HHAL MEDICAL NEWS FEBRUARY 2010
Vitamin
D and Colorectal Cancer
Compared with individuals
who had the lowest blood levels of 25-hydroxyvitamin D, those who had the highest levels
had lower risk for colorectal cancer.
Several
small studies have suggested that higher blood levels of vitamin D are associated with lower risk for colorectal cancer (CRC). To examine this association further, investigators conducted a nested, case-control
study involving 520,000 participants from the general population in 10 European countries.
Dietary
information and blood samples were collected at study enrollment, and circulating 25-hydroxy vitamin D (25[OH]D) levels were
measured. The researchers identified 1248 individuals who received diagnoses of incident CRC approximately 4 years, on average,
after enrollment. These individuals were matched to 1248 healthy controls. CRC risk estimates were adjusted for potential
confounding factors, including body-mass index, smoking status, physical activity, socioeconomic status, and total energy intake, as well as consumption of fruits and vegetables, red and processed meats, and alcohol.
Compared
with midlevel 25(OH)D serum concentrations (50–75 nmol/L), lower 25(OH)D concentrations (<25 and 25–50 nmol/L)
were associated with higher CRC risks (incidence ratios, 1.32 and 1.28, respectively), and higher concentrations (75–100
and > 100 nmol/L) were associated with lower CRC risks (IRs, 0.88 and 0.77, respectively). Risk reductions in the higher
quintiles did not reach significance compared with the middle quintile, but patients in the highest quintile had a 40% lower
risk for CRC than those in the lowest quintile (P<0.001). Risk reductions were
found for colon cancer but
not for rectal cancer, and diminished risk for CRC was associated with greater dietary
intake of calcium but not of vitamin D.
Published in Journal Watch Gastroenterology February 26, 2010
Jenab M et al. BMJ 2010 Jan 21; 340:b5500
Test for vitamin D deficiency all year round
Is there a seasonal bias as to when testing is done for vitamin D deficiency? Many physicians test toward the end
of the year, although the lowest vitamin D levels occur in the first part of the year. Many elderly patients, however, have
vitamin D deficiency throughout the year, arguing for testing to be done whenever patients present with fatigue, myalgias
and arthralgias.
Conclusion
Clinicians may have a seasonal bias, favoring testing for vitamin D status
in the latter part of the year even though the lowest vitamin D levels are observed in the first part of the year. Although
an argument could be made to check for peak 25(OH) vitamin D levels in September and trough
levels in March, the seasonal contribution to vitamin D deficiency is overshadowed by ongoing vitamin D deficiency
throughout the year. Thus, it may be prudent to test for vitamin D deficiency in patients
presenting with fatigue, myalgias, and arthralgias regardless of the season of presentation.
http://www.jamda.com/article/S1525-8610(09)00407-1/abstract
Ca
and D
Higher serum 25(OH)D levels were associated with lower levels of nonmelanoma skin
cancer in elderly men.
Solar radiation that initiates nonmelanoma
skin cancer (NMSC) also initiates vitamin D synthesis in the skin. One might expect that populations with histories of NMSC
might also have high serum levels of vitamin D and its more reliably measured precursor, 25(OH)D.
In
a recent study, researchers studied the relation between 25(OH)D levels and NMSC risk. Serum levels of 25(OH)D were measured
in 1441 randomly selected men enrolled in an osteoporosis study. At baseline and after 5 years, participants were asked whether
they had ever had NMSC. Respondents were divided into three groups: never had NMSC (n=930), had NMSC before baseline (n=178),
and developed NMSC between baseline and 5 years (n=100). Those in the higher quintiles of 25(OH)D level had less NMSC, even
after adjustments for age, body-mass index, season of blood draw, clinic site, smoking, and outdoor walking activity. The
odds of having NMSC were 47% lower in the highest quintile than in the lowest quintile. The incident rate (development of
NMSC between baseline and 5 years) was also lower in men with adequate 25(OH)D ( 32ng/mL) than in those with lower levels.
Tang JY et al. Cancer Causes Control 2009 Nov 18
Use
of Metformin in Obese Adolescents
Weight loss at
1 year was not clinically significant.
Wilson DM et
al. Arch Pediatr Adolesc Med 2010
Feb 164:116
Metformin and Vitamin B12 Deficiency
Evidence suggests that metformin lowers
vitamin B12 levels in patients with diabetes.
Observational studies have suggested that metformin causes vitamin B12 deficiency in some patients; researchers have proposed several possible mechanisms
whereby metformin might interfere with B12 absorption. Understanding
this interaction is important, because B12 deficiency could exacerbate
neuropathic symptoms in patients with diabetes.
In this prospective case-control study,
Canadian investigators identified 122 type 2 diabetic patients with peripheral neuropathy: Half had taken metformin for at
least 6 months, and half had never received metformin. Otherwise, clinical characteristics of the groups were similar.
Median
serum B12 level was significantly lower in the metformin group
than in the no-metformin group (231 vs. 486 pmol/L). Metformin recipients also had significantly higher levels of homocysteine
and methylmalonic acid (markers of B12deficiency) and significantly worse scores on standardized clinical assessments
of severity of neuropathy. In multivariate analyses controlled for age, duration of diabetes, and glycosylated hemoglobin
(HbA1c) level, metformin therapy was associated independently with worse neuropathic symptoms.
CONCLUSIONS: Metformin exposure may be an iatrogenic cause for exacerbation of peripheral neuropathy
in patients with type 2 diabetes. Interval screening for Cbl deficiency and systemic Cbl therapy should be considered upon
initiation of, as well as during, metformin therapy to detect potential secondary causes of worsening peripheral neuropathy.
Diabetes Care. 2010 Jan;33(1):156-61
http://www.ncbi.nlm.nih.gov/pubmed/19846797?dopt=Abstract
Metformin's Fishy Smell May Account for Drug Discontinuation
Patients taking generic versions of the diabetes drug metformin may report
a "fishy" smell, researchers describe in the Annals of Internal
Medicine.
The authors describe two case reports in which patients stopped taking generic
metformin after being nauseated by the drug's fish-like smell. Pharmacists have also noted the peculiar odor, "like
old locker-room sweat socks," the authors write.
They conclude: "When patients
stop taking metformin, physicians should consider inquiring more closely about revulsion to the odor of the medication. Trial
of a film-coated, extended-release formulation may be a reasonable approach in such cases."
Annals
of Internal Medicine article
Does
Offering a Choice of Vegetables Affect Children's Consumption?
Offering a choice of vegetables at meals
does not increase consumption.
Zeinstra GG et al. Am J Clin Nutr 2010 Feb 91:349
Statin therapy: Absolute risk of diabetes vs. coronary events
Statin therapy is associated with
a slightly increased risk of development of diabetes, but the risk is
low both in absolute terms and when compared with the reduction in coronary events. Clinical practice in patients with moderate
or high cardiovascular risk or existing cardiovascular disease should not change.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61965-6/abstract
Slow
nephropathy in antihypertensive treatment
Initial antihypertensive treatment with
benazepril plus amlodipine should be considered in preference to benazepril plus hydrochlorothiazide since it slows progression
of nephropathy to a greater extent.
Renal
Outcomes Better with Benazepril plus Amlodipine vs. Benazepril plus Hydrochlorothiazide?
Hypertensive patients who take the ACE inhibitor benazepril plus the calcium channel blocker amlodipine have better renal outcomes than those taking benazepril plus
the diuretic hydrochlorothiazide, according to a prespecified secondary analysis from the industry-funded ACCOMPLISH trial,
published online in the Lancet. Editorialists,
however, call the findings into question.
Some 11,500 hypertensive patients at high cardiovascular
risk were randomized to take benazepril plus either amlodipine or hydrochlorothiazide. At 3 years, progression of chronic kidney disease — defined as a doubling
of serum creatinine or end-stage renal disease —
had occurred significantly less often with benazepril-amlodipine than with benazepril-hydrochlorothiazide (2% vs. 4%).
Editorialists
point out that the reduction in chronic kidney disease seen with benazepril-amlodipine was "completely driven by the
doubling of serum creatinine with no difference in end-stage renal disease, which did not occur much." They say that
the benefits of the drug combination were "based on the haemodynamic and not the structural effect," suggesting
that there was "no difference in renal protective properties."
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)62100-0/abstract
Better sleep quality? Positive mental health? Look to chronic vigorous
exercise
A study comparing adolescent athletes to a control group
found that chronic vigorous exercise is positively related to higher sleep quality, lower
anxiety and fewer depressive symptoms.
In conclusion, along with only two other studies .the present
data show that engaging in high amounts of exercise is positively related to favorable sleep patterns and psychological functioning
in adolescents. These results provide grounds for promoting ready access to sports activities and for motivating adolescents
to exercise regularly, especially male adolescents reporting little exercise behavior.
http://www.jahonline.org/article/S1054-139X(09)00255-9/fulltext
Study: 25% of stroke patients likely will die within a year
A U.S. study published in Neurology found 25% of stroke
patients likely will die within one year and 8% will have another attack within a year. Researchers said blacks were at higher
risk than whites and the risks increased with age and co-morbidities. MSNBC/Reuters
http://www.msnbc.msn.com/id/35410389/ns/health-heart_health/
Antipsychotic use and hip fracture. Cause and effect?
Hip fractures may occur more in older nursing home patients with
dementia who use antipsychotic drugs.
Because hip fractures increase mortality, caution should be used when prescribing antipsychotic medications, especially concerning
long-term use of antipsychotics
Conclusion
:APs appear to increase the risk of hip fracture among older adults with dementia residing in an NH. Hip fractures may be
a contributory mechanism to the increased risk mortality observed among AP users. Journal of the American Medical Directors Association
http://www.jamda.com/article/PIIS1525861009003673/abstract
Mediterranean diet may protect against brain infarcts
An NIH-funded
study found that people who follow a Mediterranean-style diet are less likely to suffer strokes or other brain damage linked
to cognitive problems in older people. Compared with people who did not adhere to the diet, those who followed it moderately
were 21% less likely to have brain damage, while those who followed the diet most closely saw a 36% risk drop. The study will
be presented at the American Academy of Neurology annual meeting.HealthDay
News (2/8)
http://healthday.com/Article.asp?AID=635737
Fibrates vs. statins vs. pravastatin: Where's the bleeding risk?
These authors found that
initiation of a fibrate or statin that inhibits CYP3A4 enzymes, including atorvastatin, was associated with an increased risk
of hospitalization for gastrointestinal bleeding in patients taking warfarin. Initiation of pravastatin, which is mainly excreted unchanged, was not associated with an increased
risk. The American Journal of Medicine
Conclusions
Initiation of a fibrate or statin that inhibits CYP3A4 enzymes, including atorvastatin, was associated with an
increased risk of hospitalization for gastrointestinal bleeding. Initiation of pravastatin,
which is mainly excreted unchanged, was not associated with an increased risk.
http://www.amjmed.com/article/S0002-9343(09)00862-6/fulltext
Optimizing Statin Use at the Population Level: What Is the Best Approach?
In
a simulation study, improving patient adherence produced better outcomes than lowering the treatment threshold.
The benefits of statin therapy in patients at risk for coronary disease
is unquestioned. However, many patients who would benefit from statin use are not taking them. Expanding statin use could
be achieved in two ways: (1) lowering the treatment threshold, or (2) improving adherence. To compare how implementing these
strategies would alter the population-level benefit of statin therapy, Shroufi and Powles used data from the prospective Melbourne
Collaborative Cohort Study, involving 41,141
participants, to conduct a simulation study.
In the U.K., the National Institute for Health and Clinical Excellence (NICE)
recommends that adults with a 20% or greater 10-year risk for heart
disease should receive statin therapy. For the model based on a lower
treatment threshold, the investigators assumed that adults with a 15.5% or greater 10-year risk would be eligible for statin
therapy. For the improved-adherence model, the authors assumed an increase in adherence (defined as taking 80% of the prescribed monthly
dose) from 50% to 75%.
The improved-adherence strategy resulted in about twice as
large a reduction in cardiovascular deaths as did the lower treatment-threshold strategy. The improved-adherence strategy
also showed a modest improvement in averting the onset ofcardiovascular disease, compared
with the lower treatment-threshold strategy.
Published in Journal Watch Cardiology February 17, 2010
http://www.ncbi.nlm.nih.gov/pubmed/20056964?dopt=Abstract
How low is too low in glucose control?
This study found that low and high mean HbA1c values were
associated with increased all-cause mortality and cardiac events. If confirmed, diabetes guidelines might need revision to
include a minimum HbA1c value.
Background
Results of intervention studies in patients with type 2
diabetes have led to concerns about the safety of aiming for normal blood glucose concentrations. We assessed survival as
a function of HbA1c in people with type 2
diabetes.
Methods
Two cohorts of patients aged 50 years and older with type
2 diabetes were generated from the UK General Practice Research Database from November 1986 to November 2008. We identified
27 965 patients whose treatment had been intensified from oral monotherapy to combination therapy with oral blood-glucose
lowering agents, and 20 005 who had changed to regimens that included insulin. Those with diabetes secondary to other
causes were excluded. All-cause mortality was the primary outcome. Age, sex, smoking status, cholesterol, cardiovascular risk,
and general morbidity were identified as important confounding factors, and Cox survival models were adjusted for these factors
accordingly.
Findings
For combined cohorts, compared with the glycated haemoglobin
(HbA1c) decile with the lowest hazard (median HbA1c 7·5%, IQR 7·5—7·6%), the adjusted hazard ratio (HR)
of all-cause mortality in the lowest HbA1c decile
(6·4%, 6·1—6·6) was 1·52 (95% CI 1·32—1·76), and in the highest HbA1c decile (median 10·5%, IQR 10·1—11·2%)
was 1·79 (95% CI 1·56—2·06). Results showed a general U-shaped association, with the lowest HR at an HbA1c of
about 7·5%. HR for all-cause mortality in people given insulin-based regimens (2834 deaths) versus those
given combination oral agents (2035) was 1·49 (95% CI 1·39—1·59).
Interpretation
Low and high mean HbA1c values
were associated with increased all-cause mortality and cardiac events.
If confirmed, diabetes guidelines might need revision to include a minimum HbA1c value.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61969-3/abstract
Breast arterial calcium detected on mammography: Not much of a predictor
Breast arterial calcium was not positively associated
with cardiovascular risk factors, documented coronary artery disease or acute cardiovascular
events, suggesting that the presence of breast arterial calcium as determined by mammography is not a useful predictor of
coronary artery disease in intermediate- to high-risk patients. The American Journal of Cardiology
http://www.ajconline.org/article/S0002-9149(09)02410-2/fulltext
Heart Groups Issue Advisory on Cardiovascular Risks with Thiazolidinediones
The American Heart Association and
the American College of Cardiology have
issued a science advisory summarizing the data on cardiovascular risks associated with the use of thiazolidinedione drugs
in type 2 diabetes.
The
advisory, published in Circulation, says
that there are insufficient data to support the choice of pioglitazone over rosiglitazone.
Further, it says the drugs increase the risk for heart
failure and "should not be initiated" in patients with class
III/IV heart failure.
Citing the "limited and inconclusive" evidence at hand, the advisory
concludes that until better data become available, "patients and clinicians will need to weigh the accepted benefits
of improved glycemic control on
risk for microvascular disease from glucose-lowering agents against the worrisome, i
completely absent information about
the effects of these agents on macrovascular
Rosiglitazone Should
Be Removed from the Market, Some FDA Staff Advise
Patients
may be asking about a New York Times report that some FDA staff are recommending that rosiglitazone, sold in the U.S.
as Avandia to treat type 2 diabetes, "be removed from the market."
The story,
based on "internal FDA reports" and a Senate Committee on Finance staff report, says that "hundreds of people
taking Avandia ... needlessly suffer heart attacks and heart
failure each month." The committee report concludes: "The totality of evidence suggests that [GlaxoSmithKline]
was aware of the possible cardiac risks associated with Avandia years before such evidence became public."
In
separate press releases, GlaxoSmithKline disputes the conclusions, both of the Times article and the Senate report, saying that "the scientific evidence simply
does not establish that Avandia increases ischemic cardiovascular risk or causes myocardial ischemic events."
New
York Times story (Free)
Senate Committee on Finance report on Avandia (Free PDF)
AAN Releases Guidelines
on Treating Muscle Cramps
Although quinine derivatives
are "likely effective" for treating muscle cramps, they should
not be used routinely because of the potential for adverse events, according to new guidelines from the American Academy of
Neurology (AAN).
The guidelines, published in Neurology, specify
that quinines should be considered only when cramps are very severe, when other agents haven't helped, and when there
can be ongoing monitoring for adverse effects (e.g., hematologic abnormalities, headache).
Among the AAN's other conclusions:
·
Vitamin
B complex and the calcium channel blocker diltiazem are "possibly effective" and may be considered as
treatment.
·
Studies of gabapentin
(1 trial) and magnesium (2 trials) found no treatment benefit.
·
There are no clinical
trials evaluating baclofen, carbamazepine, or oxcarbazepine for managing muscle cramps, despite their frequent use for
this indication.
·
Data are insufficient
to recommend for or against calf stretching.
Neurology article (Free)
http://www.neurology.org/cgi/content/full/74/8/691
Aspirin Use Associated with Reduced Risk for Breast Cancer Mortality
Women who use aspirin regularly after breast cancer diagnosis might be less
likely to die from the illness, according to an observational
study in the Journal of Clinical Oncology.
The analysis included
nearly 4200 Nurses' Health Study participants who were diagnosed with stage I, II, or III breast cancer from
1976 to 2002. Aspirin use was assessed via questionnaire beginning one year after diagnosis and until death or June 2006.
Roughly 8% of participants died from breast cancer. After adjustment for cancer stage, treatment, and other confounders,
breast cancer mortality was about 70% less likely among women who used aspirin regularly (2–5 days/week or 6–7
days/week), compared with never-users. Distant recurrence was also reduced with regular aspirin use.
The authors suggest several possible mechanisms underlying the observed association, including the potential for aspirin
to lower serum estradiol.
http://jco.ascopubs.org/cgi/reprint/JCO.2009.22.7918v1
Muscle Relaxant Adds No Benefit to Ibuprofen for Cervical Strain
Pain relief did not differ among patients who received ibuprofen, cyclobenzaprine,
or both drugs.
http://emergency-medicine.jwatch.org/cgi/content/full/2010/205/1?q=etoc_jwgenmed
http://www.ncbi.nlm.nih.gov/pubmed/20078917?dopt=Abstract
Childhood Obesity, Glucose Intolerance, and Hypertension Increase
Risk for Premature Adult Mortality Childhood Obesity, but Not Cholesterol,
Linked to Death Before 55
High
body-mass index, increased levels of glucose intolerance,
and hypertension in
childhood are all linked to premature death,
according to a study of American Indians published in the New
England Journal of Medicine.
Researchers assessed the BMI, glucose tolerance, cholesterol,
and blood pressure of
nearly 5000 nondiabetic children aged 5 to 19 and then followed them for a median of almost 25 years. Rates of death before
age 55 among those in the highest quartile of BMI were more than double those with BMIs in the lowest quartile. Similarly,
those with the highest levels of glucose intolerance at baseline showed significantly higher premature mortality, as did those
with childhood hypertension.
Childhood cholesterol levels showed
no association with early death.
The authors
conclude that this evidence "underscores the importance of preventing obesity starting in the early years of life."
A possible association between childhood obesity and premature
death might be partially mediated by childhood glucose intolerance and hypertension.
Conclusions Obesity, glucose intolerance, and hypertension in childhood
were strongly associated with increased rates of premature death
from endogenous causes in this population. In contrast, childhood
hypercholesterolemia was not a major predictor of premature death
from endogenous causes.
Franks PW et al. N Engl J Med 2010 Feb 11; 362:485
http://content.nejm.org/cgi/content/full/362/6/485?linkType=FULL&journalCode=nejm&resid=362/6/485
Population-Based
Benefits of Salt Reduction
Daily intake of 3 g less per person could
lower annual U.S. cardiac-related deaths by as many as 92,000.
Excessive salt intake
is associated with a higher population-based risk for hypertension
and coronary heart disease. Current
daily mean salt intakes in the U.S. — three quarters of which come from processed foods — are 10.4 g for men and
7.3 g for women (roughly twice the recommended levels). Researchers used validated models for predicting CHD and stroke to
estimate benefits that would accrue from lowering salt intake in adults. The investigators assumed that a linear benefit would
accrue from lowering daily salt intake by as much as 3 g and that benefits would be accentuated for blacks, people with hypertension,
and elders (age,
65).
Lowering daily salt intake by 3 g was estimated to attenuate the
annual incidence of CHD by 60,000 to 120,000 cases, of strokes by 32,000 to 66,000, of myocardial infarctions by 54,000 to 99,000, and
of cardiac-related deaths by 44,000 to 92,000. Lowering daily salt intake by even 1 g would prevent 15,000 to 32,000 deaths
annually. Lowering population-wide daily salt intake by 3 g would have about the same benefit as cutting tobacco use by 50%,
lowering body-mass index in obese adults by 5%, giving statins to all adults at low or intermediate risk for CHD, or controlling
hypertension in all adults.
Bibbins-Domingo K et al. N
Engl J Med 2010 Jan 20;
http://content.nejm.org/cgi/content/abstract/362/7/590
Does Screening Colonoscopy Prevent Right-Sided
Cancer?
Findings
raise more questions about screening colonoscopy.
In a published case-control study from Canada, screening colonoscopy was associated with lower mortality from left-sided, but not right-sided, colorectal
cancer (JW Gastroenterol Feb 20 2009). Now, in another study, investigators have reexamined the issue.
German researchers performed
screening colonoscopy in 3287 people (age, 55); 586 had undergone screening colonoscopy
within the previous 10 years (average, 5 years previously), and 2701 had never undergone screening colonoscopy. The prevalence
of advanced left-sided neoplasia (cancer or advanced adenoma)
— from splenic flexure to rectum — was significantly higher in the previously unscreened group than in the previously
screened group (9% vs. 3%). However, the prevalence of advanced right-sided neoplasia — from cecum to transverse colon
— was similar in the two groups (3%). Adjustment for age, sex, and family history did not change these associations.
Comment: Several
studies suggest that screening colonoscopy affords less protection against proximal cancer than against distal cancer. Possible
reasons include biological differences between proximal and distal neoplasias, and poorer visualization of the proximal colon
due to operator factors or bowel preparation. Randomized trials of screening colonoscopy have not been performed; thus, we
must resort to observational studies like this one — despite their limitations — to evaluate the procedure.
As noted by editorialists, the findings raise provocative questions about whether the incremental effectiveness of colonoscopy
— compared with flexible sigmoidoscopy — is sufficient to justify its greater risk and cost.
CONCLUSION: Prevalence of left-sided advanced colorectal neoplasms,
but not right-sided advanced neoplasms, was strongly reduced within a 10-year period after colonoscopy, even in the community setting
http://www.ncbi.nlm.nih.gov/pubmed/20042716?dopt=Abstract
C-Reactive
Protein and Cardiovascular Disease: Cause, Mediator, or Marker?
Much of the association between CRP levels and ischemic vascular disease
depends on other risk factors.
The Emerging Risk
Factors Collaboration. Lancet 2010
Jan 9; 375:132
Lipid
Levels and Stroke
In a large meta-analysis, non-HDL cholesterol was associated with
risk for ischemic but nothemorrhagic stroke; triglycerides, HDL, and apolipoproteins were not associated with
stroke risk. The Emerging Risk Factors Collaboration. JAMA 2009 Nov 11; 302:1993
Smoking
Cessation and Risk for Type 2 Diabetes
Excess diabetes risk in quitters is mediated partially by weight gain.
Yeh H-C et al. Ann
Intern Med 2010 Jan 5; 152:10
Proteinuria Associated with Adverse Outcomes, Regardless of GFR
Proteinuria independently predicts mortality and other adverse outcomes,
regardless of estimated glomerular filtration rate (eGFR), JAMA reports.
Researchers
in Canada studied more than 900,000 adults without end-stage kidney disease who had both serum creatinine and proteinuria measured as part
of routine care. During a median follow-up of roughly 3 years, 3% of patients died and less than 1% experienced an MI, began
renal-replacement therapy, or had a doubling of serum creatinine.
Risks for these adverse
outcomes were higher among patients with lower eGFRs and heavier proteinuria. However, at all levels of eGFR — even
those not "overtly abnormal" — heavier proteinuria remained an independent predictor of risk.
The
authors note that current guidelines for classifying chronic
kidney disease are based on eGFR "without explicit consideration
of the severity of concomitant proteinuria." They conclude that revisions of such guidelines should take proteinuria
into account.
JAMA article (Free)
Androgen Deprivation May Increase CVD Risk, Circulation Statement Warns
It's
"reasonable" to conclude that a link may exist between androgen-deprivation therapy (ADT) for prostate cancer and
heightened cardiovascular risk, according to a group comprising members of major heart, cancer, and urological societies.
The group's statement, issued online in Circulation, points to published evidence
that ADT increases body weight, reduces insulin sensitivity, and adversely affects lipid profiles.
The group makes the following recommendations:
Patients
starting ADT should have periodic follow-up with their primary-care physician beginning within 3 to 6 months.
Such evaluations should include assessment of blood pressure, lipid profile, and glucose
level.
Glucose and lipids should be checked at least yearly.
Circulation statement (Free PDF)
http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.109.192695v1
Do
Marine-3 Fatty Acids Slow Cellular Aging?
Telomere length might tie together benefits of fatty acids and exercise.
Farzaneh-Far R et al. JAMA 2010 Jan 20; 303:250
