HHAL MEDICAL NEWS AUGUST2009
Mediterranean Diet Improves Glycemic Control in Patients with Type 2 Diabetes
A Mediterranean-style diet
may be better than a low-fat diet for
helping patients with type 2 diabetes delay treatment with antihyperglycemic drugs, reports Annals of Internal Medicine.
Italian
researchers randomized some 200 overweight patients with newly diagnosed diabetes to either a Mediterranean-style diet (less
than 50% of calories from carbohydrates) or a low-fat diet (less than 30% of calories from fat).
At 4 years, fewer patients on the Mediterranean diet than on the low-fat diet had HbA1c levelsgreater than 7%, thus requiring treatment with antihyperglycemic drugs (44% vs. 70%). The Mediterranean diet group also
had a larger increase in insulin sensitivity,
greater weight loss, and reduced coronary risk factors.
The authors say the Mediterranean diet's effects could be explained by the high consumption of
monounsaturated fatty acids, which may increase insulin sensitivity. They conclude: "The findings reinforce the message
that benefits of lifestyle interventions should not be overlooked."
Mediterranean
Diet, Exercise Associated with
Less Cognitive Decline in Elders
Observational studies in this week's JAMA suggest that physical activity and a Mediterranean-type diet offer cognitive benefits
to elderly adults.
In the first study, U.S. researchers followed nearly 2000 community-dwelling
elders for roughly 5 years. During that time, Alzheimer disease (AD) was diagnosed in 15%. High adherence to a Mediterranean
diet and regular physical activity (even light activity such as gardening) were independently associated with lower AD risk.
The second study examined the effects of a Mediterranean diet alone on cognition among some 1400 elders
in France. Close adherence
to the diet was associated with slower decline on a test of global cognitive performance, but it was not associated with other
cognitive measures or with AD risk.
An editorialist, commenting
on the diet's effects, says the mixed findings in the second study are "of concern." Nonetheless, he writes
that taken together with previous research, the two studies "provide moderately compelling evidence that adherence to
the Mediterranean-type diet is linked to less late-life cognitive
impairment."
Conclusions Higher adherence to a Mediterranean diet
was associated with slower MMSE cognitive decline but not consistently with other cognitive tests. Higher adherence was not associated with risk for incident dementia.
http://jama.ama-assn.org/cgi/content/short/302/6/638?home
Researchers trace memory problems to high blood pressure
People with high diastolic
blood pressure are more likely to suffer from memory problems than those with
normal readings, according to a study in Neurology involving almost 20,000 people 45 and older. Researchers said that more study is needed but that preventing
or treating high blood pressure may help
prevent cognitive impairment.
http://www.reuters.com/articlePrint?articleId=USTRE57O62820090825
Statin
Reload Beneficial in Percutaneous Coronary Intervention
The ARMYDA-RECAPTURE results demonstrate that the protective effects of statin loading before PCI extend
to ACS patients who are already taking statins.
In the ARMYDA trials, a loading
dose of atorvastatin reduced cardiac events after percutaneous coronary
intervention in statin-naive patients whether they had stable
anginaor acute coronary syndromes (JW Cardiol May 9 2007). Might atorvastatin reloading before PCI also improve clinical outcomes in patients
already taking statins?
To find out, the ARMYDA investigators randomized 383 patients
on statin therapy (mean duration, about 9 months) to receive placebo or atorvastatin before scheduled PCI (80 mg 12 hours
before angiography and 40 mg 2 hours preprocedure). About half the patients had ACS, and more than one third had diabetes.
During 30-day follow-up, cardiac death, MI, or target-vessel revascularization occurred in 3.7% of statin-reload recipients
and in 9.4% of placebo recipients (P=0.037). Periprocedural MI — defined as levels of a single measured biomarker
(CK-MB or troponin I) >3 times baseline level or the upper limit of normal — occurred 2.4 times less often in statin-reload
recipients than in placebo recipients. In asubgroup analysis, the between-group difference
in the composite endpoint was significant only in patients with ACS (3.3% in statin-reload patients vs. 14.8% in placebo patients).
Comment: According to this study, the benefit of atorvastatin loading before PCI in statin-naive patients extends
to patients on continuing statin therapy as well. Possible mechanisms producing this benefit include reduced endothelial activation,
platelet inhibition, and anti-inflammatory and other effects independent of lipid-lowering. Although the clinical importance
of a "small enzyme leak" after PCI is debated, the low risk of statin loading and the benefit now observed in multiple
studies suggest that this therapy should become routine before PCI.
Vitamin D? Should we -- and how do we -- correct an insufficiency?
In addition to reducing the risk for bone disease,
vitamin D plays a role in reduction of falls, as well as decreases in pain, autoimmune diseases, cancer, heart disease, mortality and cognitive function. This
review supports the concept that vitamin D deficiency and insufficiency can be both corrected and prevented safely through
supplementation.
Conclusions
Vitamin D deficiency remains an evolving, worldwide health concern contributing to a multitude
of disease entities, whereas vitamin D sufficiency is proving to be essential for overall health and well-being. Although
ultraviolet radiation serves as an option to assist in increasing serum vitamin D levels, less harmful and more reliable alternatives
exist. Because ultraviolet radiation-induced skin cancer and photoaging are an increasing problem, we recommend vitamin D
supplementation over deliberate sun exposure to ensure adequate vitamin D levels, especially in fair-skinned individuals.
Mounting evidence has shown that it remains vital for physicians and health professionals to counsel their patients and ensure
adequate intake to avoid the harmful effects of vitamin D deficiency.
http://www.amjmed.com/article/S0002-9343(09)00440-9/fulltext
Low Vitamin D Levels Common in U.S.
Children, Linked to Cardiovascular Risk Markers
Nearly 10% of U.S. children and adolescents have deficient vitamin D levels, while 60% have insufficient levels, according to a cross-sectional study published
online in Pediatrics.
Researchers examined 2001-2004 NHANES data on some 6300 participants aged 1 to 21 years. Among other findings:
Factors associated with lower vitamin D levels included older age, female sex, non-Hispanic black or
Mexican-American ethnicity, obesity, low milk intake, and nonuse of supplements.
Vitamin D deficiency (less than 15 ng/mL) was independently associated with lower serum calcium, higher systolic blood pressure, lower HDL
cholesterol, elevatedparathyroid hormone,
and higher prevalence of hypertension.
Insufficiency (15-29 ng/mL) was associated with higher diastolic BP, lower HDL cholesterol, and greater
prevalence of elevated C-reactive protein and parathyroid hormone.
The authors point out that only 4% of participants were taking the recommended supplement dose.
Pediatrics article (Free
abstract; full text requires subscription)
Physician's
First Watch coverage of AAP's recommendation to double kids' vitamin D intake (Free)
2009 H1N1 Update: Childhood Deaths; Two-Dose Vaccine Likely;
N95 Respirators
Two-thirds of 36 children
who died from 2009 H1N1 influenza infection had underlying conditions, and many of the rest had subsequent bacterial infections,
according to an MMWR report.
In
briefing the media, CDC director Thomas Frieden made the following points:
The children's
underlying conditions were primarily cerebral palsy, muscular dystrophy, or longstanding
respiratory or cardiac disease.
Some children without underlying conditions suffered bacterial coinfection, prompting
Frieden to urge clinicians to suspect bacterial infection in children who return with high feverafter apparently getting better.
People
with underlying conditions (e.g., heart or lung disease, diabetes, or pregnancy) should be seen promptly if they get a fever.
It's
"very likely," Frieden says, that kids will require two shots for 2009 H1N1.
Meanwhile, the Institute of Medicine recommends
that healthcare workers in close contact with influenza patients use fit-tested N95 respirators. The CDC will review the recommendation over the coming weeks, Frieden says.
MMWR article (Free)
CDC briefing transcript (Free)
Institute of Medicine report brief on protecting healthcare workers (Free)
NEJM/Journal Watch H1N1 Influenza Center (Free)
Thin
Thighs Associated with Increased Risk for Death, Cardiovascular Disease
Adults with very thin thighs may be at increased risk for
cardiovascular disease and death, BMJreports.
Researchers measured thigh circumference in some 2800 men and women, aged 35 to 65, and then followed
them for about 10 years to assess incident cardiovascular disease, coronary
heart disease (CHD), and mortality.
In adjusted analyses, a thigh circumference below roughly 24 inches
(60 cm) was associated with significantly elevated risk for death and cardiovascular disease (but not CHD),
with risk increasing as circumference decreased. While a circumference above 24 inches appeared to be protective, the benefit did not continue to increase with increasing circumference.
As a potential underlying mechanism, the authors cite research suggesting that low subcutaneous thigh
fat results in poor glucose and lipid metabolism.
They and an editorialist call for further research to confirm these findings.
BMJ article (Free)
BMJ editorial (Subscription required)
Conclusion A
low thigh circumference seems to be associated with
an increased risk of developing heart disease or premature death.
The adverse effects of small thighs might be related to
too little muscle mass in the region. The measure of thigh circumference
might be a relevant anthropometric measure to help
general practitioners in early identification of individuals at
an increased risk of premature morbidity and mortality.
http://www.bmj.com/cgi/content/full/339/sep03_2/b3292
Combination Lipid-Lowering Therapy May Not Be More Effective Than High-Dose Statin Monotherapy
"Limited evidence"
suggests that combination lipid-lowering therapy is no more effective than high-dose statin monotherapy for improving clinical
outcomes, according to a meta-analysis published online in Annals of Internal
Medicine.
Researchers examined studies comparing the efficacy of statin
monotherapy with combination therapy in high-risk patients. Among the findings:
·
In three fair- to
poor-quality trials, statin-ezetimibe and statin-fibrate combinations did not improve all-cause
mortality relative to high-dose statin monotherapy.
·
No relevant trials
assessed MI, stroke, or revascularization outcomes.
·
Two fair-quality
trials found statin-ezetimibe superior to monotherapy in terms of LDL reductions.
The authors point out several limitations of their analysis, including the lack of long-term data.
They conclude: "The available evidence supporting the use of combination
therapies over high-dose statin monotherapy ... is insufficient to
guide many clinical decisions."
Annals
of Internal Medicine article (Free)
Physician's
First Watch coverage
of study on efficacy of ezetimibe (Free)
Conclusion: Limited
evidence suggests that combinations of lipid-lowering
agents do not improve clinical outcomes more than
high-dose statin monotherapy. Very-low-quality evidence favors
statin–ezetimibe treatment for attainment of low-density lipoprotein
cholesterol goals.
http://www.annals.org/cgi/content/full/0000605-200911030-00144v1
FDA Reviewing Orlistat's Association with Liver Problems
The FDA said last week that it is
reviewing adverse hepatic side effects associated with the weight-loss drug orlistat. Both the prescription (Xenical) and
the OTC (Alli) forms are under review.
There have been some
30 reports of liver injury. The agency says
that although "no definite association" has been established, it asks that clinicians report signs of liver injury
in patients taking orlistat to the FDA's MedWatch program.
Until
its review is completed, the FDA says consumers may continue using the drug as directed.
FDA announcement (Free)
MedWatch online reporting form (Free)
Steroids Might Relieve Sore Throat Pain
A meta-analysis shows that a single dose of steroids, given in addition to standard antibiotics, hastens
resolution of pain in adults with exudative pharyngitis or bacterial pharyngitis.
Smokeless
Tobacco Use Is Associated with Fatal MI and Stroke
Let patients who use smokeless tobacco know that it is not a "safe"
alternative to cigarettes and cigars.
Optimism reduces mortality risk, heart disease in women
Women who have an optimistic outlook were 14% less likely
to die over 8 years, 9% less likely to develop coronary heart disease and 30% less likely to die of heart complications, compared
with more pessimistic women, a study in Circulation of 97,000 U.S. women ages 50 to 79 found. The lead researcher said optimism
may have a direct impact on preventing disease.
http://www.reuters.com/articlePrint?articleId=USTRE5795CA20090810
Prophylactic
Probiotics for Cold and Flu Symptoms
Probiotics reduced the incidence of cold symptoms and antibiotic use.
Vitamin
D Levels and Bone Loss in Older Men
In men older than 75, 25(OH)D levels lower than 20 ng/mL were associated
with accelerated bone loss.
Active
Commuting and Cardiovascular Risk
Walking or biking to work is associated with some favorable risk markers,
but whether these practices confer a benefit is unclear.
Ghrelin: It's Not Just for Food; Let's Drink to That
In an animal study, central ghrelin signaling activates the mesolimbic
reward system for alcohol.
To
Attenuate Risk for Cardiovascular Disease, Start with Lifestyle
Healthy lifestyles were associated with lower risk for heart failure in
men and hypertension in
women; obesity was the strongest risk factor for hypertension.
Are Organic Foods More Nutritious?
Conventionally and organically produced foods have similar nutritional value.
Many of our patients (and some of our colleagues) pay premium
prices for "organic" food. Two reasons for this behavior are the perceived absence of pesticides and other chemicals
on organic foods and
that less greenhouse gases are generated by organic
farming. In addition, many people think that organically grown foods have superior nutritional content.
A team from the London School of Hygiene identified 55 studies addressing the nutritional content of organic versus nonorganic foods that they deemed
to be methodologically sound. A systematic review of the data showed that, among 11 different types of evaluated nutrient
content, only 3 showed small but significant differences between organic and conventional foods. Conventionally produced crops
had higher levels of nitrogen, and organically produced crops had higher levels of phosphorus and acidity. The authors judged
the differences to have no clinical significance.
Comment: Some previous nonsystematic reviews have concluded that organically produced foods have superior nutrient
composition; however, this large systematic review leads to a different conclusion. Hotly debated questions remain about whether
the pesticides and chemicals that are used in producing conventional foods have clinical consequences. And, whereas most people
agree that production of organic foods is "greener," discussions continue as to how important the difference in
farming methods is to the larger problem of global climate change.
Some COX-2 inhibitors help knee cartilage. Maybe.
This study suggests that nonselective NSAIDs may have deleterious effects, while selective COX-2 inhibitors might have beneficial effects on knee cartilage. Randomized controlled trials examining knee structure to confirm
this finding are warranted.
Conclusions
This study suggests that nonselective NSAIDs may have deleterious effects, while selective
COX-2 inhibitors might have beneficial effects on knee cartilage. Randomized controlled trials examining knee structure to
confirm this finding are warranted.
http://www.amjmed.com/article/S0002-9343(09)00341-6/fulltext
Traffic and air pollutants: More risk factors
in cardiac instability
The study concluded, following hospitalization
for coronary artery disease, that being in traffic and short-term ambient or indoor black carbon exposures increase t-wave Alternans,
a marker of cardiac electrical instability.
In conclusion, after hospitalization for coronary artery disease,
being in traffic and short-term ambient or indoor BC exposure increased TWA, a marker of cardiac electrical instability.
http://www.ajconline.org/article/S0002-9149(09)01014-5/fulltext
Is 140/90 Low Enough for Nondiabetic Hypertensive Patients?
A study
supports a more aggressive approach to BP reduction.
Most guidelines
recommend 140/90 mm Hg as the blood pressure target for nondiabetic patients with hypertension. But, no randomized
trials of systolic blood pressure (SBP) reduction to
130 mm Hg have been conducted in this population.
With
funding from three pharmaceutical manufacturers, Italian investigators randomized 1111 nondiabetic hypertensive patients to
tight (<130 mm Hg) or usual (<140 mm Hg) SBP control. Patients (age, 55) had baseline SBP levels
of 150 mm Hg after receiving antihypertensive therapy for at least 12 weeks and had at
least one other cardiovascular risk factor.
Treatment was open-label and individualized and included previous (background) therapy plus various combinations of furosemide,
hydrochlorothiazide, ramipril, telmisartan (Micardis), amlodipine, bisoprolol, and clonidine.
Clinicians
measured blood pressure by auscultation every 4 months and reported the average of three seated readings after 10 minutes
of rest. In the tight-control group, one SBP reading >130 mm Hg at any visit led to intensification
of treatment; in the usual-control group, one SBP reading <130 at any visit led to down-titration of treatment. The primary
endpoint was prevalence of electrocardiographic left
ventricular hypertrophy (LVH), as assessed by blinded readers.
At
baseline, blood pressures were equal in the two groups, and roughly 20% of patients in each group had LVH. After 2 years,
27% and 72% of patients in the usual- and tight-control groups, respectively, had SBP <130 mm
Hg, and significantly more patients in the usual-control group than in the tight-control group (17.0% vs. 11.4%) had LVH.
In addition, significantly more patients in the usual-control group than in the tight-control group (9.4% vs. 4.8%) reached
a secondary composite endpoint that consisted of any of nine adverse clinical cardiovascular outcomes.
Comment: Left ventricular hypertrophy is not a clinical endpoint, but it is a powerful predictor of cardiovascular events. According to this study,
an aggressive approach to blood
pressure reduction can be well-tolerated and might lower the incidence
of adverse cardiovascular outcomes. Larger and longer studies will be required to measure individual cardiovascular
outcomes directly and to test this hypothesis in patients at lower baseline risk.
http://www.ncbi.nlm.nih.gov/pubmed/19683638?dopt=Abstract
Fitness linked to longer life in adults
A study of almost 4,400 healthy older adults found people ranking
in the lowest 20% of fitness levels were twice as likely to die over the next nine years as the 20% of folks in the next-lowest
fitness level. About 25% of people in the least-fit group died during the study period compared with 6% in the most-fit group.
The study was published in the journal Medicine and Science in Sports and Exercise.
http://abcnews.go.com/print?id=8383222
Waistline
fat raises risk of asthma in women, study says
Results of the California Teachers
Study found women with a waist circumference of about 35 inches had a 37% higher risk of developing asthma, even
if they are not considered overweight. The study in Thorax, which included more than 88,000 women, showed women with a BMI
of 30 or higher had double the incidence of asthma. http://news.yahoo.com/s/hsn/20090826/hl_hsn/widerwaistboostsasthmarisk/print
Exercise, diet improve quality of life for cancer survivors
Interviews with people who survived colorectal, breast and
prostate cancers found those who exercised more and had a better diet also had a higher physical quality of life, researchers
reported. The study, published in Cancer, also found the more people weighed, the poorer their physical quality of life
http://www.upmccancercenters.com/news/reuters/reuters.cfm?article=14339b
High cholesterol raises dementia risk for middle-age adults
High cholesterol in middle-age adults increases their risk
of developing Alzheimer's disease or vascular dementia, according to a 40-year Kaiser Permanente study of 10,000 people.
Data showed those with cholesterol readings of 240 or higher had a 66% greater risk of Alzheimer's
disease later in life and those with levels between 200 and 239 had a 25% greater risk.
http://cnn.site.printthis.clickability.com/pt/cpt?action=cpt&title=Study:+Cholesterol+levels+tied+to+increased+risk+for+dementia+-+CNN.com&expire=-1&urlID=407953280&fb=Y&url=http://www.cnn.com/2009/HEALTH/08/04/cholesterol.dementia/index.html&partnerID=211911
The mind, the pocketbook and the heart
This review points out that the influence of psychosocial
risk factors on cardiovascular disease remains under-recognized compared with traditional cardiac risk factors. Given this
strong relationship between psychosocial risk factors and cardiovascular disease, physicians need to be proactive participants
in their patients' care, with the possible solution of adding questions about psychosocial risk factors when obtaining
medical histories.
Conclusions
The
recent American Heart Association Science Advisory on Depression in Coronary Heart Disease recommends screening for depression
in patients with cardiovascular disease.30 Their
proposed algorithm (Figure 4) offers a strategy for assessment and referral of patients with cardiovascular
disease with depressive symptoms. Patient Health Questionnaire-2 and Patient Health Questionnaire-9 if needed (Table 1, Table 2) are brief questionnaires for assessing depressive symptoms in patients
with cardiovascular disease that can be used during office visits. The Executive Summary of the European Guidelines on Cardiovascular
Disease Prevention and Clinical Practice offers tips to help physicians work with their patients with cardiovascular disease
to assess potential psychosocial stressors in their life (Table 3).29 One
new approach to fostering this more compassionate, identifying relationship between patient and healthcare practitioner is
Narrative Medicine, which seeks to improve effectiveness of care by developing the capacity for attention, reflection, representation,
and affiliation with patients and colleagues.38 The
time has come for physicians to take notice. Encouraging data suggest that intervention can affect patients with coronary
artery disease with psychosocial stressors. Further study will be required to determine which treatments definitively provide
benefit. In addition to increasing the risk of cardiovascular events and worsening the prognosis of cardiovascular disease,
psychosocial factors might act as barriers to treatment adherence and efforts to improve lifestyle.
http://www.amjmed.com/article/PIIS0002934309004021/fulltext
When C-reactive protein should guide statin treatment
The findings of this study from the JUPITER trial suggest
that, given the demonstrated benefits of statin therapy, along with the cost of measuring C-reactive protein (CRP) and the
high percentage of older U.S. adults with high CRP, universal statin therapy for older adults warrants investigation.
Conclusion
Although randomized controlled trial data demonstrate the benefits of
statin therapy for older adults with CRP levels ≥2 mg/L, the cost-effectiveness and public health risks and benefits
of nearly universal statin therapy for older US adults warrant further
investigation.
http://www.ajconline.org/article/S0002-9149(09)00810-8/fulltext
ADHD as another consequence of maternal smoking
A rigorous longitudinal study showed that maternal smoking
is a risk factor for both ADHD and conduct disorder, although the risk for conduct disorder appears to be conditional on other
familial factors.
Conclusions
These results support the hypothesis that maternal smoking
during pregnancy is a risk factor for both ADHD and CD, independently of each other. However, the risk for CD appears to be
conditional on family risk status.
http://www.jahonline.org/article/S1054-139X(08)00660-5/fulltext
Regular alcohol intake ups risk of various cancers in men
Canadian researchers found that men who drink moderate to
high amounts of beer and liquor during their lifetime are at a greater risk of developing
certain cancers, including esophageal, colon, lung and prostate cancers. The researchers used data from a study in
the 1980s that looked at the alcohol consumption and cancer history of men between the ages of 35 and 70, who had been diagnosed
with cancer. The findings were published in Cancer Detection and Prevention.
http://healthday.com/printer.asp?AID=629800
Non-Drinkers More Likely to Be Anxious, Depressed
Teetotalers may experience
social exclusion, have health problems, study suggests
http://healthday.com/printer.asp?AID=630645
Severe sleep apnea raises risk of death by 46% in adults
A study in PLoS Medicine of 6,400 adults found those who had major sleep apnea had a 46% greater risk of dying from any cause, regardless of age, sex, race, weight or smoking. Researchers
said people who had less severe sleep-breathing problems didn't have the elevated risk.
http://www.reuters.com/articlePrint?articleId=USTRE57H0CP20090818
Heart
disease risk factors improve soon after smoking stops
Women who quit smoking saw major reductions in
several markers for inflammation associated with heart disease, including C-reactive protein and tumor necrosis factor, within six to seven weeks, a U.S. study in Chest found.
Researchers said giving people quantifiable information on their cardiovascular health may be a positive reinforcement to
help them quit and remain smoke free.
http://www.reuters.com/articlePrint?articleId=USTRE57D4CH20090814
Beer
for better bones?
In phalangeal bone ultrasound data on a group of 1,697 women pre-
to postmenopausal, values were better among the beer drinkers. The authors do not recommend alcoholic beverage
consumption per se, but suggest oral silicon
and the phytoestrogen compounds in beer may be the beneficial components.
Talking Points:
U.S. Life Expectancy Continues to Rise
U.S. life expectancy reached an all-time high of 77.9 years in 2007 — up from 77.7 years in 2006 —
according to preliminary data from the CDC.
The data were taken from roughly 90% of national death certificates for 2007. Among other findings:
·
Life
expectancy for males was 75.3 years and for females, 80.4.
·
For
black males, life expectancy reached a record 70 years.
·
In the past decade,
overall life expectancy increased by 1.4 years.
http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_01.pdf
Aspirin Use After Colorectal Cancer Diagnosis Linked to Lower Mortality Risk
Regular aspirin use after
— but not before — receiving a diagnosis of colorectal cancer is associated with reduced mortality, JAMA reports.
Researchers
assessed aspirin use in nearly 1300 health professionals with nonmetastatic colorectal cancer. Over a median 12 years'
follow-up, patients who regularly took aspirin after their cancer diagnosis had reduced risk for overall and colorectal-cancer–specific
mortality, compared with nonusers. (Those who used aspirin before their diagnosis did not see a similar risk reduction.)
The benefits of aspirin — a COX-2
inhibitor — were limited to patients with COX-2–positive
primary tumors (70% of tumors assessed).
An editorialist says
the results "bring an observational study as close as it can to offering patients a way to help themselves." However,
the authors conclude that until further studies are conducted, use of aspirin or other COX-2 inhibitors for cancer treatment "cannot be recommended, especially
in light of concerns over their related toxicities, such as gastrointestinal
bleeding."
Conclusion Regular aspirin use after the diagnosis
of colorectal cancer is associated with lower risk of colorectalcancer–specific
and overall mortality, especially among individuals with tumors
that overexpress COX-2.
http://jama.ama-assn.org/cgi/content/short/302/6/649?home
Breast-Feeding Associated with Lower Premenopausal
Breast Cancer Risk in Women with Family History
Breast-feeding in women with a family history of breast cancer is associated with a reduced risk
for premenopausal breast cancer, according to an Archives of Internal
Medicine study.
Researchers examined data from 60,000 premenopausal parous women in the Nurses' Health Study II. They found that women
who had ever breast-fed had a lower risk for premenopausal breast cancer, but the association was limited to women with a
first-degree relative with the disease (adjusted hazard
ratio, 0.41).
The authors conclude that women with
a family history of breast cancer should be encouraged to breast-feed.
Conclusion In this
large, prospective cohort study of parous premenopausal
women, having ever breastfed was inversely associated with
incidence of breast cancer among women with a family history
of breast cancer.
http://archinte.ama-assn.org/cgi/content/abstract/169/15/1364
Chinese Herb Appears Better Than Standard Treatment for Rheumatoid
Arthritis
Tripterygium wilfordii Hook F (TwHF) extract offers better symptom relief
than sulfasalazine inpatients with rheumatoid arthritis, reports Annals of Internal Medicine. (TwHF
— also known as "thunder god vine" or "lei gong teng" — is used in traditional Chinese medicine to treat inflammatory
conditions.)
U.S.
researchers randomized some 120 adults with active rheumatoid arthritis to receive the extract (180 mg) or sulfasalazine (2 g) daily for 24 weeks. Participants were allowed
to use stable prednisone dosing (up to 7.5 mg/day) but not disease-modifying antirheumatic drugs.
In intent-to-treat analyses, significantly more patients assigned to TwHF versus sulfasalazine achieved
at least a 20% improvement in arthritis symptoms (65% vs. 33%). In analyses limited to the roughly 50% of patients who completed
the study, results were similar. Adverse events did not differ between the two groups.
The authors write that three of TwHF's metabolites — triptolide, tripdiolide, and triptonide
— may account for its anti-inflammatory and immunosuppressive effects.
Albuminuria Associated with Poor Prognosis in Heart Failure
Albuminuria "might be of value" in risk stratification in heart failure, according to a Lancet study.
Urinary albumin-to-creatinine ratios were measured in some 2300 patients with heart failure at baseline
and over the course of a 3-year follow-up. An increased ratio was associated with higher likelihood of suffering cardiovascular
death, hospital admission for worsening heart failure, or death from any cause. Risks were significantly increased with both
micro- and macroalbuminuria, even after adjustment for renal
function, presence of diabetes, and hemoglobin
A1c levels.
The authors point out that reducing albuminuria
"might be useful in the prediction of improvement in clinical outcomes."
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61378-7/fulltext
Healthy Living Is the Best Revenge
Conclusion Adhering to 4 simple healthy lifestyle factors can
have a strong impact on the prevention of chronic diseases.
http://archinte.ama-assn.org/cgi/content/abstract/169/15/1355?ct
Thiazolidinediones and Fractures in Men and Women
Conclusions Both
men and women who take thiazolidinediones could be at increased risk of fractures. Pioglitazone may be more strongly associated with fractures than rosiglitazone. Larger
observational studies are needed, and fracture data from clinical
trials need to be fully published so that fracture risks
can be known with greater certainty.
http://archinte.ama-assn.org/cgi/content/abstract/169/15/1395?ct
Poor Prognosis Among Community
Dwellers with Mild Hyponatremia
In
middle-aged or older adults, mild hyponatremia predicted death and MI.
In
hospitalized patients, hyponatremia is associated with elevated risk for adverse clinical outcomes. However, little is known
about the prognostic value of mild hyponatremia in the general population. Danish researchers examined serum sodium levels
in 671 middle-aged or older community dwellers (mean age, 65) who did not have known heart disease, stroke, cancer, or other life-threatening illnesses.
Serum
sodium levels ranged between 129 and 152 mEq/L for all participants. During a median follow-up of 6.3 years, the primary endpoint
— death or myocardial infarction — occurred in 103 participants (15.3%). The incidence of the primary endpoint
was associated strongly with hyponatremia: The endpoint occurred in 6 of 14 people (43%) with Na 134 mEq/L, in 17 of 62 people
(27%) with Na 137 mEq/L, and in 86 of 609 people (14%) with normal serum sodium levels (Na >137
mEq/L). The difference in risk among the groups persisted after controlling for multiple risk factors (including diuretic
use) and in subgroup analyses among patients who did not use diuretics and among patients with sodium levels near the lower
limit of normal (135–137 mEq/L). Higher all-cause mortality (but not excess MIs) accounted for the risk conferred by
hyponatremia.
Comment: In
this study of apparently healthy community-dwelling older adults, mild hyponatremia predicted a higher risk for death. If
the results can be replicated, additional research would be warranted to determine the mechanisms responsible for this observation
and to determine whether interventions that raise the serum sodium level might also prolong life in these patients
Vertebroplasty No Better Than
Sham Procedure in Osteoporotic Fractures
Two placebo-controlled trials of vertebroplasty find no added benefit
in pain relief or
quality of life. The studies appear in the New
England Journal of Medicine.
In both studies,
patients with painful osteoporotic vertebral fractures underwent randomization to either vertebroplasty or a sham procedure.
Among some 80 Australian patients in the first study, there were no differences between the groups
in overall pain improvement at the 3-month mark, the primary outcome measure.
Similarly, in the second study, some 130 patients from the U.S., U.K., and Australia
underwent randomization and subsequent follow-up for clinical improvement at the 1-month mark. Again, no significant differences
were found.
An editorialist says the results may consign vertebroplasty
to being considered "no better than placebo." And in Journal
Watch General Medicine,
Dr. Allan S. Brett writes that unless studies can identify a subgroup of patients who benefit from it, the procedure "should
be viewed skeptically."
http://content.nejm.org/cgi/content/short/361/6/557
Sex Hormone–Binding Globulin and Risk of Type 2 Diabetes in Women
and Men
Conclusions Low circulating levels of sex hormone–binding globulin are a strong predictor of the risk of type 2 diabetes in women and men. The clinical usefulness of both SHBG genotypes and plasma levels
in stratification and intervention for the risk of type 2
diabetes warrants further examination.
http://content.nejm.org/cgi/content/full/NEJMoa0804381?query=TOC
