HHAL MEDICAL NEWS JUNE 2012
Life Expectancy Of Women In Their 70s Extended By Exercise And A Healthy Diet Of
Fruits And Vegetables
Women in
their seventies who exercise and eat healthy amounts of fruits and vegetables have a longer life expectancy, according to
research published in the Journal of the American Geriatrics Society.
Researchers at the University of Michigan and Johns Hopkins University studied 713
women aged 70 to 79 years who took part in the Women's Health and Aging Studies. This study was designed to evaluate the
causes and course of physical disability in older women living in the community.
"A number of studies have measured the positive impact of exercise and healthy eating on life expectancy, but
what makes this study unique is that we looked at these two factors together," explains lead author, Dr. Emily J Nicklett,
from the University of Michigan School of Social Work.
Researchers
found that the women who were most physically active and had the highest fruit and vegetable consumption were eight times
more likely to survive the five-year follow-up period than the women with the lowest rates.
To estimate the amount of fruits and vegetables the women ate, the researchers measured blood levels
of carotenoids - beneficial plant pigments that the body turns into antioxidants, such as beta-carotene. The more fruits
and vegetables consumed, the higher the levels of carotenoids in the bloodstream.
Study participants' physical activity was measured through a questionnaire that asked the amount of time the spent
doing various levels of physical activity, which was then converted to the number of calories expended.
The women were then followed up to establish the links between healthy eating, exercise
and survival rates.
Key research findings included:
·
More than half of the 713 participants (53%) didn't do any exercise, 21% were moderately active, and the remaining
26% were in the most active group at the study's outset.
·
During the five-year follow up, 11.5% of the participants died. Serum carotenoid levels were 12% higher in the women
who survived and total physical activity was more than twice as high.
·
Women in the most active group at baseline had a 71% lower five-year death rate than the women in the least active group.
·
Women in the highest carotenoid group at baseline had a 46% lower five-year death rate than the women in the lowest
carotenoid group.
· When taken together, physical
activity levels and total serum carotenoids predicted better survival.
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=246050
Heart Aging Decreased On Calorie-Restricted Diet
People who restrict their caloric intake in an effort to live longer have hearts that function
more like those in people who are 20 years younger.
Researchers at Washington University School of Medicine in St.
Louis have found that a key measure of the heart's ability to adapt to physical activity, stress, sleep and other factors
that influence the rate at which the heart pumps blood, doesn't decline nearly as rapidly in people who have significantly
restricted their caloric intake for an average of seven years.
The study is available online in the journal Aging Cell.
"This is really striking
because in studying changes in heart rate variability, we are looking at a measurement that tells us a lot about the way the
autonomic nervous system affects the heart," says Luigi Fontana, MD, PhD, the study's senior author. "And that
system is involved not only in heart function, but in digestion, breathing rate and many other involuntary actions. We would
hypothesize that better heart rate variability may be a sign that all these other functions are working better, too."
The researchers hooked portable heart monitors to 22 practitioners of calorie restriction
(CR) who ate healthy diets but consumed 30 percent fewer calories than normal. Their average age was just over 51. For comparison
purposes, researchers also studied 20 other people of about the same age who ate standard Western diets. Heart rates were
significantly lower in the CR group, and their heart rate variability was significantly higher.
"Higher heart rate variability means the heart can
adjust to changing needs more readily," says lead author Phyllis K. Stein, PhD. "Heart rate variability declines
with age as our cardiovascular systems become less flexible, and poor heart rate variability is associated with a higher
risk of cardiovascular death."
Stein, a research associate professor of medicine in the Division of Cardiology, has measured
heart rate variability in a number of different groups, from older adults to those with depression. This study was her first
experience evaluating heart rate variability in the group often referred to as CRONies (Calorie Restriction with Optimal Nutrition),
but members of that group have been studied extensively by Fontana, a research associate professor of medicine at Washington
University and investigator at the Istituto Superiore di Sanita in Rome, Italy.
"The idea was to learn, first of all, whether humans on CR, like the calorie-restricted animals that have been
studied, have a similar adaptation in heart rate variability," Fontana says. "The answer is yes. We also looked
at normal levels of heart rate variability among people at different ages, and we found that those who practice CR have hearts
that look and function like they are years younger."
Laboratory
animals with a restricted calorie intake tend to live 30 percent to 40 percent longer than those that eat standard diets.
Many humans who practice calorie restriction believe they also will live significantly longer, but that won't be known
for several more years. Still, Fontana says much of his research suggests calorie restriction with optimal nutrition contributes
to significant changes in people that are similar to changes seen in animals.
"In many of our studies, we have found that a number of metabolic and physiologic changes that occur in calorie-restricted
animals also occur in people who practice CR," Fontana says.
And
he says the finding that heart rate variability is better in people who practice CR means more than just that their cardiovascular
systems are flexible. He says the better ratio suggests improved health in general.
"But we can't be absolutely positive that the practice of CR is solely responsible for the flexibility of
the cardiovascular system," Stein says. "People who practice CR tend to be very healthy in other areas of life,
too, so I'm pretty sure they don't say to themselves, 'Okay, I'll restrict my calorie intake to lengthen my
life, but I'm still going to smoke two packs a day.' These people are very motivated, and they tend to engage in a
large number of very healthy behaviors."
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=246285
Waist Size, Regardless Of BMI, Linked To Diabetes Risk
Waist circumference is strongly and independently linked to diabetes type
two risk, even after accounting for body mass index (BMI), and should be measured more widely for estimating risk, researchers from the Medical Research
Council (MRC) Epidemiology Unit, UK, reported in PLoS Medicine. The
authors explained that overweight people with a large waist, over 102cm (40.2 inches) for men and over 88cm (34.6 inches)
for women, have approximately the same or higher risk of eventually developing diabetes type 2 as obese individuals.
Dr Claudia Langenberg and team gathered data on over 340,000 individuals from eight European
countries to determine what their future risk of developing diabetes type 2 might be.
Dr Claudia Langenberg, said:
"Type 2 diabetes is a serious and increasingly
common disease. More than a third of the UK adult population is overweight and at increased risk of diabetes, but they are
not systematically monitored for this risk. Our findings suggest that if their waist circumference is large, they are just
as likely to develop the condition as if they were obese.
We do not suggest replacing BMI as a core health indicator,
but our results show that measuring waist size in overweight patients allows doctors to 'zoom in' on this large population
group and identify those at highest risk of diabetes. These people can then be offered lifestyle advice, which can reduce
their risk of developing the disease."
Diabetes type 2 is a long-term condition that occurs when the
person's body cannot produce enough insulin, or when the cells in the body do not react properly to insulin. The exact
causes of type 2 diabetes are not precisely understood, but experts say that being obese or overweight are the main modifiable
risk factors.
Langenberg and team set out to determine what the link between
BMI, waist size and the likelihood of developing diabetes type 2 might be - they also aimed to find out what the risks were
separately for men and women. They gathered data from the European Union funded InterAct Study, consisting of 12,403 individuals
with diabetes type 2 who had developed the disease during a 15-year follow up.
They found that:
·
7% of males with a large waist who were overweight eventually developed diabetes type 2 within ten
years
· 4% of females with a large waist who
were overweight eventually developed diabetes type 2 within ten years
·
Large-waisted overweight men and women were found to have either the same or higher risk of eventually developing diabetes
type 2, compared to obese individuals
· Normal weight men with a small
waist had only a 1.6% chance of developing the disease
·
Normal weight women with a small waist had a 0.6% risk of developing the disease
·
Pear-shaped people - those who were overweight but had a small waist - were found to have a relatively low risk of developing
diabetes type 2
·
Women with a BMI greater than 35 (obese women) with a large waist were nearly 32-times more likely to eventually develop
diabetes type 2 compared to thin women with a small waist
·
Obese men with a large waists were 22-times more likely to develop the disease compare to their lean and small-waisted
counterparts
Principal Investigator of the
InterAct Study, Professor Nick Wareham, said:
"This is one of the most comprehensive studies of lifestyle and diabetes risk to date, not just in scale,
but in the powerful prospective design which allows us to follow a population over a long period of time to see how and why
disease develops. The results of this important research will help inform new strategies for the prevention of this devastating
condition that affects almost three million people in the UK."
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=246275
Tart Cherries
May Help Millions Reduce Inflammation To Manage Pain, According To New Research
Tart cherries may help reduce chronic inflammation,
especially for the millions of Americans suffering from debilitating joint pain and arthritis, according to new research from
Oregon Health & Science University presented at the American College of Sports Medicine Conference (ACSM) in San Francisco,
Calif.1 In fact, the researchers suggest tart cherries have the "highest anti-inflammatory content of any food"
and can help people with osteoarthritis manage their disease.
In a
study of twenty women ages 40 to 70 with inflammatory osteoarthritis, the researchers found that drinking tart cherry juice
twice daily for three weeks led to significant reductions in important inflammation markers - especially for women who had
the highest inflammation levels at the start of the study.
"With
millions of Americans looking for ways to naturally manage pain, it's promising that tart cherries can help, without the
possible side effects often associated with arthritis medications," said Kerry Kuehl, M.D, Dr.PH., M.S., Oregon Health
& Science University, principal study investigator. "I'm intrigued by the potential for a real food to offer
such a powerful anti-inflammatory benefit - especially for active adults."
Often characterized as "wear and tear" arthritis, osteoarthritis is the most common type of arthritis. Athletes
are often at a greater risk for developing the condition, given their excessive joint use that can cause a breakdown in cartilage
and lead to pain and injury, according to the Arthritis Foundation.
The
inflammation benefits could be particularly important for athletes, according to Kuehl's previous research. In a past
study he found that people who drank tart cherry juice while training for a long distance run reported significantly less
pain after exercise than those who didn't.
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=246030
No Urgent Need To Get Vaccinated To Prevent A Second Shingles Episode
People who have had an episode of herpes zoster, also
known as shingles, face a relatively low short-term risk of developing shingles, according to a Kaiser Permanente Southern
California study published online in the Journal of Infectious Diseases. These findings suggest that among people with immune systems that have not been compromised, the
risk of a second shingles episode is low.
Researchers reviewed electronic
health records and monitored recurrence of shingles for more than 6,000 individuals. They found fewer than 30 cases of recurrent
shingles in an average of two years of follow-up and little difference in the rate of recurrence between the vaccinated and
unvaccinated population.
"This study's findings are important
because we found that the risk of having a recurrent shingles episode is not as high as previous research indicates,"
said Hung-Fu Tseng, PhD, MPH, study lead author with the Kaiser Permanente Southern California Department of Research &
Evaluation in Pasadena, Calif. "We now have empirical data that show the risk of recurrence is low among an elderly population
who did not have compromised immune systems, regardless of their vaccination status."
More than 1 million people develop shingles every year in the United States. Shingles is a painful contagious rash
caused by the dormant chickenpox virus which can reactivate and replicate, damaging the nerve system. The elderly are especially
vulnerable because immunity against the virus that causes shingles declines with age.
When the Food and Drug Administration approved the shingles vaccine in 2006, the agency said that having an episode
of shingles boosts immunity and suggested it was unlikely that people would experience a recurrence. It further stated that
the effectiveness of the vaccine in preventing repeat episodes had not been proven in clinical trials because trials have
not been conducted.
By contrast, the Centers for Disease Control and
Prevention's Advisory Committee on Immunization Practices recommended the herpes zoster vaccine for people ages 60 and
older, including those who reported a previous episode.
"While
this latest study adds to the growing evidence base of emerging knowledge about the shingles vaccine, more research is needed.
Our findings need to be replicated by studies with larger populations. Kaiser Permanente Southern California researchers will
continue to follow this population of vaccinated people in order to determine the long term preventative efficacy," said
Dr. Tseng.
Researchers studied electronic health records for 1,036
vaccinated and 5,180 unvaccinated Kaiser Permanente members aged 60 and older. The vaccinated population included members
who received vaccines between 2007 and 2010. The zoster vaccine is not recommended for patients with immune systems that have
been compromised as a result of cancer or other medical conditions, so they were excluded from this study.
Based on the clinically confirmed cases, researchers found the risk of the recurrence
of shingles after a recent episode is fairly low regardless of vaccination status. Each year, on average, 19 persons per 10,000
in the vaccinated cohort experienced a recurrence of shingles. The rate was only slightly higher for the unvaccinated population,
at approximately 24 persons per 10,000 per year.
This is the latest
in a series of published Kaiser Permanente studies conducted to better understand vaccine effectiveness and safety. Among
these studies were:
· In 2011, Dr. Tseng was a lead
researcher in a Vaccine Safety Datalink study published in the Journal of Internal Medicine that found
the herpes zoster vaccine to be safe.
·
Also last year, Dr. Tseng published a study in the journal Vaccine that found that administering the pneumococcal and
the herpes zoster vaccines at the same time is as beneficial as if they are administered separately.
·
On top of that study, Dr. Tseng published a study in 2011 in the Journal of the American Medical Association that
found that the shingles vaccine is associated with a 55 percent reduced risk of developing the disease.
·
In 2010, another study by Dr. Tseng in JAMA found the pneumococcal pneumonia vaccination is not associated
with a reduced risk of heart attacks or strokes in men.
·
Two Kaiser Permanente studies found that the combination vaccine for measles, mumps, rubella, and chickenpox is associated
with double the risk of febrile seizures for 1- to 2-year-old children, compared to same-day administration of the separate
vaccine for MMR (measles, mumps, rubella) and the varicella vaccine for chickenpox.
·
Other Kaiser Permanente studies found that children of parents who refuse vaccines are nine times more likely to get
chickenpox and 23 times more likely to get pertussis (commonly known as whooping cough), compared to fully immunized children.
·
Another study found that herpes zoster is very rare among children who have been vaccinated against chickenpox.
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=246247
Dark Chocolate
Might Lower CV Risk in People with Metabolic Syndrome
In a statistical model,
daily consumption of 100 g of dark chocolate lowered risks.
Dark Chocolate May Be Cost Effective in Lowering Cardiovascular Risk
Dark chocolate may be a cost effective — and palatable
— option to reduce cardiovascular risk in high-risk patients, according to a BMJ study.
To construct
their model, Australian researchers used data from meta-analyses that showed dark chocolate consumption reduced systolic blood
pressure by 3.2 mm Hg and LDL cholesterol by 0.15 mmol/L (roughly 6 mg/dL). The model included 2000 people with hypertension
and metabolic syndrome who were free of cardiovascular disease.
They
calculated that over a decade, regular dark chocolate consumption could prevent 70 nonfatal cardiovascular events and 15 cardiovascular-related
deaths per 10,000 population treated. The strategy would be cost effective if $42 was spent per person per year on a dark
chocolate prevention strategy (e.g., advertising, educational campaigns, or chocolate subsidies). The strategy would still
be cost effective with only 80% compliance.
The authors conclude:
"Chocolate benefits from being by and large a pleasant, and hence sustainable, treatment option. Evidence to date suggests
that the chocolate would need to be dark and of at least 60-70% cocoa, or formulated to be enriched with polyphenols."
BMJ article
Zomer
E et al. BMJ 2012
May 31; 344:e3657
Combination
Nasal Steroid–Antihistamine Is More Effective Than Either Agent Alone
For patients with allergic
rhinitis, twice-daily azelastine plus fluticasone cut nasal symptoms.
Carr
W et al. J Allergy Clin Immunol 2012
May 129:1282
Effects of Thiazide
Diuretics on Glucose Metabolism
Two crossover studies confirm
adverse effects of thiazide diuretics — but not of potassium-sparing diuretics or beta-blockers —
on short-term glucose tolerance.
Stears AJ et
al. Hypertension 2012
May 59:934
Elliott WJ. Hypertension 2012 May 59:911
Achieving Normal Glycemic Levels — Even
Temporarily — Linked to Lower Diabetes Risk in Patients with Prediabetes
Patients with prediabetes who achieve normal glucose regulation —
even transiently — are less likely to develop diabetes, according to a follow-up to the Diabetes Prevention Program
published in the Lancet.
This
observational study included some 1990 patients without diabetes who had been randomized to lifestyle intervention, metformin,
or placebo during the 3.2 years of the Diabetes Prevention Program. After a 13-month bridge period, patients were then followed
for an additional 5.7 years.
Patients who achieved at least one reading
of normoglycemia during the treatment phase had a 56% lower risk of progression to diabetes during follow-up. The risk was
further reduced the more frequently a patient achieved normal glucose levels.
Commentators
write: "On the assumption that this finding is confirmed, identification of regression to normoglycemia could be an important
way to stratify people into those at higher and lower risk of progression to diabetes."
Lancet article
Does Insulin Therapy Prevent Adverse Cardiovascular
Events in Early Diabetes?
Insulin
glargine conferred no benefit in a large randomized trial.
In
the ACCORD, ADVANCE, and VADT trials, intensive glycemic control did not prevent fatal plus nonfatal cardiovascular (CV) events
in patients with long-standing type 2 diabetes (JW Cardiol Jun 6 2008 and JW Gen Med Dec 24 2008). In those studies, substantial proportions
of patients in both the intensive-treatment and control groups received insulin. In a new study (the ORIGIN trial), researchers
asked a somewhat different question: In patients with early diabetes, does provision of basal insulin itself confer CV benefit?
The
trial included 12,500 patients with either previous adverse CV events (59%) or high CV risk. Additionally, 88% of patients
had mild diabetes (stable on 0 or 1 oral agent, and not receiving insulin), and the other 12% had impaired fasting glucose
or impaired glucose tolerance. Patients were randomized to either nightly insulin glargine (Lantus; titrated to reduce fasting
glucose to
95 mg/dL) or standard care. The study was funded by the maker
of insulin glargine. Another component of the study, in which patients received -3 fatty acid supplements
or placebo, has been summarized separately (JW Gen Med Jun 12 2012).
During 6 years
of follow-up, researchers found no significant differences between the insulin group and standard-care group for all combined
and single CV outcomes; for example, the composite of CV-related death plus nonfatal myocardial infarction or stroke occurred
in about 16% of patients in both groups. By the end of the trial, 80% of intervention patients and 11% of controls were using
insulin; controls were more likely to be using multiple oral agents. Glycosylated hemoglobin (HbA1c) levels at
the end of the trial were 6.2% and 6.5%, respectively. Hypoglycemia occurred more frequently in the insulin group.
The ORIGIN Trial Investigators. N Engl J Med 2012 Jun 11;
Should Anyone Not Take a Statin?
In a meta-analysis, benefits
of statins outweighed risks, even in the healthiest patients.
Cholesterol
Treatment Trialists' (CTT) Collaborators. Lancet 2012
May 17;
Ebrahim S and Casas JP. Lancet 2012 May 17;
Your Brain — Use It or Lose It
An active cognitive lifestyle does not protect against Alzheimer disease pathology, but using cognitive abilities helps
men and women minimize changes in aging in different ways.
Valenzuela
MJ et al. Biol Psychiatry 2012
May 1; 71:783
Doraiswamy PM. Biol
Psychiatry 2012 May 1; 71:765
Aortic Diameter Is Associated with Risks
for Mortality and Hospitalization
During 7 years of follow-up, excess morbidity was found among men with aortic diameters of 25 to 29
mm.
Duncan JL et al. BMJ 2012 May 4; 344:e2958
Case Series Associates Olmesartan with
Spruelike Disease
The antihypertensive olmesartan (Benicar) seems to have played a role in the development of otherwise unexplained
spruelike enteropathy in 22 patients, according to a report in the Mayo
Clinic Proceedings.
The patients, all of whom were taking
olmesartan, were seen at the Mayo Clinic for evaluation of chronic severe diarrhea that had been present for a median of 18
months. Nausea and vomiting were present in two thirds, as was fatigue; abdominal pain was present in half. Treatment with
a gluten-free diet and corticosteroids was ineffective. When olmesartan was withdrawn, the diarrhea resolved, and changes
seen on intestinal biopsies also resolved.
The authors speculate
that the delay between starting olmesartan and the onset of enteropathy (average, 3 years) suggests some effect of olmesartan
on cell-mediated immunity rather than a type I hypersensitivity reaction. Their case series does not prove causality,
they write, but they encourage physicians to consider medications as a cause when evaluating diarrheal syndromes.
Mayo Clinic Proceedings article
Pioglitazone Is
Associated with Excess Risk for Bladder Cancer
Using pioglitazone for >2 years or
exceeding a cumulative dose of 28,000 mg imparted the highest risk.
In 2011, the FDA
issued a safety warning for the antidiabetic drug pioglitazone (Actos). The warning states that use for longer than 1 year might
be associated with excess risk for bladder cancer, based on data from a French study and an interim analysis of a manufacturer-sponsored,
U.S. observational study. U.K. investigators now report on a case-control study in which they evaluated the same outcome.
Researchers
identified 116,000 patients (mean age, 64) with type 2 diabetes who were new users of oral antidiabetic drugs. After a mean
follow-up of 4.6 years, 470 patients had received diagnoses of bladder cancer (89 cases per 100,000 person-years). Each patient
with bladder cancer was matched with as many as 20 controls. Ever use of pioglitazone was associated with 83% higher risk
for bladder cancer — a significant increase — compared with never users. The bladder cancer rate increased significantly
with duration of pioglitazone use, with the highest rates in patients who were exposed for >2 years, and in patients whose
cumulative dose exceeded 28,000 mg. Notably, no excess risk for bladder cancer was observed for patients who received rosiglitazone
(Avandia).
Azoulay L et al. BMJ 2012 May 31; 344:e3645
JAMA study compares effects of 3 diets
A study in the Journal of the American Medical Association found that participants
who followed a low-carbohydrate diet burned 300 calories more daily than did those on
a low-fat diet, but they also showed higher levels of cortisol and an inflammation marker, potentially increasing
their risk of heart disease and diabetes. Participants on the low-fat diet fared worst on energy expenditure and had increased
triglyceride levels, researchers said. However, a low-glycemic-index diet helped participants burn 150 additional calories
daily and did not show adverse effects on cholesterol and hormones, researchers added.
Drinking Moderate Amounts of Coffee Linked to Reduced Heart Failure Risk
Drinking a moderate amount of coffee is associated with reduced risk for heart failure,
according to a meta-analysis in Circulation: Heart Failure.
Researchers assessed findings from five Nordic studies, comprising 140,000 participants and 6500 heart
failure events. Overall, they found a J-shaped association between coffee consumption and heart failure. Individuals who drank
2 to 4 cups a day had about a 10% reduced risk for heart failure, relative to those who didn't drink any. People who drank
more coffee had roughly the same risk for heart failure as those who abstained.
The
authors note: "Our finding of a nadir of risk for 4 cups of coffee per day may seem like a large amount, but based on
the current US serving size, this is only slightly more than two cups of coffee at popular coffee chains, where a standard
serving size varies from 295 to 590 mL, and this does not take into account the strength of the brew."
Circulation: Heart Failure article
Prediabetes
Is Associated with Risk for Stroke
Findings varied by definition
of prediabetes.
Lee M et al. BMJ 2012 Jun 7; 344:e3564
Common Diabetes Drugs Associated With Increased Risk Of Death
Compared to another popular drug, three widely used diabetes medications
are associated with a greater risk of death, a large new analysis finds. The results were presented at The Endocrine Society's
94th Annual Meeting in Houston.
The drugs, glipizide, glyburide, and glimepiride, are known as sulfonylureas, which help decrease blood-sugar levels
among type 2 diabetes patients by stimulating the pancreas to produce insulin. In the past, these medications were considered
comparable to one another in terms of effectiveness and safety. Recently, however, research has shown some sulfonylureas may
be safer than others. These findings led to this latest research, which compared them to another type of blood-sugar-reducing
drug known as metformin. All four medications are available under low-cost, generic labels.
"We have clearly demonstrated that metformin is associated
with a substantial reduction in mortality risk, and, thus, should be the preferred first-line agent, if one has
a choice between metformin and a sulfonylurea," said study lead author Kevin M. Pantalone, D.O., an endocrinologist at
Summa Western Reserve Hospital in Cuyahoga Falls, OH, who conducted this study in conjunction with a team of researchers from
Cleveland Clinic in Cleveland, OH.
In the United States, nearly 26
million people, or 8 percent of the population, have diabetes, according to the Centers for Disease Control and Prevention.
Many of these patients also have other underlying medical conditions, including heart, or coronary artery, disease.
Investigators found that all three sulfonylureas studied were associated with a more
than 50 percent greater risk of death compared to metformin. Additionally, among diabetes patients with heart disease, only
glimepiride did not increase the risk of death compared to metformin. In contrast, glipizide was associated with a 41 percent,
and glyburide with a 38 percent greater risk.
"Since many patients
with type 2 diabetes also have coronary artery disease, our results could potentially impact the care of a large number of
patients," Pantalone said. "In these patients, we now know that glimepiride appears to be safer than the other commonly
prescribed sulfonylureas, glipizide and glyburide, available in the United States."
For this retrospective study, using the electronic health-record system at Cleveland Clinic, the investigators identified
23,915 patients with type 2 diabetes who previously had received treatment with one of the four medications. Overall, the
study population's average age (years) was 62, and 50 percent were male. Among the subgroup with heart disease, the average
age was 68, and 69 percent were male. Both groups comprised primarily Caucasian patients. The median follow-up was slightly
more than two years.
According to Pantalone, this research serves
as a reminder that adverse events can occur with any medication. "All drugs have risks, even those which are generic
and relatively inexpensive," he said. "It is important to talk to with your doctors about which drugs may be better
and safer options, which may vary depending on your other health conditions."
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=247069
Glycemic effect on heart disease risk: Gender differences
This study found that high dietary glycemic load and glycemic index
significantly increased risk of coronary heart disease in women but not in men, and the unfavorable effects may be more
pronounced in overweight and obese individuals. Further studies are needed to verify these findings and elucidate the underlying
mechanisms.
Inactive, retired physicians would retrain under new bill
Rep. John Sarbanes, D-Md., has introduced the Physician Reentry Demonstration
Program Act meant to help curb the physician shortage by retraining retired or otherwise inactive doctors. The bill would
assist participants with loans and credentialing costs while requiring them to serve two years at a Veterans Affairs medical
center or a school- or community-based health center.
Fat America: Where obesity rates are headed over the next 20 years
Prior studies generated from a linear trend predicted that 51% of the
U.S. population would be obese by 2030. In the current study, authors report a lower obesity prevalence at 42%. Despite this
lower rate, if their forecasts prove accurate and obesity rates are not kept at 2010 levels, the increase would lead to an
additional $549.5 billion in medical expenditures.
Too little sleep raises stroke risk in middle age
People aged 45 and older who get less than six hours of sleep every night
have a fourfold higher risk of suffering a stroke, a three-year study found. The findings, based on 5,666 normal-weight people
without a history of stroke, were presented at the Associated Professional Sleep Societies meeting.
High-sodium diet is tied to high blood pressure
A study published in the journal Circulation of more than 5,500 men and
women across a six-year period showed that people who ate more sodium had higher levels of albumin and uric acid in the blood,
indicators for the likelihood of developing high blood pressure. Study participants who ate 6,200 mg of salt per day were
21% more likely to develop high blood pressure than were those who ate 2,200 mg per day.
Urinary albumin excretion predicts heart disease
These data support current guideline recommendations to screen for urinary
albumin excretion in all type 2 diabetics, even in the absence of nephropathy, and suggest that serial urinary albumin excretion
measurements even after initiation of antihypertensive therapy has prognostic value independent of traditional cardiovascular
risk factors.The American Journal of Cardiology
Coronary risk in chronic kidney disease
This study's findings suggest that chronic kidney disease could be
added to the list of criteria defining people at highest risk of future coronary events. (Free registration required.) The Lancet
Kidney disease: Do you know?
Among patients identified as having chronic kidney disease at a health screening,
only a small proportion had been made aware of their diagnosis previously by clinicians. This subgroup was at a disproportionately
high risk for mortality and end-stage renal disease.The American Journal of Medicine
Cholesterol reduction and stroke prevention
This study concluded that non-high-density lipoprotein cholesterol is
the strongest predictor among the blood lipid risk factors of incident cerebrovascular disease in patients with established coronary heart disease. The American Journal of Cardiology
Moderate coffee consumption lowers heart failure risk
People who drank two 8-ounce servings of coffee a day had an 11% lower risk
of heart failure compared with people who don't drink coffee, according to a meta-analysis published in the journal Circulation:
Heart Failure. However, researchers said the protective quality of coffee appears to wear off with increased consumption,
and more than four cups a day may be harmful. CNN/The Chart blog
Exposure to secondhand smoke increases diabetes risk
Data on more than 6,300 U.S. adults showed those exposed to secondhand smoke
had higher BMI and type 2 diabetes rates compared with nonsmokers. Higher measures of insulin resistance, fasting blood glucose
and HbA1C levels were also noted in participants exposed to secondhand smoke, researchers said. The findings were presented
at the Endocrine Society's annual meeting. HealthDay News
Glucose-lowering treatments in prediabetes
This study concludes that prediabetes is a high-risk state for diabetes,
especially in patients who remain with prediabetes despite intensive lifestyle intervention. Reversion to normal glucose regulation,
even if transient, is associated with a significantly reduced risk of future diabetes independent
of previous treatment group.
Guidelines
Agree on Cervical Cancer Screening
Two similar sets of guidelines
recommend that most women get screened for cervical cancer every 3 to 5 years.
The principal recommendations from the U.S. Preventive Services Task Force (in the Annals of Internal
Medicine) and the American Cancer Society and related organizations (in Ca:
A Cancer Journal for Clinicians) include:
·
Women between ages 21 and 65 without risk factors (such as DES exposure or immunodeficiency) should
undergo cytologic screening every 3 years.
· Those aged
30 to 65 wishing to extend the screening interval could undergo screening with both cytologic exam and human papillomavirus
testing every 5 years.
· Women younger than 21 should
not be screened.
· Women older than 65 who have
been adequately screened previously should not be screened.
Ca: A Cancer Journal for Clinicians guidelines
from American Cancer Society et al. (Free PDF)
Annals of Internal Medicine USPSTF guidelines
USPSTF issues updated obesity guidelines
The U.S. Preventive Services Task Force has released new guidelines on obesity, urging primary care physicians to screen patients for the condition and connect
them with diet and exercise resources if necessary. The guidelines are similar to those issued in 2003, but include new evidence,
the panel said. "The good news is that even what you might consider to be modest rather than radical weight loss has
tremendous health benefits," said task force member Susan Curry of the University of Iowa College of Public Health. Reuters
USPSTF Guidelines Recommend Obesity Screening and Counseling
Group Recommends Annual Lung Cancer Screening for People at High Risk
Annual screening with low-dose computed tomography is recommended for certain patients at high
risk for lung cancer, according to new guidelines developed by the American Association for Thoracic Surgery and published
in the Journal of Thoracic and Cardiovascular Surgery.
The guidelines recommend screening for the following groups:
·
Current and former smokers aged 55 to 79 who have smoked 30 pack-years (guidelines from other societies
call for an upper age limit of 74)
· Current and
former smokers aged 50 to 79 who have smoked 20 pack-years and have other risk factors (additional cumulative lung cancer
risk of 5% or more over 5 years)
· Long-term
lung cancer survivors until age 79
Journal of Thoracic and Cardiovascular Surgery article
Brigham and Women's Hospital news release
PSA Testing Reduces Prostate Cancer Mortality, Follow-Up Study Shows
Screening with prostate-specific antigen (PSA) testing reduces
prostate cancer deaths, according to a follow-up report from the European Randomized Study of Screening for Prostate Cancer
published in the New England Journal of Medicine. (The study's
initial report, from 2009, yielded similar findings.)
The study included
over 160,000 European men aged 55 to 69. The screening group was offered PSA testing (roughly every 4 years), while the controls
were not. After a median 11 years' follow-up, prostate cancer mortality was reduced by 21% in the screening versus control
group (absolute reduction, 1.07 deaths per 1000 men). Overall mortality did not differ between the groups.
The authors calculated that to prevent one prostate cancer death, 1055 men would need to be offered
screening, and 37 cancers would need to be detected over 11 years.
They
conclude: "More information on the balance of benefits and adverse effects, as well as the cost-effectiveness, of prostate-cancer
screening is needed before general recommendations can be made."
NEJM article
USPSTF Finalizes Its Recommendation Against PSA Screening
Despite criticism, the "D" recommendation stands.
Six months after issuing a preliminary draft recommendation against prostate-specific antigen
(PSA) screening for prostate cancer, the U.S. Preventive Services Task Force (USPSTF) has finalized its position: It formally
recommends against screening — a "D" recommendation in its scheme. We covered the essence of the USPSTF
analysis in October 2011 (JW Gen Med Oct
27 2011). But how has
the USPSTF addressed the public commentary submitted by critics in response to last year's draft recommendation (nearly
2 pages of the final report are devoted to the USPSTF's response to critics)?
·
Some commentators asked the USPSTF to change from a "D" to a "C" recommendation (in the USPSTF scheme,
a "C" means that "Clinicians may provide this service to selected patients . . . [although] there
is likely to be only a small benefit."). The USPSTF responded that it did not change to "C" because it does
not concede that benefit outweighs the substantial harms.
· Some commentators asked the
USPSTF to provide more information about the consequences of avoiding PSA screening. In response, the new document includes
a summary table showing specific numbers of potential benefits and harms per 1000 men screened.
·
In response to criticism that a separate recommendation for black men was not included, the USPSTF notes that "it
is problematic to selectively recommend PSA-based screening for black men in the absence of data that support a more favorable
balance of risks and benefits."
· Some commentators believed that
the USPSTF relied too heavily on the negative U.S. PLCO screening trial, which was tainted by high rates of screening outside
the trial in the control group. The USPSTF responded that it also "heavily weighted" the European ERSPC trial, which
had certain flaws and which showed a small mortality benefit at the expense of large numbers needed to screen and treat to
benefit one person (JW Gen Med Mar
18 2009).
·
Responding to the assertion that screening probably is responsible for the observed decrease in U.S. prostate cancer
mortality during the past 2 decades, the USPSTF replies that (a) this trend started before screening could have had an effect,
and (b) many other factors, including better treatment, probably contribute to this trend.
·
Some commentators asked why the USPSTF did not consider effects on morbidity as well as mortality. In response, the
USPSTF notes that data are simply insufficient to conclude that screening lowers morbidity or improves quality of life substantially.
The USPSTF document is accompanied by two editorials in theAnnals of Internal Medicine.
In one editorial, Dr. Otis Brawley, the chief medical officer of the American Cancer Society, largely agrees with the USPSTF's
position. In the other, nine authors, including four urologists, disagree strongly.
Notably, the USPSTF document does not directly advise primary care physicians on handling PSA
screening in real-life office practice. In fact, the document begins with the following disclaimer, which might frustrate
clinicians who are looking for firm guidance: "The USPSTF recognizes that clinical decisions involve more considerations
than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or
situation." When patients request PSA tests or initiate discussions about the new recommendation against screening,
clinicians obviously will need to take a position one way or the other. But what about men who don't bring up the issue?
For example, should clinicians who agree with the "D" recommendation still mention the PSA test — if only
to tell the patient why they discourage screening? We are interested in your views on these matters: Please answer the brief
online survey that accompanies this summary, and we will tally and publish the results.
USPSTF Draft Recommendation: No Vitamin D, Calcium Supplementation for Healthy Postmenopausal Women
Healthy postmenopausal women should not take daily low-dose vitamin D and calcium supplements
to prevent fracture (grade D recommendation), the U.S. Preventive Services Task Force said on Tuesday in a draft recommendation
statement.
The group says that 400 IU of
vitamin D3 and 1000 mg of calcium carbonate taken daily don't reduce osteoporotic fractures and slightly increase the
risk for kidney stones.
In addition,
the USPSTF determined there was not enough evidence to make recommendations for or against the following:
·
Vitamin D and calcium supplementation to prevent fractures in men or premenopausal women
·
Higher doses of vitamin D for fracture prevention in healthy postmenopausal women
·
Vitamin D — with calcium or alone — for cancer prevention in adults
USPSTF draft recommendation
Guidance on Appropriate Use of Arterial Ultrasound, Physiologic Testing Offered
A group of professional societies has released appropriate-use criteria for peripheral arterial
ultrasound and physiologic testing. The document appears in the Journal of the American College of Cardiology and
other society journals.
The authors
examined over 200 indications for use of noninvasive vascular testing. Here are some examples of inappropriate uses:
·
Screening for renal artery stenosis in asymptomatic patients with peripheral artery disease and well-controlled
hypertension
· Screening for abdominal aortic
aneurysm in patients under age 65 with no history of smoking
· Follow-up
or surveillance for carotid artery stenosis in asymptomatic patients with a normal prior examination
JACC article
Estrogen for Depression in Menopausal Women?
Studies in mice provide a physiological rationale for the benefit of estrogen therapy in depressed menopausal women.
When depressed menopausal women plan to use estrogen therapy, should physicians
delay specific antidepressant interventions to see whether the hormonal therapy will improve mood and cognitive symptoms?
Two recent preclinical studies provide relevant data.
Suzuki and colleagues (with some
industry support) tested the effects of estrogen and an estrogen-β receptor (ERβ) agonist on tryptophan hydroxylase
(TPH) expression in serotonin neurons in the dorsal raphe. Wild-type mice were ovariectomized (OVX) and at 1, 3, and 10 weeks
postsurgery received implants of estrogen, an ERβ agonist, or placebo. Examination of neurons occurred 3 days after implantation.
Compared with intact mice, OVX mice had significantly lower TPH expression in dorsal raphe serotonin neurons and more spindle-shaped
neurons. Estrogen or ERβ agonist implants reversed these effects, but only when implantation occurred at 1 or 3 weeks
after OVX (i.e., not at 10 weeks afterward). Effects in ERβ-knockout mice were similar to those in OVX animals.
In
the study by the Phan group, OVX mice received vehicle or 17β-estradiol (3 doses consistent with the physiological estrus
cycle) and were tested within 15 to 40 minutes on an array of social and object learning and memory paradigms. This rapid
testing allowed researchers to distinguish 17β-estradiol effects from long-term genomic effects. A second set of OVX
animals received similar 17β-estradiol doses or placebo; brains were examined at 40 minutes after testing. All 17β-estradiol
doses significantly improved learning and memory and increased the density of dendritic spines in hippocampal CA1 regions.
Aspirin's protective
effect
Nonvascular deaths, including cancer deaths, are reduced with low-dose aspirin.
Low-Dose Aspirin Use Raises Risk for Major
Bleeding
Results raise questions
about aspirin use for primary prevention of adverse cardiovascular events in low-risk patients.
De Berardis G et al. JAMA 2012
Jun 6; 307:2286
Siller-Matula JM. JAMA 2012 Jun 6; 307:2318
Soy Supplementation in Women Has No Effect
on Global Cognition
A trial designed to simulate
soy equivalents in an Asian diet fails to demonstrate a significant benefit on cognition in postmenopausal women.
Older women don't
benefit from low doses of vitamin D, calcium
Low doses of vitamin D and calcium supplements had little positive effect in preventing fractures among
postmenopausal women, according to draft recommendations from the U.S. Preventive Services Task Force. The panel noted that
such doses slightly elevated the odds of adverse reactions such as the development of kidney stones and said they should not
be taken.
Vitamin D plus calcium
may reduce mortality risk in seniors
The risk of dying earlier among older people who took vitamin D and calcium supplements
was 9% lower over a three-year period compared with those who didn't take the supplements, Danish researchers wrote in
the Journal of Clinical Endocrinology & Metabolism
Defining Optimal Serum 25-Hydroxyvitamin
D Concentration
Low
levels were associated with elevated risk for hip fracture, myocardial infarction, cancer, and death.
de Boer IH et al. Ann
Intern Med 2012 May 1; 156:627
Dietary Fats Are Associated
with Cognition
In healthy older women,
low saturated fat intake and high monounsaturated fat intake were beneficial.
Okereke
OI et al. Ann Neurol 2012
May 17;
Chill Out and Live Longer
In men, but not in women,
high levels of cynical hostility are linked to shorter telomeres and greater telomerase activity.
Brydon L et al. Biol Psychiatry 2012
May 1; 71:767
Purpose in Life Is
Good for the Soul and Good for the Brain
Having a strong purpose
in life is associated with better cognitive function despite Alzheimer neuropathology.
Boyle PA et al. Arch Gen Psychiatry 2012
May 69:499
Elevated Serum
Uric Acid Predicts Metabolic Syndrome in Adolescents
Male adolescents with the highest uric
acid levels at baseline were 6 times more likely to develop metabolic syndrome after 3 years than those with the lowest levels.
Wang J-Y et al. J Pediatr 2012
May 11;
Are Calcium Supplements Bad for the Heart?
Supplements,
but not dietary calcium intake, were associated with elevated risk for myocardial
infarction.
Li K et al. Heart 2012 Jun 98:920
Reid
IR and Bolland MJ. Heart 2012
Jun 98:895
Corticosteroid
Injections for Plantar Fasciitis
Healing
was faster with dexamethasone injections.
McMillan
AM et al. BMJ 2012
May 22; 344:e3260
HDL Cholesterol: Causal
or Just a Marker for Coronary Risk?
Genetically elevated
HDL cholesterol level was not associated with lower risk for myocardial infarction.
Voight BF et al. Lancet 2012
May 17;
Harrison SC et al. Lancet 2012 May 17;
Dietary Fats Are
Associated with Cognition
In healthy older women,
low saturated fat intake and high monounsaturated fat intake were beneficial.
Okereke
OI et al. Ann Neurol 2012
May 17;
Practice Guidelines for Management of Nonalcoholic Fatty Liver Disease
Three U.S. medical associations issue their first joint recommendations
on diagnosing and managing NAFLD.
Ibuprofen
Reduces the Severity of Acute Mountain Sickness
. . .
and is likely as effective as acetazolamide or dexamethasone.
Researchers
randomized 86 healthy nonacclimated adult volunteers to receive oral ibuprofen (600 mg) or placebo every 6 hours, beginning
6 hours before rapidly ascending from an altitude of 4100 feet to 12,570 feet in California. Outcome measures were incidence
and severity of acute mountain sickness on the validated, self-reported, symptom-based Lake Louise Questionnaire. Acute mountain
sickness was defined as a symptom score of >3 with headache and one other symptom.
Significantly
fewer volunteers in the ibuprofen group than in the placebo group developed acute mountain sickness (43% vs. 69%; number needed
to treat, 3.9). Among volunteers who developed mountain sickness, symptom severity was lower in the ibuprofen group, although
the difference was not statistically significant.
Comment: The efficacy of prophylactic ibuprofen
is similar to that of traditional altitude sickness prophylaxis with acetazolamide and dexamethasone. Given the more favorable
safety profile of ibuprofen compared with acetazolamide and dexamethasone, ibuprofen seems to be the obvious choice until
a head-to-head comparison demonstrates that one is clearly better.
Medline abstract
FDA Approves First New Weight-Loss Drug in 13 Years
The FDA has approved lorcaserin (Belviq) as an adjunct to diet and exercise
for ongoing weight management — the first new weight-loss drug to be approved in the U.S. in 13 years.
Lorcaserin is approved for use in adults with
a BMI of 30 or more, or for those with a BMI of 27 or more who have at least one weight-related condition (type 2 diabetes,
dyslipidemia, hypertension). In trials, lorcaserin recipients lost roughly 3.5% of body weight after 1 year.
Lorcaserin activates the brain's serotonin 2C receptor, which may help people feel full after
eating smaller amounts. Treatment can cause serotonin syndrome, especially when taken with medications that raise serotonin
levels or activate serotonin receptors, including antidepressants and migraine drugs.
Heart valve abnormalities, a concern with previous antiobesity drugs, did not appear to differ between
patients treated with lorcaserin and those on placebo. However, the FDA warns that it should be used with caution in patients
with congestive heart failure, because such patients may have higher levels of serotonin 2B receptors.
Linagliptin Noninferior to Glimepiride as Add-On
to Metformin in Type 2 Diabetes
In
poorly controlled type 2 diabetes, the dipeptidyl peptidase-4 (DPP-4) inhibitor linagliptin is noninferior to the sulfonylurea
glimepiride when used as an adjunct to metformin — and is associated with fewer hypoglycemic episodes and cardiovascular
events — according to aLancet study.
In a double-blind noninferiority study done with the manufacturer's participation, researchers
randomized some 1500 patients on metformin to added treatment with either linagliptin or glimepiride for 2 years. The change
in glycated hemoglobin between baseline and week 104 was similar between groups. However, hypoglycemic episodes and cardiovascular
events (mainly strokes) were both less frequent with linagliptin. Weight decreased with linagliptin, but increased with glimepiride.
Commentators say the study confirms linagliptin's noninferiority to glimepiride in lowering glycated
hemoglobin levels; however, linagliptin costs more. They caution that longer-term studies would be required to confirm an
advantage with respect to cardiovascular events.
Lancet article
Low-Carb,
High-Protein Diet Linked to Increased CV Risk in Women
Women who regularly follow a low-carbohydrate, high-protein diet face increased risk
for cardiovascular disease, according to a prospective, observational study in BMJ.
Some 43,000 Swedish women, aged 30 to 49 and without previous cardiovascular disease, completed questionnaires
that assessed their habitual dietary patterns. During roughly 16 years' follow-up, 1270 CV events occurred.
After adjustment for confounders such as BMI, smoking status, physical activity, and saturated fat
intake, the risk for CV events increased significantly as carbohydrate intake decreased and protein intake increased. In particular,
for each 2-unit increase in a low-carb, high-protein score (on a scale of 2 to 20), women had a 5% increase in CV risk.
Editorialists conclude: "The short term benefits of low carbohydrate-high protein diets for weight
loss that have made these diets appealing seem irrelevant in the face of increasing evidence of higher morbidity and mortality
from cardiovascular diseases in the long term."
BMJ article
http://www.bmj.com/content/344/bmj.e4026
Are
Statins More Effective in Men Than in Women?
Statins lower the risk for recurrent cardiovascular events in both sexes, but the
benefits for stroke and all-cause mortality might be limited to men, according to an Archives of
Internal Medicine meta-analysis.
The analysis included 11 randomized, placebo-controlled trials of statins for secondary prevention,
comprising more than 43,000 participants (20% women). Overall, statin therapy significantly reduced the risk for any CV event
by about 20% in both men and women. Statins also significantly cut risks for all-cause mortality and stroke in men —
but not in women.
The authors say that the sex differences observed "are
likely secondary to the small proportion of women included in the trials and a worse cardiovascular health status in these
same women." They say that various limitations to the analysis make the results "less conclusive."
Commentators write that "focusing on a lack of statistical significance in the findings for women
is misleading." They suggest that "statins work just as well in women as in men."
Archives of Internal Medicine article
Statin Use Linked to Fatigue in Randomized Trial
Statin use leads to decreased energy and increased fatigue with exertion,
especially among women, according to a randomized trial published in the Archives of Internal Medicine.
Researchers
randomized some 1000 adults with elevated LDL cholesterol — and without cardiovascular disease or diabetes — to
simvastatin (20 mg/day), pravastatin (40 mg/day), or placebo. At 6 months, statin use was associated with significant worsening
in energy and exertional fatigue, with simvastatin accounting for most of the ill effects. Women seemed particularly affected.
The authors say this is the "first randomized evidence affirming unfavorable statin effects"
on these outcomes. They conclude that such effects "merit consideration when prescribing or contemplating use of statins,
particularly in groups without expected net morbidity/mortality benefit."
Archives of Internal Medicine research letter
Guidelines
Issued for Managing Osteoporosis in Men
The Endocrine Society has issued
guidelines on managing osteoporosis in men. Appearing in the Journal of Clinical Endocrinology & Metabolism,
the guidelines recommend the following:
· Men at high
risk for osteoporosis (e.g., those aged 70 and older; younger men with risk factors like low body weight, smoking,
and previous fracture) should be screened with dual-energy x-ray absorptiometry (DXA).
·
Men with low levels of vitamin D (less than 30 ng/mL) should take vitamin D supplements.
·
Those with or at risk for osteoporosis should consume 1000 to 1200 mg of calcium every day,
preferably from dietary sources.
· Men aged
50 and older with prior spine or hip fracture, low bone mineral density, or other clinical risk factors should receive
drug therapy.
· Those receiving treatment should
have their bone mineral density assessed by DXA at the spine and hip every 1 to 2 years.
Journal of Clinical Endocrinology & Metabolism article
Six-Minute Walk Test Improves Clinical Assessment of Stable CHD
The distance a patient with stable coronary heart
disease can walk in 6 minutes adds as much prognostic information to their risk for heart failure, MI, and death as treadmill
testing, according to an Archives
of Internal Medicine study.
Researchers
evaluated walking distances in some 550 patients with stable disease; on the same day, the patients also underwent treadmill
exercise testing. After a median follow-up of 8 years, those in the lowest quartile of walking distance (ranging from 87 to
419 meters) had four times the rate of heart failure, MI, or death as those in the highest quartile (544 to 837 m). The authors
found that adding walking test results to traditional risk factors improved risk classification by 39%. They further observed
a similar predictive ability between the cheaper walking test and treadmill testing.
A
commentator points out possible selection bias but argues that regular use of the walking test could be a way to get patients
started on regular exercise.
Archives of Internal Medicine article
Screening
Strategies For Osteoporosis In Young Adults Outlined In New Review
http://mnt.to/l/46NZ
New Clinical Practice Guidelines On The Management Of Osteoporosis In Men
http://mnt.to/l/46MH
Breast Cancer Risk May Be Reduced By Exercise,
Even Mild Physical Activity
http://mnt.to/l/46TS
Keeping
Fit May Reduce Breast Cancer Risk
http://mnt.to/l/46SZ
How The Key Enzyme Involved In Aging, Cancer Assembles
http://mnt.to/l/46MY
Protein That Binds To Growth Factor Receptor, Priming It For Normal
Function, Likely Linked To 4 Cancers
http://mnt.to/l/46Sg
Antioxidant
Enzyme Reduces Cardiovascular Disease Risk
http://mnt.to/l/46R7
How Dietary Fat Regulates Cholesterol Absorption
http://mnt.to/l/46Sx
Common Diabetes Drugs Associated With Increased Risk Of Death
http://mnt.to/l/46Vf
Fructose
In Moderation Could Be Beneficial For Diabetics
http://mnt.to/l/46RM
Agricultural Fungicide Linked To Insulin Resistance
http://mnt.to/l/46TP
Reduced Weight And Waist Size With Long-Term Testosterone Treatment
For Men
http://mnt.to/l/46Sv
Study Finds Declining Testosterone Levels In Men Not Part Of Normal
Aging
http://mnt.to/l/46St
Improved
Understanding Of How Bacteria Spread
http://mnt.to/l/46QB
Researchers Help Develop First Brain Map Of Love And Desire
http://mnt.to/l/46Qd
Vitamin B3 Found In Milk May Result In Substantial Health Benefits
http://mnt.to/l/46TG
Weight Gain Linked To Vitamin D Deficiency In Older Women
http://mnt.to/l/46TY
Dopamine And Sleep Regulation
http://mnt.to/l/46NB
A New Study Of Sardinian Men Finds Height Is A Factor In Longevity
http://mnt.to/l/46Pf
Prostate Cancer Risk Higher For Heavy Tea Drinkers
http://mnt.to/l/46Nt
Inflammation Reduced In Overweight Older Adults By Omega-3
http://mnt.to/l/46QF
Add Exercise To Dieting To Improve Insulin Sensitivity
http://mnt.to/l/46TK
Natural Compound Found In Fruit, Nuts And Wine Led To Improved
Strength And Endurance
http://mnt.to/l/46NJ
Salads With Dressing May Be Better For You Than Without
http://mnt.to/l/46T3
Overall
Post-Meal Blood Sugar Levels Reduced By Snacking On Raisins
http://mnt.to/l/46SH
How Do Infections Lead To Malignancy?
http://mnt.to/l/46Nq
Preclinical Study Links Aging And Cancer, With Lethal Host Metabolism
In The Tumor Microenvironment
http://mnt.to/l/46Ky
Virus Kills Cancer By Hitching Ride On Blood Cells
http://mnt.to/l/46K4
Successful With New Immune Approach To Fighting Some Cancers
http://mnt.to/l/46Jq
From
Infection To Inflammation To Cancer: Scientists Offer New Clues
http://mnt.to/l/46H6
Statins Cause Fatigue
http://mnt.to/l/46JT
LDL-C
Lowering Of Pitavastatin Equivalent To Other Statins But Effect On HDL-C And Triglycerides Superior
http://mnt.to/l/46Hy
Nectarines, Plums And Peaches May Fight Obesity And Diabetes
http://mnt.to/l/46Mg
Hidden
Vitamin In Milk Yields Remarkable Health Benefits
http://mnt.to/l/46M5
Can
Too Much Salt Damage Blood Vessels? Yes
http://mnt.to/l/46Mf
Tiny Vitamin In Milk, In High Doses, Makes Mice Leaner, Faster
And Stronger
http://mnt.to/l/46KC
Vitamin D - How Much Is Too Much?
http://mnt.to/l/46HF
Hope For Therapy To Repair Damage To The Peripheral Nervous System
http://mnt.to/l/46Ln
How
Music Benefits The Brain
http://mnt.to/l/46Lc
Sensual Caress - How Does The Brain
Respond? Neuroscientists Explain
http://mnt.to/l/46L7
Study Suggests Life-extending Benefits Of Longer Telomeres If Recent
Male Ancestors Reproduced At Older Ages
http://mnt.to/l/46Fs
Diabetic Peripheral Neuropathy Linked To Obstructive Sleep Apnea
http://mnt.to/l/46Lh
Beta Amyloid May Be The Key To Diagnosis Of Alzheimer's In
Healthy Patients
http://mnt.to/l/46Fk
Your
Attitude Towards Age May Increase Your Risk Of Dementia Diagnosis
http://mnt.to/l/46F5
Coffee
Linked To Alzheimer's Disease Avoidance
http://mnt.to/l/46z6
The Brains Of Anxious Girls Work Harder
http://mnt.to/l/46zp
Early Menopause Predicts A Milder Form Of Rheumatoid Arthritis
http://mnt.to/l/46CP
How Cells' Common Sugar Molecules Influence Inflammation, Cancer
Metastasis, And Related Conditions
http://mnt.to/l/46Dx
Ginseng For Cancer Patients Says Mayo Clinic
http://mnt.to/l/46zM
Heart Aging Decreased On Calorie-Restricted Diet
http://mnt.to/l/46Bf
Pre-Diabetic Patients Respond To Agressive Glucose-Lowering Treatment
http://mnt.to/l/46Gk
One
In Four Type 2 Diabetes Patients Do Not Take Basal Insulin As Prescribed And More Than A Third Suffer From Hypoglycemia
http://mnt.to/l/46FN
Long
Term Insulin Not Linked To Higher Risk Of Heart Attack, Stroke, Cancer
http://mnt.to/l/46F3
Risk Of Stroke Found In Pre-Diabetic Patients
http://mnt.to/l/46DK
Diabetes
Could Be Reduced With Aggressive Treatment Of Pre-Diabetes, Study
http://mnt.to/l/46Dy
Lean People With Type 2 Diabetes Have Greater Genetic Predisposition
To The Disease
http://mnt.to/l/46xq
Waist Size, Regardless Of BMI, Linked To Diabetes Risk
http://mnt.to/l/46B3
Study With Music Challenges Theory About Right-Brain And Left-Brain
Functions
http://mnt.to/l/46zV
neural
rhythms found to drive physical movement
http://mnt.to/l/46yj
First Atomic-Level Images Of The Circadian CLOCK Complex
http://mnt.to/l/46yn
Side Effects Of Statins
http://mnt.to/l/46F8
Brown Fat Activated By Cold, Not Ephedrine
http://mnt.to/l/46zy
Nicotinamide
Riboside In Milk May Protect Against Obesity
http://mnt.to/l/46zr
Vitamin D - Which Type Is Best?
http://mnt.to/l/46zP
The Immune System Plays Important Role In Protecting Against Alzheimer's
http://mnt.to/l/46tG
Tart Cherries May Help Millions Reduce Inflammation To Manage Pain,
According To New Research
http://mnt.to/l/46v3
Gout Risk From Purine Rich Foods
http://mnt.to/l/46vF
Increasing Fiber In Adolescents' Diets Has Many Health Benefits
http://mnt.to/l/46wY
Mediterranean
Diet Good For Mental And Physical Health
http://mnt.to/l/46xt
Snacking On Raisins Controls Hunger, Promotes Satiety In Children
http://mnt.to/l/46wC
Choosing The Right Type Of Vitamin D For Health Benefits
http://mnt.to/l/46wm
Life Expectancy Of Women In Their 70s Extended By Exercise
And A Healthy Diet Of Fruits And Vegetables
http://mnt.to/l/46vs
Updated Guidelines on Brain Death Determination in Children
New guidelines affirm that a determination of brain death
can be made in an infant or child solely based on clinical examination and apnea testing.
Journal Watch Neurology summary
