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HHAL
MEICAL NEWS DECEMBER08
Vigorous exercise reduces risk Conclusions—In this cohort of men, elevated BMI, even in the preobese range, was
associated with an increased risk of HF, and vigorous physical activity was associated with a decreased risk. Public
health measures to curtail excess weight, to maintain optimal weight, and to promote physical activity
may limit the scourge of HF. Abstract
Full Text (subscription or payment may be required) http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=573054 But omega 3 fats do not reduce incidence of arrhythmias or sudden cardiac death Fish oil supplementation is
associated with a reduction in deaths from cardiac causes, but does not have an impact on arrhythmias or sudden cardiac death,
according to a report published online Dec. 23 in BMJ. Hernando Leon, M.D., Ph.D., of the Epidemiology Coordinating and
Research Centre in Edmonton, Alberta, Canada, and colleagues conducted a review of 12 studies covering 32,779 patients to
assess the effects of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) from fish oil on arrhythmias and mortality.
They looked at arrhythmic end points of appropriate implantable cardiac defibrillator intervention and sudden cardiac death
as the primary outcomes. Three studies comprising 1,148 patients came up with a neutral impact from fish oil on cardiac defibrillator
intervention and six studies comprising 31,111 patients concluded that fish oil had a neutral effect on sudden cardiac death,
the researchers report. None of the studies pointed to a significant impact from fish oil on the primary endpoints, the review
showed, although there was a significant reduction in deaths from cardiac causes. "The effect of fish oil on arrhythmic
events remains inconclusive," the authors write. "Ongoing trials…and future studies might help to clarify
whether the reduction in deaths from cardiac causes results from a reduction of arrhythmias or from a delay in the progression
of coronary artery disease. Abstract
Full Text
Editorial http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=573167
Short
Sleep Duration and Incident Coronary Artery Calcification
Longer
Sleep Duration Linked to Lower Risk for Coronary Artery Calcification Middle-aged adults
who get more sleep each night may face lower risk for coronary artery calcification, according to an observational
study in JAMA. Some 500 adults aged 35 to 47 without calcification were
followed for 5 years. During that time, sleep data were collected in two separate years, for six nights total, with use of
wrist-activity monitors. Calcification developed in 12% of the participants during follow-up. After
adjustment for confounders such as age, smoking, and other cardiovascular risk factors, the
odds of calcification were 34% lower with each additional hour of sleep per night — an effect equivalent to that of
a 16.5-mm Hg drop in systolic blood pressure, the authors note. They conclude that whether
the association between sleep duration and coronary artery calcification translates into a reduction in coronary disease events
remains to be determined. Results Five-year calcification incidence was 12.3% (n = 61). Longer measured
sleep duration was significantly associated with reduced calcification incidence (adjusted odds ratio, 0.67
per hour [95% confidence interval, 0.49-0.91 per hour]; P = .01). No potential mediators
appreciably altered the magnitude or significance of sleep (adjusted odds ratio estimates ranged from
0.64 to 0.68 per sleep hour; maximum P = .02). Alternative sleep metrics were not significantly
associated with calcification. Conclusion Longer measured sleep is associated with lower calcification incidence
independent of examined potential mediators and confounders. http://jama.ama-assn.org/cgi/content/full/300/24/2859 High-dose vitamin D prevents fractures in some older people
Clinical
question
Does vitamin D supplementation decrease
falls or hip fractures in elderly patients?
Bottom line
This analysis showed
that high doses of vitamin D -- 700 IU to 800 IU per day -- with calcium supplementation are
needed to produce a benefit on important fractures in elderly people living in an institution. The effect was not seen in
older people living in the community. (LOE = 1a)
Reference
Cranney A, Horsley
T, O'Donnell S, et al. Effectiveness and Safety of Vitamin D in Relation
to Bone Health. Evidence Report/Technology Assessment No. 158 (Prepared
by the University of Ottawa Evidence-based Practice Center (UO-EPC) under
Contract No. 290-02-0021. AHRQ Publication No. 07-E013. Rockville, MD: Agency for Healthcare Research and Quality. August
2007. [Link to free full-text AHRQ evidence report online]
Study design: Meta-analysis (randomized controlled trials)
Setting: Various
(meta-analysis)
Synopsis
Several meta-analyses have come to different conclusions regarding the effectiveness
of vitamin D and calcium supplementation on important fractures in older people. This evidence report was compiled by the
University of Ottawa Evidence-based Practice Center. To conduct their review they searched 6 databases, including the Cochrane
Center Register of Controlled Trials, with 2 reviewers independently screening the literature and 2 researchers independently
abstracting the data. The researchers graded the evidence but did not limit their analysis to high-quality studies. Vitamin D3 in doses of
400 IU to 800 IU per day without calcium supplementation did not reduce the risk of fractures. Higher doses -- 700 IU to 800
IU per day -- combined with calcium supplementation reduced both nonvertebral fractures and hip fractures. However, the researchers
found via subgroup analysis that the effect on hip fractures is limited to older people living in institutions and is not
seen in community-dwelling elderly. Vitamin D supplementation also has a small and inconsistent effect on the prevention of
falls, reducing the likelihood by approximately 20% (odds ratio = 0.79; 95% CI, 0.65 - 0.96).
Another recent meta-analysis found a similar decrease (Tang BM, et al. Lancet 2007;370:657-66). Inflammatory,
Lipid, Thrombotic, and Genetic Markers of Coronary Heart Disease Risk in the Women's Health Initiative Trials of Hormone
Therapy Jacques
E. Rossouw, MD; Mary Cushman, MD, MSc; Philip Greenland, MD; Donald M. Lloyd-Jones, MD; Paul Bray, MD; Charles Kooperberg,
PhD; Mary Pettinger, MS; Jennifer Robinson, MD; Susan Hendrix, DO; Judith Hsia, MD Arch Intern Med. 2008;168(20):2245-2253.
Background
Clinical trials of postmenopausal hormone therapy (HT) have shown increased risk of coronary heart disease (CHD)
in the first few years after initiation of therapy and no overall benefit. Methods This nested case-control
study evaluates a range of inflammatory, lipid, thrombotic, and genetic markers for their association
with CHD in the 4 years after randomization and assesses whether any of these markers modified or mediated
the initially increased risk associated with HT in postmenopausal women aged 50 to 79 years at baseline.
Conjugated equine estrogens, 0.625 mg/d, or placebo was given to 10 739 hysterectomized women,
and the same estrogen plus medroxyprogesterone acetate, 2.5 mg/d, was given to 16 608 women with an intact
uterus. Results In multivariate-adjusted analyses of 359 cases and 820 controls in the combined trials,
baseline levels of 12 of the 23 biomarkers studied were associated with CHD events: interleukin 6, matrix
metalloproteinase 9, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol,
triglycerides, D-dimer, factor VIII, von Willebrand factor, leukocyte count, homocysteine, and fasting insulin.
Biomarkers tended to be more strongly associated with CHD in the initial 2 years after randomization.
The genetic polymorphism glycoprotein IIIa leu33pro was significantly associated with CHD. Baseline low-density
lipoprotein cholesterol interacted significantly with HT so that women with higher levels were at higher risk
for CHD when given HT (P = .03 for interaction). The levels of several biomarkers were
changed by HT, but these changes did not seem to be associated with future CHD events. Conclusions Several thrombotic, inflammatory, and lipid biomarkers were associated
with CHD events in postmenopausal women, but only low-density lipoprotein cholesterol modified the effect
of HT. Further research is needed to identify the mechanisms by which HT increases the risk of CHD. Arch Intern Med.
2008; 168:2245-2253. ABSTRACT | FULL TEXT | PDF Rapid Kidney Function Decline
and Mortality Risk in Older Adults Dena E. Rifkin, MD; Michael G. Shlipak, MD, MPH; Ronit Katz, DPhil; Linda F. Fried, MD, MPH; David
Siscovick, MD, MPH; Michel Chonchol, MD; Anne B. Newman, MD; Mark J. Sarnak, MD, MS Arch Intern Med. 2008;168(20):2212-2218.
Background
Impaired kidney function is associated with increased mortality risk in older adults. It remains unknown,
however, whether longitudinal declines in kidney function are independently associated with increased cardiovascular
and all-cause mortality in older adults. Methods The Cardiovascular Health Study evaluated a cohort
of community-dwelling older adults enrolled from 1989 to 1993 in 4 US communities with follow-up through
2005. Among 4380 participants, the slope of annual decline in estimated glomerular filtration rate (eGFR)
was estimated using both serum creatinine (eGFRcreat) and cystatin C (eGFRcys) rates, which
were measured at baseline, year 3, and year 7 of follow-up. Rapid decline in eGFR was defined as a loss
greater than 3 mL/min/1.73 m2 per year, and cardiovascular and all-cause mortality were assessed over
a mean of 9.9 years of follow-up. Results Mean (SD) levels of creatinine and cystatin C were 0.93 (0.30)
mg/dL and 1.03 (0.25) mg/L, respectively; mean (SD) eGFRcreat and eGFRcys were 79 (23) mL/min/1.73
m2 and 79 (19) mL/min/1.73 m2, respectively. Individuals with rapid decline measured
by eGFRcreat (n = 714; 16%) had increased risk of cardiovascular (adjusted hazard ratio [AHR],
1.70; 95% confidence interval [CI], 1.40-2.06) and all-cause (AHR, 1.73; 95% CI, 1.54-1.94) mortality.
Individuals with rapid decline measured by eGFRcys (n = 1083; 25%) also had increased
risk of cardiovascular (AHR, 1.53; 95% CI, 1.29-1.80) and all-cause (AHR, 1.53; 95% CI, 1.38-1.69) mortality.
The association of rapid decline in eGFR with elevated mortality risk did not differ across subgroups
based on baseline kidney function, age, sex, race, or prevalent coronary heart disease. Conclusion
Rapid decline in eGFR is associated with an increased risk of cardiovascular and all-cause mortality in older
adults, independent of baseline eGFR and other demographic variables. ABSTRACT | FULL TEXT | PDF
Randomized
Controlled Trial of Calcium Supplementation in Healthy, Nonosteoporotic, Older Men
Ian R. Reid, MD; Ruth Ames, NZCS; Barbara Mason, BSc;
Helen E. Reid, BSc; Catherine J. Bacon, MSc; Mark J. Bolland, MBChB; Gregory D. Gamble, MSc; Andrew Grey, MD; Anne Horne,
MBChB Arch
Intern Med. 2008;168(20):2276-2282. Background There is no consistent evidence, to our knowledge,
that calcium supplementation affects bone mineral density (BMD) in men, despite male osteoporosis being a
common clinical problem. Methods To determine the effects of calcium supplementation (600 mg/d,
1200 mg/d, or placebo) on BMD in men, we conducted a double-blind, randomized controlled trial for a 2-year period
at an academic clinical research center. A total of 323 healthy men at least 40 years old (mean age, 57 years)
were recruited by newspaper advertisement. Complete follow-up was achieved in 96% of subjects.
Results The BMD increased at all sites in the group receiving calcium, 1200 mg/d, by 1% to 1.5% more
than those receiving placebo. The results for the group receiving calcium, 600 mg/d, were not different
from the placebo group at any BMD site. There was no interaction between the BMD treatment effect and either
age or dietary calcium intake. There were dosage-related, sustained decreases in serum parathyroid hormone
(P < .001), total alkaline phosphatase activity (P = .01), and procollagen
type 1 N-terminal propeptide (P < .001) amounting to 25%, 8%, and 20%, respectively, in the
group receiving calcium, 1200 mg/d, at 2 years. Tooth loss, constipation, and cramps were unaffected
by calcium supplementation, falls tended to be less frequent in the group receiving calcium, 1200 mg/d, but
vascular events tended to be more common in the groups receiving calcium vs the group receiving placebo. Conclusion
Calcium, 1200 mg/d, has effects on BMD in men comparable with those found in postmenopausal women but a dosage
of 600 mg/d is ineffective for treating BMD. Arch
Intern Med. 2008; 168:2276-2282. ABSTRACT | FULL TEXT | PDF Perioperative β-Blockers: The POISE TrialIn this very large study, patients who
underwent noncardiac surgery didn’t benefit from newly initiated β-blocker therapy. http://general-medicine.jwatch.org/cgi/content/full/2008/1229/5?q=etoc_jwgenmed
Preventing Adverse Cardiovascular Events in Patients with Type 2 DiabetesIn younger patients with
newly diagnosed diabetes, intensive glucose-lowering therapy appears to prevent macrovascular events; in patients with established
diabetes, the jury is still out. http://general-medicine.jwatch.org/cgi/content/full/2008/1229/11?q=etoc_jwgenmed Prevention of Recurrent Ischemic
StrokeCost and side effects, not effectiveness, might be the discriminators between aspirin
plus dipyridamole and clopidogrel. editorialists concluded that aspirin plus dipyridamole
might be minimally superior to clopidogrel alone (although not significantly so), whereas clopidogrel might be minimally superior
to aspirin alone (again, not significantly). As such, cost and side-effect profiles probably should factor into physicians’
choices among these treatments for individual http://general-medicine.jwatch.org/cgi/content/full/2008/1229/10?q=etoc_jwgenmed REM Sleep Behavior Disorder May Portend Parkinson Disease Patients may be
asking about a Neurology study showing that REM sleep behavior disorder may increase
a patient's odds of developing Parkinson disease or dementia. Researchers
followed nearly 100 patients with REM sleep behavior disorder — characterized by excessive motion, such as punching,
crying out, or kicking, during REM sleep — for a mean of 5 years. They calculated that
the 5-year risk for developing parkinsonism or dementia was 18%, while the 12-year risk was
52%. The authors note that prior studies indicate this association may be related to the
degeneration of sleep-regulating nuclei in the brainstem. http://www.neurology.org/cgi/content/abstract/01.wnl.0000340980.19702.6ev1 Relations of Thyroid Function to Body Weight Cross-sectional
and Longitudinal Observations in a Community-Based Sample Caroline S. Fox, MD, MPH; Michael J. Pencina,
PhD; Ralph B. D’Agostino, PhD; Joanne M. Murabito, MD; Ellen W. Seely, MD; Elizabeth N. Pearce, MD; Ramachandran S.
Vasan, MD Arch
Intern Med. 2008;168(6):587-592. Background Overt hypothyroidism and hyperthyroidism may
be associated with weight gain and loss. We assessed whether variations in thyroid function within the reference
(physiologic) range are associated with body weight. Methods Framingham Offspring Study participants
(n = 2407) who attended 2 consecutive routine examinations, were not receiving thyroid hormone
therapy, and had baseline serum thyrotropin (TSH) concentrations of 0.5 to 5.0 mIU/L and follow-up concentrations
of 0.5 to 10.0 mIU/L were included in this study. Baseline TSH concentrations were related to body weight
and body weight change during 3.5 years of follow-up. Results At baseline, adjusted mean weight increased
progressively from 64.5 to 70.2 kg in the lowest to highest TSH concentration quartiles in women (P < .001
for trend), and from 82.8 (lowest quartile) to 85.6 kg (highest quartile) in men (P = .007
for trend). During 3.5 years of follow-up, mean (SD) body weight increased by 1.5 (5.6) kg in women and 1.0
(5.0) kg in men. Baseline TSH concentrations were not associated with weight change during follow-up. However,
an increase in TSH concentration at follow-up was positively associated with weight gain in women (0.5-2.3
kg across increasing quartiles of TSH concentration change; P < .001 for trend) and
men (0.4-1.3 kg across quartiles of TSH concentration change; P = .007 for trend). Conclusions
Thyroid function (as assessed by serum TSH concentration) within the reference range is associated with body
weight in both sexes. Our findings raise the possibility that modest increases in serum TSH concentrations within
the reference range may be associated with weight gain. FREE Abstract Full Text PDF
Triiodothyronine
can restore normal coronary vascular density after injury Thyroid hormone receptors (TRs) are important for coronary angiogenesis, and normal vascular density can be restored
after injury by chronic triiodothyronine (T3) treatment, according to a study published online Dec. 12 in Endocrinology. Ayako Makino, and colleagues
from the University of California San Diego in La Jolla investigated the role of TRs on coronary microvascular formation in
mice with cardiac hypertrophy due to pressure overload induced by ascending aortic constriction. The researchers found that the
myocardium from the left ventricle of hypertrophied hearts had significantly lower capillary density, which was restored by
chronic treatment with T3. Endothelial cells isolated from these hearts had lower expression of TRβ, which was restored
by chronic T3 treatment. Mice lacking TRβ had significantly lower capillary density in their left ventricles, and endothelial
cells from these mice were unable to form capillary networks, the report indicates. "These data suggest that TRβ in the
coronary endothelial cells regulates capillary density during cardiac development, and downregulation of TRβ results
in coronary microvascular rarefaction during pathological hypertrophy," Makino and colleagues conclude. Abstract
Full Text (subscription or payment may be required) http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=572515 Cardioprotection from Moderate
Drinking Is Limited to People with Unhealthful BehaviorsNonsmokers who ate healthful diets and exercised
didn’t benefit from alcohol. In observational studies, researchers have found an association between moderate drinking
and lower risk for myocardial infarction, but less is known about whether this benefit is limited to select groups. Researchers
in London prospectively followed 9655 middle-aged adult civil servants (mean age, 44; none with known MI at enrollment) for
a median of 17 years. Subjects were characterized according to number of unhealthful behaviors (smoking, lack of exercise,
poor diet). Among people who reported regular physical activity, daily fruit and vegetable consumption, and no smoking, alcohol
use had no effect on incidence of fatal coronary heart disease or nonfatal MI in analyses that were adjusted for age, sex,
and socioeconomic status. Among participants with two or three unhealthful behaviors, moderate alcohol intake (8–112
g, or about 1–9 standard U.S. drinks weekly) was associated with half the risk for CHD; in addition, adjusting for diabetes,
angina, hypertension, and cardiovascular medication use yielded similar results. Comment: Even if moderate drinking lowers risk
for CHD (a hypothesis that has not been confirmed yet in clinical trials), alcohol ingestion appears to have no such benefit
for people who exercise, eat fruits and vegetables, and do not smoke. The authors cite one large cohort study, done in the
U.S., with similar results. Therefore, they recommend that this typically overlooked variability in the effect of moderate
drinking be emphasized in public health messages and advice about alcohol use. Such a message — which would acknowledge
potential benefits among people with certain unhealthful behaviors — also would emphasize lack of benefit in others
and the importance of healthful behaviors. The message is complicated further by the lack of controlled trials, by research
that suggests benefits accrue mainly to those with genetic predispositions to alcoholism, and by harms associated with moderate
drinking (e.g., excess risk for certain cancers). http://general-medicine.jwatch.org/cgi/content/full/2008/1218/1?q=topic_lipid May be important in protecting against emphysema, chronic obstructive pulmonary disease These
results suggest that targeting the Nrf2 pathway during the etiopathogenesis of emphysema may represent an important approach
for prophylaxis against COPD. Abstract
Full Text (subscription or payment may be required) http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=573053 Vitamin D and Actinic KeratosesIndividual susceptibility
to development of actinic keratoses is influenced, in part, by polymorphisms in the gene that encodes for the vitamin D receptor.
The active form of vitamin D — 1,25-dihydroxyvitamin D — inhibits the growth of many kinds of tumors by
binding to the vitamin D receptor and influencing gene transcription. The gene for the vitamin D receptor, VDR, has
polymorphisms that can encourage or discourage transcriptional activity when the receptor is occupied, thereby augmenting
or decreasing vitamin D’s inhibitory effects on tumor growth. Because actinic keratoses (AKs) are tumors, and because
vitamin D plays a role in prevention of skin cancer, polymorphisms of VDR may influence individual susceptibility
to developing AKs. In an Australian skin cancer study, researchers genotyped the VDR polymorphisms ApaI, TaqI, and FokI in
380 people, 190 of whom had one or more AKs at the time of examination. Subjects with and without AKs were matched for age,
sex, and ethnicity. The researchers found a significant difference in AK prevalence in individuals with the TaqI polymorphism
(P=0.008). In both the ApaI and TaqI polymorphisms, genotypic differences were significantly associated with the
prevalence of AKs and the propensity to sunburn. Specifically, heterozygous genotypes, in conjunction with skin color and
ability to tan, appeared to confer protection from AKs. Comment: Ultraviolet radiation causes
skin cancer, but it also causes production of vitamin D, which inhibits tumor development. Now, we find that the situation
is additionally complicated by polymorphisms of the vitamin D receptor gene. The authors of a recent meta-analysis of six
studies concluded that various polymorphisms of VDR were associated with increased risk for melanoma. http://dermatology.jwatch.org/cgi/content/full/2008/1024/1 This Season's Flu Virus Largely Resistant to Tamiflu, Early Tests Show Tests
performed on this season's most common influenza virus (H1N1) indicate that it's largely
resistant to oseltamivir (Tamiflu), according to data released Friday by the CDC. Of
50 H1N1 isolates tested, 49 showed resistance to the drug. However, the CDC says it's too early in the season to conclude
how prevalent resistant viruses are. The agency points out that the number of specimens tested is limited, with most coming
from just two states (Hawaii and Texas, according to the Associated Press). So far, the virus
is well-matched to strains included in this year's vaccine, the CDC notes. Still, CDC director
Julie Gerberding says that if H1N1 proves to be the dominant strain, providers may need to
change how they treat patients, the AP reports. She notes that combining oseltamivir with the antiviral rimantadine may be
one option. (All 50 isolates were sensitive to zanamivir [Relenza], but as the AP notes, that drug
is not approved for certain groups, including children under age 7.) CDC's weekly flu report (Free) Associated Press story (Free) Hypertensive patients had lower cognitive scores when their blood pressure was
higher than usual http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=572623 More than three-quarters of children and adolescents have either insufficient or deficient
levels http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=572510 Prevalence of Hypovitaminosis D in Cardiovascular Diseases (from the
National Health and Nutrition Examination Survey 2001 to 2004)This cross-sectional study examined the burden
of cardiovascular diseases (CVDs) using serum 25-hydroxyvitamin D (25[OH]D) and prevalence of hypovitaminosis D in adults
with CVDs using data from NHANES 2001 to 2004. Serum 25(OH)D levels were divided into 3 categories (≥30, 20 to 29, and
<20 ng/ml), and hypovitaminosis D was defined as vitamin D <30 ng/ml. Of 8,351 adults who had 25(OH)D measured, mean
25(OH)D was 24.3 ng/ml, and the prevalence of hypovitaminosis D was 74%. The burden of CVDs increased with lower 25(OH)D categories,
with 5.3%, 6.7%, and 7.3% coronary heart disease; 1.5%, 2.4%, and 3.2% heart failure; 2.5%, 2.0%, and 3.2% stroke; and 3.6%,
5.0%, and 7.7% peripheral arterial disease. Across all CVDs, hypovitaminosis D was more common in blacks than Hispanics or
whites. Compared with persons at low risk for CVDs (68%), it was more prevalent in those at high risk (75%; odds ratio [OR]
1.32, 95% confidence interval [CI] 1.05 to 1.67), with coronary heart disease (77%; OR 1.48, 95% CI 1.14 to 1.91), and both
coronary heart disease and heart failure (89%; OR 3.52, 95% CI 1.58 to 7.84) after controlling for age, race, and gender.
In conclusion, hypovitaminosis D was highly prevalent in US adults with CVDs, particularly those with both coronary heart
disease and heart failure. Exercise, calcium may lower metabolic syndrome riskLow-Glycemic-Index Diet Improves Glycemic
Control, HDL in Type 2 Diabetes Patients with stable type 2 diabetes can improve their glycemic control and HDL level with a low-glycemic-index
diet, according to a study published in JAMA. Roughly
200 patients taking antihyperglycemic drugs underwent randomization to either a low-glycemic-index diet or a high-cereal-fiber
diet for 6 months. (The low-glycemic-index diet emphasized foods like pumpernickel bread, bulgur-and-flax breakfast
cereal, and peas, lentils, and nuts; the high-cereal-fiber diet emphasized whole-grain breads and breakfast
cereals, brown rice, and avoidance of starchy foods.) By
the 6-month mark, hemoglobin A1c levels decreased and HDL levels rose, both significantly,
in patients on the low-glycemic-index diet. The authors say the low-glycemic-index diet may add further
glycemic control in patients on antihyperglycemic drugs. JAMA article (Free) Signs of cognitive decline appear up to 12 years before onset of dementia http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=571733 The effect of glucosamine and/or chondroitin sulfate on the progression of knee osteoarthritis: a report
from the glucosamine/chondroitin arthritis intervention trial.
. CONCLUSION: At 2 years, no treatment achieved a predefined threshold of
clinically important difference in JSW loss as compared with placebo. However, knees with K/L grade 2 radiographic OA appeared
to have the greatest potential for modification by these treatments. http://www.ncbi.nlm.nih.gov/pubmed/18821708?dopt=Abstract Resveratrol protects intervertebral disc cartilage http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=570931 Vitamins
E and C in the Prevention of Prostate and Total Cancer in Men The Physicians' Health Study II Randomized
Controlled Trial Conclusions In this
large, long-term trial of male physicians, neither vitamin E nor C supplementation reduced the risk of prostate
or total cancer. These data provide no support for the use of these supplements for the prevention of cancer in
middle-aged and older men. http://jama.ama-assn.org/cgi/content/full/2008.862 Enriching the diet with nuts has even better results Results At baseline, 61.4%
of participants met criteria for the MetS. One-year prevalence was reduced by 6.7%, 13.7%, and 2.0%
in the MedDiet + VOO, MedDiet + nuts, and control diet groups, respectively (MedDiet + nuts vs control groups,
P = .01; MedDiet + VOO vs control group, P = .18).
Incident rates of the MetS were not significantly different among groups (22.9%, 17.9%, and 23.4%, respectively).
After adjustment for sex, age, baseline obesity status, and weight changes, the odds ratios for reversion of
MetS were 1.3 (95% confidence interval, 0.8-2.1) for the MedDiet + VOO group and 1.7 (1.1-2.6)
for the MedDiet + nuts group compared with the control diet group. Conclusion A traditional
MedDiet enriched with nuts could be a useful tool in the management of the MetS. Abstract
Full Text (subscription or payment may be required) Neither fenofibrate
nor ezetimibe show benefit in reduced carotid artery intima-media thickness Conclusions:
Reducing LDL-C to aggressive targets resulted in similar regression of CIMT in patients who attained equivalent
LDL-C reductions from a statin alone or statin plus ezetimibe. Common carotid artery IMT increased in those achieving
standard targets. (Stop Atherosclerosis in Native Diabetics Study [SANDS]; NCT00047424 [ClinicalTrials.gov http://content.onlinejacc.org/cgi/content/abstract/j.jacc.2008.10.031v1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Ezetimibe&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT Abstract - Fleg
Full Text
Abstract - Hiukka
Full Text
Editorial
Treatment with β blockers in the first 24 hours after a heart attack reduces in-hospital death in patients with
sustained ventricular arrhythmias, according to the results of a study
Treatment with β blockers in the first 24 hours after a heart attack reduces in-hospital death in patients with
sustained ventricular arrhythmias, according to the results of a study
Treatment with β blockers in the first 24 hours after a heart attack reduces in-hospital death
in patients with sustained ventricular arrhythmias, according to the results of a study Abstract
Full Text (subscription or payment may be required) http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=569837
Older people with depression may be at increased risk of developing abdominal obesity, Abstract
Full Text (subscription or payment may be required) In Hypertension, ACE
Inhibitor Plus Calcium Channel Blocker Is Superior to ACE Inhibitor Plus Diuretic Pairing
an ACE inhibitor with a calcium channel blocker, rather than a diuretic, may offer greater cardiovascular benefit to hypertensive
patients, reports the New England Journal of Medicine. In
the industry-funded ACCOMPLISH trial, some 11,500 hypertensive adults at high risk for cardiovascular events were randomized
to receive the ACE inhibitor benazepril plus either the calcium channel blocker amlodipine or the diuretic hydrochlorothiazide. The
trial was stopped early, after 3 years' follow-up, because of superior outcomes with benazepril-amlodipine. Namely, the
incidence of the primary endpoint — a composite of cardiovascular events and cardiovascular death — was 9.6% with
benazepril-amlodipine and 11.8% with benazepril-hydrochlorothiazide. (Blood pressure reductions
were similar in the two groups.) An editorialist says "it is time to reexamine"
the "strong preference" for thiazide diuretics as initial therapy for hypertension. He calls for "greater flexibility"
in drug choice, noting that it should be driven by "compelling indications or contraindications, coexisting conditions,
adverse effects, race, and the clinician's experience." NEJM article (Free abstract; full text requires subscription) NEJM editorial (Subscription required)
Vitamin K Protective Against Insulin Resistance in Men Daily supplementation with phylloquinone (vitamin K) over three years protects against insulin resistance in older
men, but not women Abstract
Full Text http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=568903 Intensive Glucose Lowering Does Not Cut CV Risks
in Patients with Long-Standing Type 2 DiabetesResults of a VA trial add to evidence produced by the ACCORD and ADVANCE trials.
In
the recent ACCORD and ADVANCE trials, intensive glucose-lowering therapy did not lower risks for cardiovascular (CV) death,
nonfatal myocardial infarction, or nonfatal stroke in people with type 2 diabetes and end-organ complications or CV risk factors
(JW Jun 6 2008). The results of a similar trial, the Veterans Affairs Diabetes Trial (VADT),
are now available. Investigators randomized 1791 veterans (mean age, 60) with long-standing type 2 diabetes (mean duration, 11.5 years)
to receive intensive glucose-lowering therapy or standard therapy. Other CV risk factors were treated uniformly in both groups.
After a median follow-up of 5.6 years, the median glycosylated hemoglobin (HbA1c) level was significantly lower
in the intensive-therapy group than in the standard-treatment group (6.9% vs. 8.4%). However, no between-group differences
were noted for death from any cause, CV death, or time from randomization to first major CV event. Furthermore, researchers
found no differences in microvascular events (e.g., retinopathy, nephropathy, neuropathy). However, hypoglycemic episodes
were significantly more common in the intensive-therapy group. Comment: Intensive glucose-lowering therapy does not lower risks for major
CV events or death in patients with long-standing type 2 diabetes. In response to the results of the ACCORD, ADVANCE, and
VADT trials, the American Diabetes Association, the American College of Cardiology Foundation, and the American Heart Association
issued a joint position statement suggesting that less-stringent glycemic control is appropriate for patients with histories
of severe hypoglycemic events, long-standing diabetes, or advanced microvascular and macrovascular complications. However,
clinicians should continue to follow guidelines for healthy-lifestyle behaviors, smoking cessation, blood pressure control,
and lipid lowering in these patients (J Am Coll Cardiol 2008; 52). Notably, the results of ACCORD, ADVANCE, and VADT might not apply to patients
with newly diagnosed type 2 diabetes; evidence suggests such patients benefit from intensive glucose-lowering therapy
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