HHAL MEDICAL NEWS APRIL 2012
The Physical Harm
Caused By Smoking May Be Reduced By Omega-3 Fatty Acids
Omega-3
fatty acids may help to reduce the physical harm caused by smoking, according to a new study presented at the World Congress of Cardiology.
The study, carried out in Greece, assessed the effect of four-week
oral treatment with 2 g/day of omega-3 fatty acids on the arterial wall properties of cigarette
smokers. The results showed that short-term treatment with omega-3 fatty acids improves arterial stiffness and moderates
the acute smoking-induced impairment of vascular elastic properties in smokers.
"These findings suggest that omega-3 fatty acids inhibit the detrimental effects
of smoking on arterial function, which is an independent prognostic marker of cardiovascular risk," said Dr. Gerasimos
Siasos, University of Athens Medical School, 1st Department
of Cardiology, "Hippokration" Hospital. "The cardioprotective effects of omega-3 fatty acids appear to be due
to a synergism between multiple, intricate mechanisms involving anti-inflammatory and anti-atherosclerotic effects. Furthermore,
AHA recommends that people without documented history of coronary heart disease should consume a variety of fish (preferably
oily - rich in omega-3 fatty acids) at least twice per week."
"The World
Heart Federation strongly encourages all smokers to quit," said Dr Kathryn Taubert, Chief Science Officer at the World
Heart Federation. "The only way to protect your body from the harmful effects of tobacco is to stop smoking. We encourage
all people, both smokers and non-smokers, to eat healthy diets, which includes foods
rich in omega-3 fatty acids."
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=244408
At Breakfast, Eating Low Glycemic Index Foods Can Control Blood Sugar Throughout The Day
http://mnt.to/l/45zp
Chronic Stress Linked To Inflammation And Disease
http://mnt.to/l/45wx
Consumers
Of Tree Nuts Likely To Have Lower Body Weight And Lower Prevalence Of Health Risks
http://mnt.to/l/45Gd
Caffeine, Exercise May Cut Skin Cancer Risk
http://mnt.to/l/45xd
Compound Found In Red Wine, Fruit Could Help Block Fat
Cell Formation
http://mnt.to/l/45zq
A Ray Of Sunshine For The Critically Ill: Vitamin D Deficiency Is Associated With Increased Mortality In Intensive Care
Patients
http://mnt.to/l/45xV
Metformin Helps Some Cancer Patients
http://mnt.to/l/45wRCruciferous Vegetables Help Improve
Breast Cancer Survival
Heart Attack - Immediate Glucose Dose Reduced Fatality
http://mnt.to/l/45rk
Coronary CT Angiography Rapidly Rules Out Heart Attack
In Emergency Departments
http://mnt.to/l/45sj
Improving Heart Health With Hot Pepper Compound
http://mnt.to/l/45r5
Moderate Alcohol Consumption Reduces Deaths In Men Who Have Survived A Heart Attack
http://mnt.to/l/45qW
Victoza Superior To Januvia In Blood Sugar And Body Weight Control
http://mnt.to/l/45zF
An Important Role
In Nutrition Played By Beans, Pulses And Legumes
http://mnt.to/l/45zx
Celebrating Cocoa And Chocolate's Potential Health
Benefits
http://mnt.to/l/45s5
Consuming Low-Fat Dairy
Food May Reduce Your Risk Of Stroke
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=244351
High Intake of Some Berries
Linked to Slower Cognitive Decline
Greater
consumption of blueberries and strawberries — both rich in flavonoids — is associated with a slower rate of cognitive
decline in older women, according to an industry-funded analysis from the Nurses' Health Study, published in the Annals of Neurology.
Some
16,000 women completed food-frequency questionnaires regularly beginning in middle age and then underwent cognitive assessments
once they reached age 70 or older. Over 4 years' follow-up, higher intake of strawberries and blueberries was linked to
slower cognitive decline. The strongest association was seen among women who ate at least one serving of blueberries or at
least two servings of strawberries per week. Such intake, the researchers calculated, was associated with a delay in cognitive
aging of up to 2.5 years. Total flavonoid intake was also associated with less decline.
The authors point to "substantial biologic evidence" in support of their findings —
for example, several flavonoids may influence "reductions in neuroinflammation and enhanced neuronal viability."
Annals of Neurology article
High
Doses Of Vitamin C May Lower Blood Pressure
Taking large doses of vitamin C may moderately reduce blood pressure,
according to an analysis of years of research by Johns Hopkins scientists. But the researchers stopped short of suggesting
people load up on supplements.
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=244415
How Much Does
Metformin Lower HbA1c Level?
On
average, by about 1% more than various alternatives.
Hirst JA et al. Diabetes Care 2012 Feb 35:446
Meta-Analysis: Antibiotics Safe and Effective for Uncomplicated Acute
Appendicitis
Antibiotics
are safe and effective for the primary treatment of uncomplicated acute appendicitis, according to a BMJ meta-analysis.
The
analysis included four studies that randomized 900 patients to either appendectomy or to antibiotic therapy with surgery if
needed.
Overall, the antibiotic group showed a 31% reduction in the
risk for complications, such as perforated appendicitis and peritonitis. In addition, there were no differences between the
groups in length of stay, treatment efficacy, or risk for complicated appendicitis. Of 470 patients in the antibiotic group,
40% ultimately underwent appendectomy.
The authors conclude that "initial
antibiotic treatment merits consideration as a primary treatment option for early uncomplicated appendicitis." Asked
to comment, Journal Watch Emergency Medicine editor-in-chief
Ron Walls said: "Until we know which patients might best be treated with antibiotics, the specter of perforation with
long-term complications and the significant number of patients ultimately needing appendectomy within a year argue strongly
in favor of continuing our practice of primary appendectomy."
BMJ article (Free)
Is Losartan as Good as Candesartan for
HF?
A registry
study suggests that it is, although the data contain many gaps.
Svanström H et al. JAMA 2012
Apr 11; 307:1506
High-Dose
Losartan Not Associated with Increased Mortality in Heart Failure Patients
In patients with heart failure, high doses of the angiotensin-receptor
blocker losartan do not increase mortality risk compared with another ARB, candesartan, a JAMA study finds. (A 2011 analysis found greater all-cause mortality with losartan.)
Using national databases, Danish researchers studied roughly 6500 patients who were hospitalized for
heart failure and filled new prescriptions for either losartan or candesartan. During nearly 20,000 person-years of follow-up,
some 2400 patients died.
Overall, there was no significant difference
in all-cause mortality between the two treatments. In addition, when analyzed according to dose, high-dose losartan did not
confer greater mortality risk than high-dose candesartan. Low- and intermediate-dose losartan, however, did raise mortality
risk.
The authors conclude: "These findings do not support
the hypothesis of differential effects of specific ARBs in patients with heart failure."
JAMA article
http://cardiology.jwatch.org/cgi/content/full/2012/411/1?q=topic_hypertension
Total Testosterone
or Free Testosterone?
A study illustrates the
tradeoffs between these two measurements.
In evaluating men with
suspected hypogonadism, some clinicians start by ordering total testosterone (T) levels; others order free or bioavailable
T levels, which presumably identify biochemical hypogonadism more accurately. Many factors (including obesity, drugs, comorbidities,
assay variability, and time of day) affect total T levels.
In
this study, Veterans Administration researchers analyzed data from 3700 men (mean age, 60; nearly half obese) in whom evaluation
for hypogonadism included measurement of both total T and calculated free T levels. About
15% had low free T levels (<34 pg/mL) and thus were considered to have biochemical hypogonadism. Findings about
sensitivity and specificity of total T as an indicator of biochemical hypogonadism were as follows:
·
At a cutoff of 280 ng/dL (this laboratory's lower limit of normal)
total T was 91% sensitive and 74% specific; in other words, 91% of men with
biochemical hypogonadism had total T levels <280 ng/dL, but 26% of men (100% minus the 74% specificity) without biochemical hypogonadism also had total T levels <280 ng/dL, and thus had false-positive
results.
· A cutoff of 150 ng/dL for total
T would lower sensitivity to 59% (and many cases of hypogonadism would be missed) but would improve specificity to 99% (and
false-positives would be uncommon).
· A total T cutoff of 350 ng/dL
would improve sensitivity to 97% but lower specificity to 53%.
Medline abstract
Anawalt BD et al. J
Urol 2012 Apr 187:1369
CT Angiography for Safe Discharge of Patients with Possible
Acute Coronary Syndromes
CONCLUSIONS
A CCTA-based strategy for low-to-intermediate-risk patients presenting with a possible acute coronary syndrome
appears to allow the safe, expedited discharge from the emergency department of many patients who would otherwise be admitted.
(Funded by the Commonwealth of Pennsylvania Department of Health and the American College of Radiology Imaging Network Foundation;
http://www.nejm.org/doi/full/10.1056/NEJMoa1201163?query=TOC
Hypertensive Patients Who Exercise Have Lower Death Risk
According to a presentation at the World Congress of Cardiology,
people with hypertension (high blood pressure) could reduce their risk of dying from cardiovascular
disease (CVD) or all-cause mortality to a level equivalent a reduction of 40~50 mmHg in blood pressure, simply by exercising.
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=244388
What's the Predictive Value of Cholesterol
Fractions Other Than LDL?
In
patients treated with statins, non–HDL cholesterol was the best predictor of CVD risk.
Boekholdt SM et al. JAMA 2012 Mar 28; 307:1302
Does Lowering Cholesterol Reduce Parkinson
Disease Risk?
An analysis of two
large prospective cohorts suggests it might, but cautious interpretation is warranted.
Gao X et al. Arch Neurol 2012
Mar 69:380
Treatment With RAAS Inhibitors Found To Save Lives
In Hypertension Study
Treatment with an ACE inhibitor
for lowering high blood pressure showed a significant mortality reduction in
patients with a high prevalence of hypertension, according to a report
published in the European Heart Journal, the
flagship journal of the European Society of Cardiology.
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=244241
It Is Possible To Get Key Nutrients From Canned
Foods And Save Money At The Same Time
Amid the steady drumbeat from nutrition
experts and others to consume a healthier diet - particularly one rich in fruits
and vegetables - there often is a bias to eat more of the fresh variety for optimal nutrition. But is fresh always best? Not
necessarily.
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=244444
Alzheimer
Disease and Cancer: An Inverse Relation?
Framingham data support
this biologically plausible phenomenon.
Some evidence suggests that people with Alzheimer disease
(AD) have diminished risk for cancer and that cancer survivors have diminished risk for AD. To assess those possibilities,
researchers analyzed data from 1278 Framingham Heart Study participants (age 65; 61% women) without
AD at baseline; 14% were cancer survivors. Mean follow-up was 10 years.
Analyses were
adjusted for variables such as age, sex, and smoking status. When the reference group consisted of participants without cancer
at baseline, risk for incident probable AD was significantly lower among survivors of any cancer (hazard ratio, 0.67) and
survivors of smoking-related cancers (HR, 0.26), and nonsignificantly lower among survivors of non–smoking-related cancers
(HR, 0.82). Participants who developed probable AD during follow-up had significantly lower risks for subsequent development
of any cancer (HR, 0.29), smoking-related cancers (HR, 0.21), and non–smoking-related cancers (HR, 0.31) than patients
who did not develop AD.
Driver JA et al. BMJ 2012 Mar 12; 344:e1442
Vitamin D and Calcium Supplementation in
Older Adults
A randomized trial
found no effect on cancer or vascular mortality.
Avenell
A et al. J Clin Endocrinol Metab 2012
Feb 97:614
Screening ECG Abnormalities
Portend Adverse Cardiac Events in Older Adults
But cost-benefit
analysis is required before routine screening can be recommended.
Traditional risk factors
are less accurate for predicting coronary heart disease (CHD) in older adults than in middle-aged adults. Resting electrocardiography
(ECG) is not recommended for screening asymptomatic adults, but may be useful in older adults given their higher prevalence
of CHD.
A population-based sample of 2200 adults (mean age at entry, 74; 55% women; 59% white)
without known CHD was assessed with resting ECG. About 23% had major ECG abnormalities at baseline (e.g., Q-wave abnormalities,
left ventricular hypertrophy, atrial fibrillation or flutter, major ST–T wave anomalies). An additional 13% had minor
ST–T wave changes. During a median follow-up of 8 years, 351 incident CHD events occurred (96 CHD deaths, 101 acute
myocardial infarctions, and 154 hospitalizations for angina or revascularization). In analyses adjusted for traditional cardiac
risk factors, risk among participants with minor and major ECG abnormalities compared to those without abnormalities was increased
by 35% and 51%, respectively.
Auer R et al. JAMA 2012 Apr 11; 307:1497
Greenland P. JAMA 2012
Apr 11; 307:1530
Physical Activity in Advanced Age Associated with Lower Alzheimer's Risk
Daily
physical activity is associated with reduced risk for Alzheimer
disease among the elderly, according to a Neurology study.
Roughly 700
adults (average age, 82) free of dementia wore actigraphs on their wrists 24 hours a day for up to 10 days to measure their
daily physical activity. Over a mean 3.5 years' follow-up, 10% were diagnosed with Alzheimer disease.
Participants in the lowest decile of physical activity had more than twice the Alzheimer's risk
as those in the highest decile. The results remained significant after adjustment for self-reported physical, social, and
cognitive activities. More physical activity on actigraphy was also associated with less cognitive decline.
Editorialists conclude: "In a world that is becoming progressively sedentary, and in the context
of very limited success of the currently available medications to treat or delay AD, physical activity provides a promising,
low-cost, easily accessible, and side-effect-free means to prevent AD."
Neurology article
Neurology editorial Journal Watch Neurology coverage of physical activity and cognition in patients with vascular
condtions
Fewer Americans Have High Cholesterol
The percentage of American adults
with high cholesterol declined by 27% from 1999 to 2010, according to new NHANES data reported by the CDC. In 2010, some 13% of American adults had high total cholesterol; in 1999 the proportion was 18%. The
report did not assess whether people were taking cholesterol-lowering medication.
Among the other findings:
·
In the 40-to-59 age group, the prevalence of high total cholesterol dropped only among men; the prevalence
among women stayed flat, at around 19%.
·
Roughly 31% of men had low HDL cholesterol,
compared with 12% of women.
· Approximately
68% of adults had their cholesterol checked in the past 5 years. Only half of Hispanic men reported being screened.
National Center for Health Statistics data brief
BMI falls short on
estimating obesity
Data on more than 1,300 participants who underwent dual-energy X-ray absorptiometry scans showed 48% of
women who were previously not classified as obese using body mass index alone were classified as obese by the percent of body
fat on DEXA, suggesting that BMI measurement underestimates actual obesity rates in women.
The findings appear in PLoS ONE.HealthDay News
Cardiorespiratory
fitness and metabolic risk
It appears likely that enrichment of cardiovascular risk factors, especially metabolic risk factors,
accounts for a portion of the increased cardiovascular mortality in low-fitness subjects. Mechanisms responsible for this
enrichment in subjects with a low CRF represent a challenge for future research. The American Journal of Cardiology
Clopidogrel plus aspirin
for patients with atrial fibrillation
This study found that clopidogrel
plus aspirin appears cost-effective compared with aspirin alone for stroke prevention in patients with atrial fibrillation
with at least a CHADS2 of 2 and a lower-risk of bleeding. The American Journal of Cardiology
Preventing asthma: Which interventions
work?
Asthma causes 4,000 deaths each year and has become increasingly prevalent in the U.S., particularly among
children and certain minority groups. By assessing existing systematic reviews of asthma-related interventions, authors report
the two types of interventions that had evidence of effectiveness, and as a result, should be implemented by state or community
asthma control programsAmerican Journal of Preventive
Medicine
Study: Low adiponectin
level increases asthma risk in women
An analysis of data from the Coronary Artery Risk Development in Young Adults study found that middle-aged
women with low blood adiponectin levels had a twofold higher risk of developing asthma. The risk was particularly high among
those who smoked. The findings appeared online in the American Journal of Respiratory and Critical Care Medicine.PhysiciansBriefing.com/HealthDay
News
In Alzheimer Disease,
Antioxidants Hurt
Antioxidants do not improve
AD biomarkers and adversely affect cognition.
Galasko DR et al. Arch Neurol 2012 Mar 19;
The Higher the
Body-Mass Index, the Higher the Risk for Adenoma
A 5-unit increase in BMI
was associated with a 19% increased risk for colorectal adenoma.
Obesity is considered
a risk factor for colon cancer and adenomas. However, study results have been mixed on the magnitude of risk and whether it
is limited to men. Now, researchers have conducted a meta-analysis to clarify the link between body-mass index (BMI) and colorectal
adenoma.
Investigators identified 36 studies (16 case-control, 13 cross-sectional, and 7 cohort
or nested case-control) appropriate for the meta-analysis. A 5-unit increase in body-mass index (BMI) was associated with
a 19% increased risk for colorectal adenoma regardless of patient sex, study region (U.S., Europe, or Asia), or adjustment
for physical activity, smoking, caloric intake, alcohol use, and nonsteroidal anti-inflammatory drug use in a subset of studies.
In a meta-analysis based on BMI categories, obese patients (BMI 30) but not
overweight patients (BMI 25 and <30) had an increased risk for colorectal
adenoma compared with patients with normal BMI (<25). A subanalysis of 11 studies found that increased BMI was associated
with increased risk for colon adenoma but not rectal adenoma.
Ben Q
et al. Gastroenterology 2012
Apr 142:762
Dietary Fiber
and Diverticulosis
Study findings challenge
the common view that fiber intake protects against diverticulosis.
Peery
AF et al. Gastroenterology 2012
Feb 142:266
Exercise reduces sleep apnea
Exercise is associated with a reduced incidence of mild and moderate sleep-disordered breathing, and
decreasing exercise is associated with worsening of sleep-disordered breathing. The effect of exercise on sleep-disordered
breathing appears to be largely, but perhaps not entirely, mediated by changes in body habitus. The American Journal of Medicine
Sleep Apnea — Another Risk Factor
for the Development of Psoriasis?
Despite the finding of a
significant relationship, the magnitude of risk was low and some questions remain.
Yang
Y-W et al. Sleep Med 2012
Mar 13:285
Sleep apnea: Risk of
deep vein thrombosis
Sleep apnea may be an independent risk
factor for deep vein thrombosis (DVT). The American Journal of Medicine
Metformin Plus Insulin vs. Insulin Alone in Patients with Type 2 Diabetes
Combination therapy led to lower
insulin doses and better glycemic control.
Many
patients with type 2 diabetes who are treated with metformin eventually require insulin. Although metformin often is continued
in such patients, whether combining the drugs yields any benefit is unclear. In this meta-analysis of 23 randomized trials
that involved more than 2100 participants (trial durations, 3–24 months), investigators compared metformin plus insulin
with insulin alone.
Patients randomized to metformin
plus insulin required less insulin (mean difference, –19 units/day), experienced better glycemic control (mean glycosylated
hemoglobin [HbA1c] difference, –0.6%) and weighed less (mean difference, –1.7 kg) than did patients
randomized to insulin alone. Hypoglycemia was more common in the metformin-plus-insulin group. All-cause and cardiovascular-related
mortality, microvascular and macrovascular outcomes, and quality of life did not differ between the groups.
http://www.ncbi.nlm.nih.gov/pubmed/22517929?dopt=Abstract
FDA Approves New Erectile Dysfunction Drug
The FDA has approved
avanafil (brand name, Stendra), a new phosphodiesterase type 5 (PDE5) inhibitor, for the treatment of erectile dysfunction.
The as-needed pill might have a faster onset of action than other PDE5 inhibitors, according to the manufacturer.
Approval was based on three double-blind trials comprising nearly
1300 men. Patients who were randomly assigned to take avanafil 30 minutes before sexual activity reported significant improvement
in sexual function compared with those given placebo.
Back pain, flushing, headache, and nasal congestion were the common side effects seen in the studies. Like other
PDE5 inhibitors, avanafil should not be given to patients taking nitrates due to concern over sudden drop in blood pressure.
FDA news release (Free)
Treatment Failure Common for Kids with Type 2 Diabetes
Children and adolescents with type 2 diabetes experience better glycemic
control when taking metformin plus rosiglitazone than metformin monotherapy, but treatment failure is still common, according
to a New England Journal of Medicine study.
Researchers randomized some 700 patients (ages 10 to 17) with newly diagnosed type 2 diabetes to metformin
alone, metformin with intensive lifestyle change, or metformin with rosiglitazone.
After
an average follow-up of 3.8 years, the rates of treatment failure (i.e., persistently elevated glycated hemoglobin over 6
months) were 52% with metformin alone, 47% with lifestyle intervention-metformin, and 39% with rosiglitazone-metformin.
The authors conclude: "These results suggest that a majority of youth with type 2 diabetes may
require combination treatment or insulin therapy within a few years after diagnosis."
NEJM article (Free)
Once-Weekly
Exenatide: An 84-Week Study
This agent was associated with less hypoglycemia and weight gain than was insulin glargine.
Diamant
M et al. Diabetes Care 2012
Apr 35:683
The Incremental
Relation Between Fasting Glucose and Glycosylated Hemoglobin
The relation is affected,
in part, by the degree of fasting hyperglycemia and use of oral antidiabetes drugs.
Ramachandran
A et al. Diabetes Care 2012
Apr 35:749
Focal therapy for prostate cancer
Focal therapy of individual prostate cancer lesions, whether multifocal or unifocal, leads to a low rate
of genitourinary side-effects and an encouraging rate of early absence of clinically significant prostate cancer. The Lancet Oncology
Uric
acid level to predict mortality
This study concluded that elevated level of uric acid is an independent predictor of one-year mortality
across the whole spectrum of patients with acute coronary syndrome treated with percutaneous coronary intervention. The American Journal of Cardiology
A1c for diabetes diagnosis
in adolescents
Recommendations for the use of Hemoglobin A1c for the diagnosis of pre-diabetes and diabetes is based
only on adult data and may lead to a significant underestimate of the prevalence of these conditions in the pediatric and
adolescent populations. (Full-text access is time-limited.)Journal of Adolescent Health
Nicotine patch helps
with smoking cessation setbacks
A study in the journal Addiction found that nicotine patches not only help people stop smoking but
also can improve their chances of recovering from occasional relapses while trying to quit the habit. The findings suggest
that people who relapse should continue wearing nicotine patches, rather than stopping use because of the mistaken belief
that simultaneous use of nicotine patches and smoking poses a health risk, one of the researchers said. Reuters
Using Low-Dose CT to Diagnose Appendicitis in Young Adults
Use of low-dose computed tomography in the evaluation of
suspected appendicitis is noninferior to standard-dose CT, according to a New
England Journal of Medicine study.
Researchers in South Korea randomized some 900 patients aged 15 to 44 suspected of having appendicitis
to either standard-dose (aiming for 8 mSv) or low-dose (2 mSv) CT as a first-line imaging test. The primary outcome —
the rate of negative (unnecessary) appendectomies — was 3.5% in the low-dose group and 3.2% with standard-dose CT, thus
showing the noninferiority of the low-dose approach. Burst-appendix rates were also similar between groups.
In Journal Watch Emergency Medicine, Dr. J.
Stephen Bohan writes that low-dose CT scan is a "reasonable alternative to standard-dose CT scan for normal-weight patients
with suspected appendicitis. However, patients with normal habitus also are good candidates for ultrasound evaluation, which
involves no radiation exposure."
NEJM article
What's the Incidence
of Venous Thromboembolism After Knee Arthroscopy?
Incidence was 0.40% in this large cohort study.
A million arthroscopic knee procedures are performed annually in the U.S., according to the CDC; pharmacologic prophylaxis to prevent venous
thromboembolism (VTE) is not administered routinely after this procedure. In a retrospective study from California's Kaiser
Permanente health system, researchers calculated the incidence of symptomatic VTE after 21,000 recent elective knee arthroscopies.
Patients with histories of VTE and patients who received prophylaxis were excluded; only 2% of patients met these exclusion
criteria.
The 90-day incidence of symptomatic VTE was 0.40%, with cases
divided roughly evenly between proximal deep venous thrombosis only and pulmonary embolism; only a few cases involved isolated
calf-vein thromboses. VTE risk was above average in people 50 or older (odds ratio, 1.5) and in women who had been prescribed
oral contraceptives recently (OR, 2.2).
Medline abstract
Neurology Group Updates Guidelines on Migraine Prevention
The American Academy of Neurology and the American Headache Society have released updated guidelines on migraine
prevention in Neurology.
Among the
recommendations for prescription pharmacologic agents:
·
Most antiepileptic drugs (divalproex sodium, topiramate, sodium valproate), certain beta-blockers
(metoprolol, propranolol, timolol), and one triptan (frovatriptan) are effective and should be offered to patients.
·
Certain antidepressants (amitriptyline, venlafaxine), other beta-blockers (atenolol, nadolol), and
other triptans (naratriptan, zolmitriptan) are probably effective and should be considered.
·
Lamotrigine is not effective and should not be given.
Among the guidance on NSAIDs and complementary therapies:
·
Petasites (butterbur) is effective and should be offered.
·
Several NSAIDs (fenoprofen, ibuprofen, ketoprofen, naproxen), riboflavin, magnesium, feverfew, and
histamine SC are probably effective and should be considered.
· Montelukast
is probably ineffective and should not be considered.
Neurology article on pharmacologic treatment
Neurology article on NSAIDs and complementary treatments
American Lung Association Recommends
CT Screening for Lung Cancer in High-Risk Patients
The American Lung Association is now recommending that high-risk smokers receive low-dose CT scans
to screen for lung cancer. The ALA's interim guidelines follow publication of results from the National Lung Screening
Trial (NLST), which found reduced lung cancer mortality among patients randomized to low-dose CT screening, compared with
those given chest x-rays.
The ALA recommends low-dose CT screening
for patients meeting the following four NLST criteria:
·
Current or former smokers
·
Age 55 to 74
· Smoking
history of at least 30 pack-years
· No history
of lung cancer
The general population should not be screened for lung cancer with
low-dose CT scans, and chest x-rays are not recommended for lung cancer screening.
American Lung Association guidelines
Frequently asked questions for physicians
Journal Watch General Medicine summary of
NLST study
Meta-Analysis:
Subclinical Hyperthyroidism Raises Total Mortality, CHD Risks
Subclinical hyperthyroidism carries higher overall mortality and cardiovascular risks,
a meta-analysis using patient-level data shows.
The study, published
by the Archives of Internal Medicine, was designed to resolve conflicting
results from earlier meta-analyses, which didn't use patient-level data. This analysis encompassed 10 prospective cohorts
with data on over 50,000 people. Compared with euthyroid subjects, those with subclinical hyperthyroidism (defined as thyrotropin
levels under 0.45 mIU/L with normal free thyroxine levels) showed higher hazard ratios for total mortality, coronary heart
disease mortality, and incident atrial fibrillation. Risks for CHD mortality and atrial fibrillation were even higher at thyrotropin
levels below 0.10.
The authors say their results support the advice of recent
guidelines to treat subclinical hyperthyroidism. An editorialist recommends considering treatment "especially in elderly
patients with cardiac risks, hyperthyroid symptoms, or osteoporosis."
Archives of Internal Medicine article
American Thyroid Association guidelines on managing
hyperthyroidism
Long-Term Outcome of Open vs. Endovascular
Repair of Abdominal Aortic Aneurysm
In older adults, AAA-specific
and all-cause mortality were lower with endovascular repair.
Jackson
RS et al. JAMA 2012
Apr 18; 307:1621
B Vitamin and/or -3 Fatty
Acid Supplementation and Cancer
Ancillary Findings From the Supplementation With Folate, Vitamins B6 and B12, and/or Omega-3 Fatty Acids (SU.FOL.OM3) Randomized Trial
Valentina A. Andreeva, PhD; Mathilde Touvier, PhD; Emmanuelle Kesse-Guyot, PhD; Chantal
Julia, MD; Pilar Galan, MD; Serge
Hercberg, MD
Arch Intern Med. 2012;172(7):540-547. doi:10.1001/archinternmed.2011.1450
Background To advance knowledge about the cancer-chemopreventive potential
of individual nutrients, we investigated the effects of B vitamin and/or -3 fatty acid supplements
on cancer outcomes among survivors of cardiovascular disease.
Methods This was an ancillary study of the Supplementation With Folate, Vitamins B6 and B12 and/or Omega-3
Fatty Acids (SU.FOL.OM3) secondary prevention trial (2003-2009). In all, 2501 individuals aged 45 to 80 years were randomized
in a 2 x 2 factorial design to one of the following 4 daily supplementation groups: (1) 5-methyltetrahydrofolate
(0.56 mg), pyridoxine hydrochloride (vitamin B6; 3 mg) and cyanocobalamin (vitamin B12; 0.02 mg); (2)
eicosapentaenoic and docosahexaenoic acid (600 mg) in a 2:1 ratio; (3) B vitamins and -3 fatty acids; or
(4) placebo. Overall and sex-specific hazard ratios (HRs) and 95% CIs regarding the cancer outcomes were estimated with Cox
proportional hazards models.
Results After 5 years of supplementation, incident cancer was validated in 7.0% of the sample (145 events in men and 29 in
women), and death from cancer occurred in 2.3% of the sample. There was no association between cancer outcomes and supplementation with B vitamins (HR, 1.15 [95%
CI, 0.85-1.55]) and/or -3 fatty acids (HR, 1.17 [95% CI, 0.87-1.58]). There
was a statistically significant interaction of treatment by sex, with no effect of treatment on cancer risk among men and
increased cancer risk among women for -3 fatty acid supplementation (HR, 3.02
[95% CI, 1.33-6.89]).
Conclusion We found no beneficial effects of supplementation
with relatively low doses of B vitamins and/or -3 fatty acids on cancer outcomes in individuals
with prior cardiovascular disease.
TMP-SMX–Associated
Renal Toxicity
Acute kidney injury occurred in 11% of TMP-SMX recipients but nearly
always resolved after drug discontinuation.
Fraser
TN et al. J Antimicrob Chemother 2012
Feb 20;
New Fibrate Use Linked to Acute Renal Outcomes in the Elderly
Elderly patients starting therapy with a fibrate face increased
risk for hospitalization for elevated serum creatinine during the first few months of treatment, according to an Annals of Internal Medicine study.
Using Canadian databases, researchers compared outcomes among some 19,000 adults aged 66 and older
who filled new prescriptions for fibrates and nearly 62,000 older adults who filled new prescriptions for ezetimibe. They
found that fibrate users were more than twice as likely as ezetimibe users to be hospitalized for increased serum creatinine
levels within the first 90 days of treatment. There was also a trend toward more nephrologist consultations in the fibrate
group. Patients with chronic kidney disease had the greatest risks.
The
authors conclude that until the mechansim underlying fibrates' effects on creatinine is better understood, "when
fibrates are prescribed to elderly patients, it would be prudent to start the prescription at a low dosage and arrange for
close monitoring of renal function."
Annals of Internal Medicine article
Fluoroquinolone Use Linked to Retinal Detachment
Patients taking oral fluoroquinolones are at increased risk for retinal detachment,
according to a case-control study in JAMA.
Using Canadian healthcare databases, researchers examined the records of patients who visited an ophthalmologist
over 7 years. Of these patients, 4400 who were treated for retinal detachment were matched to 44,000 controls. Those with
retinal detachment were more likely to be currently using fluoroquinolones than were controls (3.3% vs. 0.6%; adjusted rate
ratio, 4.50). The mean time from a fluoroquinolone prescription being filled to retinal detachment was 5 days.
The authors speculate that the antibiotics may damage the vitreous and vitreous cortex; previous studies
have shown that fluoroquinolones can break down collagen and connective tissue.
The
authors say that although the absolute risk is low, fluoroquinolones could account for an estimated 1400 cases of retinal
detachment annually in the U.S.
JAMA article
Bisphosphonate Use Associated with Inflammatory Eye Diseases
First-time use of oral bisphosphonates is associated with greater risk for uveitis and
scleritis, according to a retrospective cohort study in the CMAJ.
Researchers assessed the health records of all patients who visited an ophthalmologist over 7 years.
Nearly 11,000 filled their first prescription for oral bisphosphonates, while 920,000 did not have any recorded bisphosphonate
use.
Bisphosphonate users had increased risks for uveitis (adjusted
relative risk, 1.45) and scleritis (adjusted RR, 1.51), relative to nonusers. The authors estimate numbers needed to harm
of 1100 for uveitis and 370 for scleritis.
They propose that patients
may experience a surge of inflammatory mediators when they begin taking bisphosphonates, which may put them at greater risk
for inflammatory eye diseases. They conclude that clinicians should "inform their patients about the signs and symptoms
of scleritis and uveitis, so that prompt treatment may be sought and further complications averted."
CMAJ article
New Warnings Added to Aliskiren-Containing Medications
The antihypertensive drug aliskiren should not be coadministered with angiotensin-converting-enzyme
(ACE) inhibitors or angiotensin-receptor blockers (ARBs) in patients with diabetes because doing so may raise risks for renal impairment, hypotension, and hyperkalemia, the FDA announced Friday. The labels of all aliskiren-containing
medications will be updated to note this contraindication.
In addition, the new labels will warn against using aliskiren with ACE inhibitors or ARBs in patients
with moderate-to-severe renal impairment.
These changes
follow preliminary results from the placebo-controlled ALTITUDE trial, in which coadministration of the drugs was associated
with increased risks for renal impairment, hypotension, and hyperkalemia. Data also suggest "a slight excess of cardiovascular
events" with aliskiren, according to the FDA.
The following brand-name drugs contain aliskiren:
· Amturnide
·
Tekturna
· Tekturna
HCT
·
Tekamlo
· Valturna
FDA MedWatch safety alert
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