HHAL
MEDICAL NEWS MAY2009
Statin Use Linked to Reduced Risk for Prostate Cancer
Men who use statins
may be at lower risk for prostate cancer,
according to an industry-supported study presented Sunday at the annual meeting of the American Urological Association.
Researchers in Minnesota enrolled some 2400 men between the ages of 40 and 79 and without histories of prostate cancer; about
one fourth were using statins at baseline.
During 14
years' follow-up, prostate cancer was diagnosed in 5% of statin users — corresponding to a 60% risk reduction compared
with those not using the drugs. Statin users were also less likely to have elevated prostate-specific antigen levels or to
undergo prostate biopsy.
The researchers "cautioned that [the results] are from an observational study and not robust enough to recommend
statin therapy to aid in prevention of prostate cancer," the Wall
Street
http://online.wsj.com/article/SB124071529612156433.html#printMode
Markers of Risk for Death from Prostate Cancer
Two markers of cell cycle regulation and microvessel density were associated with mortality.
For patients with prostate
cancer, particularly those identified by screening, a major question is whether the cancer will cause morbidity or
death. Researchers studied Veterans Affairs medical records and immunohistochemical tissue analyses for 1172 men with incident
prostate cancer (89% localized). Half the men had prostate-specific antigen levels 10 µg/L. During a follow-up of 11 to 16 years, 842 deaths occurred; 22%
of them were attributable to prostate cancer.
In analyses adjusted for age, comorbidity, tumor stage, Gleason score, and prostate-specific antigen level,
two molecular markers of cell cycle regulation measured in
prostate tumors were significantly associated with prostate cancer mortality: bcl-2, an apoptosis-related
molecule (hazard ratio, 1.6) and p53, a tumor-suppressor oncogene (HR, 1.5). Microvessel
density was also significantly associated with prostate cancer mortality (HR for the highest
vs. lowest quartile, 3.0).
http://www.ncbi.nlm.nih.gov/pubmed/19414838?dopt=Abstract
Vitamin D and Health
Do we have enough? How do we get more? What systems are affected?
http://dermatology.jwatch.org/cgi/content/full/2009/522/1?q=topic_nutrition
Vitamin D Levels in Elders
Most older people had low serum levels, and at least 25% of elders had frank vitamin D deficiency.
Two studies in the Journal
of Clinical Endocrinology and Metabolism focus on vitamin D in older
populations.
Researchers measured serum 25-hydroxyvitamin D (25[OH]D) in 6000
community-dwelling men (age range, 65–99) who lived in various U.S. regions. Average serum 25(OH)D level was 25 ng/mL; one quarter of subjects had levels lower than 20
ng/mL. In multivariable analysis, lower 25(OH)D levels were associated with older age, obesity, black or Latino ethnicity,
blood sampling in winter, and residence at a northern latitude (e.g., Minneapolis, compared with San Diego). Use of vitamin
D supplements and engaging in outdoor activities were associated with higher vitamin D levels.
Dutch researchers examined relations between vitamin D levels and bone metabolism in 1300 randomly selected older
adults (age range, 65–88). Mean serum 25(OH)D level was 21 ng/mL; half the participants
had levels lower than 20 ng/mL. Findings included the following:
·
Serum parathyroid
hormone levels were inversely proportional to vitamin D levels, without
any plateau effect.
·
Markers of bone
turnover (serum osteocalcin and urinary deoxypyridinoline) were inversely proportional to 25(OH)D levels until the latter exceeded 20 ng/mL; above that point,
bone turnover markers plateaued.
·
Total hip bone-mineral
density was directly proportional
to 25(OH)D levels until the latter exceeded 20 ng/mL; above that point, bone density plateaued.
http://www.ncbi.nlm.nih.gov/pubmed/19174492?dopt=Abstract
Intensive
Glucose Control in Diabetes Reduces
CV Events, Doesn't Affect Mortality
Intensive glucose control among patients with type 2 diabetes lowers risk for MI and coronary heart disease but does not affect stroke or mortality risk, according to a Lancet meta-analysis.
Researchers combined data from five randomized
trials comparing intensive glucose control with standard therapy in
some 33,000 adults with diabetes. After roughly 5 years' follow-up, mean hemoglobin A1c was lower with intensive treatment
than with standard therapy (6.6% vs. 7.5%).
Although
the individual trials generally failed to show a benefit from intensive glucose control, their combined data demonstrated
significant reductions in nonfatal MI (odds ratio, 0.83) and coronary heart disease (OR, 0.85).
The authors note that previous studies suggested increased mortality with intensive
glucose control, whereas their analysis shows coronary benefit without any mortality increase.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60697-8/fulltext
Atorvastatin vs. simvastatin in preventing heart failure
This study found that atorvastatin 80 mg was more efficient than simvastatin 20 mg to 40 mg in preventing development of heart failure in patients with previous myocardial infarction.
http://www.ajconline.org/article/S0002-9149(09)00464-0/fulltext
Higher
fitness levels linked to longer life
Researchers analyzed data from 33 studies that included almost 103,000 patients and found higher levels
of physical fitness really do help people live longer. People with low levels of cardiorespiratory fitness had a 70% higher
risk of death from any cause and a 56% greater chance of coronary heart
disease and cardiovascular events when compared with those who had higher
CRF levels. The review was published in the Journal of the American Medical
Association.
http://news.yahoo.com/s/hsn/20090520/hl_hsn/higherfitnesslevelstiedtolowerheartdeathrisks/print;_ylt=ArYLplgB5U.6GKRdQTq5ZoOJ.aF4;_ylu=X3oDMTB1MjgxN2UzBHBvcwMxNARzZWMDdG9vbHMtdG9wBHNsawNwcmludA--
Prediabetes
guidelines call for aggressive lifestyle changes
The American Association of Clinical Endocrinologists has issued new diet and
exercise guidelines for treating patients with prediabetes. The group called for weight loss
of 5% to 10% and at least 30 to 60 minutes of moderate to intense exercise at least five days a week. Increasing fiber,
limiting carbohydrates and salt, and avoiding alcohol also were recommended for certain patient groups.
http://usatoday.printthis.clickability.com/pt/cpt?action=cpt&title=Group+calls+for+aggressive+treatment+of+prediabetes+-+USATODAY.com&expire=&urlID=35251831&fb=Y&url=http://www.usatoday.com/news/health/2009-05-15-prediabetesguidelines_N.htm&partnerID=1660
Effect of Dipyridamole
plus Aspirin on Hemodialysis Graft Patency
Conclusions Treatment with dipyridamole
plus aspirin had a significant but modest effect in reducing the
risk of stenosis and improving the duration of primary unassisted
patency of newly created grafts. (ClinicalTrials.gov number, NCT00067119 [ClinicalTrials.gov] .)
http://content.nejm.org/cgi/content/short/360/21/2191?query=TOC
Early versus Delayed
Invasive Intervention in Acute Coronary Syndromes
Conclusions Early intervention did not differ
greatly from delayed intervention in preventing the primary outcome, but it did reduce the rate of the composite
secondary outcome of death, myocardial infarction, or refractory
ischemia and was superior to delayed intervention in high-risk
patients. (ClinicalTrials.gov number, NCT00552513 [ClinicalTrials.gov] .)
http://content.nejm.org/cgi/content/short/360/21/2165?query=TOC
Danish
study: Some NSAIDs predispose to sudden cardiac death
Diclofenac(voltaren),
celecoxib(celeblex), and rofecoxib(vioxx) are associated with dose-dependent increased risks
of sudden cardiac arrest, according to a large national Danish study.
In
contrast, no increased risk was noted in conjunction with the use of ibuprofen or naproxen,
Dr. Frederik Folke reported at the annual meeting of the American College of Cardiology.
He presented a case-crossover study involving 12,288 Danes
who experienced out-of-hospital sudden cardiac arrest in 2001-2004
Adding clopidogrel to aspirin reduces stroke risk in atrial fibrillation
For patients
with atrial fibrillation for whom vitamin K antagonist therapy is unsuitable, aspirin plus clopidogrel reduces the risk of
stroke and other vascular events, according to a study published May 14, 2009,
by The New England Journal of Medicine.
The "Atrial
Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events" (ACTIVE) included 7,554 patients with
atrial fibrillation plus at least one additional risk factor for stroke.
Acid-Suppressive Medications Linked to Increased Risk for Hospital-Acquired Pneumonia
Use of acid-suppressive medications is associated with
increased risk for hospital-acquired pneumonia, according to a prospective
observational study in JAMA.
U.S.
researchers examined electronic medical record data on nearly 64,000 adults who were hospitalized
at one medical center for at least 3 days over a 4-year period. About half the patients were prescribed proton-pump inhibitors
(PPIs) or histamine-2–receptor antagonists (H2RAs) during their stays.
In
adjusted analyses, hospital-acquired pneumonia was diagnosed significantly more often among patients receiving acid-suppressive
medications than among those not using the drugs (5% vs. 2%). When examined by drug class, PPIs — but not H2RAs
— were significantly associated with pneumonia. However, the subgroup analysis "was
not adequately powered to detect significance" for H2RAs, the authors report.
They
conclude that "further scrutiny is warranted regarding inpatient prescribing practices" of acid-suppressive drugs.
Providers Should Consider PPI Alternatives in Patients on Dual Antiplatelet Therapy,
Group Advises
For patients receiving dual antiplatelet
therapy who need heartburn treatment, healthcare providers should consider alternatives to proton
pump inhibitors, the Society for Cardiovascular Angiography and Interventions (SCAI) has advised.
The
group issued the recommendation after a large study showed adverse cardiac effects when clopodigrel
was mixed with PPIs.
The study examined nearly 16,700 patients who took clopidogrel for a year
after coronary stenting. Patients who were also using PPIs had significantly greater risk for the composite of MI, stroke,
unstable angina, or repeat vascularization. Event rates ranged from 24% to 29% with lansoprazole
(Prevacid), esomeprazole (Nexium), omeprazole (Prilosec), and pantoprazole (Protonix), compared with 18% without PPI use.
The
SCAI calls for more research, but in the meantime, it advises providers to consider using histaminergic blockers (e.g., Zantac
or Tagamet) or antacids instead of PPIs in this patient population.
http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.108.191087
Association
Between PPIs and Spontaneous Bacterial Peritonitis
Patients with
SBP were more likely to have used PPIs than were patients without SBP.
Lately, proton-pump inhibitor (PPI) use has attracted considerable attention for some
possible untoward consequences, including excess
risk for several conditions (pneumonia, Clostridium difficile-associated
disease, and fractures) and lowered efficacy of concurrent clopidogrel. Now, a retrospective case-control study suggests an
association with spontaneous bacterial peritonitis (SBP) in hospitalized patients with cirrhosis andascites.
Seventy patients with SBP were matched by age and Child’s class to 70 patients
without SBP. The prevalence of prehospital use of PPIs was much higher in the SBP group than in the control group (69% vs.
31%). Significantly heightened risk with PPI use persisted in multivariate analysis (odds ratio for association between PPI use and SBP, 4.3). Chart reviews suggested that half
the patients who received PPIs (in either group) had no indication for these drugs.
PPI
Lowers Rate of Recurrent Peptic Ulcer Bleeding
The incidence of clinically significant recurrent bleeding was lower with esomeprazole than with placebo.
In a manufacturer-funded international
randomized trial, 764 adults with bleeding from single gastric or duodenal
ulcers received IV infusions of either high-dose esomeprazole or placebo. All patients exhibited endoscopic stigmata
of recent bleeding, and nearly all underwent endoscopic treatment (i.e., injection therapy, thermal coagulation, or both).
Investigators followed patients for clinically significant rebleeding (defined as >200 mL of vomited fresh
blood or by vital sign and hemoglobin/hematocrit criteria, and endoscopic confirmation
of blood in the stomach).
During the first 72 hours, the incidence of clinically significant recurrent bleeding was lower in
the esomeprazole group than in the placebo group (6% vs. 10%). This benefit persisted at 30 days (8% vs. 14%). Esomeprazole
treatment also was associated significantly with fewer repeat endoscopic treatments, blood transfusions,
hospital days attributable to bleeding, and surgeries (the latter was of borderline statistical significance).
http://www.ncbi.nlm.nih.gov/pubmed/19221370?dopt=Abstract
The HORIZON Study: Bisphosphonates
for Patients on Corticosteroids
Once-yearly infusion of a bisphosphonate may be more effective
and more convenient than daily bisphosphonate for preventing and treating glucocorticortoid-induced osteroporosis.
I have often written about the need
to prevent and treat osteopenia and osteoporosis in patients receiving corticosteroid therapy for chronic skin disease. Lupus
erythematosus, dermatomyositis, chronic eczemas, pemphigus, and pemphigoid (among other conditions) are often managed with
systemic corticosteroids. Patients taking the equivalent of 5 mg/day or more of prednisone are at risk and should be prescribed
oral calcium, vitamin D, and a bisphosphonate. Standard bisphosphonate dosing schedules include 70 mg/week of alendronate,
35 mg/week (or 150 mg/month) of risedronate, or 150 mg/ month of ibandronate. For patients who fail to benefit from bisphosphonates,
subcutaneous injection of 20 µg/day of teriparatide may be more effective (see JW Dermatol Nov 14 2007).
In a randomized, double-blind, double-dummy, noninferiority study, researchers compared
5 mg/day of risedronate with a single intravenous infusion of 5 mg of zoledronic acid in 833 patients who were followed for
up to 1 year. They found the single infusion not inferior, and perhaps superior, to daily dosing in preserving bone-mineral
density. Zoledronic acid recipients had more adverse reactions than daily risedronate recipients in the first few days following
infusion, but the infusion otherwise had no important toxicity.
Comment: In this relatively short-term study, infusion of zoledronic
acid was compared with a daily bisphosphonate, which is rarely used in clinical practice. Although a one-time infusion was
not inferior, and may have been superior, for bone density scores, the occurrence of fracture was not assessed in these patients,
which, after all, is the process that must be prevented. The cost of these agents is roughly the same (yearly, about US$1320
for risedronate and about US$1125 for zoledronic acid). Therefore, patient convenience favors the use of a once-yearly infusion
over daily, weekly, or even monthly oral use.
http://www.ncbi.nlm.nih.gov/pubmed/19362675?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract
Smoking, Hypertension Each Account for 1
in 5 U.S. Deaths (20%)
A
new study in PLoS Medicine estimates that smoking and high blood
pressure each account for about 1 in 5 deaths among U.S. adults. The researchers, who reviewed national health survey data, also
said being overweight or physically inactive each account for 1 in 10 deaths.
http://healthday.com/printer.asp?AID=626458
False
Positives Common During Cancer Screenings
Cancer screening frequently yields false positives — with resulting invasive procedures — reportsAnnals of
Family Medicine.
Researchers studied nearly
68,500 adults, aged 55 to 74, who underwent up to 14 screenings over 3 years in the Prostate, Lung, Colorectal, and Ovarian
Cancer Screening Trial. Tests included digital rectal examination plus prostate-specific antigen measurement; chest x-ray; flexible sigmoidoscopy; and cancer antigen 125
testing plus transvaginal ultrasound.
Among the
findings:
·
The risk for having
one false positive after four tests was 37% among men and 26% among women; after 14 tests, risks rose to 60% and 49%, respectively.
·
The risk for undergoing
a false-positive–prompted invasive procedure after four tests was 17% among men and 12% among women; after 14 tests, risks were
28% and 22%, respectively.
·
Sigmoidoscopy accounted for the most false positives and related procedures.
The researchers conclude that
providers "should educate patients about the likelihood of false positives and resulting diagnostic interventions when
counseling about cancer screening."
http://www.annfammed.org/cgi/content/full/7/3/212
Diabetes and Hypertension: Diseases Associated
with Psoriasis
Two more systemic diseases are shown to be associated with psoriasis.
Although psoriasis primarily
involves the skin and joints, recent findings have identified links with a number of conditions, including lymphoma, heart disease,
and the metabolic syndrome. Researchers used
data from the Nurses’ Health Study II to evaluate the risk to patients with psoriasis for developing diabetes or hypertension. In this large study, women aged 25 to 42 responded to detailed questions about their
health in the 14-year period 1991–2005. Of 78,061 evaluable subjects, 1813 reported having psoriasis. During follow-up,
60 participants with and 1560 without existing psoriasis developed new type 2 diabetes (3.3% vs. 2.0%, respectively; adjusted relative risk, 1.63). Women w ith psoriasis also
reported 386 new diagnoses of hypertension (RR, 1.17). Psoriasis was an independent risk factor for both diabetes and hypertension,
even after adjustment for body-mass index. The authors speculate that the increased diabetes risk might be linked to the inflammatory response, a known player in the development
of diabetes, or to psoriasis treatment, particularly extensive use of topical steroids.
http://www.ncbi.nlm.nih.gov/pubmed/19380659?dopt=Abstract
Is Donepezil Effective for Mild Cognitive
Impairment?
Donepezil was not more effective than placebo,
according to the study’s primary endpoint.
A substantial proportion of patients with
the amnestic (memory-impairment) subtype of mild cognitive impairment (MCI) eventually progresses to Alzheimer disease. In
this industry-sponsored study, researchers examined the effect of donepezil — approved for use in Alzheimer disease
but not MCI — in 821 patients with amnestic MCI.
Patients
were randomized to 48-week courses of donepezil or placebo. The investigators specified that donepezil would not be considered
superior to placebo unless it was favored in scores on both of two primary endpoints (the ADAS-cog, which evaluates cognition, and the CDR-SB,
which evaluates cognition and function).
At 48 weeks,
mean ADAS-cog scores were significantly improved in the donepezil group compared with the placebo group, but the difference
was only 1 point on an 89-point scale. CDR-SB scores did not differ in the two groups. For eight secondary endpoints (representing
various other standardized assessment tools), two favored donepezil and six did not differ between groups. Adverse events
possibly or probably related to treatment were significantly more common with donepezil than with placebo (47% vs. 25%).
http://www.ncbi.nlm.nih.gov/pubmed/19176895?dopt=Abstract
Aspirin Lowers Stroke Risk in Peripheral Artery Disease
But findings limited by lack of studies on subject, researchers note
The jury is still out on whether aspirin lowers the risk of heart attack and death for
people with peripheral arterial disease, but a meta-analysis in the Journal of the American Medical Association found a 34%
lower risk of nonfatal stroke among patients on an aspirin regimen. Researchers said more study is needed on aspirin use with
PAD.
http://health.usnews.com/articles/health/healthday/2009/05/12/aspirin-lowers-stroke-risk-in-peripheral-artery_print.htm
Weighing the Benefits and Risks of Aspirin for Primary Prevention of Vascular Disease
Using aspirin in the primary
prevention of cardiovascular disease is "of uncertain net value," reports
a Lancet meta-analysis.
Researchers undertook an analysis of six primary prevention
trials encompassing some 95,000 individuals at low-average risk assigned to take aspirin or no aspirin. Aspirin was associated
with a significant reduction in risk for serious vascular events (0.51% vs. 0.57% per year), but the net effect on stroke
was not significant. Aspirin increased risks for major gastrointestinal and extracranial bleeding. (Secondary prevention trials
were also analyzed, but the authors focused their analysis on primary prevention.)
In Journal
Watch Cardiology, Dr. Harlan Krumholz calls the findings "the best compilation of evidence
from aspirin trials to date." Agreeing with the authors, he writes that the findings "challenge guidelines that
endorse the use of aspirin for primary prevention as a general public health policy and reinforce
the need to take each patient's preferences, goals, and risks into account when deciding whether aspirin therapy is appropriate."
Tamsulosin
and Complications of Cataract Surgery
Recent tamsulosin use was associated with higher risk for postoperative
complications.
Tamsulosin (Flomax) is
a strongly selective 1a-blocker that relaxes smooth muscle in
the prostate and bladder neck. Because it also relaxes iris muscle, tamsulosin can lead to
intraoperative floppy iris syndrome (IFIS) and add to the difficulty of cataract surgery.
To investigate whether tamsulosin also elevates risk for adverse events after cataract surgery, Canadian investigators conducted
a retrospective, population-based, case-control study using Ontario
administrative data.
Of 96,000 men (age, 66) who underwent cataract surgery, 284 (0.3%)
experienced one or more complications of cataract surgery within 14 days (lost lens or lens fragment, retinal
detachment, or endophthalmitis). Case patients were matched to 1102 controls without complications by age, year of
surgery, and surgeon. Patients with complications were significantly more likely to have used tamsulosin during the 14 days
before surgery than were patients without complications (7.5% vs. 2.7%; adjusted odds ratio,
2.3). Tamsulosin use prior to the 14 days before
surgery was not associated with elevated risk, nor was use of other -blockers
(e.g., terazosin, doxazosin).
http://www.ncbi.nlm.nih.gov/pubmed/19454637?dopt=Abstract
Vigorous exercise and atrial fibrillation: What's the young
-- and jogging-connection?
This study concluded that
frequency of vigorous exercise was associated with an increased risk of developing atrial fibrillation
among young men and joggers, but this
risk diminished as the population aged and was offset by known beneficial effects of vigorous exercise on other atrial fibrillation
risk factors.
http://www.ajconline.org/article/S0002-9149(09)00549-9/fulltext
Insights
from disorders such as anorexia nervosa provide a new rationale for examining the mechanisms
that link bone to fat. This article explores these relationships in the context of a new paradigm with implications for obesity
and osteoporosis.
Conclusions
Fat and bone are inexorably linked in mammalian physiology by their reciprocal needs. Skeletal remodeling, as a
finely tuned means of replenishing calcium and maintaining bone integrity, evolved over millions of year but demanded a sustainable
energy source from adipose tissue. On the other hand, fat tissue, via signaling through the hypothalamus, can regulate bone
mass as a means of controlling energy use and modulate insulin secretion and sensitivity. The clinical correlates of this
intimate relationship are profound and translatable to clinical practice. For example, the use of glucocorticoids or TZDs
cause bone loss principally by shifting the marrow equilibrium toward adipocyte differentiation. As noted previously, BMD
increases in anorexia nervosa only when body weight is restored. Similarly, the metabolic syndrome characterized by obesity
and lipid abnormalities has long been associated with multiple cardiovascular complications; however, recent studies would
suggest that fracture risk also might be increased in this syndrome. Bariatric treatment of obesity is associated not only
with weight loss but also with a profound decrease in bone mass. Thus, the evaluation and treatment of obesity must also include
an assessment of skeletal status.
In the future, therapeutic manipulation of marrow stem
cells could conceivably improve bone mass, at the expense of excess fat. Studies by Rubin and colleagues55 have been illuminating in that regard, who demonstrated that individuals standing on
a vibration platform that emits low-magnitude but high-frequency sound waves (ie, laser microprobe mass spectrometry), for
just 10 minutes per day for 2 years, have significant increases in bone mass.53 More intriguing, when laser microprobe mass spectrometry is applied to
young mice for just 10 minutes per day for 16 weeks, intraabdominal fat is lowered and stem cell allocation into the bone
lineage is enhanced, even after the mice are placed on a high-fat diet.54, 55 In sum, there is a shifting paradigm regarding body composition.
No longer can it be said that obesity per se protects against osteoporosis. Rather, as we learn more about bone and fat, it
will become more accurate to conclude that these 2 complex diseases are indeed connected through multiple hormonal, neuronal,
and environmental pathways.
http://www.amjmed.com/article/S0002-9343(09)00050-3/fulltext
When exercise can reduce agitation
This small study looked at the short-term
effects of exercise on cognitively-impaired nursing home residents. An improvement
was seen in agitation scores as well as the 60-meter walk time after the three-week program. Further study in this area is
needed to verify results.
Conclusion
There was an improvement in agitation scores and the 6-meter walk times in the subjects
after their engagement in the 3-week exercise program. Further study is needed in order to expand on these results.
http://www.jamda.com/article/S1525-8610(08)00510-0/fulltext
Study: No link between meat consumption, breast cancer
A study in the International Journal
of Cancer of 120,755 postmenopausal women did
not find an increased risk of breast cancer among those who ate meat. Researchers looked
at intake of total meat, red meat, white meat, processed meat, meat cooked at high temperatures
and levels of meat doneness, and found no associations with the risk of breast cancer.
http://news.yahoo.com/s/nm/20090525/hl_nm/us_meat_cancer/print;_ylt=Ak1jJOem25c8s8F96UrL7dUp_aF4;_ylu=X3oDMTB1MjgxN2UzBHBvcwMxNARzZWMDdG9vbHMtdG9wBHNsawNwcmludA--
What retinopathy can tell us
Retinopathy seems to be an independent risk marker
for CVD even after adjusting for micro- or macroalbuminuria. We suggest that retinopathy assessment can improve clinical cardiovascular
risk stratification in patients with diabetes.
http://www.ajconline.org/article/S0002-9149(09)00462-7/fulltext
Higher fitness levels linked to longer life
Researchers analyzed data from 33 studies
that included almost 103,000 patients and found higher levels of physical fitness really do help people live longer. People
with low levels of cardiorespiratory fitness had a 70% higher risk of death from any cause and a 56% greater chance of coronary
heart disease and cardiovascular events when compared with those who had higher CRF levels. The review was published in the
Journal of the American Medical Association
http://news.yahoo.com/s/hsn/20090520/hl_hsn/higherfitnesslevelstiedtolowerheartdeathrisks/print
Prediabetes guidelines call for aggressive lifestyle changes
The American Association of Clinical Endocrinologists
has issued new diet and exercise guidelines for treating patients with prediabetes. The group called for weight loss of 5%
to 10% and at least 30 to 60 minutes of moderate to intense exercise at least five days a week. Increasing fiber, limiting
carbohydrates and salt, and avoiding alcohol also were recommended for certain patient groups.
http://usatoday.printthis.clickability.com/pt/cpt?action=cpt&title=Group+calls+for+aggressive+treatment+of+prediabetes+-+USATODAY.com&expire=&urlID=35251831&fb=Y&url=http%3A%2F%2Fwww.usatoday.com%2Fnews%2Fhealth%2F2009-05-15-prediabetesguidelines_N.htm&partnerID=1660
Measuring biomarkers in a fish diet
The results of this study suggest that
the dietary intake of long-chain n-3 polyunsaturated fatty acids and fish is inversely associated
with concentrations of some biomarkers, reflecting lower levels of inflammation and
endothelial activation. These results may partially explain the cardioprotective effects of fish consumption.
http://www.ajconline.org/article/S0002-9149(09)00108-8/fulltext
There's a lot to learn about essential tremor
In this study Essential Tremor(ET), Parkinson's and Alzheimer's Disease patients were tested for cognition using
the MMSE (Mini-Mental State Exam), UPDRS-III (United Parkinson's Disease Rating Scale Part III), and MDS-ADL (Minimum
Data Set-Activities of Daily Living Section). Results point to an emerging view that ET is
a multifaceted disease that involves cognitive and functional disability and warrants much further study.
http://www.jamda.com/article/S1525-8610(08)00415-5/fulltext
Where does the infarction occur?
This study concluded that most ST-elevation myocardial infarctions occur at the site of a severe coronary stenosis; the diameter stenosis severity
is <50% in a minority of cases
http://www.ajconline.org/article/S0002-9149(09)00126-X/fulltext
What works best to prevent blood clots after knee replacement?
Oral rivaroxaban 10
mg once daily for 10 to 14 days was significantly superior to subcutaneous enoxaparin 30 mg given every 12 hours for the prevention
of venous thromboembolism after total knee arthroplasty.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60734-0/abstract
A new protocol for treating infertility
A novel clomiphene "stair-step"
protocol decreases time to ovulation and may improve ovulation rates in clomiphene-resistant women with polycystic ovarian
syndrome.
http://www.ajog.org/article/S0002-9378(09)00193-8/fulltext
Smoking, high BP leading causes of preventable death
A Harvard School of Public Health study that examined 12 modifiable risk factors found smoking was the leading cause of preventable
death in American men while high blood pressure caused the most preventable deaths in women. High LDL cholesterol was not
a primary cause of death at the population level, the study, published in PLoS Medicine, found. "The results of our analysis
... show that targeting a handful of risk factors has large potential to reduce mortality in the U.S.," the authors wrote
Pressure Stockings 'Should Not Be Used' to Prevent DVT After Stroke, Lancet
Commentators Say
Graduated compression stockings don't reduce the risk for deep venous thrombosis after stroke, according to a large trial published online in the Lancet.
Commentators say flatly that the stockings "should not be used after stroke and current guidelines will need to be amended."
In
an international trial, researchers randomized some 2500 immobile patients hospitalized within 1 week of an acute stroke to
either use of, or avoidance of, thigh-length stockings. Ultrasound studies done at roughly 30 days found no significant difference
between the groups with regard to the occurrence of DVT in the popliteal or femoral vessels.
However,
the risk for adverse effects (skin breaks, ulcers, blisters, and necrosis) was much higher in stocking users than nonusers
(5% vs. 1%).
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60941-7/abstract
Cholinesterase Inhibitors Linked to Increased Syncope Risk in Patients with
Dementia
Use of cholinesterase inhibitors in patients with dementia is associated with syncope, according to
a population-based cohort study in Archives of Internal Medicine.
Using
Canadian healthcare databases, researchers compared some 20,000 community-dwelling older adults who were prescribed cholinesterase
inhibitors (donepezil, galantamine, and rivastigmine) for dementia with 61,000 adults with dementia who were not prescribed
the drugs.
A first hospital visit for syncope was more common in patients taking cholinesterase
inhibitors, compared with the control group (32 vs. 19 events per 1000 person-years). The treatment
group also had higher rates of bradycardia, permanent pacemaker insertion, and hip fracture.
The authors note that cholinesterase inhibitors could increase
cholinergic activity in the cardiovascular system, which would lead "to a variety of
changes, including bradyarrhythmias." They conclude: "The risk of these
previously underrecognized serious adverse events must be carefully weighed against the drugs'
generally modest benefits."
http://archinte.ama-assn.org/cgi/content/short/169/9/867
