically significant) risk of total coronary heart disease of 13% (HR 0.87; 95% CI: 0.78 – 0.98), after controlling for demographic and other health characteristics. An approximate 13% reduced risk of heart disease was also associated with satisfaction in four of the specific life domains - job, family, sex, and self (but not with love relationships, leisure activities, or standard of living). The reduced risk of total coronary heart disease was found in both men and women.

There was a 'dose response' in these associations such that those reporting the greatest average life satisfaction appeared to enjoy the greatest risk reduction in total coronary disease. However, when examining the association between average life satisfaction and fatal or non-fatal heart attack separately from angina, reduced risk was only evident with angina, which appeared to be driving the association between life satisfaction and total coronary heart disease. Such findings may be accounted for by the relatively young age of the study participants or by the possibility that life satisfaction may relate to a general risk of atherosclerosis but not to factors predisposing individuals to heart attack. Nevertheless, the authors propose that understanding the psychological profile of patients with angina may add predictive value to an assessment of their subsequent heart disease risk.

'Taken together,' say the investigators, 'this research indicates that being satisfied with specific life domains - in particular, one's job, family, sex life, and self - is a positive health asset associated with a reduction in incident coronary heart disease independently of traditional risk factors.'

Commenting on the results, investigator Dr Julia Boehm from the Department of Society, Human Development, and Health, at the Harvard School of Public Health, Boston, USA, said: 'Although conventional risk factors such as health behaviors, blood pressure, lipids and body mass index did not explain the relationship between life satisfaction and total coronary heart disease, other behavioural or biological mechanisms that promote resilience cannot be ruled out. Moreover, these findings suggest that interventions to bolster positive psychological states - not just alleviate negative psychological states - may be relevant among high-risk individuals.'

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Adhering to a healthy lifestyle, including not smoking, exercising regularly, having a low body weight and eating a healthy diet, appears to lower the risk of sudden cardiac death in women, according to a study in the July 6 issue of JAMA.

"Sudden cardiac death (SCD) [defined as death occurring within one hour after symptom onset without evidence of circulatory collapse] accounts for more than half of all cardiac deaths, with an incidence of approximately 250,000 to 310,000 cases annually in the United States," the authors write as background information in the study. The authors also note that no prior studies have examined the combination of multiple lifestyle factors and risk of SCD.

Using data collected as part of the Nurses' Health Study, Stephanie E. Chiuve, Sc.D., of Brigham and Women's Hospital and Harvard Medical School, Boston, and colleagues examined the association between a healthy lifestyle and risk of SCD. A total of 81,722 women who participated in the Nurses' Health Study from June 1984 to June 2010 were included in the study, and lifestyle factors were assessed via questionnaires every two to four years. A low-risk lifestyle was defined as not smoking, having a body mass index (BMI) of less than 25, exercise duration of 30 minutes/day or longer, and consuming a diet closely related to a Mediterranean-style diet (emphasizes high intake of vegetables, fruits, nuts, legumes, whole grains and fish, with moderate alcohol intake).

During the 26 years of follow-up, there were 321 cases of SCD among women (average age 72 years at the time of the SCD event) in the study. All four low-risk factors were significantly and independently associated with a lower risk of SCD. Not smoking, exercising and eating a healthy diet each were inversely associated with risk of SCD. BMI also was associated with the risk of SCD, with women having a BMI between 21 and 24.9 at lowest risk.

Women at low risk for all four lifestyle factors had a 92 percent lower risk of SCD when compared with women at low risk for none of the four lifestyle factors.

"The primary prevention of SCD remains a major public health challenge because most SCD occurs among individuals not identified as high risk," the authors write. "In this cohort of female nurses, adherence to an overall healthy lifestyle was associated with a lower risk of SCD and may be an effective strategy for the prevention of SCD."

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Giving vitamin D3 (cholecalciferol) to predominantly elderly women, mainly in institutional care, seems to increase survival. These women are likely to be vitamin D deficient with a significant risk of falls and fractures. This is the key conclusion in a systematic review published in the latest edition of The Cochrane Library.

Up until now there has been no clear view on whether there is a real benefit of taking vitamin D. "A Cochrane meta-analysis published only a couple of years ago found that there was some evidence for benefit, but it could not find an effect on mortality. We were, however, aware that more trials had been published and wanted to assess the effects of vitamin D when you added all the data together," said Dr Goran Bjelakovic, who works at Department of Internal Medicine - Gastroenterology and Hepatology, at the University of Nis, in Serbia and at The Cochrane Hepato-Biliary Group at The Copenhagen Trial Unit in Copenhagen, Denmark.

The eight-strong international team of researchers identified 50 randomised trials that together had 94,148 participants. They had a mean age of 74 years, and 79% were women. "Our analyses suggest that vitamin D3 reduces mortality by about 6%. This means that you need to give about 200 people vitamin D3 for around two years to save one additional life," says Bjelakovic.

There were no significant benefits of taking other forms of vitamin D such as vitamin D2, and the active forms of the vitamin, alfacalcidol or calcitriol. However, the researchers point out that they could only find much less data relating to these types of vitamin D and so these conclusions should be taken with caution. "We need to have more randomised trials that look specifically to see whether these forms of vitamin D do or don't have benefits," says Bjelakovic. His team did conclude that alfacalcidol and calcitriol significantly increased the risk of hypercalcaemia, and vitamin D3 combined with calcium significantly increased the risk of kidney stones.

There have been reports and comments that taking vitamin D can reduce the risk of getting cancer, but this work showed no evidence that vitamin D reduced cancer-related mortality.

"Previous reviews of preventive trials of vitamin D have not included as much information and have not examined the separate influence of different forms of vitamin D on mortality. By taking data from a larger number of trials we have been able to shed much more light on this important issue," says Bjelakovic.

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Moderate reductions in the amount of salt people eat doesn't reduce their likelihood of dying or experiencing cardiovascular disease. This is the main conclusion from a systematic review published in the latest edition of The Cochrane Library.

There is lots of evidence that reducing dietary salt intake reduces blood pressure and the researchers did see some indication of this occurring. "Intensive support and encouragement to reduce salt intake did lead to a reduction in salt eaten and a small reduction in blood pressure after more than six months," says lead author Professor Rod Taylor who works at the Peninsula College of Medicine and Dentistry at the University of Exeter.

"What we wanted to see was whether this dietary change also reduced a person's risk of dying or suffering from cardiovascular events," says Taylor.

An earlier Cochrane review of dietary advice published in 2004 could not find enough evidence to allow the researchers to draw any conclusions about the effects of reducing salt intake on mortality or cardiovascular events. In Taylor's newly published research, however, the team managed to locate seven studies that together included 6,489 participants. This gave a sufficiently large set of data to be able to start drawing conclusions. Even so, Taylor believes he would need to have data from at least 18,000 individuals before he could expect to reveal any clear health benefits.

Most experts are agreed that consuming too much salt is not good for you and that salt reduction is beneficial in people with normal and high blood pressure. "We believe that we didn't see big benefits in this study because the people in the trials we analyzed only reduced their salt intake by a moderate amount, so the effect on blood pressure and heart disease was not large," says Taylor. He believes that health practitioners need to find more effective ways of reducing salt intake that are both practicable and inexpensive.

Many countries have government-sanctioned recommendations that call for reduced dietary sodium. In the UK, the National Institute of Health and Clinical Guidance (NICE) has recently called for an acceleration of the reduction in salt in the general population from a maximum intake of 6g per day per adult by 2015 to 3g by 2025.

"With governments setting ever lower targets for salt intake, and food manufacturers working to remove it from their products, it's really important that we do some large research trials to get a full understanding of the benefits and risks of reducing salt intake," says Taylor.