HHAL MEDICAL NEWS AUGUST 2013

Sugar Feeds Cancers

Previously, scientists have observed that people with Metabolic Syndrome – a condition characterized by central obesity, hypertension, and adverse glucose and insulin metabolism – are at an increased risk for certain cancers.  Using a fruit fly model, Ross L. Cagan, from the Ichan  School of Medicine at Mount Sinai (New York, USA), and colleagues have demonstrated that sugar activates oncogenes in the tumor, and also promoted tumor cell-specific insulin sensitivity by increasing the activity of the canonical signaling pathway.  The study authors submit that this feed-forward circuit may be targeted with “rationally applied drug combinations, we demonstrate the potential of combinatorial drug intervention to treat diet-enhanced malignant tumors.”

http://www.medpagetoday.com/Endocrinology/Obesity/40920

Omega-3s May Lower Breast Cancer Risk

Fish is an abundant source of omega-3 polyunsaturated fatty acids (PUFA), compounds for which a number of studies suggest a range of health effects.  Duo Li, from Zhejiang University (China), and colleagues completed a meta-analysis of 26 studies involving data on nearly 21,000 study subjects, finding that women with the highest intakes of omega-3 PUFAs from marine sources have a 14% reduction in the risk of breast cancer, as compared to women with the lowest intake.  Further analysis indicated that for each 0.1 g per day or 0.1% energy per day increment of intake, the risk fell by 5%.  Observing that: “Higher consumption of dietary [omega-3 polyunsaturated fatty acids] is associated with a lower risk of breast cancer,” the study authors submit that: “These findings could have public health implications with regard to prevention of breast cancer through dietary and lifestyle interventions.”

http://www.nutraingredients-usa.com/Research/Omega-3-intake-may-lower-breast-cancer-risk-finds-BMJ-review/

Eating Fish Cuts Risk of Rheumatoid Arthritis in Women

 (HealthDay News) – Regular consumption of dietary long-chain n-3 polyunsaturated fatty acids (PUFAs) in fish is associated with reduced risk of rheumatoid arthritis (RA) in women, according to research published online Aug. 12 in the Annals of the Rheumatic Diseases.

Daniela Di Giuseppe, of the Karolinska Institutet in Stockholm, and colleagues prospectively studied the association between dietary long-chain n-3 PUFAs and the incidence of RA in middle-aged and older women from the Swedish Mammography Cohort. Diet was assessed using a self-administered food-frequency questionnaire in 1987 and 1997.

The researchers identified 205 cases of RA during follow-up averaging 7.5 years among 32,232 women born in 1914–1948. Women consuming >0.21 g/day of dietary long-chain n-3 PUFAs had a 35% lower risk of developing RA than women consuming less. Long-term, regular intake of >0.21g/day correlated with a 52% decrease in risk of RA. Compared with those who ate less, women who ate at least one weekly serving of fish on a routine, long-term basis had a 29% decrease in risk of RA.

"Long-term consistently high intake in both 1987 and 1997 of >0.21g/day (corresponding to at least one serving per week of fatty fish [e.g., salmon] or four servings per week of lean fish [e.g., cod]) was associated with a 52% decrease in risk of RA," the authors write.

http://ard.bmj.com/content/early/2013/07/25/annrheumdis-2013-203338.short?g=w_ard_ahead_tab

B Vitamin Confers DNA Protection

Previous studies link a higher vitamin B status with a lower risk for cancer.  To elucidate the exact mechanism by which this may occur, Keisuke Kuwahara, from the National Center for Global Health and Medicine (Japan), and colleagues studied 500 subjects (293 men and 207 women), ages 21 to 66 years, employed at two municipal offices in Japan. Observing that pyridoxal – one of three forms of vitamin B6 – associated with lower urinary 8-hydroxydeoxyguanosine (8-OHdG), a marker of oxidative DNA damage, in men, the study authors write that: “The results suggest that vitamin B6 plays a role against oxidative DNA damage.”

http://www.nutraingredients-usa.com/Research/Vitamin-B6-linked-to-DNA-protection-Study/

Garlic May Protect Against Lung Cancer

A number of previous studies report a protective effect of garlic, in both in vitro and in vivo experimental studies of cancer.  Zi-Yi Jin, from the Jiangsu Provincial Center for Disease Control and Prevention (China), and colleagues interviewed 1,424 lung cancer patients, as well as 4,543 healthy control subjects, to ascertain lifestyle behaviors (particularly, if they smoked) and dietary habits (particularly, how much garlic they ate).  The data revealed that consuming raw garlic may reduce lung cancer risk by as much as 44%. Among smokers, eating raw garlic 2-3 times a week may reduce lung cancer risk by as much as 30%.  Noting a “protective association between intake of raw garlic and lung cancer,” the study authors conclude that: “garlic may potentially serve as a chemopreventive agent for lung cancer.”

http://www.nutraingredients-usa.com/Research/Garlic-reduces-lung-cancer-risk-by-44-suggests-study/

Multivitamin May Improve Mood & Well-being

The most commonly used supplement in the developed world, multivitamins are formulated with a composition that mimics a diverse assortment of healthy fruit and vegetable compounds. David Camfield, from Swinburne University (Australia), and  colleagues studied 138 healthy adults, ages 20 to 50 years, to whom a multivitamin was administered for 16 weeks.  Via at-home mobile-phone assessments, subjects reported “significantly reduced stress, physical fatigue and anxiety” after taking the multivitamin. 

http://www.nutraingredients-usa.com/Research/Multivitamin-trial-suggests-some-benefits-for-mood-and-wellbeing/

Cumulative Metformin Linked to Mortality Post-Prostate Cancer

(HealthDay News) – Among elderly men with diabetes, increased cumulative duration of metformin following a prostate cancer (PC) diagnosis correlates with decreased all-cause and PC-specific mortality, according to a study published online Aug. 5 in theJournal of Clinical Oncology.

David Margel, MD, PhD, from the University of Toronto, and colleagues analyzed data from several Ontario health care administrative databases to identify men (>66 years) with incident diabetes who subsequently developed PC. Within the cohort of 3,837 patients, they examined the impact of duration of antidiabetic medication exposure following diagnosis with PC on all-cause and PC-specific mortality.

The researchers found that the median age at PC diagnosis was 75 years. Over a median of 4.64 years of follow-up, 35% of patients died, with 7.6% dying from PC. The risk of PC-specific and all-cause mortality was significant decreased, in a dose-dependent manner, for cumulative duration of metformin treatment after PC diagnosis. For PC-specific mortality, the adjusted hazard ratio was 0.76 for each additional six months of metformin use. There was also a significant association with all-cause mortality but it declined over time, from a hazard ratio of 0.76 in the first six months to 0.93 between 24–30 months. For other antidiabetic drugs there was no relationship with cumulative use and either outcome.

"Increased cumulative duration of metformin exposure after PC diagnosis was associated with decreases in both all-cause and PC-specific mortality among diabetic men," the authors write.

Abstract

Small-Fiber Polyneuropathy ID'd in Fibromyalgia Cases

(HealthDay News) – Some patients diagnosed with fibromyalgia may actually have small-fiber polyneuropathy (SFPN), according to a study published online June 7 in PAIN.

Anne Louise Oaklander, MD, PhD, from Harvard Medical School in Boston, and colleagues analyzed SFPN-associated symptoms, signs, and pathological and physiological markers in 27 patients with fibromyalgia (who satisfied the American College of Rheumatology criteria and had documented evidence of a physician's diagnosis) and in 30 normal matched controls.

The researchers found that 41% of distal-leg neurodiagnostic skin biopsies from subjects with fibromyalgia and 3% from controls were diagnostic for SFPN. Compared with controls, patients with fibromyalgia had significantly higher Michigan Neuropathy Screening Instrument and Utah Early Neuropathy Scale scores. The prevalence of abnormal autonomic-function testing was equal between the groups. Glucose tolerance tests were normal from 13 subjects with fibromyalgia and SFPN-diagnostic biopsies, but eight, two, and one patient, respectively, had dysimmune markers, hepatitis C serologies, and apparent genetic causality.

"These findings suggest that some patients with chronic pain labeled as fibromyalgia have unrecognized SFPN, a distinct disease that can be tested for objectively and sometimes treated definitively," the authors write.

Abstract

Extension of Drosophila Lifespan by Rhodiola rosea through a mechanism independent from dietary restriction.

Abstract

Rhodiola rosea has been extensively used to improve physical and mental performance and to protect against stress. We, and others, have reported that R. rosea can extend lifespan in flies, worms, and yeast. However, its molecular mechanism is currently unknown. Here, we tested whether R. rosea might act through a pathway related to dietary restriction (DR) that can extend lifespan in a range of model organisms. While the mechanism of DR itself is also unknown, three molecular pathways have been associated with it: the silent information regulator 2 (SIR2) proteins, insulin and insulin-like growth factor signaling (IIS), and the target of rapamycin (TOR). In flies, DR is implemented through a reduction in dietary yeast content. We found that R. rosea extract extended lifespan in both sexes independent of the yeast content in the diet. We also found that the extract extended lifespan when the SIR2, IIS, or TOR pathways were genetically perturbed. Upon examination of water and fat content, we found that R. rosea decreased water content and elevated fat content in both sexes, but did not sensitize flies to desiccation or protect them against starvation. There were some sex-specific differences in response to R. rosea. In female flies, the expression levels of glycolytic genes and dSir2 were down-regulated, and NADH levels were decreased. In males however, R. rosea provided no protection against heat stress and had no effect on the major heat shock protein HSP70 and actually down-regulated the mitochondrial HSP22. Our findings largely rule out an elevated general resistance to stress and DR-related pathways as mechanistic candidates. The latter conclusion is especially relevant given the limited potential for DR to improve human health and lifespan, and presents R. rosea as a potential viable candidate to treat aging and age-related diseases in humans.

http://www.ncbi.nlm.nih.gov/pubmed/23704949

Does Vitamin D Improve Blood Pressure in the Elderly?

Vitamin D Doesn't Improve Blood Pressure in Elderly

(HealthDay News) – Vitamin D supplementation does not improveblood pressure (BP) in older patients with isolated systolic hypertension, according to a study published online Aug. 12 inJAMA Internal Medicine.

Miles D. Witham, PhD, from the University of Dundee in the United Kingdom, and colleagues randomized 159 patients ≥70 years with isolated systolic hypertension (supine systolic BP>140mmHg and supine diastolic BP <90mmHg) and baseline 25-hydroxyvitamin D levels <30ng/mL to receive 100,000 U of oral cholecalciferol or placebo every three months for one year. Office BP, 24-hour BP, arterial stiffness, endothelial function, cholesterol level, insulin resistance, and B-type natriuretic peptide level were measured during the 12 months.

The researchers found that the mean baseline office systolic BP was 163/78mmHg and mean baseline 25-hydroxyvitamin D level was 18ng/mL. Despite significant increases in 25-hydroxyvitamin D levels in the treatment group, there were no significant treatment effects seen for mean office BP at three months or for any of the secondary outcomes (24-hour BP, arterial stiffness, endothelial function, cholesterol level, glucose level, and walking distance). There were no additional adverse events in the treatment group, and the total number of falls was non-significantly lower in the group receiving vitamin D.

"Vitamin D supplementation did not improve blood pressure or markers of vascular health in older patients with isolated systolic hypertension," the authors write.

http://archinte.jamanetwork.com/article.aspx?articleid=1726994#Abstract

Data Links Air Pollution to Lung Cancer

Researchers in Europe report data that suggests a causal role for air pollution in lung cancer.  Ole Raaschou-Nielsen, of the Danish Cancer Society Research Center (Denmark), and colleagues completed a prospective analysis of data obtained by the European Study of Cohorts for Air Pollution Effects (ESCAPE).  The overall analysis comprised 312,944 study participants and about 4.1 million person-years at risk. During a mean follow-up of 12.8 years, 2,095 cases of lung cancer were diagnosed. The meta-analyses showed a significant association between lung cancer and particulate matter <10 micrometers, represented by a hazard ratio of 1.22.  Analyses of associations between air pollution and adenocarcinoma lung cancer showed significant associations for particulate matter <10 micrometers (hazard ratio of 1.51) and <2.5 micrometers (hazard ratio of 1.55). Associations were strongest for participants who resided at the same address for longer periods of time. The study authors conclude that: “Particulate matter air pollution contributes to lung cancer incidence in Europe.”

http://www.medpagetoday.com/TheGuptaGuide/Oncology/40357

Effects of Habitual Coffee Consumption on Cardiometabolic Disease, Cardiovascular Health, and All-cause Mortality.

O'Keefe JH, Bhatti SK, Patil HR, Dinicolantonio JJ, Lucan SC, Lavie CJ.

Source

Mid America Heart Institute at Saint Luke's Hospital of Kansas City and University of Missouri-Kansas City, Kansas City, MO. Electronic address: jokeefe@saint-lukes.org.

Abstract

Coffee is the most widely consumed beverage in the United States (US) after water, and is the principal source of caffeine intake among adults. The biological effects of coffee may be substantial and are not limited to the actions of caffeine. Coffee is a complex beverage containing hundreds of biologically-active compounds, and the health effects of chronic coffee intake are wide ranging. From a cardiovascular (CV) standpoint, coffee consumption may reduce the risks of type 2 diabetes mellitus (T2DM) and hypertension (HTN), as well as other conditions associated with CV risk such as obesity and depression; but it may adversely affect lipid profiles depending on how the beverage is prepared. Regardless, a growing body of data suggests that habitual coffee consumption is neutral to beneficial regarding the risks for a variety of adverse CV outcomes including coronary heart disease (CHD), congestive heart failure (CHF), arrhythmias, and stroke. Moreover, large epidemiological studies suggest that regular coffee drinkers have reduced risks for mortality-both CV and all-cause. The potential benefits also include protection against neurodegenerative diseases, improved asthma control, and lower risk of select gastrointestinal diseases. A daily intake of about 2 to 3 cups of coffee appears to be safe and is associated with neutral to beneficial effects for most of the studied health outcomes. However, most of the data on coffee's health effects are based upon observational data, with very few randomized controlled studies, and association does not prove causation. Additionally, the possible advantages of regular coffee consumption have to be weighed against potential risks (which are mostly related to its high caffeine content) including anxiety, insomnia, tremulousness and palpitations, as well as bone loss and possibly increased risk of fractures.

http://www.ncbi.nlm.nih.gov/pubmed/23871889

FDA: Acetaminophen May Cause Rare But Serious Skin Reaction

The FDA is alerting healthcare professionals and consumers that acetaminophen, while rare, can cause serious skin reactions. Acetaminophen is a fever and pain reliever that is widely used in the United States.

The three severe skin reactions linked to acetaminophen are Stevens-Johnson Syndrome (SJS), toxic epidermal necrosis (TEN), and acute generalized exanthematous pustulosis (AGEP). SJS and TEN are the two most serious reactions that may even be fatal. AGEP usually resolves within two weeks of stopping the medication.

Possible symptoms of the three serious skin diseases include rash, blisters, and widespread damage to the skin surface. Patients should be informed about the signs and symptoms of serious skin reactions and that use of acetaminophen should be discontinued at the first appearance of skin rash or any other sign of hypersensitivity. The reaction can occur at any time, even if the patient has taken acetaminophen previously without experiencing a rash.

A search within the FDA Adverse Event Reporting System (FAERS) showed 107 cases from 1969–2012, resulting in 67 hospitalizations and 12 deaths. The FDA is requiring that a warning about these skin reactions be added to the labels of all prescription medicines containing acetaminophen. Also, the FDA will work with manufacturers to get these warnings added to the labels of over-the-counter (OTC) medicines containing acetaminophen.

Acetaminophen is also used in combination medicines to treat pain, colds, coughs, allergy,headaches, and trouble sleeping.

For more information visit FDA.gov.

Caffeine reduces myocardial blood flow during exercise
This review summarizes the available medical literature specifically relating to pure caffeine tablet ingestion and reduced exercise coronary blood flow and suggests possible mechanisms. The American Journal of Medicine

Muscle mass effects of diabetes
Older men with type 2 diabetes were compared with older men with normal glycemic levels and it was found that diabetic men had an accelerated decline in leg lean mass, muscle strength and function compared with nondiabetic men. This points to a need for exercise programs specifically targeted to increase muscle mass, strength and functional capacity in those with type 2 diabetes. (Free abstract only.) Journal of the American Medical Directors Association

Protein needs in older adults
Older adults need more protein than their younger counterparts. The PROT-AGE Study group, including international experts, set out to develop updated goals for protein intake for the elderly based on evidence. To maintain good health, increase recovery from illness and support functionality, older adults should consume 1.0 to 1.2 grams of protein per kilogram of body weight per day. Those who take a higher amount of protein per day lose less lean body mass than those with lower protein intake. (Free abstract only.) Journal of the American Medical Directors Association

New risk score for dementia in diabetic patients
This is the first risk score for the prediction of 10 year dementia risk in patients with type 2 diabetes mellitus. The risk score can be used to increase vigilance for cognitive deterioration and for selection of high-risk patients for participation in clinical trials. (Free registration required.) The Lancet Diabetes & Endocrinology

Effective interventions for chronic fatigue syndrome/myalgic encephalomyelitis
A systematic review of interventions for the management of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) in children and adolescents found a range of effectiveness, with cognitive behavioral therapy showing the strongest results. (Full-text is time limited.) Journal of Adolescent Health

Is Echocardiography Valuable for Screening?

Lindekleiv H et al., JAMA Intern Med 2013 Jul 22;

Screening in the general population provides no obvious benefit.

Prevention of DVT by Intermittent Pneumatic Compression in Stroke Patients

CLOTS (Clots in Legs Or sTockings after Stroke) Trials Collaboration., Lancet 2013 May 31;

Compression devices prevented asymptomatic proximal deep venous thrombosis, but not symptomatic proximal DVT or confirmed pulmonary embolism.

Does Low-Dose Aspirin Lower Cancer Risk in Women?

Cook NR et al., Ann Intern Med 2013 Jul 16; 159:77

Taking 100 mg of aspirin every other day for 10 years was associated with lower colorectal cancer risk.

Endovascular vs. Open Repair of Ruptured Abdominal Aortic Aneurysms

Reimerink JJ et al., Ann Surg 2013 Aug 258:248

In a randomized Dutch trial, outcomes were similar with the two procedures.

Glucose Levels Predict Risk for Dementia

Crane PK et al., N Engl J Med 2013 Aug 8; 369:540

Higher glucose levels within the nondiabetic range predicted higher risk for dementia.

Does Air Pollution Increase the Risk for Acute Heart Failure?

Shah ASV et al., Lancet 2013 Jul 10;

Certain types of air pollution have a significant temporal association with heart failure–related hospitalization and mortality.

Do Antipsychotics Hasten Poor Outcomes in Patients with Alzheimer Disease?

Lopez OL et al., Am J Psychiatry 2013 Jul 30;

Psychotic symptoms and agitation, not antipsychotic medications per se, were associated with earlier nursing home admission and death.

Prevalence of Occult Prostate Cancer at Autopsy Is High

Zlotta AR et al., J Natl Cancer Inst 2013 Jul 17; 105:1050

Overall prevalence was 36%, but it reached almost 60% among Japanese men in their 80s.

Higher ω-3 Fatty Acid Levels Are Associated with Risk for Prostate Cancer

TM et al., J Natl Cancer Inst 2013 Aug 7; 105:1132

This association now has been noted in two case-control studies.

Calcium-Channel Blockers Might Be Associated with Excess Breast Cancer Risk

Coogan PF., JAMA Intern Med 2013 Aug 5;

Pituitary-Adrenal Axis Suppression After Long-Term Prednisone Use

Sacre K et al., J Clin Endocrinol Metab 2013 Aug 98:3199

About half the patients who received 5 mg to 10 mg daily had abnormal results on cosyntropin stimulation testing.

Cognitive Function and Daily Independence in Nonagenarians Are Improving

Bruce Soloway, MD Reviewing Olde Rikkert MGM and Melis R., Lancet 2013 Jul 11;

People born in 1915 scored higher than those born a decade earlier, despite no significant improvement in physical performance.

Supine Exercises for Orthostatic Hypotension in Older Adults

Galizia G et al., J Am Geriatr Soc 2013 Jul 61:1152

Leg exercises, done just before standing, attenuated the drop in systolic blood pressure.

Hormone Use During Menopause and Cognitive Outcomes

Espeland MA et al., JAMA Intern Med 2013 Jun 24;

Seven years after women stopped randomized hormone therapy or placebo, cognition did not differ.

N-Acetylcysteine for Treating Patients with COPD — A Randomized Trial

Tse HN et al., Chest 2013 Jul 144:106

The drug improved airway mechanics and prevented recurrent exacerbations among patients with chronic obstructive pulmonary disease.

Stopping Statins May Be Associated with the Development of Parkinson Disease

Lee Y-C et al., Neurology 2013 Jul 24;

In an observational study, patients who stopped lipophilic (but not hydrophilic) statins had an increased risk for incident PD.

Soy Supplementation Fails to Reduce Risk for Prostate Cancer Recurrence

Bosland MC et al., JAMA 2013 Jul 10; 310:170

In patients with locally advanced disease after radical prostatectomy, biochemical recurrence was similar with a daily soy-protein supplement or a placebo.

Kidney Injury and Androgen Deprivation Therapy

Lapi F et al., JAMA 2013 Jul 17; 310:289

Among men with nonmetastatic prostate cancer, ADT was associated with excess risk for acute kidney injury.

5α-Reductase Inhibitors Are Associated with Less Risk for Prostate Cancer Overall

Robinson D et al., BMJ 2013 Jun 18; 346:f3406

And use was not associated with excess high-grade (Gleason grade 8–10) prostate cancer.

Digoxin reduces 30-day all-cause hospital admission in ambulatory older patients with chronic systolic heart failure. Future studies need to examine its effect on 30-day all-cause hospital readmission in hospitalized patients with acute heart failure. The American Journal of Medicine

Prevalence and prognosis of aortic stenosis
Among subjects 85 years of age the prevalence of aortic stenosis is higher than previously reported and not associated with traditional vascular risk factors. Aortic stenosis but not aortic valve disease alone was independently predictive of five-year mortality. The American Journal of Cardiology

Joint effect of alcohol intake and physical activity on heart disease
The study concluded that high levels of drinking and low physical activity levels appear to increase the risk of both cardiovascular and all-cause mortality, although the data suggest that physical activity levels are more important than alcohol intake. The American Journal of Cardiology

Catheter ablation may cut risk of AF-related stroke
Data on nearly 38,000 patients with similar stroke risk profiles showed patients with atrial fibrillation who underwent catheter ablation attained better outcomes at three years than those treated only with medication. Stroke rates among the ablation group mirrored those of the general population, while the medication group experienced a stroke rate that was double that of the general population, researchers said. The study was published in the journal Heart Rhythm. Reuters

Higher CVD risk seen with more aortic stiffness in diabetes
Type 2 diabetes patients with heightened carotid-femoral pulse-wave velocity were at an increased risk of fatal or nonfatal myocardial infarction, stroke or other cardiac events compared with other patients, according to a study in Diabetes Care. "The clinical implication is that it suggests that aortic-stiffness measurement ... should be incorporated into cardiovascular risk assessment of [at least] type 2 diabetic patients [who are] at high cardiovascular risk," said senior author Gil F. Salles, Ph.D. Medscape (free registration)

Anger and myocardial infarction risk
This study found the risk of having an acute myocardial infarction is more than two times higher following outbursts of anger compared with other times, and higher intensities of anger were associated with higher relative risks. Compared to nonusers, regular beta-blocker users had a lower susceptibility to heart attacks triggered by anger, suggesting that some drugs may lower the risk from each episode of anger. The American Journal of Cardiology

Siblings are a positive influence
Based on a theoretical model of sibling influences, an afterschool program called Siblings Are Special enhanced children's self-control, social competence and academic performance. (Full-text access is time limited.) Journal of Adolescent Health

Review ties hypoglycemia to higher CVD risk in diabetes
Type 2 diabetes patients who suffered severe hypoglycemia that required outside intervention or medical treatment had more than a twofold increased risk of cardiovascular disease, an analysis in BMJ indicated. The findings demonstrate that personalized glycemic targets may boost type 2 diabetes management, researchers said. MedPage Today

USPSTF recommends low-dose CT for patients at high risk of lung cancer
The U.S. Preventive Services Task Force released draft guidelines recommending the use of low-dose CT scans to spot lung cancer in high-risk smokers and former smokers, targeting the heaviest users from ages 55 to 79. USPSTF co-vice chair and family physician Michael LeFevre, M.D., said family physicians should consider a patient's overall health when making screening decisions, but the "balance of benefit and harm is better served by focusing screening on those high-risk groups." AAFP News Now (7/29), Reuters (7/29)

Statins Reduce Cardiovascular Events in Elders Without Established CVD

Statins are associated with lower risks for myocardial infarction and stroke among elders without established cardiovascular disease, according to a meta-analysis in the Journal of the American College of Cardiology.

The analysis included eight randomized, placebo-controlled trials comprising nearly 25,000 patients aged 65 and older without CVD at baseline. During 3.5 years' follow-up, statin use was associated with a 39% reduction in the risk for MI and a 24% reduction in the risk for stroke. The researchers estimate that 24 patients would need to be treated for 1 year to prevent one MI, and 42 to prevent one stroke.

There was a trend toward a reduction in mortality, but this did not reach statistical significance.

The researchers say their study "provides first time evidence" that statins' cardiovascular benefits extend to people aged 65 and older without cardiovascular disease.

JACC article

Anemia Tied to Increased Dementia Risk

Older adults who have anemia face increased risk for dementia, according to a prospective cohort study in Neurology.

Researchers studied some 2600 initially dementia-free older adults, 15% of whom had anemia at baseline. During 11 years' follow-up, 18% of participants developed dementia. After adjustment for potential confounders such as age, sex, APOE genotype, comorbid conditions, and literacy, participants with anemia had a significant, 49% increase in risk for dementia relative to those without anemia.

The researchers say their findings are consistent with those from previous studies, and they suggest several possible mechanisms underlying the association. For example, the brain hypoxia that occurs with anemia might contribute to dementia risk, or anemia could be a marker of overall poor health. They call for additional research to determine whether hemoglobin levels should be the focus of prevention strategies.

Neurology article

Vitamin D supplementation in patients with diabetes mellitus type 2 on different therapeutic regimens: a one-year prospective study Full Text 
Cardiovascular Diabetology, 08/09/2013  Review Article

Alkharfy KM et al. – The objective of this study was to determine the effect of vitamin D3 supplementation in a cohort of Saudi DMT2 population on diet, insulin and/or different oral hypoglycemic agents and compare them with a non–DMT2 control cohort. While in all DMT2 groups circulating levels of 25–OHVitD increased after supplementation, in DMT2 patients on insulin in combination with other drugs benefitted the most in improving cardiovascular risk. Metformin improves 25–hydroxyvitamin D levels but did not seem to confer other added cardiometabolic benefits.

Methods

• A total of 499 randomly selected Saudi subjects divided into 8 groups [Non-DMT2 Control = 151; Rosiglitazone alone = 49; Diet = 15; Insulin alone = 55; Insulin + Orals = 12; Metformin alone = 121; Oral agents combination = 37; Sulphonylurea alone = 59] were included in this 12-month interventional study.
• All DMT2 patients were given 2000 IU vitamin D3 daily, while the control group received none but were advised to increase sun exposure.
• Anthropometrics, glucose, lipid profile and 25-hydroxyvitamin D (25-OHVitD) were measured at baseline, 6 and 12 months.

Results

• Circulating 25-OHVitD concentrations improved in all patient groups.
• The metformin group showed the highest change in circulating vitamin D levels both at 6 months (62.6%) and 12 months (50.6%) as compared to baseline (p < 0.001).
• No significant changes were observed in the BMI and glucose in any of the DMT2 groups.
• In contrast, the insulin + oral agents group showed more significant improvements in the metabolic profile, which included triglycerides and total cholesterol, as well as systolic blood pressure and HDL-cholesterol in males.
• Also, significant decreases in triglycerides were observed in the rosiglitazone and insulin + oral hypoglycemic agent groups both at 6 and 12 months of supplementation (both p-values <0.001).

http://www.cardiab.com/content/12/1/113

Vitamin D therapy and related metabolomics: Is the calciferol dose and form the only requirements for successful clinical therapeutics? 
Medical Hypotheses, 08/07/2013  Evidence Based Medicine  Review Article  Clinical Article

Braithwaite MC et al. – A nutraceutical that has exploded onto the prescription pad in recent years is the fat soluble vitamin, vitamin D. This is due to an increasing medical interest in the utility of the vitamin in the treatment and prevention of an array of diseases and ailments. Despite the continued debate over the correct dose, form and serum levels, many clinicians fail to achieve intended therapeutic responses with their patients and deficiencies still exist. Aspects that are proposed to influence treatment success more critically than dose and molecular form prescribed are: organ pathology, intracellular states, the endocrine system, concomitant products, genetics, lifestyle, quality of product, and modern delivery systems.

http://www.ncbi.nlm.nih.gov/pubmed/23920270

Diet and Kidney Disease in High-Risk Individuals With Type 2 Diabetes Mellitus 
JAMA Internal Medicine, 08/14/2013  Evidence Based Medicine  Clinical Article

Dunkler D et al. – Type 2 diabetes mellitus and associated chronic kidney disease (CKD) have become major public health problems. Little is known about the influence of diet on the incidence or progression of CKD among individuals with type 2 diabetes. To examine the association between (healthy) diet, alcohol, protein, and sodium intake, and incidence or progression of CKD among individuals with type 2 diabetes. A healthy diet and moderate intake of alcohol may decrease the incidence or progression of CKD among individuals with type 2 diabetes. Sodium intake, within a wide range, and normal protein intake are not associated with CKD.

Methods

• All 6213 individuals with type 2 diabetes without macroalbuminuria from the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET) were included in this observational study.
• Recruitment spanned from January 2002 to July 2003, with prospective follow–up through January 2008.
• Chronic kidney disease was defined as new microalbuminuria or macroalbuminuria or glomerular filtration rate decline of more than 5% per year at 5.5 years of follow–up.
• Authors assessed diet using the modified Alternate Healthy Eating Index (mAHEI).
• The analyses were adjusted for known risk factors, and competing risk of death was considered.

Results

• After 5.5 years of follow–up, 31.7% of participants had developed CKD and 8.3% had died.
• Compared with participants in the least healthy tertile of mAHEI score, participants in the healthiest tertile had a lower risk of CKD (adjusted odds ratio [OR], 0.74; 95% CI, 0.64–0.84) and lower risk of mortality (OR, 0.61; 95% CI, 0.48–0.78).
• Participants consuming more than 3 servings of fruits per week had a lower risk of CKD compared with participants consuming these food items less frequently.
• Participants in the lowest tertile of total and animal protein intake had an increased risk of CKD compared with participants in the highest tertile (total protein OR, 1.16; 95% CI, 1.05–1.30).
• Sodium intake was not associated with CKD.
• Moderate alcohol intake reduced the risk of CKD (OR, 0.75; 95% CI, 0.65–0.87) and mortality (OR, 0.69; 95% CI, 0.53–0.89).

CONCLUSIONS AND RELEVANCE A healthy diet and moderate intake of alcohol may decrease the incidence or progression of CKD among individuals with type 2 diabetes. Sodium intake, within a wide range, and normal protein intake are not associated with CKD. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00153101.

http://www.ncbi.nlm.nih.gov/pubmed/23939297

Low Diastolic BP Associated with Higher Mortality in Chronic Kidney Disease

The association of blood pressure with mortality in chronic kidney disease seems to follow a J-shaped curve, especially with regard to diastolic pressure, according to an Annals of Internal Medicine study.

Researchers followed some 650,000 U.S. veterans with non-dialysis–dependent disease over a median of 6 years. After adjustment for such factors as age, diabetes, and cardiovascular disease, patients with blood pressure in the range of 130 to 159 mm Hg systolic and 70 to 89 diastolic had the lowest mortality risk. Even patients with "ideal" systolic blood pressure of less than 130 had increased mortality rates if their diastolic levels were under 70.

The association could be caused, the authors speculate, by lower coronary perfusion with decreased diastolic pressure. Editorialists (and the authors) emphasize the observational nature of the data, with the "attendant limitations," and note the preponderance of male patients. "Translating these findings into practice is challenging," they conclude.

Annals of Internal Medicine article

New Risk Score Predicts Dementia in Older People with Type 2 Diabetes

A new risk score comprising diabetes-associated complications, education, and age accurately predicts dementia risk among older patients with type 2 diabetes, according to a study in the Lancet Diabetes & Endocrinology.

Researchers used two cohorts of over 30,000 patients with diabetes who were aged 60 and older to construct and validate the Diabetes-Specific Dementia Risk Score (DSDRS). The final risk score — which included age, education, microvascular disease, diabetic foot, cerebrovascular disease, cardiovascular disease, acute metabolic events, and depression — accurately predicted 10-year dementia risk. Patients with the highest DSDRS scores were 37 times more likely to be diagnosed with dementia over the subsequent decade than patients with the lowest scores.

A commentator writes: "Ease of use and ready access to complete and accurate data make DSDRS more useful than some of the previous risk scores. ... DSDRS should therefore be easy to implement."

Lancet Diabetes & Endocrinology article

Estrogen reduces mechanical injury-related cell death and proteoglycan degradation in mature articular cartilage independent of the presence of the superficial zone tissue 
Osteoarthritis and Cartilage , 08/10/2013  Review Article

Imgenberg J et al. – To study the effect of 17β–estradiol (E2) and the superficial zone (SFZ) on cell death and proteoglycan degradation in articular cartilage after a single injurious compression in vitro. E2 prevents injury–related cell death and GAG release, and might be useful for the development of treatment options for either cartilage–related sports injuries or osteoarthritis (OA). The SFZ does not seem to play an important role in (1) the E2–related tissue response and (2) the mechanically–induced cell death in deeper regions of the explants and GAG release. The latter might be related to the unconfined nature of the injury model.

http://www.ncbi.nlm.nih.gov/pubmed/23863610

Lactobacilli and bifidobacteria in the prevention of antibiotic-associated diarrhoea and diarrhoea in older inpatients (PLACIDE): a randomised, double-blind, placebo-controlled, multicentre trial 
The Lancet, 08/08/2013  Evidence Based Medicine  Clinical Article

Allen SJ et al. – Antibiotic–associated diarrhoea (AAD) occurs most frequently in older (>=65 years) inpatients exposed to broad–spectrum antibiotics. When caused by Clostridium difficile, AAD can result in life–threatening illness. Although underlying disease mechanisms are not well understood, microbial preparations have been assessed in the prevention of AAD. However, studies have been mostly small single–centre trials with varying quality, providing insufficient data to reliably assess effectiveness. Authors aimed to do a pragmatic efficacy trial in older inpatients who would be representative of those admitted to National Health Service (NHS) and similar secondary care institutions and to recruit a sufficient number of patients to generate a definitive result. Authors identified no evidence that a multistrain preparation of lactobacilli and bifidobacteria was effective in prevention of AAD or CDD. An improved understanding of the pathophysiology of AAD is needed to guide future studies.

Interpretation

We identified no evidence that a multistrain preparation of lactobacilli and bifidobacteria was effective in prevention of AAD or CDD. An improved understanding of the pathophysiology of AAD is needed to guide future studies.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61218-0/abstract?rss=yes

Wrinkle reduction in post-menopausal women consuming a novel oral supplement: a double-blind placebo-controlled randomised study 
International Journal of Cosmetic Science, 08/10/2013  Evidence Based Medicine  Clinical Article

Jenkins G et al. – The aim of the present study was therefore to evaluate the effect on skin wrinkling, of a combination of ingredients reported to influence key factors involved in skin ageing; namely inflammation, collagen synthesis and oxidative/UV stress. A supplemented drink was developed containing soy isoflavones, lycopene, vitamin C and vitamin E and given to post–menopausal women with a capsule containing fish oil. This study demonstrates that consumption of a mixture of soy isoflavones, lycopene, vitamin C, vitamin E and fish oil is able to induce a clinically measureable improvement in the depth of facial wrinkles following long term use.

Methods

• Authors have performed a double–blind randomised controlled human clinical study to assess whether this cocktail of dietary ingredients can significantly improve the appearance of facial wrinkles.

Results

• Authors have shown that this unique combination of micronutrients can significantly reduce the depth of facial wrinkles and that this improvement is associated with increased deposition of new collagen fibres in the dermis.

http://onlinelibrary.wiley.com/doi/10.1111/ics.12087/abstract;jsessionid=D2F9516D2FC1A8D8B3DE2B5E12B3D4AA.d02t02

Leukocyte Telomere Length Linked to Diabetes Risk

 (HealthDay News) – For American Indians, leukocyte telomere length is associated with the risk of incident diabetes, with an almost two-fold increased risk for those with the shortest vs. the longest length, according to a study published online Aug. 15 in Diabetes.

Jinying Zhao, MD, PhD, from Tulane University in New Orleans, and colleagues investigated whether leukocyte telomere length at baseline predicts incident diabetes, independent of known diabetes risk factors, in a cohort of 2,328 American Indians free of diabetes at baseline participating in the Strong Heart Family Study.

During an average follow-up of 5.5 years, the researchers found that 292 participants developed diabetes. Those in the lowest quartile (shortest) leukocyte telomere length had a significantly increased risk of diabetes compared with those in the highest quartile (hazard ratio, 1.83). The risk for those in the second and third quartiles was not significant.

"These findings suggest a non-linear association between leukocyte telomere length and incident diabetes, and indicate that leukocyte telomere length could serve as a predictive marker for diabetes development in American Indians, who suffer from disproportionately high rates of diabetes," the authors write.

Abstract

Vitamin D and subsequent all-age and premature mortality: a systematic reviewFull Text 
BMC Public Health, 07/26/2013  Evidence Based Medicine  Review Article

Rush L et al. – All–cause mortality in the population < 65 years is 30% higher in Glasgow than in equally deprived Liverpool and Manchester. The authors investigated a hypothesis that low vitamin D in this population may be associated with premature mortality via a systematic review and meta–analysis. Low vitamin D status is inversely associated with all–cause mortality but the risk is higher amongst older individuals and the relationship is prone to residual confounding. Further studies investigating the association between vitamin D deficiency and all–cause mortality in younger adults with adjustment for all important confounders (or using randomised trials of supplementation) are required to clarify this relationship.

Methods

• Medline, EMBASE, Web of Science, the Cochrane Library and grey literature sources were searched until February 2012 for relevant studies.
• Summary statistics were combined in an age-stratified meta-analysis.

Results

• Nine studies were included in the meta-analysis, representing 24,297 participants, 5,324 of whom died during follow-up.
• The pooled hazard ratio for low compared to high vitamin D demonstrated a significant inverse association (HR 1.19, 95% CI 1.12-1.27) between vitamin D levels and all-cause mortality after adjustment for available confounders.
• In an age-stratified meta-analysis, the hazard ratio for older participants was 1.25 (95% CI 1.14-1.36) and for younger participants 1.12 (95% CI 1.01-1.24).

http://www.mdlinx.com/internal-medicine/newsl-article.cfm/4743151/ZZ4412CAF671214A3D9CD6491E391891B4/?news_id=2288&newsdt=080713&utm_source=Newsletter&utm_medium=CME-REV&utm_content=CME-REV-article&utm_campaign=Article-Section

Vitamin B12, Folic Acid, and Bone 
Current Osteoporosis Reports, 07/23/2013  Review Article  Clinical Article

Swart KMA et al. – Vitamin B12 and folic acid deficiency are associated with a higher serum concentration of homocysteine. A high serum homocysteine is a risk factor for fractures. Both vitamins play a role in the remethylation of homocysteine to methionine. One double blind clinical trial in post–stroke patients showed that these B vitamins could decrease hip fracture incidence, but the results of further clinical trials should be awaited before a definite conclusion can be drawn.

http://www.ncbi.nlm.nih.gov/pubmed/23873438

The new hypertension guidelines 
The Journal of Clinical Hypertension, 07/24/2013  Review Article  Clinical Guideline

Stern RH – The Canadian Hypertension Education Program (CHEP) has published guidelines annually since 2000. The CHEP guidelines are a model of concise, comprehensive, up–to–date, evidence–rated guidelines for physicians who diagnose and treat hypertension. The guidelines address measurement of blood pressure and the definition of hypertension, secondary hypertension evaluation and treatment, and blood pressure targets and medication choices in patients with and without compelling indications. This review describes CHEP's process for developing guidelines and provides an overview of the 2013 recommendations.

http://onlinelibrary.wiley.com/doi/10.1111/jch.12171/full

All-cause and cardiovascular mortality risk in U.S. adults with and without type 2 diabetes: Influence of physical activity, pharmacological treatment and glycemic control 
Journal of Diabetes and its Complications, 07/27/2013  Review Article

Brown RE et al. – This study determined the joint association between physical activity, pharmacotherapy, and HbA1c control on all–cause and cardiovascular disease (CVD) mortality risk in adults with and without type 2 diabetes (T2D). Physical activity and glycemic control are both associated with lower all–cause and CVD mortality risk in adults with T2D. Adults with T2D who are physically active, pharmacologically treated, and obtain glycemic control may attain similar mortality risk as normoglycemic adults.

Methods

12,060 adults from NHANES III and NHANES continuous (1999–2002) surveys were used.

Cox proportional hazards analyses were included to estimate mortality risk according to physical activity, pharmacotherapy, and glycemic control (HbA1c <7.0%) status, with physically active, treated and controlled (goal situation) as the referent.

Results

Compared to the referent, adults with T2D who were uncontrolled, or controlled but physically inactive had a higher all–cause mortality risk (p<0.05).

Compared to the referent, only adults with T2D who were physically inactive had a higher CVD mortality risk, regardless of treatment or control status (p<0.05).

Normoglycemic adults had a similar all–cause and CVD mortality risk as the referent (p>0.05).

http://www.ncbi.nlm.nih.gov/pubmed/23886620

New-onset diabetes mellitus in elderly subjects: association between HBA_1clevels, mortality, and coronary revascularization 
Diabetes Care, 07/25/2013  Exclusive author commentary  Review Article

Twito O et al. – New–onset diabetes mellitus (DM) in elderly patients is associated with increased risk of diabetes complications and mortality. It is unknown whether glycemic control in this population influences the mortality risk. An HbA_1c level >7.5% (58 mmol/mol) is associated with increased risk for all–cause mortality and with a lower revascularization rate in elderly patients with new–onset DM.

Methods

The current study was conducted using the computerized database of the Sharon-Shomron District of Clalit Health Services in Israel.

Included in the study were subjects 65 years of age and above with new-onset DM.

The primary outcome measures were all-cause mortality and coronary revascularization procedures with either percutaneous coronary intervention or coronary artery bypass grafting.

Results

Participants (n = 2,994) were stratified into four groups according to their mean HbA_1c levels during the follow-up period (<6.5% [48 mmol/mol], 6.5–6.99% [48–52 mmol/mol], 7–7.49% [53–57 mmol/mol], and ≥7.5% [58 mmol/mol]).

During a mean follow-up of 5.54 ± 2.1 years, 1,173 (39.17%) participants died and 285 (9.51%) underwent coronary revascularization.

An HbA_1c level >7.5% (58 mmol/mol) was associated with a significantly increased all-cause mortality rate (hazard ratio [HR] 1.74 [95% CI 1.2–1.8], P < 0.0001).

This difference remained statistically significant after a multivariate model adjusted for the conventional cardiovascular risk factors and for the use of hypoglycemic agents and statins.

Kaplan-Meier survival plots revealed lower survival rates in this group of patients. Coronary revascularization rates were highest among subjects with HbA_1c 6.5–6.99% (48–52 mmol/mol) (HR 1.6 [1.01–2.4], P < 0.05) and lowest in patients with HbA_1c ≥7.5% (58 mmol/mol).

http://www.ncbi.nlm.nih.gov/pubmed/23877985

Effects of low-fat dairy intake on blood pressure, endothelial function, and lipoprotein lipids in subjects with prehypertension or stage 1 hypertension Full Text
Vascular Health and Risk Management, 07/25/2013  Review Article

Maki KC et al. – This randomized crossover trial assessed the effects of 5 weeks of consuming low–fat dairy (one serving/day each of 1% fluid milk, low–fat cheese, and low–fat yogurt) versus nondairy products (one serving/day each of apple juice, pretzels, and cereal bar) on systolic and diastolic blood pressures (SBP and DBP), vascular function (reactive hyperemia index [RHI] and augmentation index), and plasma lipids. No significant effects of consuming low–fat dairy products, compared with low–fat nondairy products, were observed for blood pressures, measures of vascular function, or lipid variables in the overall sample, but results from subgroup analyses were consistent with the hypothesis that dairy foods might improve RHI in those with endothelial dysfunction.

http://www.ncbi.nlm.nih.gov/pubmed/23901280

Watermelon Helps Soothe Aching Muscles

l-Citrulline, an amino acid shown in previous studies to reduce muscle soreness, is found abundantly in watermelons, as well as certain squashes, cucumbers, and other melons.  Martha P. Tarazona-Díaz, from the  Universidad Politecnica de Cartagena  (Spain), and colleagues administered 500 mL of natural watermelon juice (containing 1.17 g of l-Citrulline), enriched watermelon juice (4.83 g of l-Citrulline plus 1.17 g naturally occurring), or a control beverage, to seven healthy university-age sports science students (average age 22.7 years).  Whereas neither juice form improved pedaling cadence, heart rate, or perceived exertion, both juice forms reduced muscle soreness 24-hours post-exercise.  The study authors report that: “watermelon juices helped to reduce the recovery heart rate and muscle soreness after 24 h.”

http://www.nutraingredients-usa.com/Research/Watermelon-juice-soothes-sore-cycling-muscles/

Nut consumption with risk of hypertension and type 2 diabetes mellitus: A meta-analysis of prospective cohort studies 
European Journal of Preventive Cardiology, 08/12/2013  Evidence Based Medicine  Clinical Article

Guo K et al. – The aim of this study was to systematically examine longitudinal studies investigating nut intake in relation to risk of hypertension and type 2 diabetes mellitus (T2DM). In the meta–analysis, nut consumption is found to be inversely associated with hypertension risk but is not associated with the risk of T2DM.

Methods

A systematic search of the PubMed and EMBASE databases to 31 March 2013 was performed.

Reference lists of retrieved articles were also screened.

Summary relative risks (SRRs) and 95% confidence intervals (CIs) were calculated using a random-effects model.

Q and I² statistics were used to examine between-study heterogeneity.

Results

A total of nine prospective cohort studies (three for hypertension and six for T2DM) were identified.

Using random effects models, the authors found that based on the highest vs lowest analysis, nut consumption were inversely associated with risk of hypertension (SRR = 0.84, 95% CI: 0.76–0.93, p_{heterogeneity} = 0.831, I² = 0%).

Dose-response analyses indicated that nut consumption at more than two servings/wk, but not one serving/wk, had a preventative role in the hypertension.

In addition, nut consumption was not associated with risk of T2DM (SRRs = 0.98, 95% CI: 0.84–1.15; p_{heterogeneity}= 0.008, I² = 67.7%) on the basis of the highest vs lowest analysis.

This null association was also shown in the dose-response analysis.

http://www.ncbi.nlm.nih.gov/pubmed/23928568

Longer Telomeres via Long-Term Endurance Exercise

Telomeres are the end caps of chromosomes, protecting the DNA complexes from deterioration during cell division. Telomere shortening is considered a marker of cellular aging, and prematurely shortened telomeres have been linked to increased risk of cancers, heart disease, dementia and death.  Researchers from the Norwegian University of Science and Technology (Norway) report that endurance training may protect against the effects of aging in older individuals.  Javaid Nauman and colleagues recruited 20 men, half of whom were ages 22 to 27 and the other half ages 66 to 77. In each age group, half of the participants were endurance athletes who were taking part in a cross-country ski race or track competitions. The others were nonathletes who were active, but who had never competed at higher levels in any sports. All of the participants were free from known cardiovascular disease, obesity, and a history of current or past smoking. None was taking regular medications.  The team observed that in the older age group, the endurance athletes had significantly longer telomeres.  Further, in the overall cohort, telomere length was positively associated with VO2max, with the relationship strongest among the endurance athletes.  The study authors write that: “Our data suggest that VO2max is positively associated with telomere length, and we found that long-term endurance exercise training may provide a protective effect on muscle telomere length in older people.”

http://www.medpagetoday.com/PrimaryCare/ExerciseFitness/36650

Exercise Reorganizes the Brain

A discrepancy in research related to the effect of exercise on the brain has existed: namely, that exercise reduces anxiety while also promoting the growth of new neurons in the ventral hippocampus. Because these young neurons are typically more excitable than their more mature counterparts, exercise should result in more anxiety, not less. Timothy Schoenfeld, from Princeton University (New Jersey, USA), and colleagues have revealed that exercise also strengthens the mechanisms that prevent these brain cells from firing.  Employing a mouse model, the team observed that when mice allowed to exercise regularly experienced a stressor — exposure to cold water — their brains exhibited a spike in the activity of neurons that shut off excitement in the ventral hippocampus, a brain region shown to regulate anxiety. Further, the research team pinpointed brain cells and regions important to anxiety regulation that may help scientists better understand and treat human anxiety disorders. The researchers found that running prevents the activation of new neurons in response to stress. In sedentary mice, stress activated new neurons in the hippocampus , but after 6 weeks of running, the stress-induced activation of both new and mature neurons disappeared. Taken collectively, the study authors submit that their data suggest that exercise “improves anxiety regulation by engaging local inhibitory mechanisms in the ventral hippocampus.”

http://www.princeton.edu/main/news/archive/S37/28/70Q72/

Brain Atrophy Linked to Patients With Diabetes

 (HealthDay News) – Brain atrophy rather than cerebrovascular lesions may explain the relationship between type 2 diabetes mellitus (T2DM) and cognitive impairment, according to a study published online Aug. 12 in Diabetes Care.

Chris Moran, MB, BCh, from Monash University in Melbourne, Australia, and colleagues analyzed magnetic resonance imaging scans and cognitive tests in 350 participants with T2DM and 363 participants without T2DM. In a blinded fashion, cerebrovascular lesions (infarcts, microbleeds, and white matter hyperintensity [WMH] volume) and atrophy (gray matter, white matter, and hippocampal volumes) were evaluated.

The researchers found that T2DM was associated with significantly more cerebral infarcts and significantly lower total gray, white, and hippocampal volumes, but not with microbleeds or WMH. Gray matter loss was distributed mainly in medial temporal, anterior cingulate, and medial frontal lobe locations in patients with T2DM, while white matter loss was distributed in frontal and temporal regions. Independent of age, sex, education, and vascular risk factors, T2DM was associated with significantly poorer visuospatial construction, planning, visual memory, and speed. When adjusting for hippocampal and total gray volumes, the strength of these associations was cut by almost one-half, but was unchanged with adjustments for cerebrovascular lesions or white matter volume.

"Cortical atrophy in T2DM resembles patterns seen in preclinical Alzheimer's disease," the authors write. "Neurodegeneration rather than cerebrovascular lesions may play a key role in T2DM-related cognitive impairment."

One author disclosed financial ties to the pharmaceutical industry.

Abstract

Empagliflozin shows efficacy when added to metformin and sulfonylurea
Type 2 diabetes patients who took daily doses of empagliflozin as an add-on to metformin/sulfonylurea treatment attained greater reductions in A1C at six months than those in the placebo group, according to a study in Diabetes Care. Greater weight loss and improved systolic blood pressure were also seen in the empagliflozin arm compared with the control group, researchers noted. MedPage Today

Oral Apixaban for the Treatment of Acute Venous Thromboembolism

Conclusions

A fixed-dose regimen of apixaban alone was noninferior to conventional therapy for the treatment of acute venous thromboembolism and was associated with significantly less bleeding (Funded by Pfizer and Bristol-Myers Squibb; ClinicalTrials.gov number.

http://www.nejm.org/doi/full/10.1056/NEJMoa1302507?query=TOC#t=articleMethods

Saxagliptin(onglyza) and Cardiovascular Outcomes in Patients with Type 2 Diabetes Mellitus

Conclusions

DPP-4 inhibition with saxagliptin did not increase or decrease the rate of ischemic events, though the rate of hospitalization for heart failure was increased. Although saxagliptin improves glycemic control, other approaches are necessary to reduce cardiovascular risk in patients with diabetes. (Funded by AstraZeneca and Bristol-Myers Squibb; SAVOR-TIMI 53 ClinicalTrials.gov number.

http://www.nejm.org/doi/full/10.1056/NEJMoa1307684?query=OF#t=article

Alogliptin(nesina) after Acute Coronary Syndrome in Patients with Type 2 Diabetes

Conclusions

Among patients with type 2 diabetes who had had a recent acute coronary syndrome, the rates of major adverse cardiovascular events were not increased with the DPP-4 inhibitor alogliptin as compared with placebo. (Funded by Takeda Development Center Americas; EXAMINE ClinicalTrials.gov number.

http://www.nejm.org/doi/full/10.1056/NEJMoa1305889?query=OF#t=article

Dabigatran versus Warfarin in Patients with Mechanical Heart Valves

Conclusions

The use of dabigatran in patients with mechanical heart valves was associated with increased rates of thromboembolic and bleeding complications, as compared with warfarin, thus showing no benefit and an excess risk. (Funded by Boehringer Ingelheim; ClinicalTrials.gov numbers.

http://www.nejm.org/doi/full/10.1056/NEJMoa1300615?query=OF#t=articleTop

Edoxaban versus Warfarin for the Treatment of Symptomatic Venous Thromboembolism

Conclusions

Edoxaban administered once daily after initial treatment with heparin was noninferior to high-quality standard therapy and caused significantly less bleeding in a broad spectrum of patients with venous thromboembolism, including those with severe pulmonary embolism. (Funded by Daiichi-Sankyo; Hokusai-VTE ClinicalTrials.gov number.

 http://www.nejm.org/doi/full/10.1056/NEJMoa1306638?query=OF#t=articleTop

Personality Linked to Stress Regulation

The biological connection between a person’s disposition and their ability to regulate stress has been elusive.  Joelle Jobin, from Concordia University (Canada), and colleagues explored whether optimism is associated with reduced secretions of cortisol, the stress hormone, among people who perceive stress levels that are higher than their normal average – or higher than the stress levels of other individuals.  The researchers tracked 135 older adults for six years, and collected five saliva samples daily from each subject (to monitor cortisol levels).  Participants were asked to report on the level of stress they perceived in their day-to-day lives, and identify themselves along a continuum as optimists or pessimists. Each person’s levels were then measured against their personal average. The team observed that the pessimist participants tended to have a higher baseline than optimists; pessimists also had trouble with the biological regulation of their system when they encountered particularly stressful situations.   Finding that: “On days where they experience higher than average stress, we see that the pessimists’ stress response is very elevated, and they have trouble bringing their cortisol levels back down. Optimists, by contrast, were protected in these circumstances.”  The team submits that these data confirms a relationship between positivity and stress.

http://www.concordia.ca/news/stories/2013/07/24/optimists-are-better-at-regulating-stress.html

Link Between Retirement Age and Alzheimer’s Risk

A growing body of evidence suggests clear health benefits of maintaining cognitive and social stimulation in seniors.  Carole Dufouil, from INSERM (France), and colleagues completed analysis of a French healthcare insurer's records involving 430,000 pensioners as of December 2010, finding that for each year after age 60 at which a person retired, the risk of subsequently developing Alzheimer's disease was lower by 3.2%.  After adjusting for certain other risk factors, individuals retiring at 65 were 14.6% less likely to develop Alzheimer's disease than those retiring at 60 years of age.

http://www.medpagetoday.com/MeetingCoverage/AAIC/40474

A Randomized Trial of Colchicine for Acute Pericarditis

Conclusions

In patients with acute pericarditis, colchicine, when added to conventional antiinflammatory therapy, significantly reduced the rate of incessant or recurrent pericarditis. (Funded by former Azienda Sanitaria Locale 3 of Turin [now Azienda Sanitaria Locale 2] and Acarpia; ICAP ClinicalTrials.gov number,

http://www.nejm.org/doi/full/10.1056/NEJMoa1208536?query=OF#t=articleTop

Update on Finasteride to Prevent Prostate Cancer

Thompson IM et al., N Engl J Med 2013 Aug 15; 369:603

Finasteride lowered the incidence of detected prostate cancer but did not improve survival.

Centrally Acting ACE Inhibitors Might Slow Cognitive Decline in Patients with Dementia

Gao Y et al., BMJ Open 2013 Jul 25; 3:e002881

Centrally acting angiotensin-converting–enzyme inhibitors include ramipril, trandolapril, captopril, fosinopril, and lisinopril.

Recently published studies suggest that antihypertensive agents, particularly centrally acting ACE inhibitors (CACE-Is) such as angiotensin-converting enzyme (ACE) inhibitors, which cross the blood-brain barrier, may be associated with a reduced rate of cognitive decline. William Molloy, from the University College Cork, St. Finbarrs' Hospital (Ireland), and colleagues  compared the rates of cognitive decline in 361 subjects, average age 77 years, who had been diagnosed with Alzheimer's disease, vascular dementia, or a mix of both conditions.  Between 1999 and 2010, the cognitive decline of each patient was assessed using standardized scales on two separate occasions, 6 months apart.  A total of 85 of the patients were already taking ACE inhibitors; the rest were not.  The researchers also assessed the first 6 months' impact of ACE inhibitors on cognitive function of 30 patients newly prescribed ACE inhibitors.  The team observed that the subjects taking centrally active ACE inhibitors experienced marginally slower rates of cognitive decline compared with those not on the drugs (drop of 1.8 points versus 2.12 points on the Quick Mild Cognitive Impairment scores).  The study authors conclude that: “Cognitive scores may improve in the first 6 months after CACE-I treatment and use of CACE-Is is associated with a reduced rate of cognitive decline in patients with dementia.”

http://www.medpagetoday.com/Cardiology/Dementia/40699

Duration of Overall and Abdominal Obesity Linked to Coronary Calcification

Reis JP et al., JAMA 2013 Jul 17; 310:280

In a long-term study in young adults, risks for new and worsening subclinical coronary artery disease increased by 2%–4% per additional year of obesity.

The obesity epidemic is rampant, particularly in children and young adults. However, the consequences of long-term obesity are largely unknown. To find out more, investigators used data from the CARDIA study on 3275 young adults (aged 18–30; 51% women; 46% black) who were nonobese at baseline in 1985–1986 and were examined for the presence and degree of coronary artery calcification (CAC) at least once at years 15, 20, and 25.

At 25 years, 40.4% of participants had developed overall obesity (mean age of onset, 35.4), and 41.0% had developed abdominal obesity (mean age of onset, 37.7). Mean duration of obesity was 13 and 12 years for overall and abdominal obesity, respectively. CAC was present in 27.5% of all participants; in 38.2% of those with overall obesity of more than 20 years' duration; and in 39.3% of those with abdominal obesity of more than 20 years' duration. Rates of CAC increased significantly with increasing duration of obesity (adjusted hazard ratios, 1.02 and 1.03 per additional year of overall and abdominal obesity, respectively), and CAC was more likely to progress over 10 years in obese than in nonobese participants (adjusted odds ratio, 1.04 per additional year of overall or abdominal obesity). The association between obesity and CAC was not affected by race or sex.

Ginkgo Extract May Combat Dementia

Neural stem cells proliferate in the subventricular zone and hippocampal dentate gyrus of adult mammals.  Because the number of endogenous neural stem cells is insufficient to prevent cerebral ischemia/reperfusion injuries such as vascular dementia, the stimulation of endogenous neural stem cell proliferation and differentiation may prove beneficial. Yuliang Wang, from Weifang Medical University (China), and colleagues studied the effects of the ginkgo biloba extract EGb761 on proliferation of neural stem cells in the subventricular zone and dentate gyrus of rats with vascular dementia. The team found that EGb761 promoted and prolonged the proliferation of neural stem cells in the subventricular zone and dentate gyrus areas, and the cells continued to proliferate at 4 months. EGb761 also significantly improved learning and memory in rats with vascular dementia.

http://www.eurekalert.org/pub_releases/2013-07/nrr-agb072313.php

Chondroitin and glucosamine in the management of osteoarthritis: An update 
Current Rheumatology Reports, 08/19/2013  Clinical Article

Henrotin Y et al. – The objective of osteoarthritis (OA) treatment is not only control of symptoms (i.e. reducing pain and improving function) but also to preserve joint structure and maintain quality of life. This review will discuss all these subjects and emphasize the importance of the quality of tested compounds for achieving high quality clinical trials.

• OA management remains challenging.
• Glucosamine and chondroitin are two compounds available for treatment of OA patients.
• Taken alone or in combination, they have a good safety profile and a variety of effects.
• In–vitro and in–vivo experiments have revealed that both compounds induced key intermediates in the OA pathophysiological process.
• Clinical trials, although providing conflicting and questionable results, report symptomatic and structure–modifying effects for both pharmaceutical–grade compounds.

Intravenous vs. Oral Proton-Pump Inhibitors for Bleeding Peptic Ulcers

David J. Bjorkman, MD, MSPH (HSA), SM (Epid.) reviewing Tsoi KKF et al. Aliment Pharmacol Ther 2013 Aug 5.

Results of a meta-analysis suggest equal effectiveness but require validation in a larger study.

The use of proton-pump inhibitors (PPIs) has been shown to decrease rebleeding in patients with bleeding peptic ulcers (PUB) and high-risk stigmata for rebleeding. In most studies, patients have received intravenous (IV) PPIs for 3 days after endoscopic therapy. Few studies have compared oral with IV therapy in this setting.

To investigate this issue, researchers conducted a systematic review and meta-analysis of available studies. They identified six randomized, prospective studies in which clinical outcomes were compared in 615 patients with PUB (mean age, 60; 71% men) who received oral or IV PPIs.

The pooled data showed no difference in rebleeding, blood transfusions, surgery, or all-cause mortality. Length of stay was shorter for patients receiving oral PPIs. Subgroup analyses of high-dose IV administration of PPIs and of patients with severe stigmata showed no differences in any of the outcomes.

- See more at: http://www.jwatch.org/na31982/2013/08/16/intravenous-vs-oral-proton-pump-inhibitors-bleeding-peptic?query=pfw-featured#sthash.axnbkBJX.dpuf

Effect of Aliskiren on Progression of Coronary Disease in Patients With PrehypertensionThe AQUARIUS Randomized Clinical Trial

Conclusions and Relevance   Among participants with prehypertension and coronary artery disease, the use of aliskiren compared with placebo did not result in improvement or slowing of progression of coronary atherosclerosis. These findings do not support the use of aliskiren for regression or prevention of progression of coronary atherosclerosis.

http://jama.jamanetwork.com/article.aspx?articleid=1734674

Zonisamide for Weight Reduction in Obese Adults

Caroline M. Apovian, MD¹; Louis J. Aronne, MD²

Zonisamide for Weight Reduction in Obese Adults: A 1-Year Randomized Controlled Trial

Kishore M. Gadde, MD; Mariko F. Kopping, MS, RD; H. Ryan Wagner, PhD; Gretchen M. Yonish, MPH, RD; David B. Allison, PhD; George A. Bray, MD

Background Obese individuals who have failed to achieve adequate weight loss with lifestyle changes have limited nonsurgical therapeutic options. We evaluated the efficacy and tolerability of zonisamide, an antiepileptic drug, for enhancing weight loss in obese patients receiving diet and lifestyle guidance.

Methods This was a 1-year, randomized, double-blind, placebo-controlled trial conducted from January 9, 2006, through September 20, 2011, at Duke University Medical Center. A total of 225 obese (mean [SD] body mass index, 37.6 [4.9]) participants included 134 women (59.6%) and 91 men (40.4%) without diabetes mellitus. (Body mass index is calculated as weight in kilograms divided by height in meters squared.) Interventions were daily dosing with placebo (n = 74), 200 mg of zonisamide (n = 76), or 400 mg of zonisamide (n = 75), in addition to diet and lifestyle counseling by a dietitian for 1 year. Primary outcome was change in body weight at 1 year.

Results Of the 225 randomized patients, 218 (96.9%) provided 1-year follow-up assessments. Change in body weight was −4.0 kg (95% CI, −5.8 to −2.3 kg; least squares mean, −3.7%) for placebo, −4.4 kg (−6.1 to −2.6 kg; −3.9%; P = .79 vs placebo) for 200 mg of zonisamide, and −7.3 kg (−9.0 to −5.6 kg; −6.8%; P = .009 vs placebo) for 400 mg of zonisamide. In the categorical analysis, 23 (31.1%) assigned to placebo, 26 (34.2%; P = .72) assigned to 200 mg of zonisamide, and 41 (54.7%; P = .007) assigned to 400 mg of zonisamide achieved 5% or greater weight loss; for 10% or greater weight loss, the corresponding numbers were 6 (8.1%), 17 (22.4%; P = .02), and 24 (32.0%; P < .001). Gastrointestinal, nervous system, and psychiatric adverse events occurred at a higher incidence with zonisamide than with placebo.

Conclusion Zonisamide at the daily dose of 400 mg moderately enhanced weight loss achieved with diet and lifestyle counseling but had a high incidence of adverse events.

Arch Intern Med. 2012;172(20):1557-1564.

Omega-3s Aid in Cancer Battle

omega-3 polyunsaturated fatty acids, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA), inhibit cancer formation in vivo but their mechanism of action is unclear.  Zacharoula Nikolakopoulou, from the University of London (United Kingdom), and colleagues studied squamous-cell carcinoma (SCC), one of the major forms of skin cancer. In that squamous cells also occur in the lining of the digestive tract, lungs, and other areas of the body, oral squamous cell carcinomas (OSCC) are the sixth most common cancer worldwide.  In their experiments, the researchers grew cell cultures in the lab from several different cells lines to which they added fatty acids. The cell lines included both malignant oral and skin SCCs, along with pre-malignant cells and normal skin and oral cells. The team observed that omega-3 fatty acids induced cell death in malignant and pre-malignant cells at doses which did not affect normal cells, with the researchers positing the effect as partly due to an over-stimulation of epidermal growth factor, which triggered cell death.  The study authors submit that: “Our results show that, in part, [eicosapentaenoic acid] specifically inhibits [squamous-cell carcinoma] growth and development by … supporting the chemopreventative potential of [eicosapentaenoic acid].”

http://www.eurekalert.org/pub_releases/2013-08/qmuo-fa080113.php

Statins and Depression: Too Much of a Good Thing?

Hydroxymethyl glutaryl-coenzyme A reductase (HMG-CoA) inhibitors (also called statins) are the most commonly prescribed first-line medications for lowering serum cholesterol.¹

Statins also have other pleiotropic effects, including anti-inflammatory properties (eg, a reduction of C-reactive protein [CRP], tumor necrosis factor [TNF]-alpha, and interleukin [IL]-6 levels).² They have been found effective in reducing cardiovascular risk, including stroke, and in patients suffering from diabetes.^3,4

It has even been suggested that since statins reduce deleterious oxidative and inflammatory effects, they might also have utility in treating depression,⁵ which is thought to be associated with elevated levels of proinflammatory cytokines in the brain.^6,7

Conclusion

The authors conclude that in clinical practice, "we should be alert to the risk of mood disturbance in the increasing number of patients receiving lipid-lowering therapy, especially in patients with depressive tendencies or patients with normal or low serum cholesterol level."

http://www.empr.com/statins-and-depression-too-much-of-a-good-thing/printarticle/305974/

 Can Statins Save Lives During a Flu Pandemic?

The potential utility of statins in treating pneumonia and influenza has been demonstrated in several studies. For example, statins have been found effective in reducing rates of hospitalization and death in outpatients with community-acquired pneumonia, and some evidence also suggests utility in reducing mortality in inpatients with pneumonia.²

Another study found that prior statin users admitted to the hospital with pulmonary infections experienced a higher rate of mortality from sepsis or pneumonia when statins were discontinued, versus patients who continued taking statins—¹¹ an effect that might be due to "rebound hypercytokinemia."²

The effectiveness of outpatient statin treatment has not been as thoroughly examined for influenza hospitalizations and death.² One large-scale 10-year retrospective cohort study of older adults found that outpatient statin use minimally, but significantly, protects against influenza morbidity. The investigators concluded that public health officials and clinicians should focus on other measures for reducing morbidity and mortality in the next influenza pandemic.¹²

http://www.empr.com/can-statins-save-lives-during-a-flu-pandemic/printarticle/305971/  

What's the Ideal BP for Kidney Disease Patients?

 (HealthDay News) – In patients with chronic kidney disease (CKD), optimal blood pressure (BP) seems to be 130–159/70–89 mmHg, according to a study published in the Aug. 20 issue of the Annals of Internal Medicine.

Csaba P. Kovesdy, MD, from the University of Tennessee Health Science Center in Memphis, and colleagues analyzed data from 651,749 U.S. veterans with CKD. BP data were examined in 96 categories from lowest (<80/<40 mmHg) to highest (>210/>120 mmHg), in 10 mmHg increments.

The researchers found that the lowest adjusted mortality rates were seen in patients with BP of 130–159/70–89 mmHg, while those in whom both systolic BP (SBP) and diastolic BP (DBP) were concomitantly very high or very low had the highest mortality rates. There were consistently lower mortality rates in patients with moderately elevated SBP combined with DBP no less than 70 mmHg than in patients with ideal SBP combined with DBP <70 mmHg. Results were consistent in subgroups of patients with normal and elevated urinary microalbumin-creatinine ratios.

"It may not be advantageous to achieve ideal SBP at the expense of lower-than-ideal DBP in adults with CKD," the authors write.

http://annals.org/article.aspx?articleid=1726794

Urinary Albumin Linked to More Heart Disease in Blacks

 (HealthDay News) – A high urinary albumin-to-creatinine ratio at baseline is associated with a higher risk of a first coronary heart disease (CHD) event in blacks compared with whites, with no racial differences in the risk of a recurrent CHD event, according to a study published in the Aug. 21 issue of the Journal of the American Medical Association.

Orlando M. Gutierrez, MD, MMSc, from the University of Alabama at Birmingham, and colleagues examined the association between the urinary albumin-to-creatinine ratio and the risk of CHD based on race in two groups: incident CHD among 23,273 participants without CHD at baseline, and first recurrent CHD event among 4,934 participants with CHD at baseline.

Over a median of 4.4 years of follow-up, the researchers noted 616 incident CHD events and 468 recurrent CHD events. After adjusting for several factors, a higher urinary albumin-to-creatinine ratio at baseline was associated with a significantly higher risk of incident CHD among black subjects (hazard ratio [HR], 3.21 for highest vs. lowest ratio) but not white subjects (HR, 1.49). In contrast, there were no differences in the risk of recurrent CHD among blacks (HR, 2.21) and whites (HR, 2.48).

"Higher urinary albumin-to-creatinine ratio was associated with greater risk of incident but not recurrent CHD in black individuals when compared with white individuals," Gutierrez and colleagues conclude.

Several authors disclosed financial relationships with pharmaceutical companies, including Amgen, which partly funded the study.

http://jama.jamanetwork.com/article.aspx?articleid=1730510#Abstract

Warning: Fluoroquinolone Antibiotics Linked to Nerve Damage

The FDA is requiring the drug labels and Medication Guides for all fluoroquinolone antibacterial drugs be updated with the serious side effect of peripheral neuropathy. The nerve damage may occur soon after these drugs are taken by mouth or by injection, and may be permanent.

The affected fluoroquinolone drugs include: Levaquin (levofloxacin; Janssen), Cipro (ciprofloxacin;Bayer), Avelox (moxifloxacin; Bayer), Noroxin (norfloxacin; Merck), Factive (gemifloxacin;Cornerstone), and Ofloxacin.

Topical formulations indicated for the ears or eyes are not known to be associated with this risk.

RELATED: Infectious Diseases Resource Center

The FDA recommends discontinuing the fluoroquinolone if the patient develops symptoms of peripheral neuropathy. The patient should be switched to another, non-fluoroquinolone antibiotic unless the benefit outweighs the risk. Symptoms include pain, burning, tingling, numbness, weakness, or a change in sensation to light touch, pain or temperature, or the sense of body position.

For more information call (888) 463-6332 or visit FDA.gov. 

Fluoroquinolones Linked to Dysglycemia in Patients with Diabetes

Fluoroquinolones are associated with increased risk for both hyperglycemia and hypoglycemia among patients with diabetes, compared with other antibiotics, according to a study in Clinical Infectious Diseases.

Researchers in Taiwan used national insurance claims data to identify roughly 78,000 outpatients with diabetes who received a new prescription for an oral antibiotic.

Within 30 days of starting the antibiotic, patients taking moxifloxacin, levofloxacin, or ciprofloxacin had 1.75 to 2.48 times the risk for hyperglycemia-related emergency department visits or hospitalizations, relative to patients taking macrolides. Risks were similarly elevated for episodes of hypoglycemia. Moxifloxacin was associated with the highest risk for dysglycemia.

The authors conclude: "Clinicians should consider these risks when treating patients with diabetes and prescribe fluoroquinolones cautiously."

Clinical Infectious Diseases article 

Is Echocardiography Valuable for Screening?

Lindekleiv H et al., JAMA Intern Med 2013 Jul 22;

Screening in the general population provides no obvious benefit.

Prevention of DVT by Intermittent Pneumatic Compression in Stroke Patients

CLOTS (Clots in Legs Or sTockings after Stroke) Trials Collaboration., Lancet 2013 May 31;

Compression devices prevented asymptomatic proximal deep venous thrombosis, but not symptomatic proximal DVT or confirmed pulmonary embolism.

Does Low-Dose Aspirin Lower Cancer Risk in Women?

Cook NR et al., Ann Intern Med 2013 Jul 16; 159:77

Taking 100 mg of aspirin every other day for 10 years was associated with lower colorectal cancer risk.

Endovascular vs. Open Repair of Ruptured Abdominal Aortic Aneurysms

Reimerink JJ et al., Ann Surg 2013 Aug 258:248

In a randomized Dutch trial, outcomes were similar with the two procedures.

Glucose Levels Predict Risk for Dementia

Crane PK et al., N Engl J Med 2013 Aug 8; 369:540

Higher glucose levels within the nondiabetic range predicted higher risk for dementia.

Does Air Pollution Increase the Risk for Acute Heart Failure?

Shah ASV et al., Lancet 2013 Jul 10;

Certain types of air pollution have a significant temporal association with heart failure–related hospitalization and mortality.

Do Antipsychotics Hasten Poor Outcomes in Patients with Alzheimer Disease?

Lopez OL et al., Am J Psychiatry 2013 Jul 30;

Psychotic symptoms and agitation, not antipsychotic medications per se, were associated with earlier nursing home admission and death.

Prevalence of Occult Prostate Cancer at Autopsy Is High

Zlotta AR et al., J Natl Cancer Inst 2013 Jul 17; 105:1050

Overall prevalence was 36%, but it reached almost 60% among Japanese men in their 80s.

Higher ω-3 Fatty Acid Levels Are Associated with Risk for Prostate Cancer

TM et al., J Natl Cancer Inst 2013 Aug 7; 105:1132

This association now has been noted in two case-control studies.

Calcium-Channel Blockers Might Be Associated with Excess Breast Cancer Risk

Coogan PF., JAMA Intern Med 2013 Aug 5;

Pituitary-Adrenal Axis Suppression After Long-Term Prednisone Use

Sacre K et al., J Clin Endocrinol Metab 2013 Aug 98:3199

About half the patients who received 5 mg to 10 mg daily had abnormal results on cosyntropin stimulation testing.

Calcium-Based vs. Non–Calcium-Based Phosphate Binders in Patients with Chronic Kidney Disease

Jamal SA et al., Lancet 2013 Jul 19;

Those who received non–calcium-based binders had 22% lower risk for death.

Salsalate Improves Glycemic Control in Type 2 Diabetes

 Goldfine AB et al., Ann Intern Med 2013 Jul 2; 159:1

Is the Prevalence of Dementia Changing?

Matthews FE et al., Lancet 2013 Jul 16;

In England, the prevalence fell from 8.3% to 6.5% during the past 20 years.

Vitamin D and subsequent all-age and premature mortality: a systematic review

BMC Public Health Full Text    Review Article    Evidence Based Medicine    Extended Summary   

Androgen deprivation therapy and risk of acute kidney injury in patients with prostate cancer

JAMA Evidence Based Medicine    Extended Summary   

A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: results of the Cognitive Function and Ageing Study I and II

The Lancet Evidence Based Medicine    Extended Summary   

Frequency of nut consumption and mortality risk in the PREDIMED nutrition intervention trial

BMC Medicine Full Text    Evidence Based Medicine    Extended Summary  

1. Walking Versus Running for Hypertension, Cholesterol, and Diabetes Mellitus Risk Reduction
   Arteriosclerosis, Thrombosis, and Vascular Biology - 04/17/2013
2. Aspirin: Its risks, benefits, and optimal use in preventing cardiovascular events
   Cleveland Clinic Journal of Medicine - 05/08/2013
3. The Risk of Taking Ascorbic Acid
   JAMA Internal Medicine - 02/05/2013
4. Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis from the JUPITER trial
   The Lancet - 08/14/2012
5. Relationship between 25-Hydroxyvitamin D and All-cause and Cardiovascular Disease Mortality
   American Journal of Medicine - 05/24/2013
6. Drug Interactions with Grapefruit Juice
   British Journal of Medical Practitioners - 02/12/2013
7. Role of Vitamin D in Cardiometabolic Diseases
   Experimental Diabetes Research - 03/05/2013
8. The Prevalence and Prognostic Role of Vitamin D Deficiency in Patients with Acute Coronary Syndrome
   Heart, Lung, and Circulation - 04/30/2013
9. Vitamin D and heart
   Internal and Emergency Medicine - 03/21/2013
10. Nonsteroidal anti-inflammatory drug use and the risk of cognitive impairment and Alzheimers disease
    Alzheimer's & Dementia - 05/22/2012
11. Effect of Vitamin D Supplementation on Blood Pressure in Blacks
    Hypertension - 03/14/2013
12. The effect of topiramate on weight loss in patients with type 2 diabetes
    Journal of Research in Medical Sciences - 05/14/2013
13. Effect of Vitamin D Supplementation on Progression of Knee Pain and Cartilage Volume Loss in Patients With Symptomatic Osteoarthritis A Randomized Controlled Trial Vitamin D Supplementation and Cartilage Volume
    JAMA - 01/10/2013
14. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials
    The Lancet - Early Online Publication - 05/21/2012
15. Warfarin and Aspirin in Patients with Heart Failure and Sinus Rhythm
    New England Journal of Medicine - 05/04/2012
16. Egg consumption and risk of cardiovascular diseases and diabetes: A meta-analysis
    Atherosclerosis - 05/08/2013
17. Effects of Metformin Versus Glipizide on Cardiovascular Outcomes in Patients With Type 2 Diabetes and Coronary Artery Disease.
    Clinical Impact, from MDLinx - 01/16/2013
18. Advances in Stroke Prevention in Atrial Fibrillation: Enhanced Risk Stratification Combined With the Newer Oral Anticoagulants
    Clinical Cardiology - 04/11/2013
19. Diagnosis and management of supraventricular tachycardia
    British Medical Journal - 03/08/2013
20. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet
    New England Journal of Medicine - 04/08/2013

Memory Loss In Alzheimer's Recovered By Blocking Overactive Receptor
http://mnt.to/l/4fbg


Early Arthritis Associated With Reduced Consumption Of Alcohol
http://mnt.to/l/4ff6

Findings Will Help Explain Vitamin D's Role In Seasonal Illnesses
http://mnt.to/l/4fhg

2013 Update On Diagnosis And Management Of Osteoporosis, Published By Maturitas
http://mnt.to/l/4fdV

How Bone Adapts To Exercise Likely Affected By Timing Of Calcium And Vitamin D Supplementation
http://mnt.to/l/4fcn

Moderation Seems To Be Key When It Comes To Eating Fish To Prevent Atrial Fibrillation
http://mnt.to/l/4fjf

Paroxysmal Atrial Fibrillation Patients Should Be Screened For Depression
http://mnt.to/l/4fhC

Scientists Confirm That Body Makes Its Own Rotten Egg Gas, H2S, To Benefit Cardiovascular Health
http://mnt.to/l/4fdp

Adverse Cardiovascular Events May Be Predicted By Atherosclerosis In Abdominal Aorta
http://mnt.to/l/4fcq

Heart Attack, Stroke Risk Increases With Atherosclerosis In Abdominal Aorta
http://mnt.to/l/4fbQ


Screening Colonoscopy Associated With Increased Survival Duration And Rates For Patients With Colon Cancer
http://mnt.to/l/4fdm

Minimally Invasive Techniques Allow Doctors To Remove Suspicious Polyps, Keep Colon Intact
http://mnt.to/l/4fb9


Depression Treatment Failing Two Thirds Of Patients
http://mnt.to/l/4fgP

Diabetes Lifestyle Intervention Does Not Reduce Heart Attack Or Stroke Risk
http://mnt.to/l/4fj7

JANUVIA (Sitagliptin) Compared With Sulfonylurea For Patients With Type 2 Diabetes And Mild Renal Impairment
http://mnt.to/l/4fhz

Progress Made In The Development Of A First-Generation Closed-Loop Insulin Delivery System
http://mnt.to/l/4fhf



Research Breakthrough Of Essential Molecule Reveals Important Targets In Diabetes And Obesity
http://mnt.to/l/4ffv

Eating More Red Meat Associated With Increased Risk Of Type-2 Diabetes
http://mnt.to/l/4fd4


Comparing Insulin Degludec And Insulin Glargine
http://mnt.to/l/4fck

Sleep Could Be Key To Preventing Type 2 Diabetes
http://mnt.to/l/4fc5


Men Who Can't Produce Sperm Face Increased Cancer Risk, Stanford-Led Study Finds
http://mnt.to/l/4fgW

Low Sperm Linked To Cancer Risk
http://mnt.to/l/4fh7

Scientists Discover Key Signaling Pathway That Makes Young Neurons Connect
http://mnt.to/l/4fgV

'Forrest Gump' Mice Show Too Much Of A Key Neurotransmitter Called Acetylcholine Can Be Bad
http://mnt.to/l/4fgv


Scientists Create A Way To See Structures That Store Memories In A Living Brain
http://mnt.to/l/4ff2


Does Coffee Reduce Appetite?
http://mnt.to/l/4fkM

How Safe Is Splenda (Sucralose)?
http://mnt.to/l/4fkF

Vitamin D Levels Significantly Increased By Probiotic Lactobacillus Reuteri NCIMB 30242
http://mnt.to/l/4ffN

Don't Put Your Veggies In Dark Places
http://mnt.to/l/4fh5

New Tool To Measure Sugar Consumption
http://mnt.to/l/4fcK

A High-Fat Diet Impairs Memory And Learning In Adolescent Mice
http://mnt.to/l/4f9h


Causal Relationship Between Adiposity And Heart Failure, And Elevated Liver Enzymes
http://mnt.to/l/4fkp

New Low Cost Method Of Measuring Pleasure Response To Tasting Food
http://mnt.to/l/4fhZ

In Animal Model, Dietary Fructose Found To Cause Liver Damage
http://mnt.to/l/4ffH

dolescent Obesity Associated With Hearing Loss
http://mnt.to/l/4fbp

Obesity Is Now A Disease, American Medical Association Decides
http://mnt.to/l/4fdz


Relationship Between Short-Term Antidepressant Use, Stress, High-Fat Diet And Long-Term Weight Gain
http://mnt.to/l/4f9V

The Importance Of A Father's Diet Before Conception
http://mnt.to/l/4f9T

Obese Women Who Skip Breakfast At Greater Risk For Insulin Resistance
http://mnt.to/l/4f9R

Overweight Women Who Lose Weight Experience Improved Memory
http://mnt.to/l/4f9s

The Link Between Circadian Rhythms And Aging
http://mnt.to/l/4fgN

Lifespan Of Fruit Flies Boosted By Nearly 25 Percent By Herbal Extract
http://mnt.to/l/4fcs

Preventing Vascular Calcification May Treat One Of The Main Symptoms Of Premature Aging Disease
http://mnt.to/l/4fb4


Study Sheds Light On Molecular Basis For Metabolic Health And Disease
http://mnt.to/l/4fcp


Weight Loss Promoted By Drug Combination In Polycystic Ovary Syndrome
http://mnt.to/l/4fbN

Red meat may raise Alzheimer's risk
http://mnt.to/l/4gtB

Iron may be at the core of Alzheimer's disease
http://mnt.to/l/4grh

Immune response to stress 'has effect on mood'
http://mnt.to/l/4gsv

How our own bodies help turn cancer against us
http://mnt.to/l/4gtd


Higher intake of fruits and vegetables may reduce the risk of bladder cancer in women
http://mnt.to/l/4gtQ

Eating fruit may cut your risk of abdominal aortic aneurysm
http://mnt.to/l/4gq3


Family history of diabetes increases the risk of prediabetes by 26%, with effect most evident in non-obese
http://mnt.to/l/4gqT


Men with diet-induced erectile dysfunction may benefit from hitting the gym
http://mnt.to/l/4gr4


Compounds found in red wine and green tea stick to anything, retain useful antibacterial properties
http://mnt.to/l/4gtw

Acid, not bubbles, responsible for distinctive 'bite' of carbonated beverages
http://mnt.to/l/4grP

Boosting brain power through video games
http://mnt.to/l/4grD


Calcium-rich diet may reduce female mortality
http://mnt.to/l/4grr


Why BMI is inaccurate and misleading
http://mnt.to/l/4gtz


BPA exposure increases risk of childhood obesity and abnormal waist circumference
http://mnt.to/l/4gpQ

New way to improve internal clock function may treat sleep disorders
http://mnt.to/l/4gtX

Researchers discover new way to improve internal clock function, put sleep disorders to bed
http://mnt.to/l/4gsk

Weight control not weight loss strategy works better
http://mnt.to/l/4gvk

Good bacteria arrive from mother's gut via breast milk
http://mnt.to/l/4grW

Copper in diet linked to Alzheimer's disease
http://mnt.to/l/4gpr

Dementia risk score for people with diabetes
http://mnt.to/l/4gpb

Study helps to explain why we lose our balance
http://mnt.to/l/4gky


Scientists unravel cancers linked to herbal remedies containing Aristolochic Acid, a natural compound found in Aristolochia plants
http://mnt.to/l/4ggB

High cholesterol riskier for middle-aged men than women
http://mnt.to/l/4gnJ


Colorectal cancer may be triggered by mouth bacteria
http://mnt.to/l/4gjX


What are blisters? How to prevent blisters
http://mnt.to/l/4ghL

New Risk Score Predicts 10-Year Dementia Risk for Type 2 Diabetes Patients
http://mnt.to/l/4gkN


Protection against type 2 diabetes offered by a Mediterranean diet and diets low in available carbohydrates
http://mnt.to/l/4gmK

Depression in patients with type 2 diabetes associated with cognitive decline
http://mnt.to/l/4gj9


Study of testosterone spikes in non-competitive activities
http://mnt.to/l/4gjQ

Big breakfast diet could 'boost fertility for PCOS women'
http://mnt.to/l/4ghV



First steps of fungal infection prevented by new compound
http://mnt.to/l/4gjp


'No such thing' as left or right brained people
http://mnt.to/l/4gmC


A well-connected core brain network helps humans to adapt
http://mnt.to/l/4ghk

Odor memory: The nose and the brain make quite a team... in disconnection
http://mnt.to/l/4ggV


Soda drinks may make children more aggressive and distracted
http://mnt.to/l/4gn2

Improving fatty acid composition of rainbow trout
http://mnt.to/l/4gjZ

Four cups of coffee a day linked to risk of early death
http://mnt.to/l/4ghF

Gene expression may reveal who will benefit from vitamin D
http://mnt.to/l/4gjj

'Safe' levels of sugar can still be harmful to your health
http://mnt.to/l/4ghR

What are probiotics? What are the health benefits of probiotics?
http://mnt.to/l/4ggv


Maternal obesity leads to later-life death risks for offspring
http://mnt.to/l/4ghT

Obesity's impact on mortality risk increases with age
http://mnt.to/l/4ghs

Is change in BMI a good measure of success of child obesity interventions?
http://mnt.to/l/4gh8

Diabetes status should be taken into account in population studies that link weight and mortality
http://mnt.to/l/4ggR

Cardiovascular researchers examine habits that can lead to obesity, future heart risk
http://mnt.to/l/4ggz

Scientists find and assess prostate tumors with the help of sugar
http://mnt.to/l/4gn6

Research 'backs watchful waiting' in prostate cancer
http://mnt.to/l/4gm5

Targeting aggressive prostate cancer - collaborative study shows how non-coding RNAs fuel cancer growth
http://mnt.to/l/4gk8

Reducing prostate cancer risk safely with finasteride
http://mnt.to/l/4gk4

Low-grade prostate cancers may not become aggressive with time - adds support for "watch and wait" approach
http://mnt.to/l/4gf3


Singing exercises reduce snoring
http://mnt.to/l/4gpq

Insomnia helped with exercise - eventually
http://mnt.to/l/4gmd


Mediterranean diet 'reduces genetic stroke risk'
http://mnt.to/l/4gjs



New Mums with Polycystic Ovary Syndrome - substantial link between high BMI's and low breastfeeding rates
http://mnt.to/l/4ghB

Colposcopy at sexual health clinics improves cancer screening rates
http://mnt.to/l/4ghc

Early-onset dementia linked to adolescent risk factors
http://mnt.to/l/4ghb

Protein linked to Alzheimer's-like afflictions identified by neuroscientists
http://mnt.to/l/4gg2


High glucose levels linked to dementia
http://mnt.to/l/4gdk

How oxidative stress and mitochondrial damage relate to neurodegenerative diseases
http://mnt.to/l/4gd9

Association between dementia risk and blood sugar level, even in the absence of diabetes
http://mnt.to/l/4gcc

Why we don't all succumb to Alzheimer's disease
http://mnt.to/l/4gcb

Hot chocolate may prevent memory decline
http://mnt.to/l/4gc2


Duration of mother's breastfeeding leads to reduced risk for Alzheimer's
http://mnt.to/l/4g8q



Potential new way to treat anxiety
http://mnt.to/l/4g7M


Eating oily fish could cut your risk of rheumatoid arthritis
http://mnt.to/l/4ggj

Piano playing involves coarticulation, with hand muscle contractions differing depending on the sequence of notes played
http://mnt.to/l/4gfJ

Moderate exercise could be good for keeping your tendons healthy
http://mnt.to/l/4gcy

Fracture risk predicted by quality of bone as well as bone density
http://mnt.to/l/4g8r


Tamoxifen for prevention in high-risk breast cancer
http://mnt.to/l/4gc3

Blood pressure drugs linked to higher breast cancer risk
http://mnt.to/l/4g8S

How soy foods protect against colon cancer
http://mnt.to/l/4g97

Depression less likely when there is a strong grandparent-adult grandchild relationship
http://mnt.to/l/4gg4

Brain molecule discovered that regulates human emotion, mood
http://mnt.to/l/4g9W

People with psoriasis more likely to get other diseases
http://mnt.to/l/4g8K

IVF may be a risk factor for adult onset diabetes
http://mnt.to/l/4ggf


A high-calorie breakfast protects against diabetes, hypertension, and cardiovascular problems
http://mnt.to/l/4g9g

Depressed mood could be lifted by color of nightlight
http://mnt.to/l/4gb7

Overthinking can be detrimental to human performance
http://mnt.to/l/4gc4


The brain's motor cortex made more efficient by practice
http://mnt.to/l/4g7G


Researchers discover how vitamin B12 is made
http://mnt.to/l/4gdv

What are the health benefits of honey?
http://mnt.to/l/4gfp

Novel caffeine detection kit
http://mnt.to/l/4gcg

Low GI diets during pregnancy: A new weapon in the fight against obesity
http://mnt.to/l/4gbL

Could a bigger breakfast lead to a smaller waist?
http://mnt.to/l/4gbz

'Big breakfast healthier than a big dinner'
http://mnt.to/l/4gdw

Overweight children have higher risk of asthma
http://mnt.to/l/4gbN

Obesity link to lack of sleep suggested by brain scans
http://mnt.to/l/4gbM

Prioritizing USPSTF recommendations based on patient characteristics may improve life-expectancy
http://mnt.to/l/4g8p

Mental health benefits of good grandparent-grandchild relationships
http://mnt.to/l/4ggq

Normal cognitive decline with age may not be inevitable
http://mnt.to/l/4gcS

Scientists identify key protein that modulates organismal aging
http://mnt.to/l/4gcJ

Probiotics do not treat diarrhea, study says
http://mnt.to/l/4gb2

Most Americans would not wish to live to 120
http://mnt.to/l/4g9J

New treatment against cognitive dysfunction in chronic cerebral ischemia
http://mnt.to/l/4g9S

Iron-rich foods to prevent anemia could lower dementia risk
http://mnt.to/l/4g4w

'Powerful effect of exercise' against Alzheimer's
http://mnt.to/l/4g3S

Alzheimer's disease linked to poor dental health
http://mnt.to/l/4g37

Stress early in life leads to adulthood anxiety and preference for "comfort foods"
http://mnt.to/l/4g3P

Long-term calcium-channel blocker use for hypertension associated with higher breast cancer risk
http://mnt.to/l/4g6p


Blocking sugar intake may reduce cancer risk or progression in obese and diabetic people
http://mnt.to/l/4g6h


Omega-3 role in preventing oral and skin cancers
http://mnt.to/l/4g5C


New target for the fight against cancer and diseases as a result of excessive blood vessel formation
http://mnt.to/l/4g3X

Cleveland Clinic study finds lowest risk treatment for severe carotid and coronary disease
http://mnt.to/l/4g55


New signal stabilizes atherosclerotic plaques
http://mnt.to/l/4g5d

Scientists find answers on sunburn pain
http://mnt.to/l/4g8R

Walking for a "40% cut" in diabetes risk
http://mnt.to/l/4g8m

Severe low blood sugar occurs often in patients with Type 2 diabetes
http://mnt.to/l/4g3n


Oxytocin affects men and women differently in social contexts
http://mnt.to/l/4g4M


Clues to how brains focus on long-term goals
http://mnt.to/l/4g7Z

Scientists decode mechanisms of cell orientation in the brain
http://mnt.to/l/4g4J

Learning under stress - mineralocorticoid receptors play a crucial role in enabling the brain to adapt to stressful situations
http://mnt.to/l/4g3c


Longer life-expectancy found in male Holocaust survivors
http://mnt.to/l/4g4s

Cholesterol connection to Rett Syndrome
http://mnt.to/l/4g2N

Association between grape consumption and healthier eating patterns in US children and adults
http://mnt.to/l/4g7d

Diets lacking omega-3s lead to anxiety, hyperactivity in teens
http://mnt.to/l/4g2q

Taxing sugary beverages may not reduce obesity - it's likely consumers would substitute other unhealthy foods study finds
http://mnt.to/l/4g32

Could diabetes pill metformin work against aging?
http://mnt.to/l/4g4d

A small dose of testosterone taken orally prevents muscle wasting without the normal side effects
http://mnt.to/l/4g3f

Both parents experience highs and lows in sexuality after childbirth
http://mnt.to/l/4g29

Camping could help reset your internal body clock
http://mnt.to/l/4g5S

Estrogen may influence location of women's fat
http://mnt.to/l/4g2L