HHAL MEDICAL NEWS MAY 2013
Top Three Health Benefits
of Mushrooms
Low in calories, fat-free, cholesterol-free
and very low in sodium, mushrooms provide many of the nutritional attributes of produce, as well as attributes more commonly
found in meat, beans or grains. Recently published studies suggest important potential health benefits associated with
mushroom consumption:
· Promotes healthy weight: Lawrence Cheskin,
from the Johns Hopkins Bloomberg School of Public Health (Maryland, USA), and colleagues enrolled 73 obese adults, mean
age 48.4 years, who were placed in an intervention group eating approximately one cup of mushrooms per day in place of meat,
and a standard diet control group. At the end of the one-year trial, researchers found that participants who substituted mushrooms
for meat lost seven pounds, showed improvements in body composition compared to participants on the standard diet, and maintained
the weight loss. Specifically, those in the intervention group reported lower calorie and fat intake (123 calories, 4.25 grams
respectively, per day); lost more pounds and percentage body weight (7 pounds, 3.6% of their starting weight); achieved lower
body mass index (1.5kg/m2), waist circumference (2.6 inches) and percent total body fat (0.85%), as compared to participants
on the control diet. The study authors conclude that: “encouraging adults to substitute edible mushrooms for red meat
in three meals/week was found to be a useful strategy for enhancing weight loss and maintenance efforts among overweight/obese
adults.”
· Boosts immune function: Xiaoshuang Dai, from
University of Florida (Florida, USA), and colleagues enrolled 51 healthy adults, who were randomly allocated to consume either
50g/d or 100g/d of dried, whole Shiitake mushrooms for 28 days. Data revealed that one or two servings of dried shiitake
mushrooms “is immuno-modulatory, as seen by the altered pattern of cytokine secretion.”
· Raises Vitamin D levels: Michael F Holick,
from Boston University Medical Center (Massachusetts, USA), and colleagues show that eating dried white button mushroom extract
containing Vitamin D2 can be as effective at increasing and maintaining Vitamin D levels as taking supplemental D2 or D3.
The study authors report that: “These results demonstrate that in addition to vitamin D2, mushrooms can also produce
vitamin D3 and vitamin D4.”
Walnuts
Help to Lower Diabetes Risk
Walnuts are rich in polyunsaturated fatty acids, with previous
studies suggesting their consumption helps to improve various cardiometabolic risk factors. Frank Hu, from Harvard School
of Public Health (Massachusetts, USA), and colleagues investigated the association between walnut intake and incident type
2 diabetes in 2 large cohort studies: the Nurses' Health Study (NHS) and NHS II. The researchers prospectively followed
58,063 women, ages 52-77 years in NHS (1998-2008) and 79,893 women, ages 35-52 years in NHS II (1999-2009) without diabetes,
cardiovascular disease, or cancer at the study’s respective starts. Dietary habits were closely monitored, including
the frequency at which they subjects consumed nuts – particularly walnuts. The team revealed that women who consumed
walnuts two or three times a week lowered their risk of developing type-2 diabetes by 24%. Further, the
data suggested that the consumption of total nuts also inversely associated with risk of type-2 diabetes. The study
authors conclude that: “Our results suggest that higher walnut consumption is associated with a significantly lower
risk of type 2 diabetes in women.”
Nuts for a Healthy Weight
A number of previous
studies suggest an inverse association between the frequency of nut consumption and body mass index (BMI) and risk of obesity.
Gemma Flores-Mateo, from the Institut Universitari d'Investigacio en Atencio Primaria Jordi Gol (Spain), and colleagues
completed a neta-analysisis of data resulting from 31 worldwide studies and found not only that most of the studies don't
show that patients gain a significant amount of weight – but that nuts – as part of a healthy, balanced diet –
can help to stabilize insulin and suppress hunger. The study authors conclude that: “diets enriched with nuts
did not increase body weight, body mass index, or waist circumference in controlled clinical trials.”
New studies explore mango's potential health-affirming properties
A fleshy stone fruit belonging to the genus Mangifera, consisting of numerous tropical
fruiting trees in the flowering plant family Anacardiaceae, the mango is rich in vitamins, minerals and anti-oxidants, and
contains an enzyme that can act as a digestive aid. Edralin Lucas, from Oklahoma State University (Oklahoma, USA), and
colleagues examined the effects of daily mango consumption on clinical parameters and body composition in obese subjects (body
mass index [BMI] at/above 30kg/m2). Twenty adults (11 males and 9 females) participated in the study, which included daily
dietary supplementation with 10 grams of freeze dried mango (equivalent to approximately 100 grams of fresh mango, for 12
weeks. The researchers observed that blood sugar levels at the conclusion of the study were significantly lower than
the baseline in all subjects; BMI increased significantly in female subjects but not male subjects. Writing that:
“These results suggests that addition of mango to the diet may provide an alternative approach to modulating blood glucose
without negatively affecting skeletal health” the study authors submit that: “the bioactive component(s) in mango
and the mechanisms by which it modulates blood glucose and exerts potentially osteoprotective benefits warrants further investigation.”
Cocoa Compounds Boost Brain Health
A number of previous studies suggest that the antioxidant compounds – notably flavanols
– present in cocoa may exert a protective effect on cells in the brain. A. Cimini, from the University of
L’Aquila (Italy), and colleagues investigated the cellular mechanism for this effect by extracting phenols from commercial
cocoa powder and examined their effects on cell cultures. The team confirmed the antioxidant properties of cocoa, and
more importantly demonstrated that cocoa polyphenols activate the brain-derived neurotrophic factor (BNDF) survival pathway.
This observation suggests that cocoa flavanols may modulate oxidative stress that is implicated in Alzheimer’s and other
neurodegenerative diseases. The study authors conclude that: “On the light of the results obtained the use of
cocoa powder as preventive agent for neurodegeneration is further supported.”
Drinking cup of beetroot juice daily may help lower blood pressure
In the human body,
nitric oxide widens blood vessels and aids blood flow. Beetroot is rich in nitrates, which the body converts to nitrite
and then to nitric oxide. Amrita Ahluwalia, from The London Medical School (United Kingdom), and colleagues enrolled
8 women and 7 men with a systolic blood pressure between 140 to 159 mm Hg, who did not have other medical complications and
were not taking blood pressure medication. The study participants drank 250 mL of beetroot juice or water containing a low
amount of nitrate, and had their blood pressure monitored over the next 24 hours. Compared with the placebo group, participants
drinking beetroot juice had reduced systolic and diastolic blood pressure —the effect was most pronounced three to six
hours after drinking the juice but still present even 24 hours later. The study authors submit that: “Our observations
… support the concept of dietary nitrate supplementation as an effective, but simple and inexpensive, antihypertensive
strategy.”
Preventing cognitive decline in healthy seniors
Mild cognitive impairment (cognitive decline that is more than normal for someone of a
specific age) affects 10%-25% of people over age 70. The annual rate of decline to dementia (which is cognitive decline in
several areas along with some functional ability) is about 10%. With an aging population, it is estimated that the prevalence
of dementia worldwide will escalate sharply. Raza Naqvi, from University of Toronto (Canada), and colleagues reviewed
32 randomized controlled trials to assess assorted therapies purported to address age-related cognitive decline. The
researchers found that mental exercise showed benefits in the three clinical trials included in the review. This involved
computerized training programs or intensive one-on-one personal cognitive training in memory, reasoning or speed of processing.
In one trial, participants had significantly improved memory during 5-year follow-up periods. Another study showed an improvement
in auditory memory and attention in a group of seniors who participated in a computerized cognitive training program.
Citing that: ” The studies in this review that assessed cognitive exercises used exercises that were both labor- and
resource-intensive,” the lead author suggests that: “we encourage researchers to consider easily accessible tools
such as crossword puzzles and Sudoku.”
Grape intake may protect against metabolic syndrome-related organ damage
Study shows grapes reduced inflammation and fat storage, improved
antioxidant defense
Characterized
by central obesity, hypertension, and adverse glucose and insulin metabolism, Metabolic Syndrome is a condition associated
with increased risk of type-2 diabetes and cardiovascular disease. E. Mitchell Seymour, from the University of Michigan
Health System (Michigan, USA), and colleagues studied the effects of a high fat, American-style diet both with added grapes
and without grapes (the control diet) on the heart, liver, kidneys, and fat tissue in obesity-prone rats. The grapes –
a blend of red, green and black varieties – were provided as a freeze-dried grape powder and integrated into the animals’
diets for 90 days. The data revealed that three months of a grape-enriched diet significantly reduced inflammatory markers
throughout the body, but most significantly in the liver and in abdominal fat tissue. Consuming grapes also reduced
liver, kidney and abdominal fat weight, compared with those consuming the control diet. Additionally, grape intake increased
markers of antioxidant defense, particularly in the liver and kidneys.
http://uofmhealth.org/news/archive/201304/grape-intake-may-protect-against-metabolic-syndrome-related
Apple Compounds
Affect Inflammation
Apple peel is an abundant source of triterpenoids – plant-based
compounds for which anti-cancer effects are suggested. Elke Richling, from University of Kaiserslautern (Germany), and
colleagues studied the effects of ursanic, oleanic and lupanic pentacyclic triterpenoids found in apple peel for their
anti-inflammatory effects, using colon cancer cells that were exposed to the triterpenoids and then stimulated with pro-inflammatory
cytokines. Finding that the apple peel compounds inhibited the expression of IP-10, a gene that is linked to inflammatory
disorders including irritable bowel disease, the study authors submit that: “The present study confirms that triterpenoids
present in apple peel … may be implicated in the anti-inflammatory properties of apple constituents, suggesting
that these substances might be helpful in the treatment of [irritable bowel disease] as nutrient supplements.”
http://www.nutraingredients-usa.com/Research/Apple-compounds-may-influence-inflammatory-genes-show-potential-for-IBD/
Tart Cherries May Reduce Stroke Risk
In addition to positive heart health benefits, cherry-rich diet suggests decrease in stroke risk in University
of Michigan animal study
Montmorency tart cherries have been found to activate PPAR
isoforms (peroxisome proliferator activating receptors) in many of the body’s tissues. Studies suggest that anthocyanins
– the pigments that give the fruit its red color – may be responsible for PPAR activation. E. Mitchell
Seymour, from the University of Michigan (Michigan, USA), and colleagues compared the effect of tart cherries and a
prescription drug that helps to regulate fat and glucose but for which long-term use can increase stroke risk. Employing
a model of stroke-prone rats which were put through various physical tests, such as walking on a tapered beam and climbing
a ladder, the researchers found that compared to the drug, tart cherry intake significantly improved balance and coordination,
and at the same time lowered blood pressure. The study authors submit that: “intake of a physiologically-relevant
amount of anthocyanins from tart cherry significantly reduced stroke-related phenotypes, was safer than [prescription drug],
and may be a good preclinical model to explore the stroke-protective effects of an anthocyanin-rich diet.”
http://uofmhealth.org/news/archive/201304/tart-cherries-linked-reduced-risk-stroke
Black Tea Compounds Beneficial for Blood Pressure
Black tea is green tea that has been fermented. While
previous studies suggest that regular consumption of black tea may help to lower blood pressure level, Jonathan M Hodgson,
from the University of Western Australia (Australia), and colleagues investigated its effects on blood pressure variation.
The team enrolled 111 men and women with systolic blood pressure between 110 and 150 mmHg, assigning each subject to one of
two groups: the first group consumed three cups per day of black tea; and the second group received a flavonoid-free
caffeine-matched (control) beverage. After six months of consuming the respective beverages, the tea group displayed
10% lower rates of systolic and diastolic blood pressure variation during the nighttime. Writing that: “These findings
indicate that a component of black tea solids, other than caffeine, can influence the rate of blood pressure variation during
nighttime,” the study authors submit that: “small dietary changes have the potential to significantly influence
the rate of blood pressure variation.”
http://www.nutraingredients-usa.com/Research/Black-tea-compounds-show-blood-pressure-benefits-Human-data/
Flaxseed Improves Glycemic Control
An abundant source of soluble fiber and lignans, compounds
which have been studied for beneficial effects for pre-and type-2 diabetics, flaxseed also contains alpha-linolenic acid,
an important plant-based omega-3 fatty acid. Andrea M. Hutchins, from the University of Colorado (Colorado, USA), and
colleagues enrolled 25 overweight or obese men and postmenopausal women with pre-diabetes in a 12-week long study
in which subjects consumed 0, 13, or 26 grams of ground flaxseed daily. The team monitored glucose, insulin, homeostatic
model assessment (HOMA-IR), and normalized percent of alpha-linolenic fatty acid (ALA). The team observed that
13 gm/day of flaxseed significantly decreased insulin resistance. The study authors submit that: “Flaxseed intake
decreased glucose and insulin and improved insulin sensitivity as part of a habitual diet in overweight or obese individuals
with pre-diabetes.
http://www.nutraingredients-usa.com/Research/Flaxseed-may-offer-improvements-for-obese-pre-diabetics/
Omega-3s May Postpone Metabolic Disorders
Previously, studies have reported that higher plasma omega-3
polyunsaturated fatty acids (PUFA) associate with a lower risk of age related cognitive decline, and exert beneficial effects
on cardiometabolic risk factors. Inger Bjorck, from Lund University (Sweden), and colleagues enrolled 40 healthy middle-aged
men and women in a study in which subjects consumed a daily supplement containing 3g of omega-3 fish oil, or placebo, for
five weeks prior to the administration of standardized cognitive tests and collection of metabolic risk markers including
blood pressure, serum triglycerides, and fasting glucose. The team observed that the subjects who consumed the omega-3
performed better on the cognitive assessments, and had lower systolic blood pressure, triglycerides, fasting glucose, and
s-TNF-alpha (a marker of inflammation), which the study authors submit as “indicating a potential of dietary prevention
strategies to delay onset of metabolic disorders and associated cognitive decline.”
http://www.nutraingredients-usa.com/Research/Omega-3-may-delay-metabolic-malady-and-block-mental-declines-Study/
Too Much Vitamin D Increases
Cardiovascular Morbidity and Mortality
Vitamin D deficiency is known to be deleterious to health and has been linked to cardiovascular events and mortality,
yet studies have found that supplementation either fails to decrease mortality or cardiovascular events or only has a small
positive effect. Yosef Dror, PhD, of Hebrew University in Rehovot, Israel, believes that these “unpredictable results”
may be due to the misconception that a high dose of vitamin D would be more effective than a moderate dose. The researchers
conducted a study of 422,000 people aged 45-years or older, who underwent vitamin D blood assays. The results showed, for
the first time, that the safe range of vitamin D levels with respect to coronary morbidity and mortality lies between 20 to
36 ng/mL. Vitamin D levels both below and above this range were associated with a significant increase in mortality and morbidity.
More than 60% of participants were found to have insufficient blood levels of vitamin D, and half of these participants had
severely low vitamin D levels. Too little vitamin D was associated with a 1.5-times increased risk of acute coronary morbidity
or mortality. On the other end of the scale, 3% of participants had elevated vitamin D levels (>36 ng/mL), which was associated
with a 1.13-times elevated risk of coronary morbidity or death. Yror warns that there is a risk that some people who are already
within the upper-normal range, may actually increase their risk of morbidity and mortality by taking supplementary vitamin
D. However, he adds that vitamin D supplementation, with strict monitoring to avoid overload, may have a significant influence
on public health
http://www.worldhealth.net/news/too-much-vitamin-d-increases-cardiovascular-morbid/
Vitamin D Is an Essential Energy Nutrient
An underlying cause of fatigue can be suboptimal mitochondrial function,
and Vitamin D deficiency is a well-recognized cause of fatigue and myopathy. Akash Sinha, from Newcastle
University (United Kingdom), and colleagues used non-invasive magnetic resonance scans to measure the response to exercise
in 12 patients with severe deficiency before and after treatment with vitamin D. The team found that exercise recovery
rates significantly improved after the patients took a fixed dose of oral vitamin D for 10-12 weeks, with the average phosphocreatine
recovery half time decreasing from 34.4 sec to 27.8 sec. All patients reported an improvement in symptoms of fatigue after
having taken the supplements. In a parallel study, the group demonstrated that low Vitamin D levels were associated with reduced
mitochondrial function. Explaining that: “[Vitamin D] therapy augments muscle mitochondrial maximal oxidative
phosphorylation following exercise in symptomatic, vitamin D deficient individuals,” the study authors submit that:
“This finding suggests that changes in mitochondrial oxidative phosphorylation in skeletal muscle could at least be
partly responsible for the fatigue experienced by these patients. For the first time, we demonstrate a link between vitamin
D and the mitochondria in human skeletal muscle.”
http://www.eurekalert.org/pub_releases/2013-04/nu-vdp040513.php
Is Azithromycin Cardiotoxic?
A Danish study shows no excess cardiovascular-related mortality in relatively healthy
azithromycin users.
In a study published
in 2012, exposure to azithromycin was associated with excess cardiovascular-related and all-cause mortality, compared with
exposure to amoxicillin or no antibiotic; a postulated mechanism was QT prolongation (JW Gen Med May 22 2012). However, that study involved Medicaid recipients — a low-income group
with a potentially high prevalence of comorbidities. To determine whether the findings could be generalized, researchers performed
a similar study using databases encompassing all young and middle-aged adults (age range, 18–64) in Denmark. Death rates
during and immediately after 1.1 million episodes of azithromycin use were compared with death rates during similar numbers
of episodes of no antibiotic use or penicillin V use. Propensity scoring was used to account for baseline clinical and demographic
differences between the azithromycin, penicillin, and no-antibiotic groups.
Current use of azithromycin, compared with no antibiotic use, was associated with excess risk for both
cardiovascular- and noncardiovascular-related death. However, azithromycin use was not associated with excess mortality compared
with penicillin V use.
Svanström H et al. N
Engl J Med 2013 May 2; 368:1704
Chest Physicians Recommend CT Lung Cancer Screening for High-Risk
Patients
Smokers and former smokers aged 55 to 74 who have accumulated 30 or more pack-years of smoking should be screened
annually for lung cancer with low-dose computed tomography (CT), according to new guidelines from the American College of
Chest Physicians.
Published in Chest,
the guidelines specify that to lower the risk for death, screening must be performed at a center with "multidisciplinary
coordinated care and a comprehensive process for screening, image interpretation, management of findings, and evaluation and
treatment of potential cancers."
CT screening
is not recommend for younger or older smokers, those who've smoked for less than 30 pack-years, those who quit more than
15 years earlier, or those with significant comorbidities that limit life expectancy.
Chest executive summary
Urological Group's Guidelines Recommend Against PSA Screening
in Most Men
The American Urological Association's
new guidelines recommend prostate cancer screening only in men aged 55 to 69 and based on shared decision-making and the patient's
preferences. The guidelines put AUA's position more in line with other medical organizations.
In the 55-to-69 age group, one prostate-cancer death is prevented for every 1000 men
screened over a decade. For men who decide to undergo prostate-specific antigen screening, AUA recommends testing every two
years or more, rather than annual testing.
The
group now recommends against routine PSA screening for men younger than 55 who are at average risk, those older than 69, and
those with less than 10 to 15 years of expected life remaining.
The recommendations come less than a year after the U.S. Preventive Services Task Force recommended
against routine PSA screening in all men.
American Urological Association guidelines
Your New Gym: A Kitchen Chair
High-intensity interval training
(periods of intense exercise near one's peak capacity followed by brief recovery periods) could allow shortening of exercise
regimens, according to a Health and Fitness Journal study.
The New York Times' Well blog calls it "the
scientific 7-minute workout," and the only equipment that one apparently needs is a simple chair and a wall to lean (not
slouch) against. Twelve exercises are performed in strict order using 15 repetitions each, allowing opposing muscle groups
to alternate between work and rest.
Caution: the
authors say the regimen is not for the overweight, detrained, injured, or elderly.
Health
and Fitness Journal article
-3 Fatty Acids and Later-Life Mortality
In older adults,
higher circulating -3 fatty acid levels were associated with lower cardiovascular-related mortality.
Mozaffarian D et al. Ann
Intern Med 2013 Apr 2; 158:515
n–3 Fatty Acids in Patients with Multiple Cardiovascular
Risk Factors
Trials have
shown a beneficial effect of n−3 polyunsaturated fatty acids in patients with a previous myocardial infarction or heart
failure. We evaluated the potential benefit of such therapy in patients with multiple cardiovascular risk factors or atherosclerotic
vascular disease who had not had a myocardial infarction.
CONCLUSIONS
In a large general-practice cohort of
patients with multiple cardiovascular risk factors, daily treatment with n−3 fatty acids did not reduce cardiovascular
mortality and morbidity. (Funded by Società Prodotti Antibiotici and others; ClinicalTrials.gov number,NCT00317707.)
http://www.nejm.org/doi/full/10.1056/NEJMoa1205409?query=TOC#t=articleResults
Considering CRP Concentration Improves Diagnosis of Pneumonia
Low C-reactive
protein levels helped rule out pneumonia in a European study published in BMJ.
Acute bronchitis is managed expectantly, and pneumonia is managed with antibiotics.
However, accurately distinguishing these conditions, based on history and physical examination alone, is difficult. Although
chest x-ray can distinguish acute bronchitis from pneumonia, it is expensive, exposes patients to radiation (often unnecessarily),
and is unavailable in some settings. In this European study, investigators determined whether measuring blood C-reactive protein
(CRP) and procalcitonin concentrations, in addition to history and physical examination, improved diagnostic accuracy.
Among 2820 adults (mean age, 50) who presented with cough to primary care practices,
chest x-ray confirmed pneumonia in 140 patients (5%). The optimum combination of history and examination findings for pneumonia
was absence of runny nose and presence of breathlessness, crackles and diminished breath sounds on auscultation, tachycardia,
and fever. Adding CRP level as a continuous variable resulted in significantly improved ability to predict pneumonia (multivariate
odds ratio, 1.2 per 10 mg/L rise in CRP concentration). Adding CRP as a dichotomized variable (>30 mg/L as high-risk for
pneumonia) yielded similar results. Of 665 patients with low probability (<2.5%) for pneumonia based on history and examination
findings only, 11 (2%) actually had pneumonia. Adding CRP level reclassified 891 additional patients into the low-risk group
(total, 1556); of these, 31 (2%) actually had pneumonia. Procalcitonin added no diagnostic information.
Original article
Medline abstract
Benefits of Sequentially Offering CRC Screening
Tests
In a population-based screening program, 19% of people who
refused sigmoidoscopy took a fecal immunochemical test, which detected 8% of all advanced adenomas and 20% of all cancers,
according to a study in Gut.
Journal Watch Gastroenterology summary
Prophylaxis for Leg Cellulitis
Patients with leg cellulitis
who received prophylactic penicillin had fewer recurrences than those given placebo, without increases in adverse effects.
Leg cellulitis is common
and often recurrent. Does continuous treatment with phenoxymethylpenicillin 250 mg twice daily prevent recurrence? To answer
this question, investigators enrolled 274 subjects with recurrent cellulitis seen at 28 hospitals in the U.K. and Ireland
into a 36-month, double-blind, randomized, placebo-controlled trial of this prophylactic low-dose penicillin. Eligible patients
had had a recurrent episode of leg cellulitis within 24 weeks of the enrollment date and at least two other episodes of leg
cellulitis within the previous 3 years. The primary outcome was time from randomization to first recurrence.
Median time to first confirmed
recurrence was 626 days in the phenoxymethylpenicillin group versus 532 days in the placebo group. Despite prophylaxis, cellulitis
recurred in 30 of 136 active-treatment recipients (22%) compared with 51 of 138 placebo recipients (37%) — a hazard
ratio of 0.55 (95% confidence interval, 0.35 to 0.86; P=0.01) with treatment, meaning five patients with recurrent
cellulitis would need to be treated to prevent one recurrence. During a follow-up period without intervention, the rate of
leg cellulitis was 27% in both groups (P=0.88). Univariable and multivariable analysis identified some factors associated
with poor response to treatment — high body-mass index, having had three or more previous cellulitis episodes, and leg
edema.
http://dermatology.jwatch.org/cgi/content/full/2013/501/1?q=etoc_jwgenmed
Pfizer to Sell Viagra Directly from Its Website
Pfizer says it will make its most-counterfeited product, the erectile dysfunction drug Viagra (sildenafil), directly
available on its website, making it the first major drugmaker to try this approach.
A prescription is still required, and the pills will sell for $25 each, according to
the Associated Press. Three pills in the first order are free.
Pfizer announcement
FDA Approves New Cholesterol-Cutting Combination Drug
The FDA has approved a new ezetimibe-atorvastatin tablet (brand name, Liptruzet) for lowering cholesterol in patients
with primary or mixed hyperlipidemia, and in those with homozygous familial hypercholesterolemia.
In a trial of some 620 patients, the once-daily tablet reduced LDL cholesterol by 53%
at the lowest dose (10/10 mg) and 61% at the highest dose (10/80 mg). Common side effects include changes in liver function
tests, muscle pain, memory loss, and tendon problems.
The combination treatment has not been shown to improve cardiovascular outcomes better than atorvastatin, which
has some cardiologists questioning the FDA's decision. Steven Nissen, chairman of cardiology at the Cleveland Clinic,
says in Forbes that
the agency seems to be "tone deaf" to concerns "about approving drugs with surrogate endpoints like cholesterol
without evidence of a benefit for the disease [cardiologists] are truly trying to treat — cardiovascular disease."
Manufacturer's press release
Magnesium Sulfate: Drug Safety Communication - Recommendation Against Prolonged Use in Pre-term Labor
[Posted 05/30/2013]
AUDIENCE: OB/GYN, Nursing, Risk
Manager
ISSUE: FDA is advising health care professionals against using magnesium sulfate injection for more than 5-7 days
to stop pre-term labor in pregnant women. Administration of magnesium sulfate injection to pregnant women longer than 5-7
days may lead to low calcium levels and bone problems in the developing baby or fetus, including thin bones (osteopenia), and
fractures. The shortest duration of treatment that can result in harm to the baby is not known. See the Data Summary in the
Drug Safety Communication for additional information.
BACKGROUND: This use of the drug is off-label, and is not an FDA-approved
use of the drug. Magnesium sulfate is approved to prevent seizures in preeclampsia, a condition in which the pregnant woman
develops high blood pressure and protein in the urine, and for control of seizures in eclampsia. Both preeclampsia and eclampsia
are life-threatening complications that can occur during pregnancy. Preeclampsia can lead to eclampsia, seizures, stroke,
multiple organ failure, and death of the woman and/or baby.
RECOMMENDATIONS: In light of this new safety information about low calcium
levels and bone problems in the developing baby, the following information is being added to the drug label for Magnesium
Sulfate Injection, USP 50%:
· A new Warning stating that
continuous administration of magnesium sulfate injection beyond 5-7 days in pregnancy for the treatment of pre-term labor
can cause low calcium levels and bone changes in the baby.
·
A new Teratogenic Effects section conveying the potential harm to developing babies by changing the Pregnancy
Category to D from A. Pregnancy Category D means there is positive evidence of human fetal risk, but the potential benefits
from using the drug in pregnant women may be acceptable in certain situations despite its risks.
·
A new Labor and Delivery section emphasizing that continuous administration of magnesium sulfate injection
to treat pre-term labor is not approved and that the safety and efficacy of use for this indication are not established. When
used in pregnant women for conditions other than its approved indication, magnesium sulfate injection should be administered
only by trained obstetrical personnel in a hospital setting with appropriate obstetrical care facilities.
Pregnant women should discuss
with their health care professional the possibility of going into labor before term and the risks and benefits of any treatments
that may be used
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm354603.htm
Double-Dose Tamiflu No Better Than Standard Dose for Severe Flu
A double dose of
oseltamivir (Tamiflu) offers no advantage over single-dose therapy among children and adults with severe influenza, according
to a BMJ study.
Some 325 patients (three-quarters children) hospitalized with severe flu in Southeast
Asia were randomized to either double-dose oseltamivir (150 mg twice daily, or pediatric equivalent) or standard treatment
(75 mg twice daily, or equivalent). Detected viruses included various subtypes of seasonal influenza, 2009 pandemic flu, and
avian flu.
The proportion of patients with no detectable
viral RNA on day 5 did not differ between the groups (roughly 70%). In addition, the groups did not differ with respect to
clinical failure or in-hospital mortality. Findings generally were consistent regardless of patient age or flu type.
The authors say their results "do not support routine use" of double-dose
therapy in severe flu. Editorialists agree, adding that the results "could help to preserve oseltamivir stocks during
a future pandemic."
BMJ article
Doubts Over Januvia, Byetta
Patients may ask about a New York
Times article on Peter C. Butler, a UCLA endocrinologist who found precancerous
changes in the pancreatic tissue of people who'd taken the antidiabetes drugs sitagliptin (Januvia) or Byetta (exenatide).
The NIH will hold a meeting in June to investigate links between diabetes drugs and
pancreatic cancer. Butler will be one of the speakers, according to the Times.
New
York Times story
Safety of Sitagliptin: An Observational
Study
Sitagliptin
wasn't associated with excess risk for hospitalization or death.
Eurich DT et al. BMJ 2013
Apr 25; 346:f2267
Venous thrombosis
prophylaxis
Alerting providers to extend thromboprophylaxis after hospital discharge
in medical service patients increased the rate of prophylaxis but did not decrease the rate of symptomatic venous thromboembolism. The American
Journal of Medicine
The Worcester
Heart Failure Study
This study concluded that atrial
fibrillation (AF) was common among patients with acute decompensated heart failure (ADHF) and the proportion of
ADHF patients with co-occurring AF increased during the years under study. Despite improving trends in survival, patients
with ADHF and AF are at increased risk for in-hospital and post-discharge mortality. The American
Journal of Cardiology
Higher doses
of vitamin D warranted
Two different regimens of vitamin D supplementation resulted in
no change in 25(OH)D levels over 11 weeks during the fall through spring months in a diverse group of healthy adolescents
with baseline vitamin D sufficiency. (Full-text access is time limited.) Journal of Adolescent Health
Lipid levels and optimism
This is the first study to suggest that optimism is associated with
a healthy lipid profile; moreover, these associations may be explained, in part, by having healthier behaviors and a lower
body mass index. The American Journal of Cardiology
Iron-deficiency anemia in subclinical
hypothyroidism
Subclinical hypothyroidism was investigated in iron-deficient patients
with no acceptable response to iron salt alone. A combination of levothyroxine and iron salt is better than each one alone. The American Journal of Medicine
Treatments for bone mineral density
Combined teriparatide and denosumab increased bone-mineral density
(BMD) more than either agent alone and more than has been reported with approved therapies. Combination treatment might, therefore,
be useful to treat patients at high risk of fracture. (Free registration required.) The Lancet
Skeletal muscle mass and physical
decline
Does low skeletal muscle mass lead to functional decline? Nine hundred
and seventy-five women aged 75+ were followed four years to evaluate functional decline. Those with low skeletal muscle mass
(SMM) starting out showed more subsequent functional decline. Other studies have recently shown that declining functional
performance may be a predictor of physical decline. Interestingly, there was no correlation found between sarcopenic obesity
and functional decline in this study. (Free abstract only.) Journal of the American Medical Directors
Association
Study associates depression with hypoglycemic
episodes
A study published in the Annals of Family Medicine found depression was
linked to the timing of first severe hypoglycemic episode and number of episodes in adult patients with diabetes, according
to researchers. Patients with depression had shorter severe hypoglycemic episodes but also had more of them compared with
patients who were not depressed, the study found.Healio/Endocrine Today
Bronchodilators may raise heart risks in COPD
patients
Taking the long-acting bronchodilators beta-agonists and anticholinergics
was associated with a greater risk of cardiovascular events in elderly patients with chronic obstructive pulmonary disease,
researchers found. The study appeared in JAMA Internal Medicine. Medical News Today
Diet and aging
By considering healthy aging as a composite of cardiovascular, metabolic,
musculoskeletal, respiratory, mental and cognitive function, the present study offers a new perspective on the impact of diet
on aging phenotypes. The American Journal of Medicine
Study: LDL cholesterol improvements stalled
after 2008
Researchers at Quest Diagnostics saw a 13% decline in LDL cholesterol
levels among American adults from 2001 through 2008. However, researchers did not observe further improvements after 2008,
suggesting that the recession may have stalled progress, although the American Heart Association president questioned that
connection. The findings appear in PLoS One. The Huffington Post/The Associated
Press
Researchers create mortality risk calculator
for diabetes
Researchers have developed an online tool to assess type 2 diabetes
mortality risk based on nine readily available metrics. The calculator can help stratify patients with low, medium or high
risk of all-cause death within two years. "We do believe that the implementation of our model may help prioritize the
use of available resources for targeting aggressive preventive and treatment strategies in a subset of very high-risk individuals,"
according to researchers. The study was published in Diabetes Care. Medscape (free registration)
Prediabetes patients show similar heart risks
as those with diabetes
Data on 86 percutaneous coronary intervention patients showed 36%
of those with prediabetes had coronary artery disease, compared with 42% of those with diabetes and 21% of people with normal
blood glucose levels. Researchers also found 37% of prediabetes patients had hyperlipidemia, compared with 38% of those with
diabetes and 24% of those with normal blood glucose levels. The findings were presented at the American Association of Clinical
Endocrinologists annual meeting. MedPage Today
What bothers patients most?
A U.S. survey of 1,000 people found the top complaints of patients
included long wait times to see physicians, unclear descriptions of problems, slow test results and billing issues. The Consumer
Reports study found women were more bothered than men when physicians used electronic devices to record notes and when conversations
were held within earshot of other patients. PhysiciansBriefing.com/HealthDay News
Seriousness of fainting in the elderly
Syncope (fainting), especially for those with congestive heart failure
and acute coronary syndrome, can be a predictor of rehospitalization. Predictors of mortality in those with syncope, however,
were diabetes mellitus, history of smoking, and use of statins. Of 352 patient charts studied, syncope was diagnosed in 243
(69%), of which 29% had cardiac syncope. At 24-month follow-up 11% died, pointing to the seriousness of fainting in the elderly.
(Free abstract only.) Journal of the American Medical Directors
Association
Use of potentially harmful supplments
in chronic kidney disease
In the United States, the prevalence of dietary supplement use that
can be harmful to people with chronic kidney disease (CKD) is unknown, despite the fact that avoiding these substances is
important for patient safety. The authors of this study of data from the National Health and Nutrition Examination Survey,
1999-2008, found that the potentially harmful use of dietary supplements by patients with CKD is common; in fact, individuals
with CKD are equally likely to use potentially harmful supplements as are those without CKD. The authors recommend that providers
vigilantly ask patients about all ingestions and advise them about potential risks accordingly. American Journal of Kidney Diseases
High-Dose NSAIDs Pose Increased Cardiovascular Risk
High-dose diclofenac and coxibs,
non-steroidal anti-inflammatory drugs (NSAIDs), carry similarly elevated cardiovascular risks, a Lancet meta-analysis finds.
Researchers examined over 600 randomized trials — comprising over 300,000 patients — comparing
NSAIDs with placebo or another NSAID. Relative to placebo, the risk for major vascular events was about a third higher in
patients taking coxibs or diclofenac, mostly attributable to higher rates of major coronary events. The authors estimate that
coxibs or diclofenac would cause roughly three extra major vascular events per 1000 patients annually.
Ibuprofen had double the risk for major coronary events, but no increase in vascular
events, while naproxen was not associated with increased cardiovascular risk.
A commentator concludes: "Long-term use of high-dose NSAIDs should be reserved for those who receive
considerable symptomatic benefit from the treatment and understand the risks." Others should receive nonpharmacological
regimens, topical therapy, and lower-risk NSAID treatments.
Lancet article
Treatment of New Prostate Cancers Unlikely to Benefit Older, Sicker
Men
Men with comorbid
conditions who are newly diagnosed with prostate cancer should consider their risk for other-cause mortality before choosing
aggressive therapy for their cancer, according to an Annals of Internal
Medicine study.
Some 3200 men newly diagnosed with nonmetastatic prostate cancer were followed for 14 years. At entry,
the men self-reported whether they had any of 12 comorbidities, including diabetes, chronic lung disease, heart failure, and
stroke.
By the 14-year mark, other-cause mortality
was 24% for those with no comorbidities, 33% with one comorbidity, 46% with two, and 57% with three or more. The authors point
out that for those aged 60 or older with three or more comorbidities, mortality is nearly 50% at 10 years after diagnosis.
These men, they say, should "strongly weigh the risk for death from other causes before realizing any potential survival
benefit from aggressive therapy."
Annals
of Internal Medicine article
ACP Recommends Against Intensive Insulin Therapy for Hospitalized
Patients
Hospitalized patients
will probably experience more harm than benefit from intensive insulin therapy (IIT), according to an American College of
Physicians committee on clinical guidelines.
Writing
in the American Journal of Medical Quality, the panel finds "some
evidence of a marginally significant reduction" in infection and sepsis with IIT. However, panelists point to IIT's
increased risk for hypoglycemia, which was associated with increased mortality in some studies.
Their advice? In medical/surgical intensive care units, the glucose target with insulin
therapy should be between 7.8 and 11.1 mmol/L (140 to 200 mg/dL); targets under 7.8 mmol/L (140 mg/dL) should be avoided "because
harms are likely to increase" with lower targets.
American
Journal of Medical Quality article
Anterior Cutaneous Nerve Entrapment
— A Cause of Abdominal Wall Pain
A randomized
trial suggests that surgery is effective for this syndrome.
Clinicians often overlook the abdominal wall as a source of chronic abdominal pain.
One entity described in the medical literature is "anterior cutaneous nerve entrapment syndrome" (ACNES), in which
the end twigs of cutaneous intercostal nerves are entrapped as they penetrate along the lateral border of the rectus abdominis
muscle. ACNES is tentatively diagnosed if a patient has a discrete tender area along the lateral rectus abdominis and increased
tenderness during abdominal-wall tensing maneuvers (Carnett's sign). Dutch surgeons have addressed ACNES in two studies.
In an observational cohort study, 135 patients with presumed ACNES underwent diagnostic
infiltration with 1% lidocaine; 88% experienced pain relief. Of 56 patients who later underwent corticosteroid injections,
16 experienced permanent resolution of pain. Eventually, half the patients underwent surgical neurectomy; 80% of them achieved
satisfactory 6-week outcomes.
Next, the team
conducted a double-blind, sham-controlled, randomized trial that involved 44 patients. All patients underwent identical skin
and subcutaneous incisions; the surgeon proceeded to neurectomy in the intervention group but simply closed the incisions
in the sham group. At 6 weeks, intervention patients were significantly more likely than sham-surgery patients to report substantial
or complete pain relief (73% vs. 18%).
Medline abstract (Free)
Boelens OB et al.
A double-blind, randomized, controlled trial on surgery for chronic abdominal pain due to anterior cutaneous nerve entrapment
syndrome. Ann Surg 2013
May; 257:845. (http://dx.doi.org/10.1097/SLA.0b013e318285f930)
Medline abstract
Early Nutrition in
Critically Ill Patients
Feed Carefully and in Moderation
Juan B. Ochoa Gautier, MD; Flávia R. Machado, MD, PhD
JAMA. 2013;309(20):2165-2166. doi:10.1001/jama.2013.4867.
Clinicians in intensive care units (ICUs) have to decide whether supplemental parenteral
nutrition should be ordered for a critically ill patient who cannot be fed and is kept “nil per os (NPO),” for
instance, because of gastrointestinal tract dysfunction. Without early supplemental parenteral nutrition, the patient is temporarily
starved, an approach based on the assumption that physiologic compensatory processes are protective and thus there will be
no untoward clinical consequences. In contrast, clinicians who order early supplemental parenteral nutrition presumably consider
the accumulating caloric deficit to be deleterious for critically ill patients. Although determining the best approach might
seem straightforward, a clear answer remains evasive.
http://jama.jamanetwork.com/article.aspx?articleID=1689533&utm_source=Silverchair%20Information%20Systems&utm_medium=email&utm_campaign=JAMA%3AOnlineFirst05%2F20%2F2013
Combined Teriparatide and Denosumab Is
More Effective Than Either Drug Alone
Bone-mineral
density was increased significantly by combination therapy in postmenopausal women with high fracture risk.
Combination therapy with teriparatide and the monoclonal antibody denosumab increases
bone mineral density (BMD) to a greater extent than either drug alone in women with postmenopausal osteoporosis, according
to an industry-funded study in the Lancet.
Researchers randomized 100 postmenopausal women with high fracture risk to receive subcutaneous
teriparatide (daily), denosumab (every 6 months), or both for 1 year. At the end of treatment, posterior-anterior spine BMD
had increased significantly more with combination therapy (9% increase from baseline) than with either agent alone (roughly
6% each). Femoral-neck BMD and total-hip BMD had also increased more with combination therapy.
"The BMD changes in the combined-therapy group were greater than have been reported
with any approved therapies," the researchers write. They conclude that their findings "suggest that this specific
combination of drugs could be a useful option in the treatment of patients with osteoporosis at especially high risk of fracture."
Lancet article
Tsai JN et al. Lancet 2013 May 15;
Zolpidem-Related Emergency Department Visits Triple over 5 Years
The number of emergency department
visits related to the insomnia drug zolpidem (e.g., Ambien) more than tripled in the U.S. from 2005 to 2010, according to
a report from the Substance Abuse and Mental Health Services Administration.
Overall, the number rose from 6111 to 19,487. Females were especially at risk, accounting for over
two thirds of visits in 2010. (In January 2013, the FDA halved the recommended dose of zolpidem in women, noting that women
process the drug more slowly than men.) One third of visits involved adults aged 65 and older.
The report concludes: "Physicians and pharmacists can emphasize the importance
of using zolpidem safely and only for short-term problems with insomnia. This may be especially crucial for older adults,
for whom insomnia is a common complaint and who often take other prescription medications that may interact with zolpidem."
SAMHSA report
Exercise-Induced Bronchoconstriction Guidelines Released
By The Editors
The American Thoracic Society has released guidelines on exercise-induced bronchoconstriction.
The guidelines, published in the American
Journal of Respiratory and Critical Care Medicine, strongly recommend that all patients with exercise-induced bronchoconstriction
use a short-acting β2-agonist before physical activity. Patients whose symptoms continue despite using a short-acting
β2-agonist should use a daily inhaled corticosteroid, a daily leukotriene receptor antagonist, or a mast cell stability
agent prior to exercise.
American
Journal of Respiratory and Critical Care Medicine article
Orlistat Probably Doesn't
Cause Acute Liver Injury
Excess risk for liver
injury was present for 90 days before and after first orlistat prescription.
Orlistat (Alli; Xenical), which inhibits
gastric and pancreatic lipase and prevents some dietary fat absorption, is one of only a few drugs available for treating
obesity. In 2009, theFDA issued a warning about possible association between orlistat use and liver injury. In this population-based study, U.K.
investigators used several large databases to assess this possible connection.
During a mean observation period of 9 years, 95,000 patients received at least one prescription
for orlistat (median age at first prescription, 48; mean duration of orlistat treatment, 11 months). During the observation
period, about 1000 patients suffered "definite" or "probable" idiopathic liver injury; 94 patients experienced
liver injury during orlistat treatment. Compared with periods of nonuse, the first 30 days of orlistat use were associated
with significant excess risk for liver injury (incidence rate ratio, 2.2); no excess risk was noted after 30 days of use.
Risk for liver injury was also higher during the 90 daysbefore orlistat
use (IRR, 1.5). Notably, risks during the 90 days before and during the 90 days after first orlistat use were similar. When
only definite cases were considered, excess risk for liver injury was present during the 90 days before orlistat prescription
(IRR, 1.8), but not during orlistat use.
Original article
Douglas IJ et al. BMJ 2013 Apr 12; 346:f1936
Frequent Acid Reflux Associated with Throat Cancers
Gastric reflux is a risk factor for cancers of the pharynx and larynx, and the use of antacids seems to lower that
risk, according to an observational study in Cancer Epidemiology, Biomarkers
and Prevention.
In a multicenter
collaboration, researchers matched some 630 cases of laryngopharyngeal squamous cell carcinomas with twice the number of controls
without cancer. Analyses were adjusted for demographics, smoking history, and HPV16 seropositivity.
Among patients who were not heavy smokers or drinkers, a history of self-reported frequent
heartburn was significantly associated with throat cancers relative to those without heartburn (odds ratio, 1.78). Use of
antacids for heartburn was associated with a lower risk (OR, 0.59). However, there was no such inverse association seen with
the use of proton-pump inhibitors or histamine H2 receptor antagonists — possibly due to confounding from increased
disease severity leading to their use.
The
authors speculate that acid reflux may cause cancers by, for example, inducing chronic inflammation or activating signaling
pathways of cellular proliferation.
Cancer
Epidemiology, Biomarkers and Prevention article
FDA Approves Oral Solution for Subarachnoid Hemorrhage
The FDA has approved
a nimodipine oral solution (marketed as Nymalize) to treat subarachnoid hemorrhage.
The drug was previously only available in gel-capsule form. Regulators say they hope the new oral formulation, which can also
be given via nasogastric tube, will reduce medication errors caused by healthcare providers injecting the liquid contents
of the nimodipine capsules intravenously.
FDA news release
New Cardiovascular Risk Factor — Gut Bugs, Lecithin,
and TMAO
Bacteria in the gut convert
dietary lecithin to proatherogenic trimethylamine-N-oxide (TMAO), according to a study in the New
England Journal of Medicine.
Could Vitamin D Supplementation Lower Blood
Pressure in Blacks?
In a small
randomized trial, supplementation had a small but significant dose-related effect on systolic blood pressure
Compared with whites, blacks have significantly higher rates of hypertension and significantly
lower levels of 25-hydroxyvitamin D (25[OH]D). To assess the effects on blood pressure (BP) of treating the relative vitamin
D deficiency in blacks, investigators conducted a randomized, double-blind, placebo-controlled trial of cholecalciferol (vitamin
D3) supplementation (1000, 2000, or 4000 IU/day) for 3 months during
the winter in 250 black adults (93% non-Hispanic; median age, 51; median body-mass index, 31 kg/m2). Baseline patient characteristics did not differ significantly among the four treatment arms (median 25[OH]D le
vel, 15.7 ng/mL; median BP, 122/78 mm Hg; antihypertensive medication use, 42%).
Cholecalciferol use was associated with marked increases in median 25(OH)D levels at
3 months (45.9, 34.8, and 29.7 ng/mL in participants assigned to 4000, 2000, and 1000 IU/day of cholecalciferol, respectively);
3 months after treatment cessation, the increases were attenuated but still substantial (31.2, 27.0, and 21.2 ng/mL, respectively).
Systolic — but not diastolic — BP fell significantly with both increasing cholecalciferol dose (1.4 mm Hg per
1000 IU/day) and increasing plasma 25(OH)D level (0.2 mm Hg per 1 ng/mL). The treatment effect was similar in an analysis
restricted to patients who were not taking antihypertensive medications and in subgroups with baseline systolic BP levels
<120 and 
120 mm Hg, but was greater in patients with baseline plasma 25(OH)D levels <20 ng/mL than in those
with levels 20 ng/mL.
Forman JP et al. Hypertension 2013 Apr 61:779
Bronchodilators Associated with Increased CV Risk in Older Patients
with COPD
Long-acting anticholinergics
(LAAs) and long-acting β-agonists (LABAs) are associated with similarly increased risks for cardiovascular events in
older patients with chronic obstructive pulmonary disease (COPD), according to a JAMA
Internal Medicinestudy.
Using Canadian
registry data, researchers identified patients with COPD aged 66 years and older; nearly 27,000 who'd had a cardiovascular
event were matched to controls. New use of LABAs and LAAs was associated with greater risk for cardiovascular events relative
to nonuse (odds ratios: 1.31 and 1.14, respectively), with no significant difference between LABAs and LAAs. Risk appeared
to be highest 2 to 3 weeks after starting treatment.
The authors note that LABAs are thought to stimulate sympathetic control, while LAAs may suppress parasympathetic
control. Both actions are tied to increased risks for arrhythmias, myocardial ischemia, and stroke.
A commentator concludes: "Although the authors recommend that 'subjects should
be monitored closely,' a firm recommendation on what that monitoring should be cannot be made."
JAMA
Internal Medicine article
CAC
Scores Improve Prediction of CV-Related Mortality in Diabetics
Assessing coronary artery calcium was better than relying on traditional risk factors alone for determining
cardiovascular risk.
Diabetes is generally considered to be a risk equivalent of coronary heart disease because
of the elevated adverse cardiovascular (CV) event rate in people who have diabetes. Investigators retrospectively analyzed
data from 1123 participants with type 2 diabetes (mean age, 61) in a previous study of familial diabetes to investigate whether
computed tomography (CT) measurement of coronary artery calcium (CAC) can risk-stratify patients with respect to CV-related
mortality.
Eight percent of study participants
died of CV causes during an average follow-up of 7.4 years. In multivariate analysis using patients with CAC scores of 0 to
9 as a reference, the odds ratios for CV-related mortality were 2.93 for patients with CAC scores of 10 to 99, 3.17 for 100
to 299, 4.41 for 300 to 999, and 11.23 for 1000. The net reclassification index (NRI), a measure of whether patients were reclassified appropriately
to low-, intermediate-, or high-risk groups, improved significantly when CAC scores were considered.
Original article
New HbA1c Test FDA-Approved to Diagnose Diabetes
The FDA announced that it has granted marketing approval
for Roche Laboratories' COBAS INTEGRA 800 Tina-quant HbA1cDx assay
(Tina-quant HbA1cDx assay) for the diagnosis of diabetes by healthcare professionals. The Tina-quant HbA1cDx assay, a laboratory-based
test, can be used to both diagnose diabetes and monitor a patient's blood glucose control. This is the first HbA1c test
that FDA has allowed to be marketed for this use.
Current HbA1c tests on the market are approved to monitor a patient's blood glucose
level, not for diagnosing diabetes. An A1c test measures the percentage of hemoglobin A1c that is bound to glucose, giving
a patient's average glucose level over a three-month period.
Study investigators analyzed 141 blood samples and found <6% difference
in the accuracy of test results from the Tina-quant HbA1c assay compared to results from standard reference for hemoglobin
analysis.
HbA1c
tests, including the Tina-quant HbA1cDx assay, should not be used to diagnose diabetes during pregnancy and should not be
used to monitor diabetes in patients with hemoglobinopathy, hereditary spherocytosis, malignancies, or severe chronic, hepatic
and renal disease. This test should not be used to diagnose or monitor diabetes in patients with the hemoglobin variant hemoglobin
F.
The Tina-quant
HbA1c assay is available by prescription for use in clinical laboratories.
Mild-to-Moderate Iodine Deficiency in Pregnancy Linked
to Lower IQ in Offspring
The children of women with mild-to-moderate iodine deficiency during pregnancy face
increased risk for suboptimal cognitive performance, according to a Lancet study.
Researched measured urinary iodine concentrations in some 1000 U.K. women during the first trimester of pregnancy,
and then assessed their offspring's IQ and reading ability at ages 8-9 years.
Compared with iodine-sufficient women (iodine:creatine ratio, 150 micrograms/g or higher), those with
iodine deficiency (below 150 micrograms/g) were significantly more likely to have children with verbal IQ scores in the bottom
quartile at age 8 (odds ratio, 1.58), as well as reduced reading scores at age 9. Worse effects were seen among women with
severe deficiency (<50 micrograms/g) than those with mild-to-moderate deficiency (50-150 micrograms/g).
The authors of an accompanying commentary point out that moderate iodine deficiency
has reemerged in developed countries, such as the U.S., the U.K., and Australia. They call for action from U.K. public health
policy makers and advise that pregnant and breast-feeding women take prenatal vitamins containing iodine.
Lancet article
Glucocorticoids for COPD Exacerbations: 5 Days' Treatment Is
Enough
A 5-day course of glucocorticoids
is sufficient to treat acute exacerbations of COPD, according to a placebo-controlled noninferiority trial published in JAMA. Currently, most guidelines recommend 10 to 14 days' treatment.
Some 300 patients presenting to Swiss emergency departments with COPD exacerbations
were randomized to receive systemic glucocorticoids for 5 or 14 days. Patients also received antibiotics and other standard
COPD medications (additional glucocorticoids were given as needed throughout the study).
During 6 months' follow-up, re-exacerbation rates did not differ significantly between
the groups. Similarly, secondary outcomes such as death and need for mechanical ventilation did not differ. Patients in the
5-day group had less cumulative glucocorticoid exposure.
Editorialists write: "The clinical implications of this study are clear. Most patients with acute COPD exacerbations
can be treated with a 5-day course of prednisone or equivalent.… This is welcome news for patients ... who experience
multiple exacerbations annually and are exposed to repeated courses of systemic corticosteroids."
JAMA article
When Should CV Risk Be Remeasured
in People at Low or Intermediate Risk?
Few people whose baseline cardiovascular risk was very low or low became high risk after 8 years.
The Framingham
risk assessment tool employs age, sex, cholesterol levels, smoking status, and blood pressure to estimate 10-year risk for
an adverse cardiovascular (CV) event. According to NIH guidelines, the threshold LDL cholesterol level at which to
start lipid-lowering drug therapy depends on one's 10-year risk; nearly all people at high risk (i.e., those with 10-year
risk >20%) are candidates for drug therapy. To determine the probability of progressing to high risk for CV disease among
people at low and intermediate risk, investigators analyzed data from a total of 18,000 participants in two separate cohorts
(Tokyo and Framingham). At baseline, all participants (age range, 30–74) had CV risk <20%, and none were using agents
to lower blood pressure or lipid levels.
Participants
were stratified by CV risk (very low risk [<5%], low risk [5%–10%], intermediate risk [10%–15%], and high-intermediate
risk [15%–20%]). At baseline, most participants were at very low or low risk. In the Tokyo cohort, the probability of
crossing the 20% threshold at 3 years was <1% for those at very low or low risk, 6% for those at intermediate risk, and
16% for those at high-intermediate risk. In the Framingham cohort, the probability of crossing the high-risk threshold at
8 years was <1% for those at very low risk, 9% for those at low risk, 32% for those at intermediate risk, and 74% for those
at high-intermediate risk.
: Observational
study. BMJ 2013 Apr
3; 346:f1895. (http://dx.doi.org/10.1136/bmj.f1895)
Original article
Medline abstract
Calcium-Channel Blockers and Chronic Eczematous
Eruptions of the Aged
Findings confirm the association of CCBs with chronic eczematous eruptions of "unknown" cause
in patients 50 years and older.
Summers EM et al. JAMA Dermatol 2013 May
1;
DHA-enriched fish oil targets B cell lipid microdomains and enhances ex vivo and in vivo B cell function.
Gurzell EA, Teague H, Harris M, Clinthorne J, Shaikh SR, Fenton JI.
Source
Michigan State University,
East Lansing, MI 48824-1224, USA. imigjeni@msu.edu
Abstract
DHA is a n-3 LCPUFA in fish oil that generally suppresses T lymphocyte function. However, the effect
of fish oil on B cell function remains relatively understudied. Given the important role of B cells in gut immunity and increasing
human fish oil supplementation, we sought to determine whether DFO leads to enhanced B cell activation in the SMAD-/- colitis-prone
mouse model, similar to that observed with C57BL/6 mice. This study tested the hypothesis that DHA from fish oil is incorporated
into the B cell membrane to alter lipid microdomain clustering and enhance B cell function. Purified, splenic B cells from
DFO-fed mice displayed increased DHA levels and diminished GM1 microdomain clustering. DFO enhanced LPS-induced B cell secretion
of IL-6 and TNF-α and increased CD40 expression ex vivo compared with CON. Despite increased MHCII expression in the
unstimulated ex vivo B cells from DFO-fed mice, we observed no difference in ex vivo OVA-FITC uptake in B cells from DFO or
CON mice. In vivo, DFO increased lymphoid tissue B cell populations and surface markers of activation compared with CON. Finally,
we investigated whether these ex vivo and in vivo observations were consistent with systemic changes. Indeed, DFO-fed mice
had significantly higher plasma IL-5, IL-13, and IL-9 (Th2-biasing cytokines) and cecal IgA compared with CON. These results
support the hypothesis and an emerging concept that fish oil enhances B cell function in vivo.
http://www.ncbi.nlm.nih.gov/pubmed/23180828
Lutein + Zeaxanthin
and Omega-3 Fatty Acids for Age-Related Macular DegenerationThe Age-Related Eye Disease Study 2 (AREDS2)
Randomized Clinical Trial
The Age-Related Eye Disease Study 2 (AREDS2) Research Group*
JAMA. 2013;309(19):2005-2015.
doi:10.1001/jama.2013.4997.
Results
Median follow-up was 5 years, with 1940 study eyes (1608 participants) progressing to advanced AMD. Kaplan-Meier probabilities
of progression to advanced AMD by 5 years were 31% (493 eyes [406 participants]) for placebo, 29% (468 eyes [399 participants])
for lutein + zeaxanthin, 31% (507 eyes [416 participants]) for DHA + EPA, and 30% (472 eyes [387 participants])
for lutein + zeaxanthin and DHA + EPA. Comparison with placebo in the primary analyses demonstrated no
statistically significant reduction in progression to advanced AMD (hazard ratio [HR], 0.90 [98.7% CI, 0.76-1.07]; P = .12
for lutein + zeaxanthin; 0.97 [98.7% CI, 0.82-1.16]; P = .70
for DHA + EPA; 0.89 [98.7% CI, 0.75-1.06]; P = .10
for lutein + zeaxanthin and DHA + EPA). There was no apparent effect of beta carotene elimination or lower-dose
zinc on progression to advanced AMD. More lung cancers were noted in the beta carotene vs no beta carotene group (23 [2.0%]
vs 11 [0.9%], nominal P = .04), mostly in former smokers.
Conclusions
and Relevance Addition of
lutein + zeaxanthin, DHA + EPA, or both to the AREDS formulation in primary analyses did not further reduce
risk of progression to advanced AMD. However, because of potential increased incidence of lung cancer in former smokers, lutein + zeaxanthin
could be an appropriate carotenoid substitute in the AREDS formulation.
http://jama.jamanetwork.com/article.aspx?articleID=1684847&utm_source=Silverchair%20Information%20Systems&utm_medium=email&utm_campaign=MASTER%3AJAMALatestIssueTOCNotification05%2F14%2F2013
More magnesium may slash heart disease risk by 30%: Harvard meta-analysis
Vitamin D may ease exercise-related muscle damage: Animal data
Combating 'hidden hunger' with Vitamin Angels
High dose B vitamins help prevent Alzheimer’s, says researchers
Higher doses of vitamin C show promise as cancer treatment adjunct
Scientists
Discover Cinnamon Compounds' Potential Ability To Prevent Alzheimer's
http://mnt.to/l/4dJG
Alzheimer's Cause Found In Trigger Of Brain Protein Malfunction
http://mnt.to/l/4dGQ
Stress Can Encourage Good Habits Too
http://mnt.to/l/4dLX
Novel Medicine For The Treatment Of Chronic Wounds
http://mnt.to/l/4dDC
Your Feet Are Home To Nearly 200 Types Of Fungi
http://mnt.to/l/4dGz
Itch And Pain Have Separate Brain Circuits
http://mnt.to/l/4dHX
Avoiding Type 2 Diabetes With The Help Of Fish Oil Supplements
http://mnt.to/l/4dGW
Link Between Calcium Supplements And Longer Lifespans In Women
http://mnt.to/l/4dGV
Omega Oils Protect The Heart From Mental Stress
http://mnt.to/l/4dHP
Compound In Mediterranean Diet Makes Cancer Cells 'Mortal'
http://mnt.to/l/4dDZ
Statin Drugs May Increase Risk Of Diabetes
http://mnt.to/l/4dJY
Mediterranean Diet Seems To Boost Ageing Brain Power
http://mnt.to/l/4dCG
Skin Cancer Link To Lower Risk Of Alzheimer's Disease, Says Study
http://mnt.to/l/4dzj
Kava Successfully Treats Anxiety In World First Clinical Trial
http://mnt.to/l/4dvN
Study Suggests Cutaneous Squamous Cell Carcinoma Carries Risk Of Metastasis And Death
http://mnt.to/l/4dzf
Retirement Bad For Physical And Mental Health
http://mnt.to/l/4dyQ
Exercise Lowers Risk Of Lung And Colorectal Cancer Among Middle Aged Men
http://mnt.to/l/4dzs
Too Much Body Fat Makes Arteries Become Stiff After Middle Age
http://mnt.to/l/4dyt
Detrimental Effects In The Brain Of High-Fat Diets May Be Stalled By Fish Oil
http://mnt.to/l/4dwH
Aging Brains May Benefit More From Mediterranean Than Low Fat Diet
http://mnt.to/l/4dCT
High Fiber Diets Linked To Increased Risk Of E.coli
http://mnt.to/l/4dCP
Key To Muscle Fitness Revealed By Differences Between 'Marathon Mice' And 'Couch Potato Mice' Reveal
http://mnt.to/l/4drw
Physical Activity Reduces Breast Cancer Risk
http://mnt.to/l/4dr5
Novel Hormone Released From Fat Cells Could Impact Type 2 Diabetes Treatments
http://mnt.to/l/4dpX
Risk Of Insulin Resistance In Children Increased By Air Pollution
http://mnt.to/l/4dsP
Sun Exposure Could Benefit Health And Prolong Life
http://mnt.to/l/4dqq
Sun Exposure Benefits May Outweigh Risks Say Scientists
http://mnt.to/l/4dqb
In Spinal Stenosis, Spinal 'Spacer' Procedure Has Fewer Complications, But Higher Risk Of Repeat Surgery
http://mnt.to/l/4dqg
Walnuts And Walnut Oil Benefit Heart Health Beyond Lowering Cholesterol
http://mnt.to/l/4dr2
Soy And Tomato Combination May Help Prevent Prostate Cancer
http://mnt.to/l/4ds3
Clue To Explain The Reversible Memory Loss Sometimes Caused By The Use Of Statins
http://mnt.to/l/4dtL
Memory Problems In Some Older Adults May Be Related To Anticholinergic Use
http://mnt.to/l/4dqm
Magnesium Intake, Absorption Significantly Associated With Bone Density In Children
http://mnt.to/l/4dmy
Dogs Can Detect Breast And Lung Cancer Cells In Vitro
http://mnt.to/l/4dgC
Bad Cholesterol Lowered In Men On Heart-Healthy Diet, Regardless Of Weight Loss
http://mnt.to/l/4dhf
Low HDL-Cholesterol - Not Quantity, But Quality
http://mnt.to/l/4dfp
Saxagliptin/Metformin Combination: Added Benefit Is Not Proven
http://mnt.to/l/4ddy
Cure For Gray Hair And Vitiligo Found
http://mnt.to/l/4dkX
Having A Poor Relationship With A Spouse Can Increase Risk Of Depression
http://mnt.to/l/4dgm
Recognizing 5 Sudden Symptoms Of Stroke Could Save A Life
http://mnt.to/l/4dkP
Green Tea Extract With Additional Compound Could Be Effective For Body Weight Control And Type 2 Diabetes
http://mnt.to/l/4ddv
Dabigatran Etexilate (Pradaxa) And Intracranial Hemorrhage
http://mnt.to/l/4dhd
Unlocking Brain Function With The Help Of Mathematics
http://mnt.to/l/4dm5
Does Cracking Knuckles Or Joints Cause Arthritis?
http://mnt.to/l/4d83
New Astrocytes Play Unexpected Role In Healing After Brain Injury
http://mnt.to/l/4d8d
Mango's Potential Health-Affirming Properties Explored
http://mnt.to/l/4d7p
Mangos Help Regulate Blood Sugar Levels Among Obese People
http://mnt.to/l/4dc6
Vitamin D Supplements Or Mushroom Powder? You Choose
http://mnt.to/l/4d5N
Berries Help Brain To Clear Toxic Accumulation
http://mnt.to/l/4d5J
Mushrooms Substituted For Meat In Meals Aid Weight Loss
http://mnt.to/l/4d6g
Tree Nuts And Health
http://mnt.to/l/4d6f
The Benefits Of Eggs, Even For Those At Cardiovascular Risk
http://mnt.to/l/4d7g
Examining Caffeine's Effect On Cognitive Tasks, Food Pairing
http://mnt.to/l/4d6n
