HHAL MEDICAL NEWS SEPTEMBER 2011
Adequate folate intake is tied to lower risk of colorectal cancer
A National Cancer Institute study found people who consumed at least 900 micrograms
of folate daily were 30% less likely to develop colorectal cancer than those whose intake was less than 200 micrograms. The
study in the American Journal of Clinical Nutrition also did not find evidence that very high sustained levels of folate were
linked to increases in cancer rates.Reuters
Rosuvastatin Fails
to Outperform Atorvastatin in High-Risk Patients
Rosuvastatin (Crestor) is not significantly better than
atorvastatin (Lipitor) in slowing the progression of atherosclerosis, according to results from the SATURN trial.
The 2-year trial, conducted by rosuvastatin's manufacturer, included some 1300 patients
with coronary artery disease randomized to daily rosuvastatin (40 mg) or atorvastatin (80 mg). The study's primary endpoint
— change in atheroma volume on intravascular ultrasound — did not differ significantly between the groups, the
manufacturer said in a press release, although the absolute numbers favored rosuvastatin.
The findings come
in anticipation of generic atorvastatin hitting the market in November, the Wall Street Journal reports.
Wall Street Journal story
Chocolate
Consumption Is Associated with Reduced Risk for Adverse CV Outcomes
People who ate chocolate more than five times a week had lower risks for any cardiovascular disease and stroke.
Cocoa products contain polyphenols, which have salutary cardiovascular (CV) effects. In this
systematic review and meta-analysis, investigators evaluated whether an association exists between chocolate consumption and
CV outcomes.
Seven observational studies involving 114,000
adults (age range, 25–93; follow-up range, 8–16 years) were included in the analysis. After adjustment for various
potential confounding variables, high chocolate consumption (i.e., >5 times weekly) was associated with a significantly
reduced risk for any CV disease (relative risk, 0.63) and stroke (RR, 0.71) compared with low chocolate consumption (i.e.,
none). High chocolate consumption was not associated with reduced risk for heart failure.
Medline abstract (Free)
Increased Coffee Consumption Linked to
Lower Depression Risk in Women
The more caffeinated coffee women drink, the less likely they are
to develop depression, according to a prospective study in the Archives of Internal Medicine.
Some 50,000 Nurses' Health Study participants without depressive symptoms at baseline were followed for roughly
10 years. During that time, about 5% reported physician-diagnosed depression.
Overall,
as self-reported caffeinated coffee consumption increased, the risk for depression decreased. In particular, compared with
women who drank 1 cup or less a week, those drinking 2 to 3 cups a day had a 15% lower relative
risk for depression, and those drinking 4 or more cups a day had a 20% lower risk. No link was seen between other sources
of caffeine and depression, or between decaffeinated coffee and depression.
An editorialist
says that the while these and other data may provide reassurance that coffee drinking has "no glaringly deleterious health
consequences ... it seems premature to recommend coffee consumption."
Archives
of Internal Medicine article (Free abstract)
Coffee Lowers Depression Risk In Older
Females
The more coffee an older woman drinks the
lower her risk of depression is, researchers from the Harvard School of Public Health reported in Archives of Internal Medicine.
The researchers stressed that theirs was an observational study, and can only suggest the possibility of coffee's protective
effect, rather that prove that it reduces depression risk.
The authors explained that about 80% of caffeine consumption worldwide is in the form of coffee - it is the most commonly
used CNS (central nervous system) stimulant.
Previous studies have looked at associations between coffee drinking and depression risk - one prospective study among
young adult males suggested coffee consumption might be linked to depression risk. Depression is often a long-term (chronic)
condition that has a tendency to come back, it affects twice as many females as males. Experts say that about 1 in every 5
women in the United States will suffer from depression at some point in their lives.
The authors wrote that:
"(the) identification of risk factors for depression among women and the development of new preventive
strategies are, therefore, a public health priority."
Michel Lucas, Ph.D., R.D. and team set out to determine whether the
consumption of coffee or some drinks containing caffeine might be linked to depression risk.
They gathered data on 50,737 women, average age 63 years; none of
them had depression when the study began. They had all participated in the Nurses' Health Study. They were prospectively
followed up until June 2006. Questionnaires had asked them what their caffeine consumption was from 1980 to 2004. The researchers
had data on how often they consumed caffeinated and non-caffeinated coffee, nonherbal tea, caffeinated sodas (sugared or low
calorie), all types of caffeine-free soft drinks, and chocolate during a twelve month period before filling in each questionnaire.
In this study, depression was defined as having a diagnosis
of clinical depression and being prescribed regular antidepressants during the previous two years.
They analyzed the cumulative consumption over a period and then looked
at a two-year latency period. For example, caffeine consumption data from 1980 through 1994 were used to predict clinical
depression rates from 1996 through 1998.
They identified 2,607 new diagnoses of depression during the 10-year follow up period 1996-2006.
Below are some highlighted data from their findings:
Women who consumed two to three cups of caffeinated coffee per day were 15% less likely to develop depression
compared to those who drank a maximum of one cup of caffeinated coffee per week
Women
who drank at least 4 cups per day had a 20% lower risk than the maximum 1 cup per week females
Those who consumed at least 550mg per day of caffeine had a 20% lower risk of developing depression compared to the
women whose daily consumption was 100mg or less per day
The consumption of decaffeinated coffee
had no impact on depression risk
http://mnt.to/l/3ZTc
Progression Of Clogged Arteries Reduced By Soy Proetein In Women Within 5 Years Of Menopause
A
new study published in the November 2011 issue of Stroke reveals some promising data on the positive effects of soy protein
reducing the progression of clogged arteries in women who were within five years of menopause. This study was the largest
and longest randomized controlled human study conducted to-date that directly investigated the efficacy of isolated soy protein
consumption on the progression of atherosclerosis (lipid deposition in the artery walls).
"These results are consistent with what we have learned through
research conducted over the past decade," said Howard N. Hodis, MD, USC Keck School of Medicine and lead author of the
study. "The literature demonstrates that there is a 'window of opportunity' of a potential beneficial effect
on coronary heart disease for products that bind to the estrogen receptor including hormone-replacement therapy, soybean isoflavones
or selective estrogen receptor modulators (SERMs) when initiated in women within 5-6 years of menopause."
The progression rate of carotid artery intima-media thickness
(CIMT) trended to be 16 percent lower on average in the isoflavone-containing soy protein group compared with the placebo
group. However, in women who had experienced menopause within the past five years, isolated soy protein consumption was associated
with a significant 68 percent reduction in CIMT progression compared to those consuming the placebo.
Excellent compliance was observed for this study as determined
by package and bar count (86.5 percent for placebo and 91.0 percent for isolated soy protein). Compliance was confirmed by
plasma and urine isoflavone measurements.
"The high compliance suggests that the clinical study products provided by Solae were very palatable and were not
associated with any significant adverse effects as confirmed by the data," said Elaine Krul, PhD, nutrition discovery
lead, Solae.
Subjects in this study were 'healthy'
with no previous signs of cardiovascular disease which may explain the lack of significant reduction in plasma lipids that
is seen in persons with higher plasma lipid levels.
"This study also showed a significant increase in HDL ("the good") cholesterol in participants consuming
isolated soy protein," said Krul. "The results of this study reinforce that soy protein can provide health benefits
for the healthy aging market segment."
The study* was conducted between 2004 and 2009. It was a double-blind, placebo-controlled parallel-design study of 350
postmenopausal women aged 45-92 years without diagnosed diabetes or heart disease that were recruited in Greater Los Angeles.
http://www.medicalnewstoday.com/releases/234900.php
Soy Isoflavones
and Menopause: No Benefit
Soy provided no improvement in bone density or hot flashes.
Levis S et al. Arch Intern Med 2011 Aug 8/22; 171:1363
Newton KM and
Grady D. Arch Intern Med 2011 Aug 8/22; 171:1369
Colon Cancer's
Spread To The Liver Blocked By Soy Peptide/Chemo Drug Combo
http://mnt.to/l/3ZMN
Sleep-Disordered
Breathing Raises Risk for Cognitive Decline in Older Women
Risk might be related to hypoxic episodes.
Yaffe K et al. JAMA 2011 Aug 10; 306:613
Canessa N and Ferini-Strambi L. JAMA 2011 Aug 10; 306:654
Holter Monitoring
in Octogenarians with Syncope
11% of patients had symptomatic arrhythmias.
Kühne M et al. J Am Geriatr Soc 2011 Jul 59:1293
Physical
Activity and Cognitive Health, Revisited
Rx: 30 minutes of brisk walking daily to maintain cognition despite vascular
risk factors
Vercambre M-N et al. Arch Intern Med 2011 Jul 25; 171:1244
Antidepressants
Are Ineffective for Depression in Dementia Patients
With no differences in effectiveness between
antidepressants and placebo, psychosocial treatment approaches should be routinely pursued in the initial phase of treatment.
Banerjee S et al. Lancet 2011 Jul 30; 378:403
Does Circadian-Activity-Rhythm
Architecture Predict Future Cognitive Decline?
A prospective, observational study in older women suggests that it does.
Tranah GJ et al. Ann Neurol 2011
Apples And Pears Can Reduce Stroke Risk By 52%
Consuming fruit with white edible portions,
such as pears and apples, can reduce the risk of stroke by 52%, researchers from Wageningen Uninversity in the Netherlands
wrote in the journal Stroke: Journal of the American Heart Association. This is the first study to look at the link between
fruit and vegetable color groups and stroke risk, the authors explained.
Apparently, you can tell whether a fruit is rich in phytochemicals by the color of its edible portion. Phytochemicals
are naturally-occurring compounds that are found in plants. Generally, phytochemicals refers to plant compounds that may have
an impact on human health although they are not established essential nutrients. Examples include carotenoids and flavonoids.
Linda M. Oude Griep, M.Sc. and team set out to determine whether
there might be a link between vegetable and fruit color group consumption and 10-year stroke incidence. Their study involved
20,069 adults, with an average age of 41 years. None of them had any cardiovascular disease when the study began - they had
all filled in a 178-item food frequency questionnaire for the previous year.
They classified the fruits and vegetables into the following color groups:
Cabbages, lettuces and other dark green leafy vegetables
Orange and yellow colors, most of which were citrus fruits
Red and purple colors, most of which were red vegetables
White colors, apples and pears made up 55% of them
The researchers documented 233 strokes
during the ten-year follow up period. They found that stroke incidence was not impacted by the consumption of orange/yellow
and red/purple fruits. However, a high intake of white fruits and vegetables was found to be associated with a 52% lower risk
of developing stroke, compared to a low intake.
There was a 9% reduced risk of stroke for every 25 gram increase in daily white fruit and vegetable consumption. An
average sized apple weighs about 120 grams.
Linda M. Oude Griep, M.Sc., said:
"To prevent stroke, it may be useful to consume considerable amounts of white fruits and vegetables. For example,
eating one apple a day is an easy way to increase white fruits and vegetable intake.
However, other fruits and vegetable color groups may protect against
other chronic diseases. Therefore, it remains of importance to consume a lot of fruits and vegetables."
Pears and apples are rich in quercetin,
a flavonoid, as well as dietary fiber. The authors wrote that white category fruit and vegetables include cucumber, chicory,
cauliflower and banana. Potatoes were classed as starch.
Current US federal dietary guidelines recommend picking varying vegetables from five subgroups: starchy, legume, red/orange,
dark/green and other vegetables.
The authors say their study should be confirmed
by further research before it is adopted into everyday practice.
Oude Griep said:
"It may be too early for physicians
to advise patients to change their dietary habits based on these initial findings."
As food frequency questionnaires are sometimes
unreliable, an Accompanying Editorial in the same journal advises readers to interpret the findings with caution.
Heike Wersching, M.D., M.Sc., of the Institute of Epidemiology
and Social Medicine at the University of Münster, Germany, wrote:
"The observed reduction in stroke risk might further be due to a generally healthier lifestyle of individuals
consuming a diet rich in fruits and vegetables."
http://www.medicalnewstoday.com/articles/234574.php
Listeria Outbreak Death Toll Rises, US
Health officials in the United States are suggesting as many as 14 deaths could be linked to the recent outbreak
of listeriosis caused by a strain of the bacterium Listeria monocytogenes traced to whole canteloupe melons from Jensen Farms,
Colorado.
The
US Centers for Disease Control and Prevention (CDC) reported last week that 55 people had fallen ill and 8 had died in connection
with the outbreak. The Associated Press in Washington reported late yesterday that health officials in Kansas, Nebraska, Texas
and Wyoming are now linking another six deaths to the outbreak.
The CDC's National Center for Emerging and Zoonotic Infectious
Diseases reported recently that as of 5pm EDT on 20 September, 14 states have reported a total of 55 people infected with
outbreak-associated strains, as follows: California (1 person), Colorado (14), Illinois (1), Indiana (1), Maryland (1), Montana
(1), Nebraska (4), New Mexico (10), Oklahoma (8), Texas (9), Virginia (1), West Virginia (1), Wisconsin (2), and Wyoming (1).
All
fell ill on or before 4 August, and joint investigations by local, state and federal health officials and regulators show
that the source is whole cantaloupe melons grown at fields belonging to Jensen Farms in Granada, Colorado.
Since
then, Jensen Farms have issued a voluntary recall of its Rocky Ford brand cantaloupes.
Listeriosis
is a serious infection caused by eating food contaminated with L. monocytogenes. According to the CDC, it is an important
public health problem in the US, where an estimated 1,600 people become seriously ill with it every year, of whom 260 die.
The disease primarily affects older adults, pregnant women, newborns, and adults
with weakened immune systems. It is rare for people not in these groups to fall ill with it, but they do.
The
CDC says you can reduce your risk getting listeriosis, by following some simple recommendations, such as:
Thoroughly
cook raw meat and poultry to a safe internal temperature.
Rinse raw vegetables thoroughly under running tap water before
eating.
Keep vegetables, ready-to-eat foods and cooked foods well away from uncooked meats
and poultry.
Avoid unpasteurized milk and foods made from it.
Eat
perishable and ready to eat food sooner rather than later.
Wash your hands, utensils, cutting boards and worktops before
and after handling and preparing all foods.
The CDC recommends that people at high risk for listeriosis
and consumers who want to reduce their risk of getting it, avoid eating Rocky Ford cantaloupes from Jensen Farms.
Even
if you have eaten some of these canteloupes without getting ill, throw the rest away at once. The bacterium can grow in the
fruit at room temperature and even when refrigerated.
For more information about this outbreak, see the CDC: Multistate
Foodborne Outbreaks website.
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=235148
Elderly With Low Vitamin B12 Risk Brain Shrinkage
And Cognitive Decline
Elderly individuals with low blood vitamin B12 levels have a greater risk of brain
shrinkage and losing their cognitive skills, researchers from Rush University Medical Center, Chicago reported in the journal
Neurology. Foods rich in vitamin B12 are mainly from animals and include, eggs, milk, liver, meat, and fish.
Christine C. Tangney, Ph.D. and team carried out a study with
121 individuals aged at least 65 years from the south side of Chicago. They underwent blood tests to check for their levels
of B12 and B12-related metabolites which can give an indication of a B12 deficiency. They were also assessed for memory and
other cognitive skills. About four-and-a-half years later magnetic resonance imaging (MRI) scans of their brains were taken
to see how big their brains were, as well as identifying some other signs of brain damage.
Those with four of five markers for vitamin B12 deficiency were found
to have a higher risk of getting lower cognitive test scores and smaller total brain volumes.
Christine C. Tangney said:
"Our findings definitely deserve further examination. It's too early to say whether increasing vitamin
B12 levels in older people through diet or supplements could prevent these problems, but it is an interesting question to
explore. Findings from a British trial with B vitamin supplementation are also supportive of these outcomes."
Cognitive scores ranged from -2.18 to +1.42
- the average score was 0.23. Homocysteine is a marker of B12. For every rise of one micromole per liter of homocysteine cognitive
scores dropped by 0.03 points.
It was not the vitamin B12 blood level
that was linked to smaller brain size or cognitive problems, Tangney explained. It was the markers that indicate B12 deficiency.
Low vitamin B12 is much harder to detect in elderly individuals.
The National Institute of Aging funded the study.
Vitamin B12
Vitamin B12 or Cobalamin is a water soluble vitamin - it dissolves
in water and travels through the bloodstream. It is one of eight B vitamins. The human body cannot store Vitamin B12, any
excess is excreted through urine.
The molecular formula for vitamin B12 is
C63H88CoN14O14P.
Cobalamin is a general term for compounds
containing the dimethylbenzimidazolylcobamide nucleus of vitamin B12.
Vitamin B12 plays a key role in normal nervous system functioning and brain development. It is also involved in the
formation of red blood cells.
Cobalamin plays a role in the metabolism
of every cell in the human body, experts say. It affects DNA synthesis and regulation, as well as the synthesis of fatty acids
and energy production.
Structurally, vitamin B12 is the most complicated
of all the vitamins, as well as being the largest. Cobalamin can be industrially produced through bacterial fermentation synthesis.
Vitamin B12 is a large molecule, the most complicated of all the vitamins
Vegans should take vitamin B12 dietary supplements to avoid
deficiency, because this vitamin comes from animal sourced proteins. Supplements are generally presented as cyanocobalamin,
which the body easily converts to the active forms of methylcobalamin and 5-deoxyadenosylcobalamin.
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=235018
Doubts Raised Over "Longevity
Gene", Other Factors Now Thought To Be Responsible
Researchers who re-tested findings of previous
studies suggesting the so-called "longevity gene" prolonged lifespan through the production of sirtuin proteins, say the effect is most likely not due to that gene but to other confounding genetic factors
in the modified organisms used in the experiments. They also show that dietary restriction alone probably increases lifespan,
independently of sirtuins. The researchers, led by Dr David Gems at the Institute of Healthy Ageing at University College
London (UCL), UK, write about their findings in a paper published this week in the journal Nature.
Previous studies suggested sirtuins significantly increased lifespan
in organisms used as biological models for studying aging in humans. They showed than when the genes of yeast, the nematode
worm and the fruit fly were engineered to over-produce sirtuin, this increased their lifespan, by as much as 50% in the case
of nematodes.
Further work looking at the effects of
dietary restriction on longevity, also suggested this effect was due to activation
of sirtuins.
The studies received a lot of publicity,
and the sirtuin-producing gene became known as the "longevity gene".
Some anti-aging creams also claim to target sirtuins by including a plant-based drug called resveratrol,
thought to be a sirtuin activator: traces of resveratrol can be found in red wine. But later studies have cast doubt on whether
resveratrol stimulates sirtuin production.
In their Nature study, which was funded by the Wellcome Trust and the European Union, Gems and his team at UCL, joined
by colleagues from the University of Washington, Seattle, in the US, and Semmelweis University in Budapest, Hungary, provide
almost conclusive evidence that the effects on animal longevity demonstrated in the earlier studies were not due to sirtuin.
They started by looking at two different strains of nematode
worm, each from a different prior study. The worms had been genetically modified so their sirtuin genes were over-active.
Not surprisingly, they found that the genetically modified
worms lived longer than the "wild" type control worms that had not been genetically modified.
However, when they did the test again, this time making sure
that the only difference between control and manipulated worms was the latter's ability to overproduce sirtuin, they found
the longevity effect disappeared. This suggested some other genetic factor had caused the previous effect. In one of the two
original strains, they identified a likely mutation in a gene that is involved in the development of nerve cells.
The researchers then turned to another set of experiments,
this time using a transgenic model of the fruit fly Drosophila melanogaster that had been the subect of the earlier studies
that had suggested longevity was due to overproduction of sirtuins.
Again, the researchers found that genetic factors other than sirtuins were behind the longevity effect. They suggest
it was the DNA that had been inserted in the fly's genome as part of the construct used to overproduce sirtuin that had
caused the effect. They became even more convinced when they produced a new strain of fruit fly that produced even higher
levels of sirtuins and found it did not have a longer lifespan.
And, despite repeated attempts, both in the UK and the US labs, the researchers were not able to show that resveratrol
activates sirtuin.
In a third set of experiments, Gems and
colleagues re-examined the suggestion that dietary restriction causes longevity by activating sirtuins. For these they modified
fruit flies so they lacked the sirtuin gene and found that dietary restriction still led to longer lifespan. They concluded
dietary restriction did not work through sirtuins.
Gems told the press they found the results "very surprising".
"We have re-examined the key experiments linking sirtuin with longevity in animals and none seem to
stand up to close scrutiny. Sirtuins, far from being a key to longevity appear to have nothing to do with extending life."
But he said they see this as good news, because it is just
as important to revise old ideas as to present new ones.
"This work should help to redirect scientific efforts toward those processes that really do control aging,"
he added.
The study has had a mixed reception. Some
researchers say it has helped to clear the air, there has been a lot of hype about sirtuins, while others claim the sirtuin
case is still robust.
Johan Auwerx, a researcher at the Federal
Institute of Technology in Lausanne, Switzerland, has worked with sirtuins but did not take part in the Gems study. He told
Nature News the Gems study will help to free the field to focus on other effects of sirtuins, such as regulating metabolism
and responding to environmental stress:
"The field has been over focused on overhyped claims of longevity," said Auwerx, "I don't think that's
the main function of the sirtuins."
But another sirtuin researcher, Leonard Guarente, based at the Massachusetts Institute of Technology in Cambridge, who
published the original research on the nematode worm, argues that the longevity link exists, and describes Gems' paper
as a mere "bump in the road".
"Our data are rock solid," he told Nature News, "I stand by them, and they have been replicated in other
labs."
Gems himself was originally reluctant to
work on this, but he eventually decided to investigate the rumours that were circulating and questioning some of the original
findings.
Auwerx said the previous hype may have
done some damage to the field. He was interested in starting a biotech company to use his work on sirtuins, but investors
were getting nervous. He said there were too many claims around longevity, and "the field needs to calm down".
Gems told Nature News we should still be interested in sirtuins.
They were interesting proteins in their own right, and have some very interesting metabolic effects: they could still be useful
drug targets, he added.
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=234815
Even High Doses of Saw Palmetto Do Not Reduce
Lower Urinary Tract Symptoms
High doses of saw palmetto extract are no more effective than placebo
in improving urinary tract symptoms attributed to benign prostatic hyperplasia, according to a JAMA study.
Some 370 men with lower urinary tract symptoms were randomized to increasing doses of saw palmetto or placebo
for 72 weeks. Men in the saw palmetto group began with the widely used, 320-mg daily dose, and then increased to a double
dose at 24 weeks and a triple dose at 48 weeks.
Although there were small improvements
in urinary symptoms in both groups during the study, there were no significant differences between the groups.
The authors note that their findings concur with those from the 2006 STEP trial, in which the standard dose
of saw palmetto proved no better than placebo for benign prostatic hyperplasia.
JAMA
article (Free abstract)
Saw Palmetto Worse Than Placebo For Urinary Symptoms Linked
To Enlarged Prostate
http://mnt.to/l/3ZX3
Asthma And 'Belly Fat' Linked
http://mnt.to/l/3ZSh
The Largest And Most Affordable Source
Of Potassium Is In Potatoes
http://mnt.to/l/3ZWh
Spicing Up Broccoli Boosts Its
Cancer-Fighting Power
http://mnt.to/l/3ZDp
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=234385
Brain's
Reward Centers Demand Glucose
http://mnt.to/l/3ZLb
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=234669
For The
Treatment Of Obesity And Metabolic Syndrome, Cardiotrophin 1 Shows Promising Results
http://mnt.to/l/3ZDn
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=234384
Calcium
Increases Risk For Prostate Cancer; Genetics May Predict Why
http://mnt.to/l/3ZJm
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=234579
Findings
In Hibernating Arctic Ground Squirrels Have Implications For Human Health
http://mnt.to/l/3ZH9
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=234521
Vegeterian
Diet Reduces Risk Of Serious Disease Considerably
http://mnt.to/l/3ZKm
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=234628
Dietary Supplement May Lower Risk Of Developing Type 2 Diabetes
UCLA researchers demonstrated that an over-the-counter
dietary supplement may help inhibit development of insulin resistance and glucose intolerance, conditions that are involved
in the development of Type 2 diabetes and metabolic syndrome, which affect millions worldwide.
In this early preclinical study, a naturally produced amino acid-like molecule called GABA was given orally to mice that were obese, insulin resistant and in the early
stages of Type 2 diabetes. Researchers found that GABA suppressed the inflammatory immune responses that are involved
in the development of this condition.
According to study authors, GABA helped
prevent disease progression and improved glucose tolerance and insulin sensitivity, even after onset of Type 2 diabetes in
mice. Researchers also identified the regulatory immune cells that likely direct GABA's activity in inhibiting inflammation.
IMPACT: Researchers note that in the future, GABA taken as
a supplement or related medications may provide new therapeutic agents for the treatment of obesity-related Type 2 diabetes
and metabolic syndrome.
AUTHORS: Dr. Jide Tian and Dr. Daniel Kaufman,
both professors in the Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, are available
for interviews.
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=234551
http://mnt.to/l/3ZQ4
Lab Testing Isn't Helpful in Patients with
Chronic Urticaria
Among 350 patients, 17% of test results were outside the normal range, but only
1.6% led to further evaluation, and only one patient benefited.
Even with extensive testing, a cause for
chronic urticaria (CU) rarely is established. Although not evidence based, U.S. practice parameters from 2000 recommend complete
blood count (CBC), urinalysis, liver function tests, erythrocyte sedimentation rate (ESR), and thyroid-stimulating hormone
(TSH) measurement (Ann Allergy Asthma Immunol 2000; 85:521). European guidelines recommend only CBC and ESR (Br J Dermatol
2001; 144:708). Cleveland Clinic researchers conducted a retrospective review of 356 patients (69% women) with CU at their
allergy clinic.
Patients underwent a median of six tests (total, 1872), and 17% of
studies were abnormal. The most commonly ordered tests were TSH (performed in 74% of patients), CBC (73%), comprehensive or
basic metabolic panels (71%), ESR (60%), antithyroid antibodies (50%), urinalysis (39%), and antinuclear antibodies (37%);
1.6% of abnormal tests results led to further work-ups, including specialist consultation or additional laboratory testing.
Only one patient seemed to benefit from such testing: Her thyroxine dose was increased based on a high TSH result, and her
urticaria resolved.
http://www.ncbi.nlm.nih.gov/pubmed/21875543?dopt=Abstract
Cytisine a Possible Cheaper Approach to Smoking
Cessation
Cytisine, a partial nicotine agonist extracted from acacia
seeds, sustains smoking cessation better than placebo, according to a New England Journal of Medicine study.
Researchers randomized 740 smokers to 25 days' treatment with cytisine or matching placebo. The primary
outcome, biochemically confirmed smoking cessation at 1 year, was 8.4% with cytisine and 2.4% with placebo.
Gastrointestinal side effects — stomachache, dry mouth, dyspepsia, and nausea — occurred more
often with cytisine.
The authors conclude that cytisine's low cost (about $15
for a course of therapy) "may make it an attractive treatment option for smokers in low-income and middle-income countries."
NEJM article (Free abstract)
Coronary Artery Calcium Might Help Identify Low-Risk Patients Who Would Benefit from
Statins
CAC might be more useful than high-sensitivity C-reactive protein.
http://www.ncbi.nlm.nih.gov/pubmed/21856482?dopt=Abstract
HEALTH CARE REFORM
Encounter Frequency and Serum Glucose Level, Blood Pressure, and Cholesterol Level Control in Patients With Diabetes
Mellitus
Fritha Morrison, MPH; Maria Shubina, ScD; Alexander Turchin, MD, MS
Arch Intern Med. 2011;171(17):1542-1550. doi:10.1001/archinternmed.2011.400
Background
More frequent patient-provider encounters may lead to faster control of hemoglobin A1c level, blood pressure (BP),
and low-density lipoprotein (LDL) cholesterol (LDL-C) level (hereafter referred to as hemoglobin A1c, BP, and LDL-C) and improve
outcomes, but no guidelines exist for how frequently patients with diabetes mellitus (DM) should be seen.
Methods This retrospective cohort study
analyzed 26 496 patients with diabetes and elevated hemoglobin A1c, BP, and/or LDL-C treated by primary care physicians at
2 teaching hospitals between January 1, 2000, and January 1, 2009. The relationship between provider encounter (defined as
a note in the medical record) frequency and time to hemoglobin A1c, BP, and LDL-C control was assessed.
Results Comparing patients who had encounters
with their physicians between 1 to 2 weeks vs 3 to 6 months, median time to hemoglobin A1c less than 7.0% was 4.4 vs 24.9
months (not receiving insulin) and 10.1 vs 52.8 months (receiving insulin); median time to BP lower than 130/85 mm Hg was
1.3 vs 13.9 months; and median time to LDL-C less than 100 mg/dL was 5.1 vs 32.8 months, respectively (P < .001 for all).
In multivariable analysis, doubling the time between physician encounters led to an increase in median time to hemoglobin
A1c (not receiving [35%] and receiving [17%] insulin), BP (87%), and LDL-C (27%) targets (P < .001 for all). Time to control
decreased progressively as encounter frequency increased up to once every 2 weeks for most targets, consistent with the pharmacodynamics
of the respective medication classes.
Conclusions
Primary care provider encounters every 2 weeks are associated with fastest achievement of hemoglobin A1c, BP, and LDL-C
targets for patients with diabetes mellitus.
Coronary Artery Calcium
Might Help Identify Low-Risk Patients Who Would Benefit from Statins
CAC might be more useful than high-sensitivity
C-reactive protein.
Cardiovascular Risk: What Good Is Identifying
the Lowest of the Low?
Coronary artery calcium may be better than hsCRP for stratifying
cardiac risk, but the benefits of using either marker to guide statin treatment in low-risk patients remain unproven.
Blaha MJ et al. Lancet 2011 Aug 20; 378:684
Metabolic syndrome and kidney stones. An increased risk
Metabolic syndrome is increasingly common worldwide and associated with significant morbidity
and mortality. Risks associated with metabolic syndrome may extend beyond cardiovascular disease, with Jeong et al revealing
an independent 25% increased risk of stones in people with metabolic syndrome. Further research is essential to evaluate whether
interventions addressing metabolic syndrome could also impact kidney stone disease. American Journal of Kidney Diseases
Venous thrombosis risk? Reduce it with statins
These authors report that the use of statins and antiplatelet therapy is associated
with a significant reduction in the occurrence of venous thromboembolism with a dose-related response of statins. The American Journal of Medicine
Dietary fish oil: What's the effect post cardiac surgery?
In a mixed cardiac surgery population, supplementation with dietary
fish oil did not result in a significant reduction in the incidence of postsurgical atrial fibrillation; however, there was
a significant reduction in the time spent in ICU. The American Journal of Cardiology
More evidence links diabetes, Alzheimer's disease
In a Japanese study that followed about 700 people, 27% of those with
type 2 diabetes developed Alzheimer's disease, compared with 20% of those without diabetes. The findings in the journal
Neurology strengthen the evidence for a link between the two diseases. Another study found that using insulin nasal spray
may slow the progression of the cognitive disorder, researchers said. MSNBC
Moderate, heavy drinking raise colorectal cancer risks
A review of study data showed moderate drinking raised the risk of
colorectal cancer by 21% while heavy alcohol consumption (four or more drinks per day) increased it by 52%, French researchers
reported in the Annals of Oncology. The report found that men who drank moderately were more at risk than women who did the
same, and Asians who were heavy drinkers had a higher risk of colorectal cancer linked to alcohol consumption than did other
ethnic groups. Medscape (free registration)
Aerobic vs resistance exercise: What's best?
When weighing the time commitment versus health benefit, the data suggest that aerobic training
alone was the most efficient mode of exercise for improving cardiometabolic health. The American Journal of Cardiology
Overweight women, excessive gestational weight gain, higher infant body fat. It's all connected
These authors report that gaining excessive weight in pregnancy is associated with greater
infant body fat at birth. The effect is greatest in overweight women. American Journal of Obstetrics & Gynecology
Diabetes cases reach 366 million worldwide
Diabetes now affects 366 million people worldwide and is responsible for one death every seven
seconds, or about 4.6 million deaths each year, according to a study presented at the annual meeting of the European Association
for the Study of Diabetes. The results underscore the importance of urgent government intervention in the high-level U.N.
meeting focusing on noncommunicable diseases that is slated for next week, doctors said. Reuters
The Mediterranean diet: A success in reducing heart disease risks
This study found that Mediterranean diets appear to be more effective than low-fat diets in
inducing clinically relevant, long-term changes in cardiovascular risk factors and inflammatory markers. The American Journal of Medicine
Waist circumference and mortality in chronic kidney disease: A study with answers
In adults with chronic kidney disease, BMI alone may not be a useful measure to determine
mortality risk associated with adiposity because it takes into consideration both abdominal adiposity as well as beneficial
muscle mass. In comparison, waist circumference reflects abdominal adiposity alone and, in the REGARDS study, was a
useful measure to assess obesity-associated mortality in adults with CKD, when used in conjunction with BMI. American Journal of Kidney Diseases
Are oxidative stress and inflammation associated with the risk of breast cancer?
Using a food-frequency questionnaire to assess nutrient intake, researchers found evidence
to suggest that oxidative stress and inflammation may be associated with the risk of breast cancer. Patients with breast cancer
had significantly higher blood levels of oxidative stress markers compared with control subjects. Nutrition
What can -- and can't -- prevent sudden cardiac death in the very old?
Age and glomerular filtration rate are the main determinant of survival in octogenarians
and nonagenarians with left ventricular dysfunction, but after correcting for these parameters, these authors report that
the implantable cardioverter-defibrillators do not appear to confer a survival benefit. The American Journal of Cardiology
Salt plus inactivity affects cognitive decline, study shows
Older people who have a high salt intake but low levels of physical activity had more declines
in cognitive function in three years than peers who were active or had lower salt intake, Canadian researchers
reported in the journal Neurobiology of Aging. The researchers said the results held regardless of hypertension or diet-quality
factors, and show the importance of focusing on both diet and exercise. Medscape
For diabetics after heart failure, how does weight matter?
The mechanisms underlying the association between weight status and mortality are not fully
understood. Additional research is needed to explore the effects of body composition, recent weight changes and prognosis
after hospitalization for heart failure among patients with diabetes. The American Journal of Medicine
Amiodarone and pulmonary toxicity: Who's at risk?
These authors found that the population-based incidence of amiodarone pulmonary toxicity
(PT) is in the lower range of what has been previously reported. However, patients with atrial fibrillation (AF) who use amiodarone
have an approximately 50% higher risk of PT than nonusers. These results may help identify patients at higher risk for PT
so clinicians can identify strategies to increase monitoring or select an alternative therapy. The American Journal of Cardiology
For a healthy old age, look at total cholesterol in midlife
This study concluded that low total cholesterol value in midlife predicts both better survival
and better physical functioning in old age. The American Journal of Cardiology
Breast Cancer Mortality Rate Lowered By Plant Compound
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http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=234398
Heart Failure Risk Decreased By Healthy Lifestyle Habits
http://mnt.to/l/3ZCT
Preventing Colon Cancer Without Increasing Heart Disease Risk
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http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=234402
Possible
Link Between Two Diabetes Drugs And Pancreatic Cancer
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USPSTF Analysis: Still No
Reason to Use ECG Screening in Low-Risk Patients
There's still not enough evidence to justify resting
or exercise electrocardiographic screening in asymptomatic adults, concludes
an analysis commissioned by the U.S. Preventive Services Task Force and published in the Annals
of Internal Medicine. The task force reached the same conclusion in 2004.
Researchers
reviewed published data since 2002 to examine the benefits of screening on clinical outcomes, how screening affects treatment,
whether screening helps stratify patients into risk groups, and whether there are harms associated with screening. They found
that ECG abnormalities predict increased risk, but with uncertain implications regarding treatment.
An editorialist writes: "We cannot assume that because a clinical measurement predicts risk, incorporating
it into clinical care will reduce risk." He adds that, given the lack of high-level evidence of benefit, "clinicians
should not incorporate screening with resting or exercise electrocardiography into their practices except in the context of
clinical trials."
Annals of Internal Medicine article
USPSTF's 2004 recommendations (Free)
Varicose Vein Treatments Compared
Laser treatment and ligation with stripping
are equally safe and effective for the treatment of varicose veins, according to a study in the Archives
of Dermatology.
Researchers
in Germany randomized 400 adults with great saphenous vein insufficiency to endovenous laser
ablation or high ligation and stripping. After roughly 2 years' follow-up, the primary outcome — clinical recurrence
of varicose veins — did not differ significantly between the groups (16% with laser treatment and 23% with stripping).
Most secondary outcomes (e.g., disease-related quality of life) also did not differ, although ultrasound-detected saphenofemoral
reflux was more common after laser treatment.
The authors conclude
that the two procedures are "comparably safe and effective" but call for more research into the excess of ultrasound-detected
recurrences in the laser treatment group.
Archives of Dermatology article
Breast Cancer Screening Does Not Seem to Reduce Mastectomy Rates
Breast cancer screening does not lead
to lower mastectomy rates, according to an observational study from Norway published in BMJ.
Using a national
cancer registry, researchers examined breast surgery rates in the following periods: before routine mammography was offered
(1993–1995), while mammographic screening was being introduced (1996–2004), and after screening was established
(2005–2008).
The researchers found that while mastectomy rates declined
between the prescreening and established screening periods, the decline was seen both among women who were eligible for screening
and among younger women who were not. In addition, during the introduction period, annual mastectomy rates actually increased
among screen-eligible women (by 9%) and decreased among ineligible women (by roughly 15%).
The authors conclude: "In contrast with what has been claimed in invitations to screening and
on websites supported by numerous governmental screening institutions and cancer charities, screening does not lead to a reduction
in mastectomy rates."
BMJ article
Treating Cardiovascular Risk Factors Can Improve Sexual Function
in Men with ED
Using lifestyle modification or drug therapy to treat cardiovascular risk factors can ameliorate erectile
dysfunction, according to a meta-analysis in the Archives of Internal
Medicine.
The meta-analysis included four randomized trials that looked
at the effects of lifestyle modification (e.g., weight loss, exercise) and two trials that examined the impact of atorvastatin
on CV risk factors and erectile dysfunction. Some 740 men were included, and follow-up ranged from 2 to 24 months.
Overall, reducing CV risk factors with either lifestyle changes or statin therapy was associated with
statistically significant improvements in sexual function. The benefits persisted even when patients were also using phosphodiesterase
type 5 inhibitors (e.g., sildenafil).
The researchers write: "Erectile
dysfunction detection in the primary health clinic may provide an opportunity for early adoption of a healthy lifestyle to
improve the overall health of men."
Archives of Internal Medicine article
Strict Hand Hygiene, Other Simple Measures,
Cut Infection Rates and Medical Costs
Enforcing compliance with simple infection control practices in a pediatric intensive care unit lowers
mortality and cuts costs, according to a Health Affairs study.
The University of North Carolina Hospitals' PICU implemented an intervention for
improving compliance with protocols for three infection control measures: hand hygiene, maintenance care of central-line catheters,
and oral care and other measures for patients on ventilators. Active enforcement of compliance included weekly audits, posting
audit results, and sending notices to repeat offenders.
Researchers
compared clinical and economic outcomes before and after intervention among some 2400 patients. Compared with baseline, intervention
patients had significantly lower rates of mortality, ventilator-associated pneumonia, and central-line bloodstream infections.
In addition, the intervention shortened average total hospital stay by 2.3 days and lowered average total hospital stay costs
by more than $12,000.
The researchers note that the costs of the intervention —
an education campaign, oral care kits, chlorhexidine patches, and hand sanitizers — were "modest." The projected
annual cost saving for the PICU was $12 million.
Simvastatin
Doesn't Benefit Patients with Alzheimer Disease
Randomized trials failed to show that
statins can prevent or treat Alzheimer disease.
Sano M et al. Neurology 2011
Aug 9; 77:556
Intensive Glucose-Lowering
Treatment Does Not Lower 5-Year Mortality
In this meta-analysis, treatment did not lower risks for other adverse outcomes associated
with type 2 diabetes.
Boussageon R et al. BMJ 2011 Jul 26; 343:d4169
Minimal Physical
Activity Confers Mortality Benefit
Just 15 minutes of exercise daily lowered
8-year mortality and cancer incidence.
Wen CP et al. Lancet 2011 Aug 16;
Weekly Medical News Newsletter
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Chondroitin Sulphate Effective Treatment For Patients With Osteoarthritis
http://mnt.to/l/3Zs8
Research Reveals Parents' Stress Leaves Lasting Marks On Children's Genes
http://mnt.to/l/3Zkq
Glucocorticoid Treatment May Prevent Long Term Damage To Joints
http://mnt.to/l/3ZpZ
Soil Bacteria Help Kill Cancer Tumors
http://mnt.to/l/3Zr4
Dangerous Arrhythmia Analyzed In A Heartbeat
Just one second, one heartbeat.
That's what is needed for a new, noninvasive functional imaging technology to record data for locating the
source in the heart of a dangerous cardiac arrhythmia called ventricular tachycardia (VT).
VT is an abnormal,
fast beating of the heart, which, if ignored, can lead to ventricular fibrillation, which causes some 400,000 cases of sudden
death yearly in the United States alone.
The technique, developed by a Washington University in St. Louis scientist,
is called Electrocardiographic Imaging (ECGI). It combines computerized tomography (CT) with
250 electrocardiograms recorded by electrodes placed on a vest across a patient's torso to map the source and pattern
of VT in the heart and determine the kind of VT irregularity.
Using a special algorithm, ECGI can generate
movies of the distinctive VT excitation waves, radiating like the wake caused by a pebble dropped into a pool, or rotating
like a tornado, from recordings of multiple heartbeats.
While a wealth of information can be deduced from ECGI
analysis of just one heartbeat, multiple heartbeats up to minutes long are often imaged to reveal even more about the nature
of the arrhythmia.
Yoram Rudy, PhD, the Fred Saigh Distinguished Professor of Engineering, professor of biomedical
engineering and of medicine and director of the Cardiac Bioelectricity and Arrhythmia Center (CBAC) at WUSTL, developed ECGI,
first publishing on the technique in 2004.
Now, published in the Aug. 31, 2011, issue of Science Translational
Medicine, Rudy and his collaborators in the Washington University departments of biomedical engineering and medicine, report
the first systematic study of 25 cardiology patients with VT using ECGI to map noninvasively, beat by beat, the mechanisms
and processes of VT in humans.
Co-authors WUSTL's Yong Wang, PhD, postdoctoral research associate in radiology
who was a PhD student in Rudy's biomedical engineering lab, and Phillip S. Cuculich, MD, assistant professor of medicine
at the School of Medicine, contributed equally to the study and are members of CBAC, an interdisciplinary center whose goals
are to study heart rhythms and their disorders (cardiac arrhythmias) and to develop new tools for their diagnosis and treatment
in the prevention of disabilities and cardiac death.
The other co-authors are Junjie Zhang; Kavit A. Desouza,
MD; Ramya Vijayakumar; Jane Chen, MD; Mitchell N. Faddis, MD, PhD; Bruce Lindsay, MD; and Timothy W. Smith, DPhil, MD.
Saves hours of mapping
The heart, among other things, is an electric marvel. The 25 VT patients were scheduled
to undergo catheter ablation to correct their electrical defects, but first underwent ECGI imaging.
The imaging
correctly found the VT origin and categorized the two VT mechanisms, one called focal, comprising a mass of abnormal cells,
the other re-entry, in which excitation waves become circular, forming a closed loop called a re-entry circuit.
In each mechanism, the heart's pacemaking activity is seized from its natural, normal site in the sinus node. Rudy and
his collaborators showed that the abnormal excitation patterns of VT often began in scar tissues that were tell-tale signs
of previous heart attacks.
The study is a breakthrough in the analysis and treatment of arrhythmias in general
- VT specifically - because it is noninvasive, fast and can map electrical activity on the entire heart surface in one heartbeat.
Current noninvasive diagnosis of heart rhythms relies on the conventional ECG, which employs 12 electrodes on
the body surface.
The ECG can only provide general information about the global heart electrical activity. To
locate the source of VT in the heart, a patient must endure up to several hours of invasive mapping using an electrode-carrying
catheter that is inserted into the heart and moved as a roving probe to obtain sequentially electrical recordings from many
points.
Once the arrhythmia source has been located, ablation is performed to eliminate this source and stop the
arrhythmia.
In the state-of-the-art protocol, ECGI would far more quickly find the source and type of VT, saving
hours of mapping.
In the future, it is hoped that experimental techniques such as gamma knife radiosurgery and
high-frequency ultrasound, under study for noninvasive ablation of cardiac tissue, might be used with ECGI, paving the way
for total noninvasive treatment of VTs.
'Tool that opens the door'
ECGI can locate the source
of cardiac excitation in the heart with an accuracy of about 6 millimeters. In contrast, the conventional ECG provides only
global information.
As Rudy explains: "The big difference between the two is that the ECG measures the reflection
of the heart's electrical activity far away from the heart on the torso surface. In the process, resolution is lost.
"ECGI gets far closer," Rudy says. "Imagine a car coming toward you at night from far away. You see
only one light. But as it gets closer and closer, you start to resolve the two headlights and their location in space. It's
similar here. With ECG, you're far on the body surface and get only a global view instead of the real local details on
the heart surface.
"ECGI is a treasure for basic medical research. It is a tool that opens the door to study
the electrical functioning of the heart and arrhythmia mechanisms in people with various (hereditary and non-hereditary) cardiac
disorders.
"Clinically, it is promising as a diagnostic tool that could guide therapy of cardiac arrhythmias,
and because it is noninvasive, it could also be used as a follow-up tool to evaluate progression of the disorder and the results
of therapy," Rudy says.
"Someday it might help to identify patients at risk of developing VT, so that
preventive measures can be taken before sudden death occurs.
"Nobody can imagine medicine today without noninvasive
imaging. If you have a suspicious backache, you often get an MRI. Yet nothing like this has existed for cardiac arrhythmias,
which, as our population ages, are becoming more and more common.
"There should be many ECGI revelations
and applications in the future."
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