TUESDAY, May 6 (HealthDay News) -- Folic acid and vitamin B supplements aimed at reducing blood levels of the amino acid homocysteine did not protect women against heart disease and stroke, a long-term study found.

It's the latest of several trials to douse the hope that lowering homocysteine levels could reduce the incidence of cardiovascular disease, said study lead author Dr. JoAnn Manson, chief of preventive medicine at Harvard's Brigham and Women's Hospital in Boston.

"To our knowledge, this is the trial with the longest follow-up," Manson said. "And to date, it is the largest study of women."

The trial also included a large number of women without cardiovascular disease, she said. Most earlier studies concentrated on people who already had had a heart attack, stroke or other cardiovascular problem.

The new findings were published in the May 7 issue of the Journal of the American Medical Association.

The trial included more than 5,400 U.S. women who were health professionals. Some had a history of cardiovascular disease, and others had three or more coronary risk factors, such as high blood pressure, obesity or diabetes. Half of the women took a daily combination pill containing 2.5 milligrams of folic acid, 50 milligrams of vitamin B6, and 1 milligram of vitamin B12, while the other half took a placebo.

Over the next 7.3 years, 14.9 percent of the women taking the active pill had a cardiovascular event, such as a heart attack or stroke. The incidence of such events in the women taking the inactive pill was almost the same -- 14.3 percent.

There still are ongoing trials, all stimulated by past studies suggesting an association between high blood levels of homocysteine and cardiovascular disease. But the latest results "cast further doubt on the hypothesis that lowering homocysteine prevents cardiovascular events," Manson said. "Folic acid supplements should not be used for the express purpose of preventing cardiovascular events."

The supplements do have their uses, Manson was quick to add. Folic acid is known to prevent birth defects that affect a baby's brain and spine. "We strongly recommend that women who might become pregnant take additional folic acid supplements," she said.

Manson used the word "additional," because bread and other grain products in the United States and other developed countries are fortified with folic acid. Natural sources of folic acid include green leafy green vegetables and citrus fruits.

Supplements could be recommended routinely for people in countries where no such fortification is done, said Dr. Eva Lonn, professor of medicine at McMaster University in Hamilton, Ontario, Canada, who wrote an accompanying editorial in the journal.

"But what we have learned from the trials in North America, where folic acid is added to flour products, is that there is no role for homocysteine screening or treatment in cardiovascular disease," Lonn said.

Some studies have indicated that folic acid supplements might protect against Alzheimer's disease, she said. "But they aren't conclusive," she added. "We need randomized trials with hard endpoints."

More information

A woman's guide to folic acid is offered by the U.S. National Women's Health Information Center.

WEDNESDAY, April 30 (HealthDay News) -- Results of a small study show that the electromagnetic field produced by incubators affect the heart rates of newborn babies, Italian researchers report.

Whether these changes in cardiac rhythms have long-term effects isn't known, but they could have implications for premature infants who can spend several weeks or months in incubators, the researchers said.

"Neonatal incubators are designed to shield fragile babies from external foes and to preserve their temperature, and they are good for this. Yet we showed that most of them produce relevant electromagnetic fields, and this study is the first to show that this exposure has an influence on babies' autonomous nervous system," said lead researcher Dr. Carlo Bellieni, of the University of Siena's Department of Pediatrics, Obstetrics, and Reproductive Medicine.

"Neonatal incubators are not electromagnetically neutral, and this data deserves as much attention as the concerns about risks from cellular phones or high voltage lines on adults," he said.

However, Bellieni doesn't think that people should be overly concerned by this phenomenon.

"Alarm is not justified, because incubators are necessary to babies and because no long-term effect of this exposure has been demonstrated on babies' health," Bellieni said. "Thorough analyses of possible long-term effects of this exposure are needed."

The report was published in the May issue of the Archives of Disease in Childhood.

In the study, Bellieni's team looked at the changes of heart rates among 43 newborns, who were critically ill or premature. The researchers assessed the heart rates of 27 babies over three five-minute periods during which the incubators motor was left on, then switched off and then turned on again.

To determine if the noise of the motor might be a factor, 16 of the infants were exposed to background noise, while the incubators motor was turned off.

Bellieni's group found that background noise did not affect heart rate. However, heart rate was significantly affected by the incubators. When the incubator was turned on, the heart rate variability dropped significantly, the researchers found.

A drop in heart rate variability is a strong predictor of poor outcomes in adult patients with heart disease, the researchers noted.

More information

For more on premature infants, visit the U.S. National Institutes of Health.

THURSDAY, May 1 (HealthDay News) -- Exercise and counseling are the prescription for improving the quality of life of heart failure patients who suffer depression, a new report says.

Aerobic exercise -- such as walking outdoors -- paired with cognitive behavioral therapy aimed at improving the patient's attitude boosted physical abilities and reduced symptoms of depression, according to researchers who were expected to present their findings Thursday at the American Heart Association's Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke in Baltimore.

In the study, researchers divided 74 heart failure patients with clinical depression into four groups: One group received a 12-week, home-based program of exercise and psychological counseling; one received counseling alone; another did only exercise; and the last received only standard care.

"By combining exercise with psychological counseling, these depressed patients do better in all parameters compared to the other groups," study author Rebecca Gary, an assistant professor in the School of Nursing at Emory University in Atlanta, said in a prepared statement. "This may be the best method for improving their depression, symptom severity and quality of life."

Patients who exercised followed a progressive program of low-to-moderate intensity in which they were encouraged to walk outdoors three times a week for at least 30 minutes. They received heart rate monitors and training in how to track their exertion level and when to stop exercising. All patients achieved these goals, even though some were quite debilitated at the start of the sessions.

Those receiving counseling had weekly one-on-one cognitive therapy sessions in their homes with psychiatric nurse specialists and doctoral students trained in counseling techniques for 12 weeks.

"The cognitive behavioral therapy was geared toward changing the attitude of the patients about their illness," Gary said. "We wanted them to change their negative thoughts and beliefs, and restructure and reformat how they think about their illness and limitations. For example, we developed a volunteer and activities sign-up sheet in each community that provided transportation for those who wanted to get out of the home or contribute in some way."

Patients combining exercise and behavioral therapy improved significantly in a six-minute walk test than the other groups. They also had fewer symptoms of depression than those having only standard care.

Oddly, even though those in the counseling-only group had fewer depressive symptoms after therapy, they believed their quality of life was worse than those of the combined group or exercise-only group.

More information

The American Academy of Family Physicians has more about depression and heart failure  .

MONDAY, April 28 (HealthDay News) -- No matter when postmenopausal women start hormone replacement therapy (HRT), high doses of the treatment increase their risk of stroke, a new study finds.

The risk for stroke does appear lower in younger women taking HRT and in those taking the lowest doses of estrogen, Harvard researchers say. However, in women who took high doses of hormones, that increased risk was as much as 62 percent.

"If you take medium to higher doses of hormone therapy, you are at increased risk of stroke," said Dr. James Liu, chairman of the Department of Obstetrics and Gynecology at MacDonald Women's Hospital, University Hospitals Case Medical Center in Cleveland.

"If you are on estrogen, the risks of clotting abnormalities are slightly increased versus if you are not on estrogen," Liu said. "So, the risk of stroke is increased."

The report was published in the April 28 edition of the Archives of Internal Medicine.

In the study, Francine Grodstein and colleagues at Brigham and Women's Hospital and Harvard Medical School collected data on 121,700 women who participated in the Nurses' Health Study from 1976 to 2004.

The researchers looked at the association between HRT and stroke. Over the course of the study, 360 women who had never used HRT had strokes compared with 414 women taking hormones, Grodstein's team found.

"This increased risk was observed for women initiating hormone therapy at young ages or near menopause and at older ages or more than 10 years after menopause," the researchers wrote.

However, women taking HRT for less than five years at younger ages did not have a clear increase of stroke, which might be due to the small number of cases studied, the researchers noted.

"The incidence of stroke was relatively low in younger women, and the attributable risk in women aged 50 through 54 years indicated approximately an additional two cases of stroke per 10,000 women per year taking hormones," the researchers added.

Liu noted that older women are at an increased risk of stroke due to their age, whether or not they are taking HRT.

In addition, higher doses of estrogen were associated with an increased risk for stroke, Grodstein's group found. In fact, women taking high doses of estrogen increased their risk of stroke by 62 percent.

"In summary, our findings in the Nurses' Health Study indicate that hormone therapy is associated with an increased risk of stroke, regardless of the hormone regime or the timing of hormone therapy initiation," the researchers concluded. "However, in younger women, who are at lower absolute risk of stroke, the attributable risk of stroke owing to hormone use is modest, and our data suggest that risk might be further minimized by lower doses and shorter duration of treatment."

Liu noted that HRT is given differently than it was in 1976. "The doses we're using now are much, much lower," he said.

"The advice to women is, if you are on HRT, you should be on the lowest dose that will control your symptoms," Liu said. "In addition, you should be monitored and evaluated, and if you are going to continue on it; you need to understand what the risks are."

Another expert thinks only women with the most severe symptoms should start HRT, and then only at the lowest dose.

"You don't really see an increased risk of stroke with the lowest estrogen does," said Dr. Jennifer Wu, an obstetrician/gynecologist at Lenox Hill Hospital in New York City. "This study confirms that you should be on hormone replacement therapy for the shortest time possible at the lowest dose."

Wu thinks only women with the most severe menopausal symptoms who can't function well on a daily basis should start HRT. "We try to start [on] the lowest dose possible and decrease that dose even further, if possible," she said. "We keep them on a low dose for six months, and then take them off and see how they do."

Wyeth Pharmaceuticals, which sells the hormone therapy called Premarin, said in a statement that the findings reflect previous research and the current labeling on all hormone therapy products.

"Hormone therapy continues to be an effective option for many women when used at the lowest dose for the appropriate duration consistent with treatment goals and risk for the individual woman," Danielle Halstrom, senior director of global public relations at Wyeth Women's Health Care, said in a statement. "Hormone therapy is the most effective FDA-approved treatment for menopausal symptoms, and the benefits of hormone therapy may outweigh the risks for many symptomatic menopausal women."

More information

For more on hormone replacement therapy, visit the Women's Health Initiative.