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HHAL MEDICAL NEWS OCTOBER
2012
Fish Rich in Omega-3s Associated with Moderate Reduction in Cerebrovascular
Events Adults who eat several servings of omega-3-rich fish per week may have a reduced risk for cerebrovascular events, according
to a BMJ meta-analysis.
Omega-3 supplementation, however, does not appear to confer the same benefit. Researchers examined data
from 26 prospective cohort studies and 12 randomized controlled trials evaluating the effects of fish consumption and omega-3
fatty acid intake on cerebrovascular risk. Some 794,000 participants and 35,000 cerebrovascular events were included. There were small but significant
reductions in cerebrovascular risk for participants who consumed 2–4 servings and 5 or more servings of fish weekly,
relative to those who consumed less (relative risks: 0.94 and 0.88, respectively). The beneficial effect was limited to omega-3-rich
fish. In contrast, omega-3 supplements showed no significant effect. Findings were similar for participants with
and without preexisting heart disease. The authors conclude: "The beneficial effect of fish intake
on cerebrovascular risk might be mediated through a complex interplay among a wide range of nutrients commonly found in fish."
Smoking Shaves 11 Years Off Women's
Lives Smoking shortens the life expectancy of
women by over a decade, according to a new study in the Lancet. British researchers studied
the smoking habits of nearly 1.2 million women born around 1940, who were recruited around the turn of the millennium. They
were followed for 12 years. At ages 50 to 80 years, women who smoked had triple the annual mortality rate of women
who never smoked. Even women who smoked fewer than 10 cigarettes per day faced a doubling of mortality risk. Smoking throughout adulthood
reduced the life span of women by roughly 11 years. Women who stopped smoking by age 45 avoided about 90% of the excess lung-cancer
and all-cause mortality. Stopping smoking by age 35 avoided about
97% of this risk.
Smoking Cuts Life Span by About a Decade Smoking may cut the average
life span by about 10 years, according to a prospective study inBMJ. Nearly 70,000 residents of Hiroshima and
Nagasaki, Japan, were followed for an average of 23 years. Of the men born between 1920 and 1945 who started smoking by age 20, 72% survived to age 70. Men of the same age who never smoked lived 8 years longer.
Of the women in this age group who started smoking by age 20, 79% survived to age 70. Women who never smoked lived, on average,
10 years longer. People who gave up smoking by age 35 were able to cut most of the excess mortality risk observed in
current smokers.
Lycopene Associated with
Reduced Stroke Risk in Men Patients may ask about a
study in Neurology that
links the antioxidant lycopene — found in tomatoes and some other red fruits and vegetables
— with reduced stroke risk. Researchers tested blood levels of several antioxidants in about 1000 middle-aged men
in Finland. During 12 years' follow-up, 67 strokes occurred. After adjustment for standard stroke risk factors, men in
the highest quartile of serum lycopene had a 55% lower risk for any stroke and a 59% lower risk for ischemic stroke, compared
with men in the lowest quartile. Other measured antioxidants were not associated with stroke risk. S. Andrew Josephson of Journal Watch Neurology, cautions: "The number of strokes in the
study was small, and the lack of longitudinal measurements of serum lycopene limits generalizability. For now, clinicians
should continue to recommend a diverse diet high in fruits and vegetables for general health, but further work is needed to
determine which, if any, specific dietary components have beneficial effects in stroke prevention."
In a Randomized Trial, Multivitamins Lower Cancer RiskBut multivitamins
had no effect on 11-year cancer-specific or overall mortality. A diet rich in vegetables
and fruits is associated with many health benefits, including lower cancer risk, but whether use of vitamin and mineral supplements,
either individually or in a multivitamin, confers similar benefit is unclear. In a large, randomized, placebo-controlled U.S.
trial of 14,641 male physicians (age, 50; mean age,
64) with relatively healthy lifestyles (mean body-mass index, 26 kg/m2; 3.6% current smokers), researchers assessed
the effect of a daily commercial multivitamin (Centrum Silver) on cancer incidence
and mortality. Adherence was roughly 70% throughout the mean follow-up period of 11.2 years. Approximately half of
all 2669 incident cancers during the study were prostate cancer. Total cancer incidence was lower in the multivitamin group
than in the placebo group (17.6% vs. 18.8%; P=0.04). No significant
risk reductions were noted for any specific type of cancer (including prostate), cancer-specific mortality, or all-cause mortality. Multivitamins May Confer a Small, but Significant, Cancer Risk Reduction in Men Middle-aged and older men who take multivitamins have a modestly reduced
risk for cancer, according to an industry-supported study in JAMA. Nearly 15,000 male U.S. physicians
aged 50 and older were randomized to a daily multivitamin or placebo and then followed for roughly 11 years. Multivitamin
recipients had a small but significant reduction in total cancer diagnoses (17.0 vs. 18.3 cancers per 1000 person-years).
There were, however, no reductions in site-specific cancers — including prostate cancer,
the most frequently diagnosed. The authors conclude: "Although the main reason to take multivitamins
is to prevent nutritional deficiency, these data provide support for the potential use of multivitamin supplements in the
prevention of cancer in middle-aged and older men."
Hormone Therapy Soon After Menopause: New Findings Get Attention Patients may want to discuss widely reported findings about hormone therapy for early
menopausal symptoms presented Wednesday evening at a North American Menopause Society meeting. The Kronos Early Estrogen
Prevention Study (KEEPS) randomized some 700 women within 3 years
after menopause to 4 years' treatment with micronized progesterone (Prometrium) plus either oral conjugated equine
estrogens (Premarin, 0.45 mg/day), transdermal estradiol (Climara patch, 50 μg/day), or placebo. "The data showed improvements in cognition, mood, menopausal symptoms, and sexual function in younger women,"
Kronos Longevity Research Institute director S. Mitchell Harman said in a news release. "In addition, some measures showed
slight evidence that hormone therapy might be cardio-protective in this age group,
although results were not definitive and would require additional study." The trials results have not yet been published.
Women who initiate hormone therapy within 5 years of menopause have a lower risk for
Alzheimer disease, according to a Neurology study. Researchers followed some
1800 women aged 65 and older for roughly 7 years. During that time, 10% developed Alzheimer's. Those who reported starting
HT within 5 years of menopause had a 30% lower risk for Alzheimer's than those who did not use HT. Later initiation of
HT was not significantly associated with risk. Editorialists say the findings "support the possibility that young
age or temporal proximity to menopause represents a window during which relatively short-term hormone use might reduce long-term
[Alzheimer's] risk. Yet these new results do not resolve lingering issues of unrecognized confounding and nongeneralizability,
and they do not provide a sufficient foundation for new clinical recommendations."
Incorrect
Weight Shifting Is a Frequent Cause of Falls in the Elderly Improper shifting of weight is the most common cause of falls among elderly residents of long-term care
facilities, according to an observational study in the Lancet. Researchers examined video
footage of the common areas of two long-term care facilities to analyze some 200 falls by residents over 3 years. Roughly 40% of all falls
were caused by incorrect transfer or shifting of body weight (e.g., leaning too far when walking or standing). The next most frequent causes
of falls were tripping or stumbling, loss of support from an external object, being bumped, and collapsing or losing consciousness.
The most common activity at the time of the fall was walking forward, followed by standing quietly, sitting down, and beginning
walking. The authors write: "Our findings emphasize the need to target each of these activities in fall
risk assessment and prevention strategies."
Higher
Calcium Intake Associated with Lower Risk for Hyperparathyroidism Women consuming higher levels of calcium through diet or supplements show a decreased risk for primary hyperparathyroidism,
according to a BMJ study.
An editorialist says the results support encouraging women to take daily calcium supplements, in modest doses. Researchers followed some
58,000 U.S. women — participants in the Nurses' Health Study — over a 22-year period. At the outset, none
had a history of primary hyperparathyroidism. Calcium intake was estimated by regular food-frequency questionnaires, and on
that basis the women were placed into one of five intake levels. During follow-up, 277 women developed primary
hyperparathyroidisim. The adjusted relative risk was 0.56 among those with the highest versus lowest dietary calcium intake.
In women taking more than 500 mg/day of calcium supplements, the risk was 0.41 relative to those not taking supplements, after
adjustment for dietary intake. The authors speculate that calcium intake may influence
the production of parathyroid hormone and, thus, the development of parathyroid adenomas. Aspirin for Prostate Cancer?In
an observational study of men with localized prostate cancer, aspirin use was associated with lower cancer-specific mortality. Recently published data
suggest that daily aspirin use can lower cancer incidence and mortality. In the present study, researchers examined whether
aspirin improved outcomes in 6000 patients with localized prostate cancer who underwent radical prostatectomy or radiotherapy.
The data came from the multicenter CaPSURE study, an observational investigation of men with prostate cancer, about a third of whom used aspirin. During median follow-up of 6 years, 3.2%
of participants died of prostate cancer. Unadjusted 10-year estimated prostate cancer–specific mortality was significantly lower among aspirin users than nonusers
(2% vs. 8%). In multivariable analysis (with adjustment for clinical stage, Gleason score, and treatment modality), cancer-specific
mortality remained significantly lower among aspirin users than among nonusers (hazard ratio, 0.43).
Aspirin Use Linked to Less Cognitive Decline
in Women at High CV Risk Aspirin use is associated
with a lower likelihood of cognitive decline among older women at high cardiovascular risk, according to an observational
study in BMJ Open. Researchers used Swedish
registries to identify some 700 women aged 70 to 92, most of whom had a 10-year CV risk of 10% or higher. Low-dose aspirin
use was assessed at baseline, and psychiatric exams were conducted at baseline and 5 years later. Women who took aspirin had
less cognitive decline then nonusers. However, the risk for dementia did not differ significantly between aspirin users
and nonusers — possibly because of the relatively short follow-up, according to the authors. They write: "Our
finding that ASA use influenced cognitive function may reflect an effect on preclinical dementia, indicating that treatment
must start early to have a sufficient neuroprotective effect."
ACE Inhibitors and ARBs Are Associated with Contrast-Induced Nephropathy In a retrospective study from Korea, patients who used angiotensin-converting–enzyme
inhibitors or angiotensin-receptor blockers exhibited increased serum creatinine after coronary angiography. In Journal
Watch General Medicine, Allan Brett writes: "We don't know when patients took their last preprocedure doses
of ACE inhibitors or ARBs. Nevertheless, the findings hint that perhaps we should hold ACE inhibitors and ARBs (and maybe
diuretics) before elective contrast-requiring procedures in patients who could tolerate being off these medications for a
few days."
As Always, Asymptomatic Bacteriuria Is
Best IgnoredA study in healthy young women confirms that treatment
leads to trouble. Many clinicians treat patients who have asymptomatic
bacteriuria (AB), but studies have confirmed that AB treatment provides no benefit in many groups, including older people, diabetic patients, and those with spinal cord injuries. Similar evidence
now is provided for healthy young women with recurrent urinary tract infections (UTIs). Almost 700 sexually active
premenopausal women with AB who presented to a single Italian clinic were randomized to receive unblinded treatment or to
be followed without treatment. All participants had experienced at least one UTI in the previous year. Those who were treated received oral antibiotics, to which their microbial isolates were confirmed to be sensitive. After 3 months, 3.5% of untreated
women and 8.8% of treated women experienced new symptomatic UTIs. The curves continued to diverge: By 1 year of follow-up,
UTI recurrence rates were dramatically higher in the treated group (by our calculations from the data provided, cumulative
UTI recurrence rates were 24% in the untreated group and 83% in the treated group). Rates of pyelonephritis were similar between
groups. At the beginning of the study, most bacterial isolates were Escherichia coli (39%)
or Enterococcus faecalis (33%).
One year later, urine samples from most recurrence-free patients in the nontreatment group grew E.
faecalis, whereas most samples from the few treated patients who were recurrence free grew E.
coli.
Study ties omega-3 intake to lower inflammation in obese
Daily intake
of omega-3 supplements was associated with reduced expression of inflammatory genes
and higher levels of anti-inflammatory compounds in fat tissues of severely obese participants without diabetes, an Austrian study showed. The results were published in the American Journal of Clinical Nutrition.
4 factors elevate PAD risk in men, study finds
Diabetes, hypertension, high cholesterol levels and smoking were associated
with an increased risk of peripheral artery disease in men, a study in the Journal of the American Medical Association showed.
Men who did not show any of the risk factors were 77% less likely to develop PAD than the other men in the study, researchers
said.
Obstetrics group revises cervical cancer screening guidelines
The American College
of Obstetrics and Gynecology issued new guidelines on cervical cancer screening that encourage women ages 30 and older to get a Pap test, along with a test for human papillomavirus, every five years, instead of every year. Women ages 21 to 29 should be screened every three years, rather than
every two years, the group said. The guidelines were published in the journal Obstetrics & Gynecology.
Vitamin D supplementation doesn't ward off colds in study
Monthly doses
of vitamin D supplements did not significantly reduce the incidence of colds and other respiratory infections, a New Zealand
study found. No difference was seen in disease severity and the duration of colds between the vitamin D group and a placebo
group. The findings appear in the Journal of the American Medical Association. More than 15 million Americans severely obese, data shows
About 6.6%,
or 15.5 million, of U.S. adults were severely obese in 2010, compared with 3.9% in 2000, according to RAND Corp. data published
in the International Journal of Obesity. Data showed the rate of severe obesity -- which is a BMI of 40 or higher, or 100
pounds or more over a healthy weight -- was 50% higher in women than in men and twice as high for blacks as for Hispanics
and whites.
Obese Teens at Increased Risk for End-Stage Renal Disease in Adulthood Overweight and obese teens face increased risk for end-stage renal disease (ESRD) years
later, according to a retrospective cohort study in the Archives of Internal
Medicine. Researchers studied nearly 1.2 million Israelis who underwent medical assessments, including
BMI measurements, at age 17 years. Those with diagnoses suggesting potentially increased risk for ESRD were excluded. During roughly 25 years'
follow-up, 874 participants developed ESRD. In adjusted analyses, those who were overweight at age 17 had three times the
ESRD risk — and those who were obese had nearly seven times the risk — as those who were normal weight. The risk
increase was much higher for diabetic than nondiabetic ESRD, but even the increase in nondiabetic disease was statistically
significant. The authors and a commentator suggest several possible mechanisms for the observed association,
including leptin-related renal fibrosis, elevated plasma renin and aldosterone levels, and underlying focal segmental glomerulosclerosis
in obese individuals. Age and Association of Kidney Measures With Mortality and End-stage Renal Disease
Context Chronic kidney disease (CKD) is prevalent in older individuals, but the risk implications of
low estimated glomerular filtration rate (eGFR) and high albuminuria across the full age range are controversial. Objective To evaluate possible effect modification
(interaction) by age of the association of eGFR and albuminuria with clinical risk, examining both relative and absolute risks. Design, Setting, and Participants
Individual-level meta-analysis including 2 051 244 participants from 33 general population or high-risk (of vascular
disease) cohorts and 13 CKD cohorts from Asia, Australasia, Europe, and North/South America, conducted in 1972-2011 with a
mean follow-up time of 5.8 years (range, 0-31 years). Main Outcome Measures Hazard ratios (HRs) of mortality and
end-stage renal disease (ESRD) according to eGFR and albuminuria were meta-analyzed across age categories after adjusting
for sex, race, cardiovascular disease, diabetes, systolic blood pressure, cholesterol, body mass index, and smoking. Absolute
risks were estimated using HRs and average incidence rates. Results
Mortality (112 325 deaths) and ESRD (8411 events) risks were higher at lower eGFR and higher albuminuria in every age
category. In general and high-risk cohorts, relative mortality risk for reduced eGFR
decreased with increasing age; eg, adjusted HRs at an eGFR of 45 mL/min/1.73 m2vs 80 mL/min/1.73 m2 were
3.50 (95% CI, 2.55-4.81), 2.21 (95% CI, 2.02-2.41), 1.59 (95% CI, 1.42-1.77), and 1.35 (95% CI, 1.23-1.48) in age categories
18-54, 55-64, 65-74, and ≥75 years, respectively (P <.05 for age interaction). Absolute risk differences for the same comparisons
were higher at older age (9.0 [95% CI, 6.0-12.8], 12.2 [95% CI, 10.3-14.3], 13.3 [95% CI, 9.0-18.6], and 27.2 [95% CI, 13.5-45.5]
excess deaths per 1000 person-years, respectively). For increased albuminuria, reduction of relative risk with increasing
age was less evident, while differences in absolute risk were higher in older age categories (7.5 [95% CI, 4.3-11.9], 12.2
[95% CI, 7.9-17.6], 22.7 [95% CI, 15.3-31.6], and 34.3 [95% CI, 19.5-52.4] excess deaths per 1000 person-years, respectively
by age category, at an albumin-creatinine ratio of 300 mg/g vs 10 mg/g). In CKD cohorts, adjusted relative hazards of mortality
did not decrease with age. In all cohorts, ESRD relative risks and absolute risk differences at lower eGFR or higher albuminuria
were comparable across age categories. Conclusions Both low eGFR and high albuminuria were independently associated with mortality and ESRD regardless
of age across a wide range of populations. Mortality showed lower relative risk but higher absolute risk differences at older
age. In summary, our analysis of more than 2 million individuals from 46 cohorts across
the world shows that CKD markers were associated with risk across the full age spectrum. There was no effect modification
for ESRD risk, while relative mortality risk decreased with age. However, absolute mortality risk difference tended to increase
with age. Although some variation in management of CKD should be considered by age based on cost and benefits, with respect
to risk of mortality and ESRD, our data support a common definition and staging of CKD based on eGFR and albuminuria for all
age groups.
A Trial of Sugar-free or Sugar-Sweetened Beverages and Body Weight in ChildrenCONCLUSIONSMasked replacement of sugar-containing beverages with noncaloric beverages reduced weight gain and fat accumulation in normal-weight children. (Funded by the Netherlands Organization for Health Research and Development and others;
DRINK ClinicalTrials.gov number
Beta-Blockers and CAD: Think Treatment, Not PreventionIn a registry study,
the agents did not reduce the risk for events in patients with — or at risk for — stable coronary artery disease. Landmark trials of beta-blockers after myocardial infarction
(MI) have led to the use of these agents in patients with stable coronary artery disease (CAD) and even in high-risk patients without
CAD. To assess the effectiveness of beta-blockers for preventing coronary events in settings other than heart failure or
post-acute MI, investigators used propensity score matching to compare outcomes with and without beta-blocker therapy
in about half of more than 44,000 participants in the REACH registry who had prior MI, CAD without MI, or CAD risk factors
only. Median follow-up was 44 months. In both cohorts with CAD, the risk for cardiovascular death, MI,
or stroke did not differ significantly between beta-blocker recipients and nonrecipients, whereas in the risk factor–only
group, the risk was significantly higher (by 18%) in beta-blocker recipients than in nonrecipients. However, in patients with recent MI ( 1 year), beta-blockers
were associated with a significant reduction in risk for major coronary events, including hospitalization for an atherothrombotic
event or revascularization (odds ratio, 0.77; 95% confidence interval, 0.64–0.92).
ACIP Updates Pneumococcal
Vaccine Recommendations for High-Risk Adults The Advisory Committee on
Immunization Practices has published updated recommendations for pneumococcal vaccination of high-risk adults in MMWR. ACIP now recommends routine
use of the 13-valent pneumococcal conjugate vaccine (PCV13; Prevnar) in addition to the previously recommended 23-valent pneumococcal
polysaccharide vaccine (PPSV23; Pneumovax) for adults aged 19 and older with immunocompromising conditions (such as HIV, cancer,
and renal disease), functional or anatomic asplenia, cerebrospinal fluid leaks, or cochlear implants. Patients who have not previously
received either vaccine should be given one dose of PCV13 followed by one dose of PPSV23 after at least 8 weeks. Patients
who have previously received PPSV23 vaccine should be given one dose of PCV13 at least 1 year after the last PPSV23 dose.
Hypertension and obesity are stronger predictors. Schoen T et al. J
Am Coll Cardiol 2012 Oct 9; 60:1421
Better fitness was associated with lower risk for chronic conditions during the next 26 years. Willis BL et al. Arch Intern Med 2012 Sep 24; 172:1333
Meta-analysis reveals associations between high body-mass index and multiple adverse cardiovascular risk factors. Friedemann C et al. BMJ 2012 Sep 25; 345:e4759 Lanphear BP. Arch Pediatr Adolesc Med 2012
Oct 8;
High sodium intake is associated with elevated risk for high blood pressure, especially in obese and overweight children. Yang Q et al. Pediatrics 2012 Oct 130:611
Supplements did not improve lipid levels, blood pressure, or C-reactive protein levels. Wood AD et al. J
Clin Endocrinol Metab 2012 Oct 97:3557
No benefit of supplementation was noted,
either in incidence or severity of URTIs. Murdoch DR et al. JAMA 2012 Oct 3; 308:1333 Linder JA. JAMA 2012 Oct 3; 308:1375
Adolescents with metabolic syndrome had lower cognitive performance and reductions in brain structural
integrity compared with matched controls. Yau PL et al. Pediatrics 2012 Oct 130:e856
Diabetes remission rate was 62% at 6 years — almost 10-fold higher than in severely obese patients who did
not have bariatric surgery. Adams TD et al. JAMA 2012
Sep 19; 308:1122
Type 2 diabetic patients whose blood pressure was <110/75 had
excess risk for mortality at 3.5 years. Vamos EP et al. BMJ 2012 Aug 30; 345:e5567
Ablation vs. Antiarrhythmic
Drugs for Paroxysmal Afib As an initial treatment,
radiofrequency ablation does not reduce the burden of paroxysmal atrial fibrillation any better than antiarrhythmic
drugs, according to an open-label, partially industry-funded trial in the New
England Journal of Medicine. Roughly 300 patients aged 70 or younger with symptomatic paroxysmal AF were randomized
to either radiofrequency catheter ablation or to class IC or III antiarrhythmic agents. The cumulative burden of
AF over 2 years did not differ significantly between the groups. At the 2-year mark, however, a treatment benefit began to
emerge in the ablation vs. drug group (85% vs. 71% free of AF). One patient in the ablation group died from a procedure-related
stroke; three had cardiac tamponade. The authors say, "Given the risk of complications with ablation, our data support
the current guidelines recommending antiarrhythmic drugs as first-line treatment in most patients with paroxysmal atrial fibrillation."
FDA Investigating 5 Deaths Linked to Monster Energy Drink The FDA has received reports of five people who died after consuming Monster Energy —
a high-caffeine energy drink — in the past 3 years, the New York
Times reports. Other adverse events reported to the agency
include one nonfatal MI, abdominal pain, vomiting, tremors, and abnormal heart rate. It is unclear whether patients who experienced
adverse events also took alcohol or drugs. In a statement, an FDA spokesperson said that it is the manufacturer's
responsibility to investigate adverse events associated with the beverage, according to the Times.
She added that the FDA had not yet established a causal link between the energy drink and the deaths. A 24-oz. can of Monster Energy
contains 240 mg of caffeine, roughly equivalent to two cups of brewed coffee. Syncope Patients with a Normal ECG Are Unlikely to Have Structural Heart Disease In a retrospective chart review of 323 consecutive patients admitted to a single ED observation
unit after a syncopal episode, no patients with normal electrocardiograms had abnormalities on transthoracic echocardiogram. In Journal
Watch Emergency Medicine, Richard D. Zane concludes: "Patients who
present with syncope with a normal ECG and who rule out for acute coronary syndromes do not need an echocardiogram as part
of their evaluation." Risk associated with hypoglycemia outweighs benefits of tight glucose control. The NICE-SUGAR Study Investigators. N Engl J Med 2012 Sep
20; 367:1108
Subclinical
Cardiovascular Disease Is Frequent in Patients with Severe PsoriasisEarly-onset, diffuse arterial atherosclerosis in
coronary and carotid arteries was evident in these patients. Epidemiologic studies suggest
that coronary artery disease and stroke are more prevalent in patients with psoriasis. If this is true, early detection might
be possible. Noninvasive means of assessing coronary artery disease and cerebrovascular disease can predict which patients
might benefit from early intervention. These authors compared 70 patients with severe psoriasis and no known cardiovascular
disease or arthritis with 51 age- and sex-matched controls. They performed high-sensitivity C-reactive protein (hs-CRP) testing,
determined coronary calcification scores by multidetector computed tomography, and assessed carotid atherosclerosis with high-resolution
ultrasound-derived carotid intima–media thickness. Baseline blood pressure, cholesterol, and diabetes measures, and
smoking behavior, did not differ between controls and patients. However, the psoriasis patients had significantly higher body
mass indexes (BMIs) than did controls. The researchers found significantly more coronary calcifications in the psoriasis patients.
Levels of hs-CRP were higher in the patients who had no other identifiable risk factors. Carotid artery thickening was age
related and was not significantly associated with psoriasis.
Both biomarkers slightly improved
prediction when added to a base model, but their comparative clinical value has yet to be determined. The Emerging Risk Factors
Collaboration. N Engl J Med 2012
Oct 4; 367:1310
Legumes Associated with Better Glycemic Control in Type 2 Diabetes A diet rich in legumes improved glycemic control in patients with type 2 diabetes in an Archives of Internal Medicine study. Researchers randomized some
120 diabetic patients to either a low-glycemic-index diet that emphasized legumes (1 cup a day) or a high-fiber diet emphasizing
whole wheat. After 3 months, the mean glycated hemoglobin level fell slightly, albeit significantly, more in the legume group
than in the wheat group (–0.5% vs. –0.3%). The legume group also had greater reductions in weight, total cholesterol,
triglycerides, blood pressure, heart rate, and 10-year coronary heart disease risk. A skeptical commentator says
it's "debatable" whether patients with diabetes can eat the amount of legumes needed to improve glycemic control,
adding: "If legumes do improve glycemia, is it because of their low [glycemic index] or high soluble fiber content?"
NIH Study of Intensive Diet, Exercise in Diabetes Stopped Early A study of an intensive lifestyle intervention to help patients with type 2 diabetes lose weight has
been stopped early because the program, while improving weight loss, did not lower risk for cardiovascular events, according
to a National Institutes of Health news release. Some 5100 overweight or obese diabetic patients were randomized to
an intensive diet and exercise regimen or to general diabetes education. While intervention participants lost more weight
than controls (roughly 5% vs. 1% of initial weight), the difference didn't translate
into a reduction in CV events at 11 years' follow-up. The New
York Times notes that blood pressure, cholesterol, and blood glucose
levels were similar in the two groups, but intervention patients used
fewer medications. "That may be the choice we are highlighting," the study's principal investigator told the Times. "You can take more medications — and more, I should
say, expensive medications — or you can choose a lifestyle intervention and use fewer
drugs and come to the same cardiovascular disease risk." Reciprocal predispositions of parkinsonism and cancer demonstrate a strong association
between these conditions. Kareus SA et al. Arch Neurol 2012 Sep 3;
In older men, the combination of high plasma homocysteine
levels and aspirin use is associated with a lower risk for depression. Almeida OP et al. Transl
Psychiatry 2012 Aug 14; 2:e151
The effect is significant at both very
high and very low thyroid-stimulation hormone levels, but whether corrective treatment improves outcomes is unknown. Gencer B et al. Circulation 2012 Aug 28; 126:1040
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