HHAL MEDICAL NEWS MARCH 2012

Healthy Habits Associated with Reduced Mortality Risk

People who meet more of the healthy goals recommended by the American Heart Association are less likely to die of cardiovascular causes, according to a JAMA study.

Researchers used NHANES surveys and physical exams of 13,000 people to study the prevalence of seven ideal cardiovascular health factors promoted by the AHA, including:

·         not smoking;

·         moderate exercise at least 5 times a week;

·         untreated blood pressure under 120/80;

·         HbA1_c under 5.7%;

·         total cholesterol under 200 mg/dL;

·         BMI less than 25;

·         a diet high in produce, fish, and whole grains, and low in sodium and sugary beverages.

Less than 2% of people reached all seven ideals. Over a 15-year median follow-up, the proportion meeting zero or one goal increased from 7.2% to 8.8%. Those who met six or seven goals had reduced risks for all-cause mortality (adjusted hazard ratio, 0.49), compared with participants meeting zero or one goal.

JAMA article article (Free)

JAMA editorial editorial (Free)

Aspirin to prevent and treat cancer: The evidence continues to build
Alongside the previously reported reduction by aspirin of the long-term risk of cancer death, the short-term reductions in cancer incidence and mortality and the decrease in risk of major extracranial bleeds with extended use, and their low case-fatality, add to the case for daily aspirin in prevention of cancer. (Free registration required.) The Lancet

Sleeping pills are tied to higher risk of cancer, death, study finds
Researchers who analyzed data of more than 10,500 people found that those who were prescribed between 18 and 132 doses of sleeping pills a year had more than fourfold greater risk of dying than their counterparts who were prescribed none. People who took the highest doses of sleeping pills were also more prone to develop several forms of cancer. The study appeared online in the journal BMJ Open. HealthDay News 

High Intake of White Rice Associated with Excess Risk for Type 2 Diabetes

This finding was particularly marked in Asian populations.

White rice — which is almost entirely starch — is the main type of rice eaten worldwide and has a higher glycemic index than other grains. High consumption of foods with high glycemic indexes is associated with excess risk for type 2 diabetes. In this meta-analysis of seven prospective cohort studies, investigators assessed the association between white rice intake and risk for type 2 diabetes mellitus.

Of 352,000 participants, 13,000 developed type 2 diabetes (follow-up range, 4–22 years). Among Asian populations, there was a significant 55% increased risk for type 2 diabetes in the highest category of white rice intake compared with the lowest category. In contrast, among Western populations, a 12% increase in risk was not statistically significant. Combining these populations, each serving per day increment of white rice consumption was associated with an 11% increased risk for type 2 diabetes.

Hu EA et al. White rice consumption and risk of type 2 diabetes: Meta-analysis and systematic review. BMJ 2012 Mar 15; 344:e1454. (http://dx.doi.org/10.1136/bmj.e1454)

Original article

Medline abstract 

Studies Show Benefits of Advocating Exercise in Primary Care

Two studies reinforce the benefits of advocating for exercise in the primary care environment.

The first, from the New England Journal of Medicine, examines changes in patients' mobility. Some 5000 overweight or obese adults with type 2 diabetes were randomized either to a lifestyle intervention (goals: increasing exercise to at least 3 hours per week and 7% weight loss) or to a support-and-education program. After 4 years, those receiving the intervention had an almost 50% relative reduction in the risk for loss of mobility.

The second, a systematic review from BMJ, analyzes studies comprising almost 9000 sedentary adults. They were either encouraged repeatedly by their clinicians to exercise, referred for exercise, or were given a control (but less active) intervention. At 12-months' follow-up, the active interventions showed small-to-medium effects on self-reported exercise, with a calculated number-needed-to-treat of 12 to get 1 patient compliant with exercise recommendations; there was no advantage of exercise referral over clinician encouragement.

NEJM article article (Free abstract)

BMJ article article (Free)

Diabetes in pregnancy: The importance of folic acid
Offspring of pregnant women with pre-existing diabetes who do not use vitamins or supplements containing folic acid during the periconceptional period may experience an increased risk for birth defects due to diabetes. American Journal of Obstetrics & Gynecology

Using Music To Evoke Positive Emotions

Music can evoke positive emotions, which in turn can lower the listener's stress levels. Everyday music listening is therefore a simple and effective way to enhance well-being and health, according to a new doctoral thesis in psychology from the University of Gothenburg. 
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=242536

Medition Helps Memory Loss Patients
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=242374

Are Selenium Supplements Good For You? Yes And No
http://mnt.to/l/44Xz

Another Mechanism Discovered By Which Sulforaphane Prevents Cancer
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=242302

Low Bad Cholesterol Tied To Cancer Risk
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=243391

Potential Strategy Aims To Stimulate The Immune System To Defeat Cancers
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=243212

Gut Bacteria Control Allergic Diseases

http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=243382

Early Exposure To Germs Is A Good Thing
http://mnt.to/l/45mc

Bisphosphonates May Have Protective Effect On Endometrial Cancer
http://mnt.to/l/45kH

New Cancer Test Is Cheap, Accurate And Fast
http://mnt.to/l/45ks

Cognitive Decline In Alzheimer's Disease May Be Compounded By Brain Insulin Resistance
http://mnt.to/l/45ny

Alzheimer's Disease And Diabetes Linked By New Evidence
http://mnt.to/l/45hc

Cell Cancer Death - Scientists Unlock Key To Mystery
http://mnt.to/l/45pT

Blood Pressure Can Be Raised By Pain Relievers
http://mnt.to/l/45hT

Memory Linked To Specific Brain Cells
http://mnt.to/l/45mH

Worm Model Of Back-Up Telomere Repair Strategy Could Speed Identification Of Anti-Cancer Drugs
http://mnt.to/l/45kY

Study Of Selenium Metabolism
http://mnt.to/l/45jY

Statins - Safety Label Changes Approved By FDA

http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=242483

A Snack With Even Higher Antioxidant Levels Than Fruits And Vegetables

Popcorn, one of the most popular snacks foods in the world, is known for being a high fiber, healthy food. Research has found that popcorn contains significant amounts of the class of antioxidants known as polyphenols. Being a popular snack food, polyphenols from popcorn are possibly part of a large portion of the polyphenol dietary intake. Popcorn without any oils is also a 100% whole grain food, whose consumption is recommended in the Dietary Guidelines for Americans. Free and total polyphenols for 40 different kernels and ingredients have been quantified using the Folin-Ciocalteu and FRAP assays. The identity of the polyphenols have been identified using UV/Vis HPLC and LC-MS. Ferulic Acid has been identified as one of the major components. By quantifying and identifying the polyphenols in popcorn; some predictions about their bioactivity can be made.
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=243369

Regular Chocolate Consumption Linked To Leaner Bodies
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=243387

Food Intake And Energy Dictated By Molecular Duo
http://mnt.to/l/44VN

In Alzheimer's Disease, Mitochondrial Dysfunction Present Before Memory Loss
http://mnt.to/l/44WD

An Epigenetic Culprit Discovered In Memory Decline
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=242331

Researchers Test Sugary Solution To Alzheimer's
http://mnt.to/l/44VR Vitamin D Intake May Reduce Fracture Risk In Girls
http://mnt.to/l/453k

In Rat Model Vitamin D Shrinks Fibroid Tumors
http://mnt.to/l/44YG

High Trans Fat Intake Increases Stroke Risk In Postmenopausal Women: Aspirin Use May Moderate Harmful Effects
http://mnt.to/l/44XZ

Dutasteride During Active Surveillance of Low-Risk Prostate Cancer

Risk for disease progression was lower with dutasteride than with placebo, but the findings come with several caveats.

Fleshner NE et al. Lancet 2012 Jan 24;

Parker C. Lancet 2012 Jan 24;

Heart disease, diabetes risks tied to kidney disease
Data on 1,456 Asians age 65 and older revealed those who had metabolic syndrome -- defined as having numerous risk factors for heart disease and diabetes -- faced an elevated risk of developing chronic kidney disease. The findings appear in the Journal of Clinical Endocrinology and Metabolism. Renal Business Today

Hypertensive disorders in pregnancy: Diabetes risk
Women with hypertensive disorders in pregnancy (HDP) have a high risk of subsequent diabetes. HDP women with obesity and hyperlipidemia are at an extremely high risk of diabetes mellitus. Early identification of women with HDP is needed for prevention, particularly those with other comorbidities. The American Journal of Medicine

Circumcision may reduce risk of prostate cancer, researchers say
Men who were circumcised prior to their first sexual experience had a 15% reduced incidence of prostate cancer compared with those who weren't circumcised or were circumcised after first intercourse, a study found. Researchers reported in the journal Cancer that the findings fit with studies that have associated sexually transmitted diseases with higher rates of prostate cancer, as uncircumcised men are slightly more likely to contract herpes and human papillomavirus. U.S. News & World Report , Reuters 

Weight does not affect mental well-being, study finds
A cross-cultural study in the European Journal of Epidemiology revealed that U.S. and British people with a body mass index of 30 or more reported mental well-being levels similar to people of a healthier weight. Researchers found low levels of physical activity had adverse effects on the mental well-being of men but not women in the U.S. Yahoo!/Indo-Asian News Service 

Genetic studies lay the foundations for anti-inflammatory drugs to prevent heart disease
Large-scale human genetic and biomarker data are consistent with a causal association between Interleukin-6 receptor (IL6R) related pathways and coronary heart disease. (Free registration required.) The Lancet 

Gliptins vs. the Alternatives for Type 2 Diabetes

Gliptins are less effective than metformin monotherapy; when used with metformin, they confer some advantages and some disadvantages compared with other combinations.

Dipeptidyl peptidase-4 inhibitors (e.g., Januvia, Onglyza, Tradjenta), also known as "gliptins," are oral hypoglycemic drugs that raise blood incretin levels, thereby inhibiting glucagon release and lowering blood-glucose levels. In a meta-analysis involving 14,000 adults with type 2 diabetes, investigators compared gliptins with metformin (8 monotherapy trials) and, in the context of concomitant metformin therapy, with other hypoglycemic agents (11 combination-therapy trials).

Compared with metformin monotherapy, gliptin use conferred a smaller reduction in glycosylated hemoglobin (HbA_1c) levels (mean difference, 0.2%), more-frequent failure to achieve HbA_1c levels <7%, and less weight loss (mean difference, 1.5 kg). However, gliptin recipients were less likely than metformin recipients to discontinue therapy because of adverse events. All differences were statistically significant.

With concomitant metformin, gliptins were less effective in lowering HbA_1c than sulfonylureas, glucagon-like peptide-1 (GLP-1) agonists, or pioglitazone. Gliptins yielded more weight loss than a sulfonylurea or pioglitazone (mean differences: 1.9 kg and 3.0 kg, respectively) but less weight loss than a GLP-1 agonist (mean difference, 1.6 kg). All differences were statistically significant. Hypoglycemia occurred less often with a gliptin plus metformin than with a sulfonylurea plus metformin.

Original article 

Medline abstract 

6-minute walking test: Predicting COPD outcomes
The six-minute walk test could be a reliable predictor of mortality and exacerbation-related hospitalization among chronic obstructive pulmonary disease (COPD) patients according to this study from the ECLIPSE investigators. Although the outcomes were influenced by age of the patient, it was found that those who walked less than 334 meters on the six-minute walk test were more likely to die during the three-year study. (Free abstract only.) Journal of the American Medical Directors Association

Alzheimer's disease patients may not benefit from antioxidants
Patients with mild to moderate Alzheimer's disease who regularly took vitamins C and E had faster declines in cognition and memory scores than groups who took coenzyme Q or placebos, a study found. However, spinal fluid markers of central nervous system damage dropped a little during the four-month period for the vitamin C and E group, researchers reported in the Archives of Neurology. No other differences were seen after 16 weeks. Reuters 

Increased heart rate in hypertension: Predictor of cardiovascular events
Increased heart rate is a long-term predictor of cardiovascular events in patients with high risk hypertension. This effect is not modified by good blood pressure (BP) control, and it is not yet known whether therapeutic reduction of heart rate (HR) would improve cardiovascular prognosis. The American Journal of Cardiology 

Arterial stiffness and cognitive disorders in the elderly
What is the role of arterial stiffness on cognitive decline? Eight hundred seventy-three institutionalized very elderly (80+ years) underwent carotid-femoral pulse wave velocity (PWV) and completed the Mini-mental Status Examination (MMSE) in addition to other measures. After a one-year followup, the PWV reading was an indicator of subsequent cognitive decline. (Free abstract only.) Journal of the American Medical Directors Association

FDA Clarifies Citalopram (Celexa) Dosing and Use Recommendations

The FDA has again revised the dosing recommendations for the antidepressant citalopram (marketed as Celexa). Previously, the agency warned that doses above 40 mg/day could lead to potentially fatal arrhythmias.

The latest recommendations:

·         The maximum dose is still 40 mg/day for most patients.

·         The maximum dose is 20 mg/day for patients older than 60, patients with liver impairment, or those on concomitant cimetidine or another CYP2C19 inhibitor.

·         The drug should not be used at any dose in patients with bradycardia, congenital long QT syndrome, hypokalemia, or a recent heart attack, or who are taking other medications that prolong the QT interval.

FDA MedWatch safety alert 

Non-HDL Cholesterol Seems a Better Target Than LDL to Gauge Statin Therapy

LDL cholesterol levels may not be the best target for statin therapy, according to a JAMA meta-analysis.

Researchers examined patient data from eight randomized trials in which nearly 40,000 patients received statins. They assessed whether non-HDL cholesterol or apolipoprotein B were more predictive of future cardiovascular events than LDL.

Increases of one standard deviation from baseline levels of LDL, apoB, and non-HDL at 1 year were all associated with increased risks for cardiovascular events, but the differences between LDL (and apoB) versus non-HDL were significant. Patients reaching the non-HDL target of 130 mg/dL or less, but not the LDL target of 100 mg/dL or less, were at lower risk than those reaching the LDL target but not the non-HDL target.

The authors conclude: "Non-HDL-C may be a more appropriate target for statin therapy than LDL-C."

JAMA article article 

Rheumatoid Arthritis Linked to Risks for Atrial Fibrillation and Stroke

Close monitoring of RA patients is warranted.

Rheumatoid arthritis (RA) is associated with elevated risks for myocardial infarction and cardiovascular mortality (for example, JW Womens Health May 20 2003). To assess whether people with RA are at excess risks for atrial fibrillation (AF) and stroke, researchers analyzed data from 4.2 million people (age >15 years) in Denmark who were free of RA, AF, and stroke before 1997 (baseline).

During a median follow-up of 4.8 years, roughly 18,000 people developed RA (mean age at onset, 59), 156,000 developed AF, and 165,000 experienced stroke. The risk for AF, adjusted for age and sex, was nearly 40% higher among people with RA than in the rest of the population (8.2 vs. 6.0 events per 1000 person-years). Adjusted risk for stroke was more than 30% higher among people with RA than in the rest of the population (7.6 vs. 5.7 events per 1000 person-years).