HHAL MEDICAL NEWS JANUARY 2012
Sexual Satisfaction In Women Increases With Age
http://mnt.to/l/43Vc
Sex and the older woman
Half of these women were sexually active, with arousal, lubrication and
orgasm maintained into old age, despite low libido in one-third. Sexual satisfaction increased with age and did not require
sexual activity. 90% reported good to excellent health. Half (49.8%) reported sexual activity within the past month with or without a
partner, the majority of whom reported arousal (64.5%), lubrication (69%), and orgasm (67.1%) at least most of the time, although
one third reported low, very low, or no sexual desire. The American Journal of Medicine
AHA: Sexual
Activity Safe for Most People with Cardiovascular Disease
Sexual activity is associated with "reasonable" risk in patients with cardiovascular disease (e.g., coronary
artery disease, valvular disease, heart failure) who are found to have a low likelihood for CV complications, according to
a scientific statement from the American Heart Association, published in Circulation.
Among the other recommendations:
·
Sexual activity is not advised for patients with severe heart disease until their condition has stabilized.
·
Cardiac rehabilitation and exercise can lower the risk for complications from sexual activity in patients
with CVD.
· PDE5 inhibitors (e.g., sildenafil) are useful
for treating erectile dysfunction in patients with stable CVD; they should not be given to patients taking nitrates.
The statement also notes that sexual activity with one's usual partner
is roughly equivalent to mild or moderate physical activity at 3 to 5 metabolic equivalents (METs).
Circulation article
Dietary
DHA Linked To Male Fertility
Docosahexaenoic
acid (DHA) is essential in fusing the building blocks of the acrosome together.
http://mnt.to/l/443d
Type Of Fat Matters: Dispelling
The Low-Fat-Is-Healthy Myth; And The Muffin Makeover
http://mnt.to/l/445G
Routine Aspirin More Likely To Harm Than Benefit Healthy People
http://mnt.to/l/442V
Atherosclerosis - Main Cause Discovered
Netrin-1 blocks the normal migration of macrophages out of arteries, causing these immune cells
to accumulate and promote the progression of atherosclerosis.
http://mnt.to/l/445D
Alzheimer's
Patients Benefit From Light Therapy
http://mnt.to/l/445d
Memory Loss In Older Adults
May Be Improved By Nicotine Patches
http://mnt.to/l/442r
2 Inch Loss In Height Could
Signal Fracture Risk And Death In Older Women
http://mnt.to/l/443p
Inflammation In Depression: Chicken
Or Egg?
Elevated levels of CRP did
not predict later depression, but the number of cumulative depressive episodes was associated
with increased levels of CRP.
http://mnt.to/l/43XR
In Overweight And Obese Adults
A Diet Rich In Slowly Digested Carbs Reduces Markers Of Inflammation
http://mnt.to/l/445g
Low Vitamin D Levels Linked
To Depression, UT Southwestern Psychiatrists Report.
Vitamin D may affect neurotransmitters, inflammatory markers and other factors, which could
help explain the relationship with depression
http://mnt.to/l/43XP
Low Vitamin D Levels Suffered
By 70 Percent Of Europeans
http://mnt.to/l/443R
Coffee Drinkers At Reduced Risk
Of Type 2 Diabetes
People
who drink four or more cups of coffee daily have a 50 percent lower risk of Type 2 diabetes. And every additional cup of coffee
brings another decrease in risk of almost 7 percent. Scientists have implicated the misfolding of a substance called human
islet amyloid polypeptide (hIAPP) in causing Type 2 diabetes.
http://mnt.to/l/444X
Protein Linking Exercise To Health
Benefits Isolated By Researchers
A natural
hormone( 'irisin,')
from muscle cells that triggers some of the key health benefits of exercise.
http://mnt.to/l/444K
Insulin Therapy May Help Repair
Atherosclerotic Lesions In Diabetic Patients
http://mnt.to/l/444p
Happiness In Old Age: Better
Research Is Needed To Understand Why Seniors Are Happier
http://mnt.to/l/43Z6
Magnesium is linked to lower stroke risk, study finds
Research in The American Journal of Clinical Nutrition indicates people
can reduce their risk of stroke by 8% and ischemic stroke by 9% for every 100 additional milligrams of magnesium they consume.
Foods rich in magnesium include almonds, cashews, brown rice, spinach, beans and oat bran. WebMD
Study: Low-protein diet leads to higher fat storage
Data on 25 healthy participants who were given about 1,000 excess calories
daily showed that those who ate a low-protein diet gained less weight than those
who either had a moderate- or high-protein diet. However, those in the low-protein group stored more than 90% of their extra
calories as fat and lost muscle mass, while those who ate more protein gained both fat and lean muscle. The findings appear
in the Journal of the American Medical Association. Reuters(1/3), USA TODAY
Exercise boosts glucose control in obese diabetes patients
Insulin-treated overweight or obese patients with type 2 diabetes who
underwent supervised aerobic and resistance exercises attained better hemoglobin A1C levels and had a lower cardiovascular
disease risk than those who received counseling alone, a study in Diabetes Care revealed. Significant reductions in BMI, waist
circumference, blood pressure and low-density lipoprotein cholesterol levels were also seen in the exercise group compared
with the counseling group, researchers said. PhysiciansBriefing.com/HealthDay News
Annual prostate cancer screening fails to cut death rates
A study of nearly 77,000 middle-aged and older men found that annual prostate cancerscreening programs resulted in a 12% increase in diagnosed cancers compared with men who received usual care, but no significant
difference in deaths. The results in the Journal of the National Cancer Institute were seen as consistent with guidelines
from the U.S. Preventive Services Task Force that men at normal risk do not need regular PSA testing. Reuters
DASH" and Weight Watchers top list of best diets
The "DASH" diet is at the top of several categories, including
Best Diets Overall, in a U.S. News & World Report ranking of weight-loss programs, while Weight Watchers was deemed the
easiest plan to follow. A panel of 22 experts analyzed 26 diets and listed the Paleo Diet at the bottom in the Best Overall
category. The Washington Post/The Checkup blog
Omega-3s and bleeding risk
The authors found no relationship between
the omega-3 index and bleeding in this large, multicenter cohort of acute myocardial infarction patients, suggesting
that concerns about bleeding should not preclude use of omega-3 supplements or increased fish consumption when clinically
indicated. The American Journal of Cardiology
Exercise in chronic kidney disease
Exercise is beneficial in older people and in people with cardiovascular
disease. In chronic kidney disease (CKD), based on very limited data, exercise appears to
be safe if begun at moderate intensity and progressed gradually. Indeed, evidence suggests that the risk of remaining inactive
is higher. This article reviews the effects of exercise in CKD patients, suggesting that these patients should be counseled
to increase their physical activity when possible and/or referred to physical therapy or cardiac rehabilitation programs. American Journal of Kidney Diseases
Greater, faster weight loss seen in gastric bypass patients
Patients who underwent gastric bypass surgery lost more weight at a faster
rate and were better at keeping the pounds off six years after the procedure, compared with those who had gastric banding
surgery, a study in the Archives of Surgery revealed. Long-term data on the weight-loss procedures may help doctors better
identify treatment options for obese patients, said Robin Blackstone, president of the American Society for Metabolic and
Bariatric Surgery.The Wall Street Journal
Weight-lifting and
hip fracture in geriatric population
High-intensity training and treatment for frailty can reduce
hip fracture patients' risk of death or nursing home admission
and reduce Activities of Daily Living (ADL) dependency. Twelve months of progressive resistance training plus interventions
on a multidisciplinary level reduced the High-Intensity Progressive Resistance Training and Targeted Multidisciplinary Treatment
of Frailty on Mortality (HIPFIT) group's risk of death by 81% compared to the usual care group. Nursing home admissions
were reduced by 84%. ADLs improved as did use of assistive devices. (Free abstract only.) Journal of the American Medical
Directors Association
Magazines rate healthiest
cities for men, women
A pair of magazines have ranked Raleigh,
N.C., as the healthiest U.S. city for women and Burlington, Vt., as the healthiest for men, based on scores in 30 categories
such as obesity, fruit and vegetable consumption, and preventive health care. Men's Health and Women's Health magazines
found the 10 unhealthiest cities were the same for both genders, and included Memphis, Tenn.,
Birmingham, Ala., Philadelphia and Detroit. Reuters
Lifetime Risk for Cardiovascular Disease Linked to Risk-Factor Burden at All Ages
Estimating a person's lifetime risk (as opposed to 10-year risk)
for cardiovascular disease depends more on the burden of risk factors found at any age than on race or the availability of
improved treatments, according to a New England Journal of Medicine study.
Investigators pooled a quarter-million
subjects from 18 published cohort studies performed over 50 years. All subjects had their risk factors ascertained and were
followed for at least 10 years. The four major risk factors assessed were hypertension, diabetes, hypercholesterolemia, and
smoking. Subjects were assigned to one of five mutually exclusive groups according to their risk-factor burden.
In men with no risk factors at age 45, the lifetime risk for suffering an atherosclerotic cardiovascular
disease event was less than 2%, while those with two or more major risk factors showed an almost 50% risk. Results were similar
in subjects evaluated at older ages. Overall, men were at higher risk than women, and blacks and whites with similar risk
burdens faced similar lifetime risks.
NEJM article
Foods Fried in Olive, Sunflower, or Other Vegetable Oils Not Linked to Heart Risk
Foods fried in olive, sunflower, or other vegetable oils were not
associated with increased cardiac risk in a BMJ study.
Some 41,000 adults in Spain completed
a food frequency questionnaire, which included questions about their consumption of fried food and the kind of oil used to
prepare it. Nearly two thirds of participants reported using olive oil for frying, while the rest used sunflower or other
vegetable oils. After a median follow-up of 11 years, fried food consumption was not associated with MI, angina requiring
revascularization, or all-cause mortality.
The authors caution
that they could not separate the effect of the oil from the type of food being fried. Editorialists conclude: "Advice
should focus on achieving an appropriate balance of fried foods — such as fish, meat, and potatoes — because these
contain considerable amounts of nutrients that affect the risk of coronary heart disease."
BMJ article
PPIs Associated
with Hip Fractures in Women, Particularly Smokers
Regular
use of proton-pump inhibitors carries increased risk for hip fracture among postmenopausal women, especially those with a
history of smoking, according to a study inBMJ.
Using data on 80,000 women from the Nurses' Health Study,
researchers noted a 35% increased risk for hip fracture among regular users of PPIs. Risk increased with longer duration of
use and returned to normal after stopping use for more than 2 years. However, the PPI-fracture link appeared to be limited
to current or previous smokers, among whom PPI use was associated with a 50% increased risk relative to nonuse.
The authors point to previous research linking smoking to impaired calcium absorption. Since PPIs may
also inhibit calcium absorption, the authors theorize that the two factors may work synergistically to increase fracture risk.
http://www.bmj.com/content/344/bmj.e372
Acid Suppression Linked to Severe Clostridium difficile Infection
Prescription use predicted
both morbidity and mortality.
Morrison RH et al. Clin Infect Dis 2011 Dec 15; 53:1173
Women with Severe Sleep Apnea at Increased Cardiovascular Risk
Women with severe sleep apnea are at increased risk for cardiovascular
death, according to a study in the Annals of Internal Medicine. However, treatment with continuous positive
airway pressure (CPAP) may reduce this risk.
Researchers followed
some 1100 women who were referred to sleep clinics in Spain for suspected obstructive sleep apnea. Over a median follow-up
of 72 months, 3.6% of patients died of cardiovascular causes.
In
adjusted analyses, women with severe sleep apnea were at greater risk for cardiovascular death than women who didn't have
apnea (hazard ratio, 3.5). This increased risk was not observed in women who received CPAP treatment or who only had mild-to-moderate
apnea.
The authors write: "Our results suggest that, similar
to that reported in men, severe [obstructive sleep apnea] may be an independent risk factor for cardiovascular death in women,
and that adequate CPAP therapy may protect against this outcome."
Annals
of Internal Medicine article
Spinal Manipulation, Home Exercise 'Viable Treatment Options' for Acute Neck Pain
Spinal manipulation is more effective than medication for
improving acute neck pain, and home exercise might be as effective as spinal manipulation, according to an Annals of Internal Medicine study.
Some 270 adults with current, nonspecific neck pain lasting 2 to 12 weeks were randomized to 12 weeks
of spinal manipulation (performed by chiropractors), medication (NSAIDs or acetaminophen, or both, as first-line treatment),
or home exercise (following two instructional sessions). Patient-rated pain improved more with spinal manipulation than with
medication both during treatment and at the 1-year follow-up. The researchers found "no important differences" between
the spinal manipulation and exercise groups.
The researchers conclude
that taken together with previous research, their findings suggest that spinal manipulation and home exercise with advice
"both constitute viable treatment options for managing acute and subacute mechanical neck pain."
Annals
of Internal Medicine article
Bariatric Surgery Associated with Lower Long-Term Risk for Cardiovascular Events
Obese adults who undergo bariatric surgery have a lower risk for
cardiovascular events than those who receive usual care, according to a secondary analysis from a Swedish study, published
in JAMA. (The primary analysis, published in 2007, found lower overall mortality with bariatric surgery.)
Some 2000 obese adults who elected to undergo one of three bariatric procedures were matched to roughly
2000 controls who opted for conventional care. During a median 15 years' follow-up, significantly fewer surgery patients
than controls experienced a first cardiovascular event (199 vs. 234 patients; adjusted hazard ratio, 0.67). Cardiovascular
mortality was similarly reduced with bariatric surgery (HR, 0.47).
The
researchers acknowledge that they did not find a significant relation between weight loss and cardiovascular events in the
surgery group. An editorialist speculates: "Perhaps patients motivated enough to undergo bariatric procedures are more
adherent with medical treatments or pursue a healthier diet, and these factors are not reflected in their BMI."
JAMA article
Bisphosphonate
Use Extends Implant Survival After Primary Hip and Knee Arthroplasty
In a U.K. study, bisphosphonate users had significantly lower rates of revision.
The most common indication for revision hip or knee arthroplasty
is implant loosening caused by resorption of bone that supports the implant. In this population-based retrospective cohort
study, investigators assessed whether use of bisphosphonates, which have antiresorptive properties, can lengthen implant survival.
Using the U.K.'s General Practice Research Database, researchers identified 42,000 patients who
underwent primary total knee or hip arthroplasty from 1986 through 2006. At 5 years, bisphosphonate users (essentially defined
as those who took bisphosphonates for at least 6 months) had a significantly lower revision rate than nonusers (0.93% vs.
1.96%). In analyses adjusted for confounding factors, bisphosphonate use was associated with a significant twofold increase
in implant survival. Assuming an arthroplasty failure rate of 2% during 5 years, the authors estimated that 107 patients who
underwent primary hip or knee arthroplasty would need to be treated with bisphosphonates to prevent one revision arthroplasty.
Medline abstract
Subclinical Atrial Fibrillation Seems Associated with Increased Stroke Risk
Subclinical episodes of atrial fibrillation (AF) predict a significantly
increased risk for stroke, according to an international study in the New England Journal of Medicine.
Researchers recruited some 2600 patients aged 65 and over who'd just received a pacemaker or an
implantable cardioverter-defibrillator. None had previous episodes of clinical AF. By 3 months, the devices detected subclinical
episodes of AF (a heart rate of 190 or more per minute and lasting longer than 6 minutes) in about 10% of patients. Over a
mean follow-up of 2.5 years, those with subclinical AF had more than twice the risk for ischemic stroke or systemic embolism
as those without subclinical AF.
Asked to comment, Journal Watch Cardiology's Dr. Mark Link writes: "Although the current findings are by no means definitive for guiding anticoagulation
decisions, they do support taking device-documented subclinical AF seriously. If an asymptomatic patient's CHADS2 score
is high and subclinical episodes are frequent or prolonged, I would consider anticoagulation."
NEJM article
When Should Bone-Density Tests Be Repeated?
A 15-year interval is reasonable in older women if baseline BMD is normal
or only mildly osteopenic.
For
many conditions, screening is conducted at arbitrary intervals — and bone-mineral density (BMD) testing is no exception.
In a prospective study, researchers sought to determine reasonable intervals for BMD screening. They identified 5000 women
(age, 67) without osteoporosis at baseline BMD testing and followed them for up to 15 years. Baseline BMD
levels were classified as normal (femoral neck or total-hip T scores, –1.00 or higher) or as indicative of mild osteopenia
(T-score range, –1.01 to –1.49), moderate osteopenia (range, –1.50 to –1.99), or advanced osteopenia
(range, –2.00 to –2.49).
The
interval during which at least 10% of women developed osteoporosis (T score –2.5 or lower) was longer than 15 years
for those whose baseline BMDs were normal or only mildly osteopenic and was 5 years for those with baseline moderate osteopenia
and 1 year for those with baseline advanced osteopenia. These estimates changed very little after adjustment for age, body-mass
index, and several other relevant variables. The estimated time for 2% of women to experience hip or vertebral fractures was
at least 15 years for those with normal BMD or mild osteopenia and 5 years for those with moderate-to-advanced osteopenia.
CONCLUSIONS:
Our data indicate that osteoporosis would develop in less than 10% of older, postmenopausal women during rescreening
intervals of approximately 15 years for women with normal bone density or mild osteopenia, 5 years for women with moderate
osteopenia, and 1 year for women with advanced osteopenia.
http://www.ncbi.nlm.nih.gov/pubmed/22256806?dopt=Abstract
Dutasteride Apparently Slows
Growth of Closely Followed, Low-Risk Prostate Cancer
The
5α-reductase inhibitor dutasteride inhibited the progression of low-risk prostate cancer in a trial conducted by the
drug's manufacturer and published in the Lancet. The study's authors conclude that dutasteride could be a
beneficial adjunct to active surveillance in low-risk cases, but a commentator disagrees.
The trial followed some 300 patients with low-risk prostate cancer for 3 years. Half received daily
dutasteride, and the others placebo. By the 3-year mark, cancer had progressed less frequently in the treatment group than
among controls (38% vs. 48%).
A commentator points to "important
limitations" in the trial, including the short duration of follow-up in a disease that progresses slowly and the ineffective
masking of treatments. He concludes that dutasteride "cannot ... be recommended as an adjunct to active surveillance."
Lancet article
Long-Term
Follow-Up from a Landmark Diabetes Trial
A period of intensive
glycemic control slowed the progression of renal impairment.
The Diabetes Control and Complications Trial was the first large randomized trial in which intensive
glycemic control in adolescents and young adults with type 1 diabetes was examined. Six-year results were published in 1993:
Intensively treated patients (mean glycosylated hemoglobin [HbA1c] level, 7.3%) exhibited slower progression of
retinopathy and albuminuria than conventionally treated patients (mean HbA1c, 9.1%
http://www.ncbi.nlm.nih.gov/pubmed/22077236?dopt=Abstract
Symptoms May Say Sinusitis, but Scans Disagree
Infection and even inflammation were not reliably present in the scans of patients with
classic sinusitis symptoms.
Chronic
sinusitis can be difficult to diagnose precisely and sometimes even more difficult to treat. Increasingly, experts are suggesting
that antibiotics may be wildly overprescribed for this condition.
In
this prospective study, patients referred to a single sinus expert for classic sinusitis symptoms were methodically evaluated
with computed tomography (CT) scans and nasal endoscopy. Of 125 consecutive patients, only 75 (60%) had evidence of sinusitis
on CT scan (meatal obstruction, air-fluid levels, or mucosal thickening [one area with >10 mm thickening, or any thickening
involving at least 4 sinuses]). A decreased sense of smell predicted an abnormal CT scan, but headache, facial pain and difficulty
sleeping were all more common in the patients with a normal scan. Further, the worse the reported facial pain, the less likely
the scan was to show abnormalities.
Purulent secretions were found on endoscopy
in only 18 patients, all of whom had abnormal CT scans. Standard pathogens associated with bacterial sinusitis were identified
in only five of these patients. No environmental exposures (including alcohol, tobacco, pets, and mold) could distinguish
patients with normal scans from the others.
Medline abstract
Predicting Thyroid
Dysfunction When Baseline TSH Is "Normal"
In women,
risk for hypothyroidism increases substantially when TSH level is 2.5 to 4.5 mIU/L.
Åsvold BO et al. J Clin Endocrinol Metab 2012
Jan 97:93
Iodinated Contrast
Media Linked with Thyroid Dysfunction
ICM exposure was correlated
with both hyper- and hypothyroidism.
Rhee CM et al. Arch Intern Med 2012 Jan 23; 172:153
Tiotropium as Part of Inhaled Triple Therapy for COPD
Mortality was lower with
triple therapy than with double therapy.
Short
PM et al. Chest 2012 Jan 141:81
Supplementation with Niacin or -3 Fatty Acids Is Ineffective for Secondary Prevention
Neither supplement prevented adverse cardiovascular events.
CT Angiography for Acute Lower Intestinal Bleeding
Accuracy of computed tomography was impressive
in a prospective study.
Martí
M et al. Radiology 2012 Jan 262:109
How Often Must INR Be Checked in Patients Taking Warfarin in Stable Doses?
A randomized
trial demonstrates no significant difference in time in therapeutic range between patients monitored every 4 weeks and those
monitored every 12 weeks.
Schulman S et al. Ann Intern Med 2011 Nov 15; 155:653
Sodium Excretion of >7 g or <3 g Daily Is Associated with Elevated Cardiovascular Morbidity
By comparison, higher
potassium excretion was associated with lower stroke risk.
O'Donnell MJ et al. JAMA 2011 Nov 23/30; 306:2229
Whelton
PK. JAMA 2011 Nov 23/30; 306:2262
Obesity-Induced Brain Changes May Be Reason Weight Control Is So Hard
http://mnt.to/l/43Sp
Regaining Weight Bad For The Health
http://mnt.to/l/43RG
Aging-Related Degeneration Can Be Caused By Defects Of Energy Metabolism In
Tissue Stem Cells
http://mnt.to/l/43Vj
Link Between Diet, Nutrient Levels And Cognitive Ability, Brain Shrinkage
·
The most favorable cognitive outcomes and brain size measurements were associated with two dietary patterns - high levels of marine fatty acids, and high levels of vitamins B, C, D and E.
·
Consistently worse cognitive performance was associated with a higher intake of the type of trans-fats found in baked
and fried foods, margarine, fast food and
other less-healthy dietary choices.
· The range of demographic and
lifestyle habits examined included age, gender, education, smoking, drinking,
blood pressure, body mass index and many others.
·
The use of blood analysis helped to eliminate issues such as people's flawed recollection of what they ate, and
personal variability in nutrients absorbed.
·
Much of the variation in mental performance depended on factors such as age or education, but nutrient status accounted
for 17 percent of thinking and memory scores and 37 percent of the variation in brain size.
·
Cognitive changes related to different diets may be due both to impacts on brain size and cardiovascular function.
http://mnt.to/l/43TD
Dementia and Alzheimer's Risk In Females - Another Possible Risk Factor Found
According to a study published Online First by the Archives
of Neurology, one of theJAMA/Archives journals, a hormone derived
from visceral fat called adiponectin may play a role as a risk factor for development of
all-cause dementia and Alzheimer disease (AD) in women.
http://mnt.to/l/43TW
Why Older People Lose Their Memory
Silent strokes may be the cause. Essentially small dead spots in the brain are found in one out of four elderly people.
http://mnt.to/l/43SB
New Theory On Osteoporosis Inspired By Deer Antlers
The loss of manganese could mean that calcium does not stick to bones and could
cause osteoporosis. This is the new theory put forward by researchers at the University
of Castilla-La Mancha (UCLM) in Spain after studying deer antlers.
http://mnt.to/l/43V4
Gestational Diabetes
Linked To ADHD Risk In Offspring
http://mnt.to/l/43Ww
Association of Lipid Subfractions and Cardiovascular Events in Women
An analysis
confirms the inverse relation between HDL cholesterol
levels and adverse coronary events in women.
Atherogenic lipoproteins include
very-low-density, low-density, and intermediate-density particles, each of which carries an apolipoprotein B molecule. High-density
lipoprotein cholesterol (HDL-C) particles carry apolipoprotein A-I. Prior studies have established the presence of an inverse
relation between HDL-C levels and adverse cardiovascular outcomes; however, the association has not been fully studied in
women across the full range of low-density lipoprotein (LDL-C) levels. In this analysis from the Women's Health Study,
researchers evaluated the relation between differing lipoprotein subfractions and incident adverse cardiovascular outcomes.<
/P>
The 27,000 participants were
followed for a mean of 11 years. After adjustment for multiple known coronary risk factors, the following associations were
noted:
· HDL-C level was inversely associated with adverse
coronary events (e.g., twofold higher risk with HDL-C level <40 mg/dL, compared with >62 mg/dL), regardless of LDL-C
level.
· Similar but weaker inverse associations were found
for apolipoprotein A-I level.
· No association was found between
HDL-C or apolipoprotein A-I levels and stroke risk.
·
Adverse coronary event rates started to plateau as HDL-C levels exceeded 57 mg/dL. Women with HDL-C levels >70 mg/dL
were not immune to adverse coronary events, but events tended to occur 10 years later.
·
Among women with low total atherogenic particle burden (apolipoprotein B level <0.90 g/L), few adverse cardiovascular
events and no interaction with HDL-C levels occurred.
Medline abstract
Mora S et al. Ann Intern Med 2011 Dec 6; 155:742
Long-Acting Exenatide Approved for Type 2 Diabetes
After two denials, extended-release exenatide (marketed as Bydureon)
has received FDA approval as an adjunct to diet and exercise for the treatment of type 2 diabetes. According to theNew York Times, approval was previously denied due to
concerns that the once-weekly injectable might contribute to heart rhythm abnormalities. (The twice-daily version, Byetta,
was approved in 2005.)
Approval was based in part on a randomized
study of some 250 adults that compared once-weekly Bydureon with twice-daily Byetta. After 24 weeks, hemoglobin A1C levels
were reduced more with Bydureon than with Byetta (1.6 vs. 0.9 percentage points lower than baseline). The most frequent side
effect — nausea — was less common with Bydureon (14% vs. 35%). Other side effects included diarrhea and upper
respiratory tract infection.
The FDA is requiring the manufacturer
to provide a Risk Evaluation and Mitigation Strategy to inform providers about the drug's risk for acute pancreatitis
and possible risk for thyroid cancer.
Manufacturer's press release
New
York Times story
Bydureon prescribing information (Free PDF)
BP Differences Between a Patient's Arms Linked to Peripheral Vascular Disease, Mortality
A systolic blood pressure difference of 15 mm Hg or more between
a patient's arms is associated with increased risks for peripheral vascular disease and mortality, according to aLancet meta-analysis.
The analysis included 20 studies, most
involving patients at high cardiovascular risk. Overall, a between-arm difference in systolic BP of 10–15 mm Hg or more
was associated with an increased likelihood of peripheral vascular disease (risk ratio, nearly 2.5). A difference of 15 mm
Hg or more was also associated with a heightened likelihood of cerebrovascular disease and cardiovascular and all-cause mortality.
The researchers say between-arm BP differences "might help to identify patients who need further
vascular assessment." Commentators point out numerous limitations (e.g., many studies were cross-sectional), but conclude
that the analysis "supports existing guidelines stating that blood pressure should be measured in both arms. Ascertainment
of differences should become part of routine care, as opposed to a guideline recommendation that is mostly ignored."
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61710-8/fulltext
Gout and Diuretics in Hypertensive Patients
Diuretic use raised risk for gout by
several percentage points.
Observational
data have suggested that gout is associated independently with both hypertension and diuretic use. In a prospective study,
researchers determined incidence of diuretic-associated gout in nearly 6000 hypertensive patients with no histories of gout
at baseline. During 9 years of follow-up, 37% of patients received diuretics.
Incidence of gout was 5.5% among diuretic users (5.0% among thiazide users and 7.0% among loop-diuretic users) and 2.9% among
patients who did not use diuretics. After adjustment for potentially confounding variables (except serum uric acid), use of
thiazides and loop diuretics were both significantly associated with incident gout (hazard ratios, 1.4 and 2.3,
respectively). Compared with serum uric acid levels in nonusers of diuretics, levels rose by a mean of 0.65 mg/dL among those
who began taking thiazides and 0.96 mg/dL among those who began taking loop diuretics. The association between diuretics and
gout was no longer significant after additional adjustment for serum uric acid; this finding is consistent with the assumption
that diuretic-induced increases in serum uric acid mediate the association between diuretic use and gout. McAdams DeMarco MA et al. Arthritis Rheum 2012 Jan 64:121 http://www.ncbi.nlm.nih.gov/pubmed/22031222?dopt=Abstract Concomitant Septic and Crystal Arthritis In a hospital setting, a
small proportion of patients with gout or pseudogout had coexisting septic arthritis. Papanicolas LE et al. J Rheumatol 2012 Jan 39:157 Blood hematocrit level as predictor of heart
failure
Higher levels
of higher hematocrit, even within the normal range, were associated with an increased risk of developing heart failure in
this long-term follow-up study. The American Journal of Cardiology Lithium use: What are the risks?
Lithium
is associated with increased risk of reduced urinary concentrating ability, hypothyroidism, hyperparathyroidism and weight
gain. The risk of congenital malformations is uncertain. Because of the consistent finding of a high prevalence of
hyperparathyroidism, calcium concentrations should be checked before and during treatment. The Lancet Statin Use and Risk of Diabetes Mellitus in Postmenopausal Women in the Women's Health Initiative Arch Intern Med. 2012;172(2):144-152. doi:10.1001/archinternmed.2011.625 Conclusions Statin medication use in postmenopausal women is associated with an increased risk for
DM. This may be a medication class effect. Further study by statin type and dose may reveal varying risk levels for new-onset DM in this population. http://archinte.ama-assn.org/cgi/content/abstract/172/2/144?ct Statins
Linked To Lung Disease Progression In Smokers Statin use appears to be associated with susceptibility or the progression of interstitial lung disease (ILD) in current and former smokers. http://mnt.to/l/442R Nicotine Patches and Gum Found
Ineffective Over the Long Term A
study in the journal Tobacco
Control casting doubt on the effectiveness of nicotine replacement therapy has garnered widespread media attention. Over several years, researchers followed some 800 smokers after they quit. By 2 years, relapse rates
were the same among people who had and had not used nicotine replacement (with or without counseling), according to news reports.
At 4 years, two thirds of participants were smoking again. The
therapies were the centerpiece of a state-sponsored program to encourage quitting in Massachusetts, but, according to a study
coauthor quoted in the Boston Globe, "what we found is that they
have absolutely no effect." The New York Times quotes another of the study's
authors as observing that "what happens in the real world is very different" from what happens in clinical trials. Tobacco
Control article Boston
Globe story New
York Times story Statin Use and Risk of Diabetes Mellitus in Postmenopausal Women in the Women's Health Initiative Arch Intern Med. Published online January 9, 2012. doi:10.1001/archinternmed.2011.625 Background This study investigates whether the incidence
of new-onset diabetes mellitus (DM) is associated with statin use among postmenopausal women participating in the Women's
Health Initiative (WHI). Conclusions Statin medication use
in postmenopausal women is associated with an increased risk for DM. This may be a medication class effect. Further study
by statin type and dose may reveal varying risk levels for new-onset DM in this population. http://archinte.ama-assn.org/cgi/content/abstract/archinternmed.2011.625v2?ct MI Risk Spikes the Day After
a Loved One Dies Patients may
ask about a Circulation study suggesting that the risk for MI increases dramatically within 24 hours after the death of a loved one. Nearly 2000 patients were interviewed while hospitalized for acute MI. Of these, 270 reported that
a significant person in their lives had died within the past 6 months, with 19 learning of a death within 24 hours before
their MI. The incidence rate of MI was increased more than 20-fold within 24 hours of learning of the death, compared with
deaths that occurred anytime in the prior 6 months. "The emotional
stress of bereavement stimulates heightened sympathetic activation," the researchers write. "The hemodynamic changes
that result such as increased vascular resistance may cause transient myocardial ischemia and/or disruption of a vulnerable
coronary plaque, especially among susceptible patients." Circulation article |
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