HHAL MEDICAL NEWS JULY 2009
Tracking
the association between poor fitness and inflammation
The results of this study suggest that the previously reported association between poor fitness and low-grade inflammation may be largely attributable to the
increased visceral adipose tissue accumulation and its associated
state of insulin resistance, conditions frequently observed
among subjects with a poor cardiorespiratory fitness.
http://www.ajconline.org/article/S0002-9149(09)00737-1/fulltext
Many prostate cancers grow too slowly to kill
Only 12% of men who had their prostates removed after being diagnosed with prostate cancer died from the disease
15 years later, compared to 38% who died from causes other than cancer, according to a U.S. study in the Journal of Clinical
Oncology that involved more than 12,600 men. Researchers said the findings add to existing evidence showing some patients might be able to avoid surgery and its side effects for the often slow-growing tumors.
http://news.yahoo.com/s/nm/20090727/hl_nm/us_cancer_prostate/print
Swine flu could hit up to 40% in U.S. this year and next without vaccine
The CDC estimates that up to 40% of Americans could get swine flu through next year and several hundred
thousand could die if the U.S. doesn't implement a successful vaccine campaign and other
public health measures. Health officials said they expect cases of the flu to increase substantially after school begins in
the fall, about the time the first vaccines will be ready.
http://usatoday.printthis.clickability.com/pt/cpt?action=cpt&title=Swine+flu+could+hit+up+to+40%25+in+U.S.+this+year+and+next+without+vaccine+-+USATODAY.com&expire=&urlID=407431737&fb=Y&url=http://www.usatoday.com/news/health/2009-07-26-swineflu27_N.htm&partnerID=1660
Breastfeeding and heart
disease: The good news
Breastfeeding in infancy is inversely associated
with adult BMI and positively associated with HDL cholesterol. Associations between breastfeeding and BMI may mediate the association between breastfeeding and HDL
cholesterol.
http://www.amjmed.com/article/S0002-9343(09)00290-3/fulltext
Getting to long-term
lipid effects on PIOGLITAZONE
This study concludes
that long-term pioglitazone therapy led to durable improvements in triglyceride and high-density
lipoprotein cholesterol levels, irrespective of baseline antihyperglycemia therapy or statin use.
http://www.ajconline.org/article/S0002-9149(09)00733-4/fulltext
Resistant hypertension
linked to excess salt intake
Patients who can't control their blood pressure with multiple
medications likely are eating too much salt, according to studies in the journal Hypertension. One group of researchers found
that when these patients drastically reduced their salt intake, their blood pressure dropped sharply.
http://www.reuters.com/articlePrint?articleId=USTRE56J5FX20090720
Extended release, niacin/laropiprant less flushing: Good results
Niacin has beneficial effects on
patient's lipid and lipoprotein profiles and cardiovascular risk, particularly at doses >2 g/day, but is underutilized
due to flushing. Improvement in flushing with extended release niacin/laropiprant supports a rapidly advanced 1-g→2-g
dosing regimen, allowing patients to start at the 1-g dose and quickly reach and tolerate the optimal 2-g dose of extended
release niacin
http://www.ajconline.org/article/S0002-9149(09)00669-9/fulltext
No improvement in cardiac
arrest survival after CPR
A study of Medicare records found survival rates
for cardiac arrest patients who received CPR in a hospital are about 18%, no better than they were a decade ago. Researchers
said blacks had survival rates 25% lower than whites. Men, seniors and people admitted to the hospital from nursing homes
also had lower survival rates after CPR, the New
England Journal of Medicine study found.
http://www.boston.com/news/nation/articles/2009/07/02/few_survive_cardiac_arrest_even_with_cpr?mode=PF
Dietary Linoleic Acid Linked to Increased Risk for Ulcerative Colitis
Nearly a third of ulcerative colitis cases may be associated with high dietary levels of linoleic acid, according to a study in Gut.
(Linoleic acid is an n-6 polyunsaturated fatty acid found in red meat and some cooking oils and margarine.)
Over 200,000 subjects in five European countries submitted food-frequency questionnaires at the start of the study,
and incident cases of ulcerative colitis were identified from disease registries, follow-up questionnaires, and hospital and
pathology databases. After a median follow-up of 4 years, those with the highest quartile of linoleic acid intake showed a
2.5-fold increased risk for ulcerative colitis relative to the lowest quartile.
The
authors say their findings probably underestimate the true effect, and if confirmed, "then there is substantial potential
for reducing the incidence of ulcerative colitis through dietary modification."
http://www.jamda.com/article/S1525-8610(09)00111-X/fulltext
Hormone Therapy
and Risk for Ovarian Cancer
Risk was elevated irrespective of duration of use, type and dosage of hormone therapy,
and route of administration.
In several
observational studies, hormone therapy (HT) has been associated with elevated risk for ovarian cancer. In this new study,
Danish investigators prospectively followed 900,000 women (age range, 50–79) who had at least one ovary and no hormone
sensitive cancers; development of ovarian cancer was linked to pharmacy registry data.
During mean follow-up of 8 years, 2681 cases of epithelial ovarian cancer were diagnosed. In analyses adjusted
for numerous demographic and reproductive factors, risk for epithelial ovarian cancer was elevated by 44% (highly significant)
for current users of any HT, and by 15% (barely significant) for former users. Risk declined after cessation of HT and approached
baseline after 2 years. There was no difference in risk between use of estrogen alone and use of combined estrogen-progesterone
and no relation between duration of use and risk. Risks for continuous and cyclical therapy were roughly equal, as were risks
for different progesterone preparations. Risk was elevated by 13% with use of transdermal estrogen therapy and by 23% with
use of vaginally administered estrogen; neither risk differed statistically from that of oral administration. Absolute risk
was roughly one extra case of ovarian cancer per 8300 HT users.
http://www.ncbi.nlm.nih.gov/pubmed/19602689?dopt=Abstract
Cardiovascular
disease and osteoarthritis link found
COPENHAGEN
(EGMN) – Women with the highest level of cardiovascular disease risk also faced a sharply increased risk for osteoarthritis,
in a study of nearly 9,000 women who were followed for 30 years.
Data collected
in men showed a similar but less dramatic relationship.
“Our study, for
the first time, provides evidence that cardiovascular disease risk factors are associated with an increased risk for osteoarthritis,”
Study confirms biomarkers of incipient
Alzheimer's disease
Three cerebrospinal fluid biomarkers can accurately identify patients
with mild cognitive impairment (MCI) who are at high risk of developing Alzheimer's disease (AD), reports a study in the
July 22/29, 2009, issue of The Journal of the American Medical Association.
The study was designed to further evaluate 3 cerebrospinal fluid biomarkers
previously reported as predictors of incipient AD in patients with MCI. The biomarkers were β-amyloid1-42 (Aβ42)
Low-risk lifestyle factors reduce women's hypertension risk
Adherence to desirable diet and lifestyle factors can significantly reduce the risk of hypertension in women, concludes
a study in the July 22/29, 2009, issue of The Journal of the American Medical Association.
The prospective cohort study included 83,882 female registered nurses enrolled
in the second Nurses' Health Study. All were healthy and had normal blood pressure at enrollment in 1991. Six modifiable
diet and lifestyle factors—body mass index, exercise, level…
Conclusions Adherence to low-risk dietary and lifestyle factors was associated with a significantly lower incidence of self-reported hypertension. Adopting low-risk dietary and lifestyle factors has the potential to prevent a large proportion of new-onset hypertension occurring among young women.
http://jama.ama-assn.org/cgi/content/abstract/302/4/401
High-Calcium
Diet in Childhood Associated with Lower Stroke Mortality Later in Life
Children from families with high-calcium diets show a lower risk for mortality from stroke later in life, according
to a 65-year follow-up study in Heart.
Some 4400 children,
whose family's 7-day household food inventories were recorded in the late 1930s, were followed up 65 years later. The
families were from England and Scotland
and were, for the most part, members of the working class.
When mortality
was traced through National Health Service records, childhood diets high in calcium were associated with a significantly reduced
risk for later stroke mortality, as well as a reduced risk for total mortality that was of borderline significance. The association
with coronary heart disease mortality was
not statistically significant.
The authors say that "further evidence
is needed to replicate these findings."
Expensive Tests to Evaluate Syncope Don't
Yield as Much as Simple Postural BP
In
evaluating syncope in
older patients, simpler less-expensive tests are more likely to affect diagnosis and treatment, according to an Archives of Internal Medicine study.
Researchers examined medical records in some
2100 consecutive admissions of patients aged 65 or older presenting to an emergency room with syncope. The researchers determined which tests affected diagnosis or management,
and they calculated the costs incurred for each management-changing test result.
Postural blood pressure measurement had
the highest yield, but was performed in only about a third of cases. Its use incurred about $20 in cost for each positive
result. Other, more frequently performed tests, like EEGs ($33,000), head CT scans ($25,000), and cardiac enzymes ($22,000),
were much less efficient in yielding useful information. Postural BP measurements affected management or diagnosis about 25%
of the time, whereas some of the more expensive tests affected practice in less than 5% of cases.
http://archinte.ama-assn.org/cgi/content/abstract/169/14/1299?ct
Drugs With Anticholinergic Properties, Cognitive Decline, and Dementia in an Elderly General Population
Conclusions Elderly
people taking anticholinergic drugs were at increased
risk for cognitive decline and dementia. Discontinuing anticholinergic treatment was associated with a decreased risk. Physicians should carefully consider prescription of anticholinergic drugs
in elderly people, especially in the very elderly and in
persons at high genetic risk for cognitive disorder.
http://archinte.ama-assn.org/cgi/content/abstract/169/14/1317?ct
Healthy Lifestyle Blunts Risks for Heart Failure, Hypertension
"Healthy lifestyle is associated with reduced risk of both hypertension and heart failure," an editorialist concludes
from two prospective JAMA studies.
One study examined the risk for heart failure in some 21,000 male physicians followed for over 20 years. The more
the subjects practiced six healthy lifestyle habits, the less likely they were to develop heart failure during follow-up.
The healthy habits included:
keeping a normal weight, not smoking, exercising regularly, drinking moderately, eating breakfast cereals,
and consuming fruits and vegetables. Heart failure risk was 21% with adherence to none of the six, and 10% with adherence
to four or more.
Similarly, a study following some 84,000 female nurses for 14 years revealed that greater
adherence to a number of lifestyle habits was associated with a lower incidence of hypertension. The factors were: BMI under
25, regular exercise, DASH-diet adherence, moderate drinking, infrequent use of nonnarcotic analgesics, and
folic acid supplementation. The difference in incidence between those adhering to all six habits versus those adhering to
none was calculated to be about 8 cases per 1000 person-years.
http://jama.ama-assn.org/cgi/content/short/302/4/394?home
Statins for Primary Prevention of
Cardiovascular Disease
Statin
users were less likely to experience major adverse coronary or cerebrovascular events.
Statins clearly confer substantial benefit in people with established cardiovascular (CV) disease (secondary prevention);
however, the magnitude of benefit in people without CV disease (primary prevention) is less clear. In this meta-analysis of
10 randomized controlled trials that
involved 70,000 patients, investigators assessed the effects of statins in people without CV disease but with CV risk factors.
Participants (mean age, 63; 34% women) were followed for an average of 4.1 years. Compared with participants in
the statin group, significantly more participants in the control group died (5.1% vs. 5.7%; odds ratio, 0.88),
had major adverse coronary events (4.1% vs. 5.4%; OR, 0.70), or had major adverse cerebrovascular events (1.9% vs. 2.3%; OR,
0.81). Also, no significant differences in treatment benefits were noted between men and women, younger and older participants,
and those with and without diabetes. Notably, statin use was not associated with excess risk for cancer.
CONCLUSION: In patients without established cardiovascular disease
but with cardiovascular risk factors, statin use was associated with significantly improved survival and large reductions
in the risk of major cardiovascular events.
http://www.ncbi.nlm.nih.gov/pubmed/19567909?dopt=Abstract
Postprandial
Walking is Better for Lowering the Glycemic Effect of Dinner than Pre-Dinner Exercise in Type 2 Diabetic Individuals
In summary, it appears that 20 minutes
of self-paced mild to moderate intensity walking may be more beneficial for controlling postprandial glycemia in type 2 diabetic
individuals when undertaken shortly after an evening meal rather than immediately beforehand. Postprandial hyperglycemia is
an established cardiovascular risk factor14 and oxidative damage resulting from such glycemic
excursions is a factor in the development of diabetic complications that may be moderated by exercise.15 Accordingly, older diabetic individuals are advised to undertake aerobic exercise after meals, including the evening
one, to blunt the glycemic response resulting from meal consumption and reduce the likelihood of negative health consequences
associated with postprandial glucose excursions.
http://www.jamda.com/article/S1525-8610(09)00111-X/fulltext
Stents Are Ineffective
for Atherosclerotic Renal Artery Stenosis and Renal Insufficiency
Optimum medical treatment and stenting yielded similar results in a randomized trial.
Treating atherosclerotic renal artery stenosis and renal dysfunction by stenting is not supported by conclusive evidence, despite
inclusion of this procedure in some practice guidelines (JW Cardiol Mar 23 2006). European investigators studied stent placement versus medical treatment alone
in a randomized trial that involved 140 people with creatinine clearance <80 mL/minute and estimated atherosclerotic renal artery stenosis of 50% (usually determined by noninvasive imaging). About
half the participants had bilateral stenosis. Of 64 patients assigned to the stent group, 46 actually received stents. (The
most common reason for not receiving a stent was that stenosis was determined to be <50% at the time of the procedure.)
Subjects in both groups were nearly equally likely to have 20% declines in creatinine clearance during 2 years (16% of the stent group and 22% of the medical-treatment group).Serious adverse events occurred only in the stent group: Two patients died due to procedure-related events,
one experienced a groin hematoma infection (requiring groin reconstruction and resulting in death 6 months later), and one
patient required permanent dialysis after repeated angiography and cholesterol embolism.
http://www.ncbi.nlm.nih.gov/pubmed/19414832?dopt=Abstract
Results from Two Previous Colonoscopies Help Identify Patients at Low Risk for Recurrent
Adenomas
Patients with low-risk adenomas on one colonoscopy and no adenomas on a follow-up exam may derive little benefit from intense surveillance,
suggests an Annals of Internal Medicine study.
Researchers
studied some 560 adults who had completed an adenoma chemoprevention trial. All patients had first adenomas removed during a baseline colonoscopy, and
then underwent second and third colonoscopies during roughly 7 years' follow-up.
Among
the findings:
Of patients with advanced or multiple adenomas on both their first and second colonoscopies,
18% had high-risk findings (advanced adenoma, cancer, or multiple adenomas) on their third exam.
Of those with high-risk first exams and no adenomas on the second colonoscopy, 12% had high-risk findings on the
third.
Among patients with low-risk findings (1 or
2 small tubular adenomas) on their first colonoscopy and no adenomas on their second, only 5% had high-risk findings
on their third. The authors conclude that a "10-year follow-up colonoscopy schedule may be appropriate" for this
last group.
http://www.annals.org/cgi/content/abstract/151/2/103
Gastrointestinal
protection in the face of low-dose aspirin
Famotidine Associated with Fewer GI Complications from Low-Dose Aspirin
In patients on low-dose aspirin, famotidine was associated with a lower incidence of gastric andduodenal ulcers and
erosive esophagitis than placebo.
Writing online in Lancet,
researchers describe a double-blind, placebo-controlled, industry-sponsored trial comprising some 400 patients eligible for
antithrombotic low-dose aspirin therapy (75 to 325 mg per day). They were randomized to either twice-daily doses of 20 mg
of famotidine (an H2-receptor antagonist) or placebo. Patients underwent endoscopy at baseline and at 12 weeks. By the 12th
week, patients on famotidine had a significantly lower incidence of gastric and duodenal ulcers, as well as of erosive esophagitis,
than those on placebo.
The authors conclude: "Famotidine might be
a useful alternative for proton-pump inhibitors in patients taking low-dose aspirin." An editorialist generally agrees,
but observes: "Some, but not all, evidence suggests that H. pylori eradication is sufficient to prevent
ulcer bleeding in aspirin users."
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61246-0/abstract
Aspirin or Anticoagulation
to Prevent Stroke in Carotid Dissection?
In a retrospective study, the incidence of stroke was similar between the two treatments.
Spontaneous extracranial internal carotid artery dissection is an uncommon cause of acute ischemic stroke. Treatment
is aimed at prevention of subsequent ischemic stroke, and the choice of treatment is largely empirical and based almost exclusively
on case series. Although anticoagulation with heparin followed by warfarin is the most common treatment, no prospective randomized
trials have compared this regimen to antiplatelet therapy.
In a retrospective
analysis of 298 consecutive adult patients who presented with spontaneous extracranial internal carotid artery dissection
to two hospitals in Switzerland during an 18-year period, investigators compared rates of subsequent ischemic events and hemorrhagic
complications between patients treated with anticoagulation alone (heparin followed by warfarin; 202 patients) and those treated
with aspirin alone (96 patients). Treatment decisions were at the discretion of the treating neurologists. During 3 months of follow-up, no statistically significant differences between the anticoagulant and aspirin groups
occurred in the frequency of ischemic events (5.9% and 2.1%) or the incidence of hemorrhagic complications (2.0% and 1.0%).
CONCLUSIONS: Within the limitations of a nonrandomized study,
our data suggest that frequency of new cerebral and retinal ischemic events in patients with spontaneous dissection of the
cervical carotid artery is low and probably independent of the type of antithrombotic treatment (aspirin or anticoagulants).
http://www.ncbi.nlm.nih.gov/pubmed/19321846?dopt=Abstract
Another
benefit of osteoporosis therapy
This study concludes that osteoporosis treatment is strongly and independently associated with a decreased progression of aortic stenosis.
http://www.ajconline.org/article/S0002-9149(09)00677-8/fulltext
Colonoscopy Beats Ingestible-Capsule Endoscopy in DetectingPolyps and Cancer
An ingestible capsule that can record video from both ends offers greater convenience,
but much less sensitivity, than traditional optical colonoscopy in detecting colonic lesions, according to a New England Journal of Medicine report.
Over 300 patients with known or suspected
colonic disease underwent capsule endoscopy followed by optical colonoscopy. Using traditional colonoscopy as the
standard of comparison, capsule endoscopy had a sensitivity of:
64% for
detecting polyps 6 mm or larger;
73%
for advanced adenomas 6 mm or larger;
74% for cancers.
Sensitivities were higher with more thorough
bowel preparation.
An editorialist observes that the device's low sensitivity for detecting large adenomas
"is cause for concern." In addition, the need for better bowel preparation — and the attendant patient dissatisfaction
— lead him to conclude that "colon capsule endoscopy cannot be recommended at this time."
http://content.nejm.org/cgi/content/short/361/3/264
Sleep-Disordered Breathing and Hypertension
In most cases, hypertension likely results from a complex interplay of various factors.
Sleep-disordered breathing (SDB) — in particular, obstructive
sleep apnea — is associated with hypertension. To determine whether this association is mediated by obesity,
researchers examined data from a multicenter prospective cohort study
of SDB and cardiovascular disease; baseline data from this study were published previously (JW Cardiol Jun 2 2000).
Nearly 2500 people (mean age, 60)
without histories of hypertension or treatment for SDB underwent overnight polysomnography (with calculation of the apnea-hypopnea
index) at baseline. During 5 years of follow-up, about 25% of participants developed hypertension. In a multivariate analysis adjusted for age, sex, and race, a significant "dose–response"
relation was noted between baseline apnea-hypopnea index and development of hypertension. But when the analysis also was adjusted
for body-mass index, the statistically significant relation disappeared. Even the association between the most severe degree
of SDB (apnea-hypopnea index 30) and incident hypertension did not quite
reach significance (odds ratio, 1.5; 95% confidence interval,
0.93–2.47) after adjustment for BMI.
Comment: This study suggests that
much of the association between SDB and hypertension is mediated by obesity. In one previously published longitudinal study in which researchers examined this topic, adjustment for obesity attenuated
— but did not eliminate — this association (JW Gen Med Jun 2 2000). However, the previous study involved much younger subjects (mean age, 47) and
differed from the current one in several other respects. The bottom line: Although SDB occasionally might be the primary cause of hypertension, in most cases, hypertension likely results
from a complex interplay of various factors.
http://www.ncbi.nlm.nih.gov/pubmed/19264976?dopt=Abstract
ACE Inhibitors and ARBs for Preventing Nephropathy and Retinopathy in Type 1 Diabetes
Treatment
did not prevent nephropathy but did prevent development of retinopathy.
Many clinicians
believe that inhibition of the renin–angiotensin system prevents diabetic
nephropathy. Similarly, researchers have hypothesized that such inhibition could prevent diabetic retinopathy. In this international randomized trial, investigators enrolled 285 normotensive patients with type 1 diabetes (mean glycosylated
hemoglobin level, 8.5%; mean diabetes duration, about 11
years) and normal urine albumin levels. Patients received
daily enalapril (an angiotensin-converting–enzyme inhibitor [ACE-I]; 20 mg), losartan (Cozaar, an angiotensin-receptor
blocker [ARB]; 100 mg), or placebo; follow-up was 5 years. The primary endpoints were nephropathy (change in mesangial fractional
volume, as measured by renal biopsy) and retinopathy (progression of 2
steps on a retinopathy scale, as measured by retinal photos).
At 5 years,
the investigators found no significant differences among the groups in the primary renal endpoint or in glomerular filtration rate changes. However, cumulative incidence of microalbuminuria was significantly higher in the losartan group (17%) than in
the enalapril group (4%) or the placebo group (6%). Placebo recipients were significantly more likely to reach the retinopathy
endpoint (38%) than were enalapril recipients (25%) or losartan recipients (21%); the difference remained significant after
controlling for blood pressure.
http://www.ncbi.nlm.nih.gov/pubmed/19571282?dopt=Abstract
Regular aspirin after diagnosis reduces risk of colon cancer death
The regular use of aspirin after a diagnosis of colorectal cancer significantly decreases
the risk of colon cancer–specific death, especially in patients with cyclo-oxygenase-2–positive tumors.
Patients with COX-2–positive tumors who began taking aspirin after their diagnosis were three
times less likely to die from their cancer than were patients with COX-2–negative tumors, for a relative risk reduction
of 61%,
Marital status affects risk of later
cognitive impairment
Marital Status at Midlife May Signal Later Dementia Risk
Living with a partner at midlife is associated with a lower risk for dementia in later life, according to a BMJ study.
Researchers examined a cohort of some 1500 Finns at midlife — at average age 50 — and then again about
20 years later. Baseline measurements included the participants' marital status: married or cohabiting; separated or divorced;
single; and widowed. Marital status was determined again at follow-up.
Participants
with the greatest risk for dementia were carriers of the apolipoprotein E e4 allele who were widowed or divorced
both at midlife and again at follow-up. Also at risk were those living without a partner at midlife.
An editorialist suggests that targeting unmarried — especially widowed — people and encouraging them
"to increase their social engagement" could be easily done in primary care practice.
http://www.ncbi.nlm.nih.gov/pubmed/19264976?dopt=Abstract
Study Questions
Optimal Level of Oral Anticoagulant Therapy
An Archives of Internal Medicine study calls into question the optimal intensity of oral anticoagulation
for patients after myocardial infarction or for those with mechanical heart valveprostheses or atrial
fibrillation.
Researchers prospectively studied some 4200 patients receiving vitamin K antagonists
at a Dutch anticoagulation clinic. During 3 years' follow-up, there were roughly 300 major hemorrhages or thromboemboli.
The lowest incidence of these adverse events occurred at international normalized ratios (INRs) of:
2.5 to 2.9 for patients with heart valve prostheses;
3.0 to
3.4 for those with atrial fibrillation;
3.5 to 3.9
in patients after MI.
The authors say that,
for the prevention of thromboembolism, their data support a target INR of 3.0 for patients with mechanical heart valve prostheses
or afib, and 3.5 for those who've had an MI. They call for research to test these "presumed" optimal intensities.
Conclusion Our study suggests target INRs of 3.0 for patients with mechanical
heart valve prostheses and atrial fibrillation and 3.5 after myocardial infarction as a starting point in
futureclinical trials.
http://archinte.ama-assn.org/cgi/content/short/169/13/1203?home
Do ACE Inhibitors Protect
Against Cognitive Decline?
ACE inhibitors as a class do not appear to
protect against cognitive decline, although those that cross the blood-brain barrier may
offer some benefit, reports Archives of Internal Medicine.
Researchers
studied 1050 older adults without dementia who were taking antihypertensive drugs at baseline. During a median 6 years'
follow-up, dementia was diagnosed in 160 patients.
Overall, 40% of patients
had some exposure to ACE inhibitors. In adjusted analyses, dementia risk did not differ significantly between exposed and
unexposed patients. When examined by ACE inhibitor type, drugs that crossed the blood-brain barrier were associated
with less decline in mental status scores, while those not crossing the blood-brain barrier were associated with greater deficits
in activities of daily living.
The authors say that "a difference in
the brain mechanisms of centrally and noncentrally active ACE inhibitors may account for some of the variable trial results,"
and they call for a randomized clinical trial to confirm their findings.
Conclusions While ACE inhibitors
as a class do not appear to be independently associated with dementia risk or cognitive decline in older hypertensive adults, there may be within-classdifferences in regard to these outcomes.
These results should be confirmed with a randomized clinical trial of a centrally active ACE inhibitor in the prevention of cognitive decline and
dementia
http://archinte.ama-assn.org/cgi/content/short/169/13/1195?home
Coronary Artery
Calcification Screening
Estimated Radiation Dose and Cancer Risk
Results The radiation dose from a single coronary artery calcification computed tomographic
scan varied more than 10-fold (effective dose range, 0.8-10.5 mSv) depending on the protocol. In
general, higher radiation doses were associated with higher x-ray tube current, higher tube potential, spiral
scanning with low pitch, and retrospective gating. The wide dose variation also resulted in
wide variation in estimated radiation-induced cancer risk. Assuming screening every 5 years from the age of 45
to 75 years for men and 55 to 75 years for women, the estimated excess lifetime cancer risk using the median
dose of 2.3 mSv was 42 cases per 100 000 men (range, 14-200 cases) and 62 cases per 100 000
women (range, 21-300 cases).
Conclusions These radiation risk
estimates can be compared with potential benefits from screening, when such estimates are
available. Doses and therefore risks can be minimized by the use of optimized protocols.
http://archinte.ama-assn.org/cgi/content/abstract/169/13/1188?ct
The Easy Way to Guard Against All Cancers
Here’s an easy way to drop your risk of any type of cancer by 10 to 15 percent: Get a move
on.
Research shows that an active lifestyle, one where you not only exercise but also keep your body busy through
as much of the day as possible, can help reduce the risk of several different types of cancer.
Bodies in Motion
In a study involving close to 80,000 Japanese adults, researchers found that the women who were most active were 16 percent
less likely to develop any type of cancer over a period of 5 to 10 years. The most active males dropped their risk by about
13 percent. But it wasn’t just exercise that they marked. Any day-to-day activities counted, including walking to the
store, doing housework, and working on a physically demanding hobby. Find out
how much longer gardeners live.
Sweat Protection
Researchers think exercise may have a beneficial
effect on certain hormones that influence the growth and spread of tumors. In the study, exercise seemed to have the most
impact on colon, liver, and pancreatic cancer risk in men, while a greater amount of activity was particularly protective
against stomach cancer in women. Here are just a few more ways that being active elevates your overall health:
It pumps up your smart machine. Here’s
how working out can increase the size of your brain.
It can send you to cloud nine. Find out
how to achieve an exercise-induced high.
It increases your mileage. Find out
which walking speed adds the most years to your life.
CONCLUSION: Greater daily total physical activity level, either from occupation, daily life,
or leisure time, may be of benefit in preventing premature death.
http://www.ncbi.nlm.nih.gov/pubmed/18504139?dopt=Abstract
