HRT DECREASE SUBSTANTIALLY CVD RISK IN WOMEN

Hormone-replacement therapy (HRT) in postmenopausal women with a mean age of 50 significantly reduced the risk of the combined end point of mortality, MI, or heart failure in a new randomized Danish study published online October 9, 2012 in BMJ [1]. The participants, who used HRT for more than 10 years, were not at significantly increased risk of breast cancer or stroke either, report Dr Louise Schierbeck (Hvidovre Hospital, Denmark) and colleagues.

"This is the longest randomized trial with hard end points, and we found a 50% reduction in cardiovascular end points for the women who took HRT, and there was no increased risk of cancer," Schierbeck told heartwire . The women were also followed for a further six years after discontinuation of randomized treatment, she noted.

Schierbeck says the findings, in 1000 women, confirm the "timing hypothesis." In 2002, primary results from the Women's Health Initiative (WHI) showed no cardiovascular benefit from HRT--something that had been suggested by numerous observational trials--and even an indication there may be harm; this led to the widespread abandonment of this therapy. But subsequent analyses of WHI, and data from other studies, have suggested that the time at which HRT is first prescribed is key. The women in this Danish study were 13 years younger, on average, than the women in WHI (mean age 63 years). "It doesn't make much sense to start treating women 13 years after menopause for menopausal symptoms. It's important to initiate the treatment at menopause and not many years later," she observes.

Asked to comment on the new findings, Dr Howard N Hodis (UCLA) told heartwire , "Until this came out there had been no trial to directly study the estrogen cardioprotective hypothesis. This is unique, because it is the only study to have looked at women, a priori, randomized basically at the time of or just a little beyond menopause. And that's a really important point that I think some of the detractors have glossed over. The women averaged 50 years old, just like the women that we treat who come in close to the menopause and say, 'I want hormones,' because they are having symptoms. So scientifically, this is a very important trial."

Ob/gyn Dr James Liu (Case Western Reserve University School of Medicine, Cleveland, OH) said: "This paper adds to the evolving data on HRT for newly menopausal women in the under-age-60 category. The study conclusions are worth noting and are statistically significant and congruent with older observational studies such as the Nurses' Health Study and the subgroup-stratified analyses of the WHI cohort from 50 to 60. Thus, there are two randomized trials that have congruent data." Among the "surprising points," says Liu, are no increase in breast cancer risk for the 16 years of follow-up and the fact that stroke risk was not increased.

Hodis also addressed criticisms that the new Danish trial is too small to yield any meaningful results. "Although the sample size is small, there are 16 years and 20 000 women-years of follow-up." Schierbeck concurs. "We had a very long study, so there are 10 000 person-years of randomized treatment, and we do have a significant outcome in 1000 women, so it's clinically relevant."

Greater-Than-50% Reduction in CV Events Without Increasing Cancer Risk

The 1006 healthy women aged 45 to 58 who were recently postmenopausal or had perimenopausal symptoms were participants in the Danish Osteoporosis Prevention Study and were randomized to receive HRT (n=502) or no treatment (control, n=504).

The primary end point was a composite of death, hospitalization for heart failure, and MI. Secondary end points were the individual components of the primary end point and admission to the hospital for stroke. Safety end points included death or a diagnosis of breast cancer or other cancer grouped together and admission to the hospital for pulmonary embolism or deep venous thrombosis (DVT).

The women in the treated group with an intact uterus received 2-mg synthetic 17-{:beta:}-estradiol for 12 days, 2 mg 17-{:beta:}-estradiol plus 1 mg  norethindrone acetate for 10 days, and 1 mg 17-{:beta:}-estradiol for six days (Trisekvens, Novo Nordisk, Denmark). In women who had undergone hysterectomy, first-line treatment was 2 mg 17-{:beta:}-estradiol a day (Estrofem, Novo Nordisk, Denmark). Other treatment modalities were offered to those who experienced side effects or insufficient relief of symptoms.

The planned duration of the study was 20 years. However, as the WHI data--which came out in 2002 around the time of the 10-year visit--indicated that use of HRT might result in more harm than benefit, the participants were advised to stop treatment. But they were followed for death, cardiovascular disease, and cancer for up to 16 years.

After 10 years of intervention, there was a 52% reduction in the primary composite end point of death, MI, or heart failure, and this was not associated with an increase in any cancer. Schierbeck said numbers were too small to draw any meaningful conclusions on venous thromboembolism (VTE), although she acknowledges that HRT is known to increase the risk of VTE but pointed out, "This is a less serious event than a CV event."

After 16 years, the reduction in the primary composite outcome was still present and still not associated with an increase in any cancer, something both Schierbeck and Hodis say is "reassuring," particularly in terms of breast cancer.

Results After 10 Years of Intervention in Danish Osteoporosis Prevention Study

End point	HRT group (n=502), n	Control group (n=504), n	Hazard ratio	95% CI	p
Primarya	16	33	0.48	0.26– 0.87	0.015
Mortality	15	26	0.57	0.30–1.08	0.084
Cancer	36	39	0.92	0.58–1.45	0.71
Breast cancer	10	17	0.58	0.27–1.27	0.17
DVT	2	1	2.01	0.18– 22.16	--b
Stroke	11	14	0.77	0.35–1.70	0.70

a. Composite end point of death, MI, or heart failure

b. Numbers too low to calculate p

Emotion Has Overtaken the Evidence in Discussions About HRT

Hodis says emotion has long overtaken reason in the HRT debate. "We have had observational studies for the past 50 years in this field, at least 40 of them, and they are all consistent--and you just don't see that in medicine--across two very important outcomes: they reduced cardiovascular disease and they reduced mortality" in women around the time of menopause, he asserts. "But when WHI was conducted, it was done in women who were 12 years or more past menopause. These are two completely different populations of women.

"In all of the emotions after WHI, that 'hormones are killing women'--which is absolutely ridiculous--nobody sat back and said, 'Where is the evidence to support that?' The guidance that unfortunately came out of the results of WHI was 'lowest dose for shortest period of time possible.' Now what we have is a well-conducted, 10-year randomized trial that clearly shows that short-term usage of these products is not going to derive maximum benefits for women."

And other "important" data have come out recently in support of HRT, he notes, including the KEEPSstudy, reported just last week. "This was the largest trial ever done to assess mood, and it showed positive effects in terms of anxiety, depression, and tension, and no adverse effects."

Schierbeck says: "It is a shame that so many women are anxious about HRT, because it's so important for life quality around the time of menopause." She agrees the current mantra seems to be that if a woman wants to use HRT to "go with the lowest dose for the shortest time," but she hopes that this study will have a major impact and influence international societies working on new guidelines.

Asked what she thinks the optimal duration of HRT should be, she said: "I don't think we can set a time limit on it. At least for 10 years, we didn't find any serious side effects."

Hodis says he does not believe there will be a seismic shift in recommendations, because doctors and women have lived in fear of HRT for so long, but "people will look at this and say we can feel comfortable going longer with therapy." Personally, he says, "I'm neither a proponent nor an opponent of HRT: I use these products in women, with or without symptoms, who want to be put on them, with caveats--for example, not if they have had blood clots. They do have risks, but they are so low, and certainly no higher than many other drugs we use."

Where Next? HRT and Chronic Disease Prevention

Hodis also believes there is a role for HRT in chronic disease prevention. "The data strongly indicate that hormones are an excellent prevention for chronic diseases, including bone fractures and heart disease." And although the reduction in deaths in the Danish study was not significant, Hodis says the totality of evidence points to HRT adding "almost two years" to the life of a woman, with the additional benefit that hormones "are cost-effective, coming in at around $2300 per quality-adjusted life-year [QALY]. There's nothing else in women that does that. Statins do not extend life and they cost $50 000 $100 000 per QALY."

But not everyone agrees. KEEPS and WHI trialist Dr JoAnn E Manson (Brigham and Women's Hospital, Boston, MA) maintained last week that HRT should be used only for the treatment of menopausal symptoms.

"We certainly would not say at this point in time to initiate hormone therapy for the express purpose of trying to prevent heart disease or cognitive decline; the evidence is not to that point," she said in an interview. "But for women who have menopausal symptoms and who are considering HRT to reduce their symptoms and improve their quality of life related to these symptoms, there were many favorable effects seen of taking HRT for four years."

Differences in Doses of Hormones, Medication Schedules

Liu says there are also some limitations to the Danish study that are pointed out by the authors, but others that are not. The latter include the fact that the medication used was lower dose than the 0.625-mg conjugated equine estrogen traditionally used [in the US] and in the WHI, although "there are some who may state that the 2-mg estradiol dose is similar," he observes. And the progestinused is different.

In addition, the type of dosing is different: "The Danish study used cycle estrogen and progestin in a 28-day dose-pack form, and the pattern of estrogen-progestin administration is somewhat unique in that the last six days used a lower estradiol dose of 1 mg.  Thus, the estrogen exposure is not uniform across the 28 days. This dose is also different from women with hysterectomy who received 2-mg estradiol continuously. This contrasts with WHI, which used continuous combined estrogen/progestin daily for those women with a uterus."

And the data end points for the Danish study--due to its small size--are combined for women on estrogen alone (due to hysterectomy) and cyclic estrogen-progestin. "This analyses is different from the WHI approach, where there were two separate studies (those with a uterus were in a separate study from those with a hysterectomy) with larger cohort sizes."

Tips for healthy living in 2013? Be positive, pray, goof around

Eat your veggies. Don't smoke. Get some exercise. Watch your weight. 

Those are good tips for staying healthy. They're also uttered so often that they go unheard by many.

Several health experts in the region gave fresh suggestions — some of them philosophical — on how to improve your health in 2013 and have a better, safer life. 

Here they are: 

» Enjoy downtime. “We don't allow ourselves opportunities to just let down,” said Dr. Donald Darst, president of Midwest Regional Health Services. “We just put ourselves through way too much. Everything has to be go, go, go, go.”

» Pray. You are more than just a physical creature, said Dr. H. Dele Davies, vice chancellor for academic affairs at the University of Nebraska Medical Center. “You have a mind, and you have a spirit.” Those who pray are happier, more satisfied. “It's controversial, but it's certainly something that I believe,” Davies said.

» Spend less time in front of screens. Go do something, said Cindy Brison, extension educator for the University of Nebraska-Lincoln Extension in Douglas and Sarpy Counties. Doing stuff instead of looking at televisions and computers means “living life instead of being a voyeur,” Brison said.

» Spend more time with family. Brison said people always say they want to make family a priority. Do it.

» Know your medical numbers. Have a primary care physician who will go through vital numbers with you. Those numbers include cholesterol, blood pressure and body mass index, or BMI, said Dr. Steph Erickson, a family physician with Alegent Creighton Clinic.

» Goof around. Having fun at work builds camaraderie, breaks down cliques and cuts tension, Darst said.

» Be ergonomically sound. Make sure you use good body positioning and posture. This reduces muscle tension, pain and repetitive strain injuries, said Rebecca Tomhave, clinic nurse for employee health at St. Elizabeth Regional Medical Center in Lincoln.

» Be positive. People who feel hopeless do worse in fighting disease and living life, Davies said. “We know that the mind has a strong influence on physical health.”

» Practice household safety. Have an escape plan in case of fire, and make sure your kids know how to open the windows, Erickson said. Assess tripping hazards, make sure the gas stove works properly and don't overtax electrical outlets.

» Review your medications. Go through your medications with your pharmacist or physician, said Amy Friedman Wilson, director of the Creighton Center for Drug Information. Make sure your meds are appropriate for your current condition and that none interact negatively. This includes natural supplements and over-the-counter drugs.

» Treat people with dignity. It helps not only others but you as well, said Dr. Ruth Margalit, director of UNMC's Service Learning Academy. “You gain just as much as you give because it opens you to the opportunity to learn from people.” 

Source  http://www.omaha.com/article/20130102/LIVEWELL01/701029962

FOOD WITH ORAL CANCER DRUGS?

Are oral oncology drugs being mislabeled? Maybe.
Most oral cancer drugs stipulate that they should be taken in a fasting state, but some actually have better bioavailability when taken with food. This is particularly true for the new prostate cancer drug abiraterone acetate (Zytiga), which has a greater interaction with food than any other marketed drug, yet it is labeled to be taken when fasting.
These points are highlighted in a comment published in the October 20 issue of the Journal of Clinical Oncology by Mark J. Ratain, MD, professor of medicine and director of the Center for Personalized Therapeutics at the University of Chicago, Illinois.
"My major concern is safety," Dr. Ratain told Medscape Medical News. "Very few patients would anticipate that the consequences of taking their medications with food...would be an effective overdose."
In the case of abiraterone acetate, the dose of the drug could be increased 10-fold by eating breakfast half an hour after taking the drug, he writes.
Dr. Ratain notes that food interactions are described in the labeling of many drugs, but are notably absent in the labeling of new oral cancer agents.
Most drugs can be taken either with or without food, he explains, because the effects of food are not clinically significant to drug absorption. There are cases in which absorption is decreased by food; generally, the labeling on those drugs instructs that they be taken on an empty stomach. Similarly, labeling on drugs for which absorption is enhanced by food typically instructs that they be ingested with meals.
"However, a recent study of oral agents approved by the US Food and Drug Administration [FDA] in the last 10 years demonstrated that oral oncology drugs have generally been labeled fasting, despite food effects as large as a 4-fold increase in bioavailability," Dr. Ratain notes.
Bias in Labeling?
This apparent bias for fasting labeling in cancer drugs is exemplified with abiraterone, he notes. Abiraterone, which was approved earlier this year in the United States for the treatment of metastatic prostate cancer, has a greater food interaction than any drug currently on the market. Depending on the fat content, food can increase drug exposure 5- to 10-fold, yet it is labeled to be taken in a fasting state, Dr. Ratain points out.
The effect of a high-fat meal indicates "that absolute bioavailability in the fasting state is no more than 10%," says Dr. Ratain, and is likely due to the low absorption rate under fasting conditions; 77% of the drug is excreted as abiraterone (or its prodrug acetate) in the stool.
"In addition, there is marked interindividual pharmacokinetic variability, with a coefficient of variation in the plasma concentration area under the curve of 59% under labeled conditions," he notes.
It is unclear why this faulty labeling is occurring, or why the FDA has not been more stringent about proper labeling for oral oncology drugs, Dr. Ratain said. He told Medscape Medical Newsthat the FDA has not responded to his inquiries and "essentially stonewalled" him because of the confidentiality of their discussions with sponsors.
"The blame could be assigned to sponsors, the Office of Oncology Drug Products, and/or the Office of Clinical Pharmacology and Biopharmaceutics," he said. "Given that there are multiple sponsors, all of whom who have a different approach to oncology..., the evidence points to an FDA origin."
Oral Drugs Relatively New
Alex Adjei, MD, PhD, who was approached by Medscape Medical News for independent comment, explained that until recently, oncology drugs have generally been given intravenously; for other diseases, oral drugs have been in common use for many years.
Perhaps that is why there has not been that much attention on the food-effect data, Dr. Adjei hypothesized. He is chair of the Department of Medicine at Roswell Park Cancer Institute, in Buffalo, New York.
"In clinical trials, we tend to give the drugs on an empty stomach," he said. "So that was how the drug was tested and that was how it was approved. We don't go back and change the label."
Dr. Adjei pointed out that unlike intravenous drugs, there is considerable variation in the way oral drugs are absorbed. "We try to simplify it by giving them on an empty stomach," he said.
Food-Effect Data Ignored
In a study published last year (Clin Cancer Res. 2010;16:4446-4451), Dr. Ratain and his colleague, Soonmo Peter Kang, MD, also from the University of Chicago, evaluated the effect of food on 99 oral agents that received FDA approval from January 2000 to May 2009. They compared food-labeling patterns between oncology and nononcology drugs using Fisher's exact test.
Food had a significant effect on drug bioavailability in 34 of the 99 drugs evaluated. In cases where food markedly enhanced bioavailability, 8 of 9 nononcology drugs were labeled to be taken with food to take advantage of the food–drug interaction. However, all oncology agents were labeled to be taken in "fasted" states (P = .01).
"The food-labeling pattern of recently approved oral oncology drug products is inconsistent with fundamental principles of oral drug delivery," they write. "The labels of 3 agents (erlotinib, nilotinib, and lapatinib) minimized bioavailability through food restrictions, which is in contrast to the labeling principles used for all other classes of oral agents."
In an editorial that accompanied the study by Drs. Ratain and Kang (Clin Cancer Res. 2010;16:4305-4307), Rajul K. Jain, MD, from the University of Texas M.D. Anderson Cancer Center, Houston, and colleagues explained that the effects of food are complex, and that multiple factors determine final labeling recommendations. "When analyzing the label given to any product or product class, all of the potential influencing factors should be considered," they said.
They also noted that "sponsors are encouraged to conduct food-effect studies early in a product's development so the results can be implemented into larger clinical trials."
In his comment, Dr. Ratain refers back to that editorial, and points out that the agency has "expressed concern about the potential for high intraindividual variability in cancer patients resulting from variability in oral intake secondary to disease or concurrent medications." This appears to indicate a preference for labeling drugs to be used when fasting, even if their bioavailability would be substantially increased when taken with food.
He explains that there isn't any evidence that this concern applies to all oral oncology drugs, and that there is no evidence that intraindividual variability in diet is greater for cancer patients than for those with other life-threatening conditions who also take daily oral drugs.
"If the US Food and Drug Administration were truly concerned about intraindividual variability in diet, why has this never come up in the labeling of nononcology drugs?" he asks.
He notes that the FDA was aware of the food-effect data from early studies of abiraterone and could have required at least 1 randomized study to be conducted to review this, so that it could have been labeled to be taken with food. The FDA has the authority to require such studies as a postmarketing requirement, but chose not to.
With the risk for poor adherence to food-effect labeling, there is a risk for overdose or underdose of a given drug, with the more serious being overdose, Dr. Ratain says.
In addition to this safety issue, there are economic implications, Dr. Ratain notes.
The standard dose of abiraterone for men without liver problems is 1000 mg once daily. But because the bioavailability of the drug is greatly increased when taken with food, it would be interesting to have studies of abiraterone at a dose of 250 mg once daily, administered with a standard breakfast. If this approach is shown to be safe and effective, it could save patients and their payers approximately $3750 per month at current prices.
"It also would send a message to the pharmaceutical industry that flawed drug development has financial consequences," he notes, "along with potential risks of product liability because of defective labeling."
He concludes: "After all, given the high attrition rate for oncology drugs, do we really need to flush our few successful products down the toilet?"
Impracticalities of Dosing and Diet
Lawrence J. Lesko, PhD, FCP, former director of the Office of Clinical Pharmacology at the FDA's Center for Drug Evaluation and Research, and a coauthor of the editorial by Dr. Jain, pointed out that the principal of labeling is consistent safety.
"The most consistent way to take drugs is on an empty stomach," said Dr. Lesko, who is now at the Department of Pharmaceutics at the College of Pharmacy at the University of Florida in Gainesville. "It would be impractical to expect that patients are going to adhere to a specific diet when taking these drugs. And it is often unclear what 'food' may mean to the patient. Is it a glass of juice, breakfast cereal, a cheeseburger?"
The goal is to minimize the variability, he told Medscape Medical News. "Food studies are generally conducted in healthy volunteers and not cancer patients. Labeling can't be done on a theoretical basis; it has to reflect what was done in the study."
Dr. Lesko noted that another problem with tying an oral drug dose to food is that many cancer patients have problems with appetite, nausea and vomiting, and gastrointestinal motility. "Their appetite can change on any given day," he said. "Some days, they may not be able to tolerate a high-fat meal, for example, which raises the bioavailability of abiraterone. It would just be impractical to do this on a day-to-day basis."
The other issue that Dr. Ratain focuses on in his comment is the comparison of oncology and nononcology drugs, Dr. Lesko pointed out. "But you really can't compare them."
For most nononcologic agents, food doesn't matter, so it isn't that important how the product is labeled, he said.
But that is not the case with oral oncologic agents. "Every drug in oncology has a narrow therapeutic index, and taking the drug with food could affect the therapeutic range," he said. "The labels are intended to minimize variability and mimic approval data."

ANTHRACYCLINE USE LINKED TO LONG TERM MEMORY PROBLEMS?

Anthracyclines might increase the risk for certain long-term memory problems and brain injury in patients with breast cancer, according to a small study published online December 3 in JAMA Oncology.

The study is the first to directly assess the neurotoxic effects of anthracyclines and nonanthracyclines in long-term survivors of breast cancer.

Cognitive problems related to cancer and its treatment are sometimes referred to as "cancer brain." These problems can persist over the long term and greatly decrease quality of life. Studies have linked chemotherapy to faster brain aging and to neurodegenerative disorders like Alzheimer's disease.

So far, the neurotoxic effects of various types of chemotherapy regimens are unclear, say researchers Shelli Kesler, PhD, from the University of Texas M.D. Anderson Cancer Center in Houston, and Douglas W. Blayney, MD, from the Stanford University School of Medicine in Palo Alto, California.

But their study indicates that regimen matters.

"Using standardized neuropsychological tests and resting state fMRI, we demonstrated significantly lower verbal memory performance and left precuneus connectivity in participants who received anthracycline regimens compared with those who received nonanthracycline regimens and to participants who did not receive chemotherapy," the pair write.

The left precuneus region is involved in memory, visuospacial processing, and consciousness. It is part of the brain's default mode network, which refers to cognitive activities carried out while the brain is at rest. Changes in connectivity in this region could lower the efficiency of information processing. Past studies have suggested that the default mode network is particularly vulnerable to the chemotherapy used to treat breast cancer. Studies have also linked changes in the default mode network to neurodegenerative disorders, Drs Kesler and Blayney report.

In their study, the researchers evaluated results from standardized cognitive tests and resting state functional MRI data for 62 survivors of primary breast cancer (mean age, 54.7 years). Patients had been off therapy for an average of 2 years. Twenty patients had received four to eight cycles of anthracycline-based chemotherapy, 19 had received four to eight cycles of nonanthracycline chemotherapy, and 23 had no history of chemotherapy. Patients were treated at Stanford University from 2008 to 2014.

There was a significant decrease in verbal memory performance in the anthracycline group, compared with the other two groups. This included a decrease in immediate recall (F = 3.73; P = .03) and delayed recall (F = 11.11; P < .001).

There was also less left precuneus connectivity in the anthracycline group than in the other two groups (F = 7.48; P = .001). And patients treated with anthracyclines had significantly less default mode network connectivity (effect size, 0.6 - 1.3; P = .001).

Patient-reported outcomes for cognitive dysfunction and psychologic distress were worse in patients treated with anthracyclines (F = 7.27; P = .002) and nonanthracyclines (F = 5.64; P = .006) than in those not treated with chemotherapy. Executive functioning and fatigue were also worse in both chemotherapy groups than in the no-chemotherapy group.

There was no association between the number of chemotherapy cycles and cognitive status (P > .50), or between the number of cycles and treatment with endocrine therapy (P > .63). Adjustment for disease stage did not significantly change the results.

The small sample size and the retrospective cross-sectional design limited the study, the researchers acknowledge.

"Larger, prospective studies are needed that include pretreatment and post-treatment assessments so that patients' individual cognitive and neurobiologic trajectories can be evaluated with respect to potential anthracycline-related neurotoxic effects," the researchers conclude. "Continued research regarding the mechanisms by which anthracyclines disrupt neurocircuitry could help identify interventions that will protect against anthracycline-associated neurotoxic effects without reducing the anticancer efficacy of these regimens."

The complexity of research in this area was highlighted in an accompanying editorial by Kelly Nudelman, PhD, Brenna McDonald, PsyD, and Andrew Saykin, PsyD, all from the Indiana University School of Medicine in Indianapolis.

Imaging studies have suggested that a wide array of brain regions are affected by cancer and chemotherapy, they write. "Connectomics," they suggest, could help create a larger picture of the way cancer and its treatment affect cognitive functioning and brain networking.

Larger studies need to include different types of cancer, evaluate genetic factors, and look at the differential role of various cancer agents in neurodegeneration and cognitive aging, they explain.

"Additional prospective studies are needed to address baseline differences and the impact of specific treatments on cognitive function, the underlying neural substrate, and specific biological pathways," the editorialists write. "Resolving the pathways leading to cognitive dysfunction will be important for development of targeted interventions."

Dr Kesler and her colleagues note that anthracyclines, such as doxorubicin, work by inducing double-stranded DNA breaks and free-radical damage in both healthy and cancerous cells. The use of these agents has been linked to neuroinflammation, oxidative stress, and cerebrovascular disease, such as microinfarcts, all of which could contribute to neurodegeneration.

10 Surprising Health Benefits of Beer

Beer drinkers rejoice: Your favorite brew may be healthier than you think.

For years, wine drinkers have indulged without guilt, reveling in the news that red wine can help protect against heart disease. Recent research shows that beer can also be good for what ails you, from reducing risk for broken bones to helping warding off diabetes and mental decline. It can even increase longevity, a large study suggests.

However, the key to tapping into beer’s benefits is moderation, meaning just one 12-ounce beer per day for women and two for men. Heavy drinking ups the threat of liver damage, some cancers, and heart problems. Bingeing on brewskis can also make you fat, since a 12-ounce regular beer has about 150 calories, while light beer has about 100.

Here are 10 surprising—and healthy—reasons to cheer about your next beer.

1. Stronger Bones

Beer contains high levels of silicon, which is linked to bone health. In a 2009 studyat Tufts University and other centers, older men and women who swigged one or two drinks daily had higher bone density, with the greatest benefits found in those who favored beer or wine. However, downing more than two drinks was linked toincreased risk for fractures.

For the best bone-building benefits, reach for pale ale, since a 2010 study of 100 types of beer from around the word identified these brews as richest in silicon, while light lagers and non-alcoholic beers contained the least.

2. A Stronger Heart

A 2011 analysis of 16 earlier studies involving more than 200,000 people, conducted by researchers at Italy’s Fondazion di Ricerca e Cura, found a 31 percent reduced risk of heart disease in those who quaffed about a pint of beer daily, while risk surged in those who guzzled higher amounts of alcohol, whether beer, wine, or spirits.

More than 100 studies also show that moderate drinking trims risk of heart attacks and dying from cardiovascular disease by 25 to 40 percent, Harvard reports. A beer or two a day can help raise levels of HDL, the “good” cholesterol that helps keep arteries from getting clogged.

3. Healthier Kidneys

A study in Finland singled out beer among other alcoholic drinks, finding that each bottle of beer men drank daily lowered their risk of developing kidney stones by 40 percent. One theory is that beer’s high water content helped keep kidneys working, since dehydration increases kidney stone risk.

It’s also possible that the hops in beer help curb leeching of calcium from bones; that “lost” calcium also could end up in the kidneys as stones.

4. Boosting Brain Health

A beer a day may help keep Alzheimer’s disease and other dementia at bay, researchers say.

A 2005 study tracking the health of 11,000 older women showed that moderate drinkers (those who consumed about one drink a day) lowered their risk of mental decline by as much as 20 percent, compared to non-drinkers. In addition, older women who downed a drink a day scored as about 18 months “younger,” on average, on tests of mental skills than the non-drinkers.

5. Reduced Cancer Risk

A Portuguese study found that marinating steak in beer eliminates almost 70 percent of the carcinogens, called heterocyclic amines (HCAs) produced when the meat is pan-fried. Researchers theorize that beer’s sugars help block HCAs from forming.

Scientists also have found that beer and wine contain about the same levels of antioxidants, but the antioxidants are different because the flavonoids found in hops and grapes are different.

6. Boosting Vitamin Levels

A Dutch study, performed at the TNO Nutrition and Food Research Institute, found that beer-drinking participants had 30 percent higher levels of vitamin B6 levels in their blood than their non-drinking counterparts, and twice as much as wine drinkers. Beer also contains vitamin B12 and folic acid.

7. Guarding Against Stroke

Researchers at the Harvard School of Public Health found that moderate amounts of alcohol, including beer, help prevent blood clots that block blood flow to the heart, neck and brain—the clots that cause ischemic stroke, the most common type.

8. Reduced Risk for Diabetes

Drink up: A 2011 Harvard study of about 38,000 middle-aged men found that when those who only drank occasionally raised their alcohol intake to one to two beers or other drinks daily, their risk of developing type 2 diabetes dropped by 25 percent. The researchers found no benefit to quaffing more than two drinks. The researchers found that alcohol increases insulin sensitivity, thus helping protect against diabetes.

9. Lower Blood Pressure

Wine is fine for your heart, but beer may be even better: A Harvard study of 70,000 women ages 25 to 40 found that moderate beer drinkers were less likely to develop high blood pressure—a major risk factor for heart attack—than women who sipped wine or spirits.

10. Longer Life

In a 2005 review of 50 studies, the U.S. Department of Agriculture (USDA) reported that moderate drinkers live longer. The USDA also estimates that moderate drinking prevents about 26,000 deaths a year, due to lower rates of heart disease, stroke, and diabetes.

These benefits appear to apply in other countries as well, with an earlier studyreporting that, “if European beer drinkers stopped imbibing, there would be a decrease in life expectancy of two years—and much unhappiness.”

SKIN CANCER SURGERY FOR ELDERLY

 More than two-thirds of people with non-melanoma skin cancer had surgery to treat the condition in a new study, including patients at least 85 years old or with multiple chronic diseases.

Forty-three percent of those patients with limited life expectancies died within five years of their diagnosis, but none from skin cancer. Many of them reported poor wound healing after skin surgery or other treatment-related complications including pain, numbness and itching.

The study team said its findings suggest many older patients may not live long enough to benefit from treatment for non-melanoma skin cancers, but can still be harmed by it.

"For so many conditions we just use a standard treatment without thinking about the long-term (clinical) cost," said Dr. Ashish Jha, a health policy researcher from the Harvard School of Public Health in Boston. "What I think doctors often underestimate is how often patients don't want aggressive care."

"Non-melanoma skin cancer in some ways is a classic example of a cancer that rarely kills people and it is something that can be treated in a variety of ways and (treatment) really should be customized," Dr. Jha, who wasn't involved in the new research, told Reuters Health.

Dr. Eleni Linos from the University of California, San Francisco and colleagues followed 1,360 people diagnosed with non-melanoma skin cancer in 1999 and 2000.

The mean age was 69. About 25% had had a limited life expectancy because they were at least 85 or had more than one chronic health condition, including heart, lung or kidney disease, diabetes and dementia.

Most of those older, sicker patients said they weren't frequently bothered by their skin cancers. Some may not have even noticed them, Dr. Linos said.

Age and underlying health did not influence what type of treatment patients received, she and her colleagues reported Monday in JAMA Internal Medicine. About 69% of all skin cancers were treated surgically, half with simple excisions and half with more elaborate procedures.

That was the case even for people who died within two years.

"We found that regardless of how old people were, how sick or frail they were, what their life expectancy was, they were getting similar treatment," Dr. Linos told Reuters Health. "We saw that as evidence that at the moment, we're not tailoring our treatment to specific patients."

Dr. Jha said he doesn't think age should be the determining factor behind who does or doesn't undergo surgery for non-melanoma skin cancer. Rather, patients should be given the relevant information about their diagnosis and underlying health and decide for themselves how aggressively their illness is treated.

"There are 80-, 85-year-olds who are extremely healthy (and) vigorous and my take is we should treat them as aggressively as they would like to be treated," he said, "whereas there are people in their 50s or 60s with advanced diseases who may have a much shorter lifespan."

Dr. Linos agreed.

"We would never want to restrict access to care based on age," she said. "Our goal really is to involve patients in this decision and to be able to say, 'Here are the risks, here are the benefits, what do you want?'"