HHAL MEDICAL NEWS OCTOBER08
Animal
model shows vitamin D deficiency induces persistent hyperthyroidism
vitamin
D enhances regulatory T cells, vitamin D deficiency would intensify the severity of Graves' disease
in the model.
Abstract
http://www.modernmedicine.com/modernmedicine/Internal+Medicine/Vitamin-D-Directly-Affects-Thyroid-Function-in-Mic/ArticleNewsFeed/Article/detail/562611?contextCategoryId=40130&srcemalert=40130
Certain
Wines May Increase Health Risks
Commercially available wines
-- with the exception of wines from Argentina, Brazil and Italy -- may contain
potentially hazardous levels of heavy metals. All wines demonstrated THQ values indicating increased levels of risk. Vanadium,
copper and manganese increased THQ measures the most. Typical potential maximum THQ values ranged from 50 to 200, with Hungarian
and Slovakian wines reaching 300. "For consumption of 250 mL daily, these wines give very high THQ values and may present
detrimental health concerns through a lifetime based upon the metal content alone," the authors conclude.
Abstract
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=562525
Adding grape
powder to high-salt diet reduces salt-sensitive hypertension, cardiac hypertrophy
Abstract
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=562320
Adjunct
therapy associated with quicker respiratory rate normalization, crackles resolution
Abstract
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=562183
Exposing
skin to low temperatures is an effective, noninvasive way to induce loss of subcutaneous fat without skin injury or scarring.
The researchers found that the treatment induced a lobular panniculitis. At some test sites, cooling led to a gradual, grossly
obvious loss of several millimeters of subcutaneous fat. They also noted adipocyte loss, lipid-laden mononuclear inflammatory
cells and local thickening of fibrous septae but no evidence of skin injury or scarring. Serum lipid levels did not change
significantly.
Prolonged, controlled local skin cooling can induce selective damage and subsequent loss of subcutaneous
fat, without damaging the overlying skin.
Abstract
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=562187
Two factors in prostate-cancer
mortality
Excess bodyweight and a high plasma concentration of C-peptide both predispose men with a subsequent diagnosis of
prostate cancer to an increased likelihood of dying of their disease. Patients with both factors have the worst outcome. Further
studies are now needed to confirm these findings
http://www.thelancet.com/journals/lanonc/article/PIIS1470204508702353/abstract?isEOP=true
Higher risk associated with higher intake of eggs and high-fat dairy
Higher
risk associated with higher intake of eggs and high-fat dairy
Abstract
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=561897
Glucose Formation By The Liver Altered By Low-Carb
Diets
A new study shows that a low-carbohydrate diet changes hepatic energy
metabolism. When carbohydrates are restricted, the liver relies more on substances like lactate and amino acids to
form glucose, instead of glycerol.
We have shown that the sources
from which endogenous glucose is produced are dependent upon dietary macronutrient composition," the authors write. They
suggest that the shift in glucose metabolism associated with a low carbohydrate diet could be beneficial in individuals with
non-alcoholic fatty liver disease (NAFLD) due to improved disposal of hepatic fat.
In conclusion, these findings
may partly explain the correlation between carbohydrate intake and severity of liver disease in individuals with NAFLD.
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=126186
Vitamin B Supplementation and Progression
of Alzheimer Disease
Dietary supplementation with folate,
vitamin B6, and vitamin B12 did not slow progression of dementia at 18 months.
Homocysteine
elevation is associated with endothelial and vascular dysfunction, neurotoxicity, and high plasma amyloid levels. Previous
short-term clinical trials of
dietary B vitamin supplementation
to lower homocysteine levels in people with normal or impaired cognitive function have yielded mixed results. In this multisite
U.S. study, 409 adults (mean age, 76) with mild-to-moderate Alzheimer disease were randomized to daily supplementation with a combination of folate (5 mg),
vitamin B6 (25 mg), and vitamin
B12 (1 mg) or to a daily placebo tablet.
At
18 months, 344 participants had completed the trial; homocysteine levels were significantly lower in the treatment group, but progression of dementia did not differ
between groups. No differences were observed in a wide range of standardized assessments of cognitive function and activities
of daily living. No overall difference was observed between the two groups in adverse events, although the treatment group
evidenced significantly more depression and depressive symptoms (28% vs. 18%).
Comment:
These results are consistent with those of a previous meta-analysis (Arch Intern Med 2007; 167:21). Despite the known association of elevated homocysteine levels with progression of dementia, B vitamin supplementation
does not attenuate the rate of decline in cognitive function in dementia patients and cannot be recommended. Editorialists
note that, once dementia becomes evident, supplementation might be ineffective. Folate supplementation in food has lowered
homocysteine levels in the general U.S. population; however, for the rare patient with a very high
homocysteine level (i.e., >20
µmol/L), a benefit from B vitamin supplementation remains possible
http://us.mc812.mail.yahoo.com/mc/showMessage;_ylt=AhtRL5QDPn3hmY8xstRhOYozm70X?mid=1_20005_AGrHjkQAATJmSP5xIAETKw73ojk&fid=HHAL%2520NEWS1008&sort=date&order=down&startMid=0&.rand=859575880&da=0
Rosiglitazone may have opposite effect in diabetics,
but more research needed for firm conclusions
"In conclusion, our meta-analysis
suggested that, compared with other oral diabetes agents and placebo, metformin appeared moderately protective against cardiovascular
effects and that rosiglitazone was possibly harmful, but a lack of power prohibited firmer conclusions
Abstract
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=561494
No Association
Between Physical Activity and Telomere Length in an Elderly Chinese Population 65 Years and Older
Telomere
shortening has been considered an aging marker since it represents lifetime exposure to oxidative and inflammatory
stress, and it has been shown to be negatively correlated with age, smoking, and mortality up to age 75 years.1
A recent article in the Archives2 reported that the benefits of leisure activity include
an association with longer telomere length in middle-aged subjects, after adjusting for confounding factors such
as body mass index, smoking, and socioeconomic status, sending a potentially powerful message that regular
exercise has antiaging effects. We report a study in an elderly Chinese population 65 years and older
that suggests that by age 70 years, this beneficial effect on telomere length is much attenuated.
http://archinte.ama-assn.org/cgi/content/extract/168/19/2163?ct
Nothing Fishy About It: Omega-3 Polyunsaturated Fatty Acids in Heart
Failure
In
a large randomized trial, adding an inexpensive, widely available supplement to heart failure treatment provided a modest
but significant incremental benefit.
Mortality from heart failure remains unacceptably high. Results from secondary prevention
trials have suggested that omega-3 polyunsaturated fatty acids (PUFAs) might confer a 20% relative reduction in risk for death
(JW Cardiol Nov 8 2006) in patients with coronary heart disease, apparently through anti-arrhythmic
effects. No large-scale trials of PUFAs have been conducted in patients with heart failure.
In a trial from the Gruppo Italiano per lo Studio
della Sopravvivenza nell’Infarto miocardico (GISSI), sponsored by multiple industry partners, investigators randomized
6975 patients with symptomatic, chronic heart failure (NYHA classes II–IV) to receive placebo or an omega-3 PUFA supplement
in addition to their other medications. Median follow-up was 3.9 years.
Patients assigned to PUFAs had a 9% reduction in relative risk for all-cause
mortality (adjusted hazard ratio, 0.91; P=0.041) and an 8% reduction in relative risk for the combined endpoint of
all-cause mortality and cardiovascular hospitalization (adjusted HR, 0.92; P=0.009). Absolute risk reductions were
1.8% (95% confidence interval, 0.3–3.9) and 2.3% (95% CI, 0.0–4.6), respectively, amounting to 56 patients needing
to be treated to avoid one death, or 44 to avoid one event, in approximately 4 years. There were no between-group differences
in important secondary outcomes of sudden cardiac death, first MI, hospitalization for heart failure, or stroke. Worsening
heart failure accounted for the most deaths in both groups, followed by presumed arrhythmic death.
Comment: Although the benefits of omega-3 PUFAs for symptomatic heart failure
observed in this study were small in absolute terms, they were incremental to those of current heart failure therapies. Moreover,
PUFAs are safe, well tolerated, and very inexpensive: The 1-g daily study dose is available in over-the-counter fish oil (omega-3)
supplements for about $60.00 per year. PUFAs represent the first new life-prolonging therapy for heart failure in nearly 7
years
http://cardiology.jwatch.org/cgi/content/full/2008/1008/1?q=topic_nutrition
Omega-3 Fatty Acids, but Not Rosuvastatin,
Lower 4-Year Mortality in Heart Failure Patients
During a 4-year study, death rates were lower among heart failure patients
who received -3 fatty acids than among those who did not.
Randomized trials have
shown that, among patients with established coronary artery disease, supplementation with -3 polyunsaturated fatty acids (PUFAs) or statins is associated with better outcomes than is no supplementation,
but these trials were not designed to examine the effects of such interventions in heart failure patients. Because observational
studies have suggested that these therapies might improve cardiovascular outcomes in heart failure patients, Italian researchers
conducted a large trial (sponsored by the manufacturer of rosuvastatin [Crestor]) in which 6975 adult patients (mean age,
67) with New York Heart Association class II–IV heart failure were randomized to receive daily -3 PUFAs (eicosapentaenoic and docosahexaenoic acids; 1 g) or placebo. Two thirds of
these patients had no indications or contraindications for statins and were randomized further to receive daily rosuvastatin
(10 mg) or placebo. Standard treatments for chronic heart failure were encouraged.
Median follow-up was 3.9 years. Fewer patients
in the -3 PUFA arms than in the placebo arms died (27% vs. 29%),
and fewer patients in the -3 PUFA arms reached the composite primary
endpoint of all-cause death or cardiovascular-related hospitalization (57% vs. 59%). These differences became statistically
significant only after adjustment for several baseline imbalances between the -3
PUFA and placebo groups. A lower incidence of arrhythmic death in patients who received -3 PUFAs accounted for most of the difference in number of deaths between treatment groups. No differences
were observed between patients randomized to rosuvastatin and those who received placebo in either all-cause mortality or
the composite endpoint.
Comment: Results from this large, randomized study corroborate those of the earlier CORONA study (JW Nov 29 2007): Rosuvastatin did not lead to longer survival in patients with
heart failure. Although these findings raised no safety concerns about rosuvastatin, the authors recommend against routine
use of statins in this population. However, -3 polyunsaturated
fatty acids appear to confer a small but significant survival advantage and might merit routine use along with other established
therapies for heart failure.
— Bruce Soloway, MD
Published
in Journal Watch General Medicine October 16, 2008
Citation(s):
GISSI-HF Investigators. Effect of n-3 polyunsaturated
fatty acids in patients with chronic heart failure (the GISSI-HF trial): A randomised, double-blind, placebo-controlled trial.
Lancet 2008 Oct 4; 372:1223.
http://general-medicine.jwatch.org/cgi/content/full/2008/1016/1?q=topic_nutrition
Prostate-specific antigen levels are influenced by a number of factors unrelated to prostate cancer
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=555687
Heart Rate Reduction from β-Blockers Linked to CV Events in Hypertensive Patients
Patients with hypertension who slow their heart rates with β-blockers may have an increased risk for cardiovascular events and death, according to a meta-analysis
in the Journal of the American College of Cardiology.
Researchers evaluated nine studies comprising 34,000 patients on β-blockers
and 34,000 taking other antihypertensives or placebo. After 3.5 years' follow-up, they conclude that the slower the heart
rate with β-blockers, the higher the risk for mortality, MI, or heart failure.
No study has shown that reducing heart rate with drugs benefits patients with hypertension,
the authors note. They say the heightened risk could result from an increase in central aortic pressure or pulse pressure.
They caution that more research is needed to establish causation, while an editorialist
concludes: "Beta-blockers will surely remain as indicated for heart failure, for after myocardial infarction, and for
tachyarrhythmias, but no longer for hypertension in the absence of these compelling indications."
Conclusions:
In contrast to patients with myocardial infarction and heart failure, beta-blocker–associated reduction in
heart rate increased the risk of cardiovascular events and death for hypertensive patients.
http://content.onlinejacc.org/cgi/content/short/52/18/1482
Those
not at high risk for cardiac failure have highest rate of myocardial infarction
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=560129
Estrogenic compound in soy products inhibits killing by natural
killer cells
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=561115
Hemorrhagic Stroke in an Atorvastatin
Stroke-Prevention Trial
Analysis
of the hemorrhagic-stroke events in the SPARCL study demonstrates higher risk in certain subgroups, independent of the statin.
The Stroke Prevention by Aggressive Reduction in Cholesterol Levels
(SPARCL) study was a large (4731-patient), randomized, controlled, manufacturer-sponsored stroke-prevention trial of atorvastatin
in patients with recent stroke or TIA and no known coronary heart disease (N Engl J Med
2006; 355:549). Compared with the placebo group, the atorvastatin group had a significant, 16% lower risk for stroke overall
but a significantly higher rate of any hemorrhagic stroke (55 with active treatment vs. 33
with placebo; unadjusted hazard ratio, 1.68) that was attributable entirely to a higher rate
of nonfatal hemorrhagic strok e.
The study authors
have now performed a post hoc exploratory statistical analysis of the SPARCL data to understand better the associations among
atorvastatin treatment, patient characteristics, and risk for hemorrhagic stroke during a median follow-up of 4.9 years. The
analysis demonstrates that risk for hemorrhagic stroke was higher in the 2% of patients who had hemorrhagic stroke at study
entry (HR, 5.65) and in male patients (HR, 1.79); these associations were independent of the increased risk for hemorrhagic
stroke associated with atorvastatin treatment. Risk for hemorrhagic stroke also increased with age and with postrandomization
hypertension. LDL- and total-cholesterol levels, cigarette smoking, and use of antiplatelet
agents did not affect hemorrhagic-stroke risk.
Comment:
Clinicians caring for stroke patients welcomed the results of the SPARCL trial as strong evidence supporting the use of statins
in reducing recurrent-stroke risk. The increase in hemorrhagic stroke in the atorvastatin-treated group tempered this enthusiasm.
The current post hoc analysis of the SPARCL study allows us to understand better which groups
are at particular risk. Patients with hemorrhagic stroke at baseline did not benefit from statin treatment. For older male
patients with difficult-to-treat hypertension, clinicians must carefully weigh the risks and potential benefits before prescribing
a statin.
http://us.mc812.mail.yahoo.com/mc/showMessage?fid=HHAL%2520NEWS1008&sort=date&order=down&startMid=0&.rand=792396043&da=0&midIndex=3&mid=1_14399_AHDHjkQAATo3SQEwpgvHJ0XbSAA&prevMid=1_11528_AG%2FHjkQAAKVRSQKaOAQYXDeoU1A&nextMid=1_14850_AGvHjkQAAIO2SQDX2wHsFTz5PnA&m=1_7140_AHDHjkQAAL5NSQj1QAH5Owl%2Ba%2FA,1_10637_AG7HjkQAAClYSQXgiARzcD8Mi8o,1_11528_AG%2FHjkQAAKVRSQKaOAQYXDeoU1A,1_14399_AHDHjkQAATo3SQEwpgvHJ0XbSAA,1_14850_AGvHjkQAAIO2SQDX2wHsFTz5PnA,1_15288_AGnHjkQAAO7MSQCfXgD9cyimjNM,1_15673_AHDHjkQAAD9hSQBftwl%2B%2FgrlqAk,1_16113_AG7HjkQAAG80SP%2F22wLC3C8DPAM,1_16556_AG3HjkQAAVM7SP%2BZ7wXOgQKyFgY,
Survival independently predicted by coenzyme Q10
Abstract
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=560810
A diet high in fruit and vegetables can reduce
risk
An unhealthy diet accounts for approximately 30 percent of the population-attributable
risk of myocardial infarction, according to a report published online Oct. 20 in Circulation: Journal of the American
Heart Association
Abstract
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=560515
Vitamin
B Supplementation and Progression of Alzheimer Disease
Dietary supplementation with folate, vitamin B6, and vitamin B12
did not slow progression of dementia at 18 months.
Homocysteine elevation is associated with endothelial and vascular dysfunction,
neurotoxicity, and high plasma amyloid levels. Previous short-term clinical trials of dietary B vitamin supplementation to
lower homocysteine levels in people with normal or impaired cognitive function have yielded mixed results. In this multisite
U.S. study, 409 adults (mean age, 76) with mild-to-moderate Alzheimer disease were randomized to daily supplementation with
a combination of folate (5 mg), vitamin B6 (25 mg), and vitamin B12 (1 mg) or to a daily placebo tablet.
At 18 months, 344 participants had completed the trial; homocysteine levels
were significantly lower in the treatment group, but progression of dementia did not differ between groups. No differences
were observed in a wide range of standardized assessments of cognitive function and activities of daily living. No overall
difference was observed between the two groups in adverse events, although the treatment group evidenced significantly more
depression and depressive symptoms (28% vs. 18%).
Comment:
These results are consistent with those of a previous meta-analysis (Arch Intern Med 2007; 167:21). Despite the known association of elevated homocysteine levels with
progression of dementia, B vitamin supplementation does not attenuate the rate of decline in cognitive function in dementia
patients and cannot be recommended. Editorialists note that, once dementia becomes evident, supplementation might be ineffective.
Folate supplementation in food has lowered homocysteine levels in the general U.S. population; however, for the rare patient with a very high homocysteine level (i.e.,
>20 µmol/L), a benefit from B vitamin supplementation remains possible.
http://us.mc812.mail.yahoo.com/mc/showMessage;_ylt=AhtRL5QDPn3hmY8xstRhOYozm70X?mid=1_20005_AGrHjkQAATJmSP5xIAETKw73ojk&fid=HHAL%2520NEWS1008&sort=date&order=down&startMid=0&.rand=784237023&da=0
More pre-stroke exercise
associated with better outcomes
Stroke patients who were physically active
before their stroke are more likely to have had a less severe stroke and more likely to have better outcomes, according to
study findings published in the Oct. 21 issue of Neurology.
Abstract
http://us.mc812.mail.yahoo.com/mc/showMessage;_ylt=AhtRL5QDPn3hmY8xstRhOYozm70X?mid=1_20005_AGrHjkQAATJmSP5xIAETKw73ojk&fid=HHAL%2520NEWS1008&sort=date&order=down&startMid=0&.rand=784237023&da=0
Fructose induces leptin resistance and may lead to obesity
Abstract
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=559979
Vitamin K Does Not Prevent Bone Density Loss,
But May Prevent Fractures And Cancers
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=125345
Discovery Of Baldness Gene:
1 In 7 Men At Risk
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=125332
Meta-analysis
reveals that combining them with statins significantly improves lipid profile
Abstract
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=559780
Protection due to efflux of cholesterol from cells
Abstract
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=559776
Protein involved in producing calcium spikes in egg
Abstract
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=559775
Aspirin, Antioxidants Offer No Primary
Cardiovascular Protection in Diabetes
Contrary to published guidelines, aspirin and antioxidants do not offer primary
preventive benefits against cardiovascular
disease in high-risk diabetic patients, a study published online in BMJ
reports.
Researchers studied almost 1300
adults with type 1 or 2 diabetes and asymptomatic peripheral arterial
disease (as evidenced by an ankle brachial pressure index under 1.00). Patients underwent randomization to one of four
regimens:
- aspirin plus placebo;
- aspirin plus antioxidant;
- antioxidant plus placebo;
- double placebo.
After a median follow-up of almost 7 years, there was no difference
among groups in the two primary endpoints: the first, a composite of death from CHD or stroke, nonfatal MI
or stroke, or above-ankle amputation due to ischemia; and the second, death from CHD or stroke.
An editorialist concludes: "Practitioners and authors of guidelines need
to heed the evidence that aspirin should be prescribed only in patients with established symptomatic cardiovascular disease."
BMJ
article (Free)
http://www.bmj.com/cgi/content/full/337/oct16_2/a1840
Tripled risk observed
among adults who report eating until full and eating quickly
Full Text
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=560643
May explain improved tolerance
in diabetics on a high-protein diet
Abstract
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=559444
Episodic treatment also increased both
atrial fibrillation recurrences and hospitalizations
While there was no difference in composite
cardiovascular endpoints in atrial fibrillation patients treated with episodic compared to continuous amiodarone therapy,
episodic treatment was associated with higher rates of atrial fibrillation recurrence, all-cause mortality and cardiovascular
hospitalizations, according to a report in the Oct. 15 issue of the Journal of the American Medical Association.
Abstract
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=558977
Alcohol
consumption linearly and inversely related to brain size
Abstract
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=558981
AAP Guidelines Recommend Doubling Children's Vitamin D Intake
The
American Academy of Pediatrics has doubled the recommended daily vitamin D intake
from 200 IU to 400 IU for infants, children, and adolescents.
The report, published online
in Pediatrics, updates guidelines from 2003. It recommends that the following groups
receive daily vitamin D supplements of 400 IU:
http://www.aap.org/new/VitaminDreport.pdf
Those
with highest quintile of intake had roughly half the risk compared to those with lowest intake
Abstract
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=558827
Smoking in Middle Age Confers Poor Quality of Life Years Later
Men
who smoke in midlife face reduced health-related quality of life in older age
Some
1650 healthy Finnish men reported on their smoking status at roughly 48 years of age and then were followed up 26 years later.
About one-fifth died during that time. Those who'd never smoked lived about 10 years longer than those who'd reported
smoking more than a pack a day.
Among survivors, never-smokers scored significantly
better than heavy smokers on most quality-of-life measures, including physical functioning and bodily pain. Smoking's
effects were dose-dependent, with quality of life declining as the number of cigarettes smoked increased.
The authors conclude that for the best outcomes, smoking "should not be started at all." Still,
they say their results might "encourage smoking
cessation" — and for those who can't quit, cutting back "may also be beneficial," given
the "dose-dependent trend" observed.
http://archinte.ama-assn.org/cgi/content/abstract/168/18/1961?ct
http://archinte.ama-assn.org/cgi/content/abstract/168/18/1968?ct
Inconsistent results may be related to COX-2 expression
Abstract
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=558108
Risk declines with moderate consumption of red wine, but not other types of alcohol
Abstract
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=557875
National survey data show a 75 percent increased risk in patients with metabolic
syndrome
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=557873
Antipsychotics Increase Risk for Stroke in Elders
The presence of dementia worsens the risk.
In several studies, antipsychotic medications increased morbidity and mortality in older patients, and some findings showed greater risks in
those prescribed atypical antipsychotics or diagnosed with dementia. Antipsychotics also specifically increased stroke risk
http://www.ncbi.nlm.nih.gov/pubmed/18755769?dopt=Abstract
Appendicular
fat best predictor of disability
Abstract
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=557361
Substance is converted to lipid messenger oleoylethanolamide in the small intestine
Abstract
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=557353
High
BMI, Hyperinsulinemia
Associated with Prostate Cancer Mortality
Being overweight, having hyperinsulinemia, or — especially — having both increases the risk for
death in men with prostate cancer, researchers report online in Lancet Oncology.
In
the prospective, 24-year Physicians' Health Study, some 2500 men developed prostate cancer. In adjusted analyses, those
who were overweight or obese at baseline had a higher risk for dying of prostate cancer than did normal-weight men (hazard
ratios, 1.5 and 2.7, respectively). Separately, those with the highest quartile of baseline C-peptide concentration (a marker
of insulin secretion) had higher prostate cancer mortality than those in the lowest quartile (HR, 2.4). Patients with both
factors had four times the risk compared to men with neither factor.
The authors suggest that the
tumors may progress via insulin growth factor receptors.
Marker of insulin secretion also linked to increased risk of death
Abstract
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=557104
Case-control study of at-risk patients shows more
than 50 percent reduction two years after vaccination
Full Text
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=557092
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=556505
Tiotropium Alleviates Symptoms, Doesn't Reduce Rates of FEV1 Decline in COPD
The inhaled
bronchodilator tiotropium failed to show a disease-modifying benefit — even as symptom control improved — for
patients with moderate-to-severe COPD, according to a large double-blind, manufacturer-sponsored trial in the New England Journal of Medicine.
Of
nearly 6000 patients randomized to daily tiotropium or placebo, only 60% completed 45 months' treatment. FEV1
improved initially during treatment and remained better in patients randomized to tiotropium compared with placebo recipients.
Tiotropium improved lung function and quality of life and decreased exacerbations. However, the primary endpoint — rates
of decline in FEV1 — did not differ. Mortality rates
were similar.
An editorialist says that the findings
may not mean tiotropium has no disease-modifying benefit. Rather, "there is increasing recognition that FEV1
alone, while important, does not capture ... the heterogeneity of COPD," and further research to test therapies for COPD
in predefined patient subgroups will be important.
NEJM article article (Free)
http://content.nejm.org/cgi/content/full/NEJMoa0805800
