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Research presented Tuesday at the 20th World Diabetes Congress in Montreal provides further evidence that healthy behaviors reduce mortality in people with and without diabetes.

“Few previous studies have measured the effectiveness of healthy behaviors in delaying mortality among adults with diagnosed diabetes,” lead researcher Dr. Sharon Saydah told Reuters Health. “We looked at the association of health behaviors with mortality in the general U.S. population among both adults with and without diabetes.”

The study included 1,177 people with diabetes and 15,217 without diabetes who took part in the Third National Health and Nutrition Examination Survey from 1988 to 1994 and were followed through 2001.

A greater number of healthy behaviors was linked to a 15 percent reduced risk of dying from any cause in diabetics and a 17 percent reduced risk in non-diabetics, after adjusting for various factors that might influence the results.

Subjects in the top 20 percent of healthy behavior “summary scores” had a 58 percent lower death rate than those in the bottom 40 percent.

Five self-reported healthy behaviors were assessed at the start of the study: physical activity, not smoking, higher healthy eating index, moderate alcohol intake (1-2 drinks per week), and maintaining weight or trying to lose weight in the past 12 months.

“Among the healthy behaviors studied, regular, moderate to vigorous physical activity was most protective for those with diabetes,” said Saydah, a senior scientist with the Centers for Disease Control and Prevention, Atlanta.

Moderate to vigorous physical activity significantly reduced the risk of dying in both adults with and without diabetes, whereas moderate alcohol use, was only protective only in people with diabetes.

In diabetes-free adults, current smoking and fewer healthy eating habits were both linked to increased risk of death, whereas the impact of diet on death in people with diabetes was inconclusive.

“These results provide information to health care providers and the general public on stressing the importance of … lifestyle factors such as physical activity in delaying mortality,” Saydah said.

A recommended treatment for heart failure is underused in U.S. hospitals, a new study finds.

The use of aldosterone antagonist therapy in patients with heart failure is designated as “useful and recommended” in chronic heart failure guidelines established by the American College of Cardiology/American Heart Association (ACC/AHA), but this study found that less than one-third of patients hospitalized for heart failure receive the treatment.

Researchers analyzed data on 43,625 patients admitted with heart failure and discharged home from 241 hospitals participating in a hospital recognition program called Get With The Guidelines — HF between 2005 and 2007.

The study found that 12,565 patients (28.8 percent) from 201 hospitals met ACC/AHA heart failure management guidelines criteria, and 4,087 eligible patients received an aldosterone antagonist when they were discharged from hospital. Overall, treatment increased from 28 percent to 34 percent during the study period, but there was wide variation in aldosterone antagonist use among hospitals — ranging from 0 percent to 90.6 percent.

“Aldosterone antagonist use in eligible patients was associated with younger age, African-American race/ethnicity, lower systolic blood pressure, history of implantable cardioverter-defibrillator use, depression, alcohol use and pacemaker implantation, and with having no history of renal insufficiency,” wrote Nancy M. Albert of the Cleveland Clinic and colleagues.

“These data confirm that in the context of a hospital-based performance improvement program, aldosterone antagonist therapy can be used according to guidelines with little inappropriate use. Given the substantial morbidity and mortality risk faced by patients hospitalized with HF and the established efficacy of aldosterone antagonist prescription in HF, a stronger uptake of aldosterone antagonist therapy indicated by evidence-based guidelines may be warranted,” the researchers concluded.

New research raises doubts about the long-held medical dogma that dangerous blood clots in the lungs, known as pulmonary emboli, originate from clots in the deep veins of the legs or other parts of the lower body, which then break up and travel up through the body.

A study appearing in the October issue of the Archives of Surgery found that 85 percent of trauma patients with pulmonary emboli showed no sign of deep vein thrombosis, or blood clots in the lower extremities.

The lead author of the study, Dr. George Velmahos, chief of the division of trauma, emergency surgery and surgical critical care at Massachusetts General Hospital and professor of surgery at Harvard Medical School in Boston, said the findings also cast doubt on the use of filters to prevent the clots from traveling.

But an outside expert said the findings need to be received cautiously, at least for now.

“I think it’s an interesting report. I wouldn’t call it a bombshell”, said Dr. Jack Ansell, chairman of the department of medicine at Lenox Hill Hospital in New York City. “I think this study by no means answers this question or reverses the original concept that most pulmonary embolisms originate as venous thrombosis [blood clots] in the deep veins of leg or sometimes in pelvis or abdomen.”

According to Velmahos, the concept of clots in the lungs originating as clots in the legs has never been challenged, despite evidence in the literature that some patients suffering from pulmonary embolism did not show signs of having had a blood clot in the lower extremities.

For this study, Velmahos and co-authors looked back over medical records of 247 trauma patients who had undergone CT pulmonary angiography and CT venography.

Among 46 patients with PE, only 7 also had DVT, or 15 percent.

There are possible explanations, the team said. It’s possible that the entire original clot detached itself, leaving no traces. However, cadaver studies suggest that only a part of the leg clot breaks away, and a remnant is typically left behind. Or it could be that small clots exist and were not picked up by imaging techniques or even that the clots start in the upper extremities, which are not routinely examined.

Ansell also pointed to what he believes are several shortcomings in the study.

“There are still some issues that could account for why they didn’t see DVTs,” Ansell said. “The screening methods may not be ideal [and] small clots in calf veins are difficult to visualize by various techniques.”

“Having said that, there certainly is the possibility with certain types of injury that there could be clots formed just primarily in the lungs and not necessarily travel from other spots,” he added.

Velmahos felt that he had already excluded potential reasons for not seeing lower-extremity clots in pulmonary embolism patients, and said he is “very confident that a correlation cannot be established.” Yet he also acknowledged that “every retrospective study [which this is] should be viewed with a grain of salt.”

More studies need to be conducted, particularly to explore the hypothesis that pulmonary emboli actually form first in the lungs.

If it turns out that DVTs do not travel far from the legs, do tiny filters now used to trap them remain useful therapy? One expert said that issue may be a minor one.

“Pulmonary embolism and DVT are huge problems in trauma patients. The question is how to treat them,” said Dr. David Gillespie, a professor of surgery at the University of Rochester Medical Center. “Anticoagulants such as heparin have been the standard of care… The interpretation here should not be that all filters are bad [but] anticoagulants should be the main therapy.”

Finally, even if DVTs don’t detach and travel to the lungs, “this does not mean that DVT is unimportant,” Ansell said. “It is clearly established that most or many pulmonary emboli do originate in the legs in the lower extremities and one still needs to provide appropriate anticoagulant [blood-thinning] prophylaxis in patients who are at risk, whether they are trauma patients or just patients immobilized for other reasons in the hospital.”

In an effort to reduce multiple births following fertility treatment, the American Society for Reproductive Medicine has revised its recommendations on the number of embryos that should be transferred during in vitro fertilization procedures.

The society reports that the guidelines are now different in two major ways.

For one, it says that doctors should only use one more embryo than called for in patients whose prognosis is less optimistic. Even in those with poor prognosis, no more than one extra embryo should be transferred.

The society also calls on doctors to advise patients about the risks of a pregnancy with several fetuses and to make notations about extra embryos and counseling in medical records.

The guidelines also make it clear that it doesn’t make any difference whether transferred embryos are fresh or frozen. The recommended number remains the same.

The society issued guidelines more than 10 years ago and says they have cut down on births with high numbers of babies by almost 60 percent.

“It is clear that these guidelines have a terrific impact on clinical practice. Over the years we have seen a reduction in the number of high order multiple births while maintaining strong success rates. This latest revision is our most recent effort to help our members provide their patients with the best, safest care possible,” said Dr. R. Dale McClure, president of the American Society for Reproductive Medicine, in a statement.