Can Cocoa Extract and a Multivitamin Help Prevent Heart Disease and Cancer?

Posted by Brigham and Women's Hospital October 3, 2016

The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) is the most extensive study to date testing the roles of cocoa extract and a multivitamin in improving health.

Contributor: Dr. JoAnn Manson is Chief of the Division of Preventive Medicine at Brigham and Women’s Hospital (BWH). She is leading the COSMOS trial with BWH Dr. Howard Sesso, an associate epidemiologist at BWH.

Researchers at Brigham and Women’s Hospital and the Fred Hutchinson Cancer Research Center are collaborating in a new research study, known as the COcoa Supplement and Multivitamin Outcomes Study (COSMOS), for the most extensive study to date testing the roles of cocoa extract and a multivitamin in improving health, including preventing heart disease and cancer.

Previous studies of cocoa flavanols conducted by researchers at BWH and other institutions have found that cocoa may reduce the risk of heart disease (including a short-term decrease in blood pressure), as well as slow age-related cognitive decline. BWH researchers have also previously found that multivitamin use modestly reduced cancer risk in a trial of more than 14,000 male physicians.

“COSMOS will allow us to further explore these promising nutritional supplements in both men and women as part of a large-scale national clinical trial,” said Dr. JoAnn Manson, Chief of the Division of Preventive Medicine at BWH and Co-Director of COSMOS with BWH epidemiologist Dr. Howard Sesso.

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Prescription for Exercise: Making Physical Activity a Priority

Posted by Brigham and Women's Hospital March 3, 2016

A recent study found that only 34 percent of adults were counseled about physical activity during their last primary care visit.

Has your doctor ever given you a prescription for exercise?

Dr. JoAnn Manson, Chief of the Division of Preventive Medicine at Brigham and Women’s Hospital, recently co-authored an article that calls for physicians and other health care professionals to make exercise counseling a consistent component of their interactions with patients. Failure to do so, explains Dr. Manson, is a lost opportunity to safely and inexpensively improve the health of patients.

“There is a consensus within the medical and public health communities that increasing physical activity among our patients should be a priority,” says Dr. Manson. “No other single intervention or treatment is associated with such a diverse array of benefits.”

Among those benefits is reducing the risk for major chronic diseases, including high blood pressure, type 2 diabetes, obesity, heart disease, stroke, cognitive decline, certain cancers, and depression.

A recent study, however, found that only 34 percent of adults were counseled about physical activity during their last primary care visit. Among adults with vascular risk factors, about 40 percent received such counseling. Dr. Manson and her co-authors suggest that this lack of guidance may be due to time constraints, a lack of useful tools, or skepticism about the impact of exercise counseling.

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Vitamin D and Omega-3s – Impact on Chronic Disease Prevention

Posted by Brigham and Women's Hospital July 9, 2015

Dr. JoAnn Manson

Can vitamin D and fish oil omega-3 supplements reduce the risks of cancer, heart disease, and stroke? That’s one of the questions researchers are hoping to answer in the the VITamin D and OmegA-3 TriaL (VITAL). VITAL is a randomized clinical trial studying the effect of vitamin D at a dose of 2,000 international units (IUs) per day and omega-3 fatty acids at a dose of one gram per day in the prevention of cancer, heart disease, and stroke in people without a prior history of these illnesses.

The Institute of Medicine currently recommends 600 IUs per day of vitamin D for adults up to age 70 and 800 IUs a day after age 70 to protect the bones and reduce the risk of fractures, osteoporosis, osteomalacia, and other bone health problems. However, it’s not known whether giving higher amounts would be of benefit in preventing heart attack, stroke, and cancer. Also of interest will be the effects of the supplements on risks of diabetes, cognitive decline, autoimmune disorders, and other outcomes. Half of the 26,000 VITAL participants are receiving 2000 IUs of Vitamin D per day, and their health outcomes are being compared to participants receiving a placebo.

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Mobile Menopause App Guides Hormone Therapy Decisions

Posted by Brigham and Women's Hospital December 16, 2014

The free MenoPro mobile app is a decision-support tool for women facing menopause.

For women facing menopause, the choice to take – or not to take – estrogen or other prescription medications can be overwhelming, complicated, and downright stressful. It turns out that clinicians often struggle with the decision-making process, too. Now, a new mobile app could help both women and their clinicians navigate this important health care decision.

The app, called MenoPro, was developed by JoAnn Manson, MD, MPH, DrPH, Chief, Division of Preventive Medicine at Brigham and Women’s Hospital, and her colleagues at the North American Menopause Society (NAMS).

It is designed to help clinicians and patients work together to personalize treatment decisions based on patients’ own preferences (hormonal vs. non-hormonal therapies) and to take into account their health risks (such as diabetes, high blood pressure, high cholesterol, and cardiovascular disease). The app features two modes, one for health care providers and another for patients.

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Aspirin and Your Health: Past, Present and Future

Posted by Brigham and Women's Hospital January 30, 2014

Aspirin, used for centuries as a pain reliever, has only been recognized as having benefits for the heart in the past several decades. In the following video, Dr. JoAnn Manson, Chief, Brigham and Women’s Hospital (BWH) Division of Preventive Medicine; Co-Director, Connors Center for Women’s Health and Gender Biology; and Co-investigator, Nurses’ Health Study, Physicians’ Health Study, and Women’s Health Study, describes the discovery by BWH researchers that aspirin could prevent first heart attacks, saving lives worldwide.

Heart Attack Prevention in Men

Due to aspirin’s ability to thin the blood and prevent platelets from clumping, clinical researchers concluded, in the late 1970s, that aspirin could help prevent heart attacks in people who had suffered them previously. Several randomized trials demonstrated this benefit in high-risk individuals.

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New Research Clarifies Role of Hormone Replacement Therapy

Posted by Brigham and Women's Hospital October 9, 2013

The benefits of hormone therapy for relieving menopause symptoms may outweigh the risks.

If you’re a woman nearing or beginning menopause, you probably have questions about whether to use hormone replacement therapy for relief of menopause symptoms such as hot flashes or night sweats. Recent findings from the Women’s Health Initiative (WHI), published in October 2013, may help you and your doctor evaluate the benefits and risk of hormone therapy in the context of your own health history.

Researchers analyzed more than 27,000 postmenopausal women, ages 50-79, in two hormone therapy trials (estrogen plus progestin and estrogen alone) over a 13 year period. They concluded that hormone therapy is helpful in managing the symptoms of menopause (such as hot flashes or night sweats) in younger women (ages 50-59); however, they cautioned against the use of hormone therapy to prevent chronic diseases, particularly in older women, due to an increased risk of adverse events.

Among women in the 50 to 59 year age group, researchers found that fewer than 1 in 100 had adverse events during five years of hormone therapy use, while the risk of adverse events were four to five times higher among the older women.  Furthermore, because younger women were more likely to experience menopausal symptoms that were relieved by hormone therapy, the quality-of-life benefits outweighed the risks of adverse events in these women.

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Benefits of Hormone Therapy for Early Menopause Symptoms

Posted by Brigham and Women's Hospital December 28, 2012

Hormone therapy during early menopause can help reduce the most bothersome symptoms.

Many women experience bothersome symptoms during menopause, such as hot flashes, night sweats, and vaginal dryness.  Hormone therapy (HT) can provide relief from the symptoms of menopause, but studies have shown that these benefits of HT may come with added risks, especially if hormone therapy is started more than 10 years after the onset of menopause. For example, in the Women’s Health Initiative (WHI), in which women were an average age of 63, the risks of combination estrogen plus progestin (stroke, heart attacks, venous blood clots, and breast cancer) outweighed the benefits. As a result, there was a sharp decrease in the number of women using HT, leaving them with few options for symptomatic relief.

Now a new study called KEEPS (Kronos Early Estrogen Prevention Study), finds that women can experience the benefits of HT while minimizing the health risks, provided therapy is given early in menopause and at low doses for up to four years.  JoAnn Manson, Chief of Preventive Medicine at Brigham and Women’s Hospital, one of the KEEPS and WHI principal researchers, said “Many newly menopausal women will be using hormone therapy for only four to five years , so these findings will have great relevance to them.”

The study included 727 women ranging in age from 42 to 58. Some of the women were randomized to estrogen pills and others to estrogen patches, both combined with natural progesterone pills taken 12 days a month. They were compared with women using placebo patches and pills.

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Landmark Women’s Health Study on Hormone Therapy Marks 10-Year Anniversary

Posted by Brigham and Women's Hospital October 9, 2012

Dr. JoAnn Manson is one of the principal investigators for the landmark Women's Health Initiiative study.

In the past decade, the Women’s Health Initiative (WHI) Hormone Therapy Trial, for which Brigham and Women’s Hospital was one of the centers,  has revealed much about the benefits and risks associated with hormone therapy for menopausal women and has changed the way women around the world manage their symptoms.

The findings from the hormone trial that included estrogen plus progestin were monumental in demonstrating a link between hormone therapy and increased risks of heart disease, stroke, pulmonary embolism, and breast cancer in postmenopausal women.

The trial was initially designed to assess the role of hormone therapy in the prevention of heart disease and chronic diseases. During the trial, the researchers discovered that overall risks of hormone therapy exceeded benefits, especially for older women in the study. Given this, the two hormone therapy trials ended early to protect study participants.

The estrogen plus progestin trial was stopped three years early because the risks clearly outweighed the benefits. The estrogen-alone trial (for women with hysterectomy) showed fewer risks but was stopped one year early due to an increased risk of stroke.

“The WHI deserves credit for stopping the growing clinical practice of prescribing hormone therapy to older women who were at very high risk of heart disease,” wrote JoAnn Manson, MD, MPH, DrPH, BWH Chief, Division of Preventive Medicine and one of the principal investigators of the WHI, in a co-authored editorial for the medical journal, Menopause. “In fact, these women did not have a reduced risk of heart disease from hormone therapy and may even have suffered harm.”

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Vitamin D and Omega-3: Can They Fight Heart Disease and Cancer?

Posted by Blog Administrator April 5, 2012

Vitamin D and Omega-3

BWH researchers are testing whether vitamin D and omega-3 help prevent cancer, cardiovascular disease, and other conditions.

Can the foods in your kitchen and supplements in your medicine cabinet really prevent major diseases? Well, researchers at Brigham and Women’s Hospital (BWH) are evaluating two common nutrients suspected of doing just that.

A new study, the VITamin D and OmegA-3 TriaL (VITAL), is testing the role of vitamin D (2,000 IU daily) and EPA+DHA (1 gram daily) in the prevention of cancer, cardiovascular disease, and a wide range of other conditions among 20,000 men and women (above age 50 and 55 respectively) nationwide.

“There has been a lot of confusion and conflicting information about the ideal intake levels and health benefits of Vitamin D and omega-3 fatty acids, and rigorous testing of their role in disease prevention has been limited,” explains Dr. JoAnn Manson, Principal Investigator of VITAL, Chief of the Division of Preventive Medicine at BWH, and the Michael and Lee Bell Professor of Women’s Health at Harvard Medical School. “The VITAL study will provide long-awaited concrete data regarding effects of these nutrients in the prevention of cancer, heart disease, stroke, and other illnesses.”

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