HHAL MEDICAL NEWS JANUARY 2010
Could
Reducing Salt Consumption Prevent Cardiovascular Events?
High salt intake
is associated in a dose-dependent manner with high rates of stroke and cardiovascular events.
Current guidelines recommend
a daily salt intake of 5 to 6 g or less. However, daily salt consumption exceeds that level
in most adult populations and is higher than 12 g in Eastern Europe and Asia.
In a meta-analysis of prospective studies with at least 3
years of follow-up published from 1966 through 2008, investigators assessed the association between salt intake and stroke
or cardiovascular events; the analysis included 19 independent cohort samples from 13 studies involving 177,025 participants.
Daily salt intake was estimated at baseline only from a single 24-hour urine measurement or dietary assessment. The average
difference between high-intake and low-intake groups was about 5 g of salt (86 mmol of sodium) per day.
During follow-up periods ranging from 3.5 to 19.0 years, more than 10,000 vascular events occurred. High salt intake was associated with increased
risks for stroke (relative risk, 1.23; 95% confidence interval, 1.06–1.43; P=0.007) and cardiovascular
disease (RR, 1.14; 95% CI, 0.99–1.32; P=0.07). After exclusion of a single study with particularly unreliable
estimates of sodium intake, a sensitivity analysis of the cardiovascular disease findings showed a pooled RR estimate
of 1.17 (CI, 1.02–1.34; P=0.02).
Comment: According
to this meta-analysis, high salt intake is associated
with significant increases in rates of stroke and total cardiovascular events. Based on the findings, a population-wide
decrease in salt intake of 5 g (about 1 teaspoon) per day could result in 23% fewer strokes and 17% fewer total cardiovascular
events. Efforts by public health authorities and the food industry to help individuals take steps toward meeting
recommended targets for salt consumption are clearly warranted.
CONCLUSIONS: High salt intake is associated with significantly increased risk of stroke and total cardiovascular
disease. Because of imprecision in measurement of salt intake, these effect sizes are likely to be underestimated. These results
support the role of a substantial population reduction in salt intake for the prevention of cardiovascular disease.
http://www.ncbi.nlm.nih.gov/pubmed/19934192?dopt=Abstract
Individual risk assessment might be the best approach.
http://general-medicine.jwatch.org/cgi/content/full/2009/1231/8?q=topic_stroke
The Scent Of A Woman: Men's Testosterone Responses To Olfactory Ovulation Cues
Women around the world spend billions of dollars each year on exotic smelling perfumes and lotions
in the hopes of attracting a mate. However, according to a new study in Psychological Science, a journal of the Association
for Psychological Science, going "au natural" may be the best way to capture a potential mate's attention.
Smells are known to be critical to animal mating habits: Animal studies have shown
that male testosterone levels are influenced by odor signals emitted by females, particularly when they are ovulating
(that is, when they are the most fertile). Psychological scientists Saul L. Miller and Jon K. Maner from Florida State University wanted to see if a similar response occurs in humans.
In two studies, women wore tee shirts for 3 nights during various phases of their menstrual cycles. Male volunteers smelled
one of the tee shirts that had been worn by a female participant. In addition, some of the male volunteers smelled control
tee shirts that had not been worn by anyone. Saliva samples for testosterone analysis were collected before and after the
men smelled the shirts.
Results revealed that men who smelled tee shirts of ovulating
women subsequently had higher levels of testosterone than men who smelled tee shirts worn by non-ovulating women or men who
smelled the control shirts. In addition, after smelling the shirts, the men rated the odors on pleasantness and rated
the shirts worn by ovulating women as the most pleasant smelling.
The authors note that "the present research
is the first to provide direct evidence that olfactory cues to female ovulation influence biological responses in men."
In other words, this study suggests that testosterone levels may be responsive to smells indicating when a woman is fertile.
The authors conclude that this biological response may promote mating-related behavior by males.
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=176029
Prolonged TV Viewing Linked To Higher
Risk Of Death Even In Regular Exercisers
Researchers in Australia
found that prolonged television viewing was linked to an increased risk of death, even in people who exercised regularly,
and recommended more be done to encourage people to spend fewer hours sitting still in front of the TV.
The study,
which appeared online on 11 January in the journal Circulation, is the work of lead author Dr David Dunstan, a researcher
at the Baker IDI Heart and Diabetes Institute in Melbourne, and colleagues.
The researchers wrote that studies
have been done on television viewing time and health, but these have focused on links with cardiovascular risk, and not risk
of death. So for this study they investigated the link between prolonged television viewing time and all-cause, cardiovascular,
cancer and non- cardiovascular/non-cancer mortality in Australian adults.
One of the surprising things they found
was that even for people who exercised regularly, the risk of death went up the longer they spent in front of the TV: they
suggest the problem was the prolonged periods of sitting still.
For six years, Dunstan and colleagues followed
8,800 people aged 25 and over who were taking part in the Australian Diabetes, Obesity and Lifestyle Study (AusDiab) and found
that those who said they watched four or more of TV a day were 46 per cent more likely to die of any cause and 80 per cent
more likely to die of cardiovascular disease compared to people who said they spent less than two hours a day in front of
their TVs.
The study revealed the following results:
The
average age of the participants at enrollment in 1999-2000 was 50 years.
284 deaths occurred over 58,087 person-years of follow up: 87 due to cardiovascular disease and 125 due to cancer.
After adjusting for age, sex, waist size, and exercise, the risk of dying from all causes, cardiovascular
disease and cancer went up for each extra hour spent sitting still in front of the TV every day.
Risk of dying from any cause went up by 11 per cent for each extra TV viewing hour (hazard ratio [HR]
for each one-hour increment was 1.11, with 95 per cent confidence interval [CI] ranging from 1.03 to 1.20).
Risk of dying from cardiovascular disease went up 18 per cent for each extra hour (HR 1.18, 95%CI 1.03-1.35).
Risk of dying from cancer went up 9 per cent for each extra hour (HR 1.09, 95%CI 0.96-1.23).
Watching TV for 2 to 4 hours a day increased the risk of dying from any cause by 13 per cent (adjusted
HR 1.13 95%CI 0.87-1.36), and from cardiovascular disease by 19 per cent (adj HR 1.19, 95% CI, 0.72 to 1.99) compared to watching
it for less than 2 hours.
Watching TV for 4 hours or more increased the risk of dying
from any cause by 46 per cent (adj HR1.46, 95%CI 1.04-2.05), and from cardiovascular disease by 80 per cent (adj HR 1.80,
95%CI, 1.00 to 3.25) compared to daily TV viewing of under 2 hours.
The
links with cancer mortality and non-cardiovascular/non-cancer mortality were not significant.
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=175656
Study Reveals How One Form Of Natural Vitamin E Protects Brain After
Stroke
Blocking
the function of an enzyme in the brain with a specific kind of vitamin E can prevent nerve cells from dying after a stroke,
new research suggests.
In a study using mouse brain cells, scientists found that the tocotrienol form of vitamin
E, an alternative to the popular drugstore supplement, stopped the enzyme from releasing fatty acids that eventually kill
neurons.
The Ohio State University researchers have been studying how this form of vitamin E protects the
brain in animal and cell models for a decade, and intend to pursue tests of its potential to both prevent and treat strokes
in humans.
"Our research suggests that the different forms of natural vitamin E have distinct functions. The
relatively poorly studied tocotrienol form of natural vitamin E targets specific pathways to protect against neural cell death
and rescues the brain after stroke injury," said Chandan Sen, professor and vice chair for research in Ohio State's
Department of Surgery and senior author of the study.
"Here, we identify a novel target for tocotrienol that
explains how neural cells are protected."
The research appears online and is scheduled for later print publication
in the Journal of Neurochemistry.
Vitamin E occurs naturally in eight different forms. The best-known
form of vitamin E belongs to a variety called tocopherols. The form of vitamin E in this study, tocotrienol or TCT, is not
abundant in the American diet but is available as a nutritional supplement. It is a common component of a typical Southeast
Asian diet.
Sen's lab discovered tocotrienol vitamin E's ability to protect the brain 10 years ago. But
this current study offers the most specific details about how that protection works, said Sen, who is also a deputy director
of Ohio State's Heart and Lung Research Institute.
"We have studied an enzyme that is present all the
time, but one that is activated after a stroke in a way that causes neurodegeneration. We found that it can be put in check
by very low levels of tocotrienol," he said. "So what we have here is a naturally derived nutrient, rather than
a drug, that provides this beneficial impact."
Sen and colleagues had linked TCT's effects to various
substances that are activated in the brain after a stroke before they concluded that this enzyme could serve as an important
therapeutic target. The enzyme is called cystolic calcium-dependent phospholipase A2, or cPLA2.
Following the trauma
of blocked blood flow associated with a stroke, an excessive amount of glutamate is released in the brain. Glutamate is a
neurotransmitter that, in tiny amounts, has important roles in learning and memory. Too much of it triggers a sequence of
reactions that lead to the death of brain cells, or neurons the most damaging effects of a stroke.
Sen and colleagues
used cells from the hippocampus region of developing mouse brains for the study. They introduced excess glutamate to the cells
to mimic the brain's environment after a stroke.
With that extra glutamate
present, the cPLA2 enzyme releases a fatty acid called arachidonic acid into the brain. Under normal conditions, this
fatty acid is housed within lipids that help maintain cell membrane stability.
But when it is free-roaming, arachidonic
acid undergoes an enzymatic chemical reaction that makes it toxic the final step before brain cells are poisoned in this environment
and start to die. Activation of the cPLA2 enzyme is required to release the damaging
fatty acid in response to insult caused by high levels of glutamate.
Sen and colleagues introduced the tocotrienol vitamin E to the cells that had already been exposed to excess glutamate. The presence of the
vitamin decreased the release of fatty acids by 60 percent when compared to cells exposed to glutamate alone.
Brain
cells exposed to excess glutamate followed by tocotrienol fared much better, too, compared to those exposed to only the damaging
levels of glutamate. Cells treated with TCT were almost four times more likely to survive than were cells exposed to glutamate
alone.
Though cPLA2 exists naturally in the body, blocking excessive function of this enzyme is not harmful, Sen
explained. Scientists have already determined that mice genetically altered so they cannot activate the enzyme achieve their
normal life expectancy and carry a lower risk for stroke.
Sen also noted that the amount of tocotrienol needed
to achieve these effects is quite small just 250 nanomolar, a concentration about 10 times lower than the average amount of
tocotrienol circulating in humans who consume the vitamin regularly.
"So you don't have to gobble up a
lot of the nutrient to see these effects," he said.
The National Institutes of Health supported this work.
The study was co-authored by Savita Khanna, Sashwati Roy and Cameron Rink of the Department of Surgery and Narasimham
Parinandi and Sainath Kotha of the Department of Internal Medicine, all at Ohio State; and Douglas Bibus of the University
of Minnesota.
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=175640
Atrial Fibrillation Risk Lower With Some Classes Of Antihypertensives
Atrial fibrillation, or irregular heartbeat, is a major risk factor for thromboembolic events, particularly stroke.
This risk is especially high in patients with high blood pressure. Antihypertensive drugs are known to reduce the risk for
atrial fibrillation by lowering blood pressure. However, some classes of antihypertensives may have greater risk reduction
through other mechanisms.
Researchers studied 4,661 patients with atrial fibrillation against 18,642 matched control
patients from a population of 682,993 patients treated for hypertension in the United Kingdom. They compared the risk for atrial fibrillation among hypertensive patients
taking angiotensin-converting-enzyme (ACE) inhibitors, angiotensin II-receptor blockers (ARBs), or beta-blockers to the reference
group taking calcium channel blockers. The researchers found that patients on long-term ACE-inhibitor,
ARB, or beta blocker therapy had a reduced risk for atrial fibrillation compared to patients on calcium channel blockers.
Patients and physicians should consider these differences when choosing an antihypertensive therapy.
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=176412
Pomegranate Compounds May Prevent Breast Cancer Growth
US researchers found that pomegranates contain six natural compounds that may prevent the growth of hormone-dependent
breast cancer by blocking the enzyme aromatase, which changes androgen to estrogen. However, experts caution this does not
mean people should expect the same results from eating pomegranates, because this was an "in vitro" (test tube)
study and results on the lab bench don't always translate to animals and humans.
The study, which was published
in the 1 January issue of Cancer Prevention Research, is the work of Dr Shiuan Chen, director of the Division of
Tumor Cell Biology at the Beckman Research Institute of the City of Hope, Duarte, California and colleagues also from City
of Hope and the Center for Human Nutrition at the David Geffen School of Medicine, University of California Los Angeles.
For the study, the researchers screened ten compounds in a group known as ellagitannins.
Chen and his team
found that the compound with the strongest impact was urolithin B (UB), which appeared to inhibit multiple estrogen-producing
mechanisms that fuel the growth of breast cancer.
They also found that UB prevented estrogen-responsive breast
cancer cells from multiplying.
Chen told the press that:
"By suppressing the production of estrogen,
urolithin B and other phytochemicals found in pomegranates can prevent hormone-responsive breast cancer tumors from growing."
The other phytochemicals they found were urolithin A (UA), methylated UA, acetylated UB, methylated UB and UB sulfate:
these also inhibited aromatase activity but to a lesser extent.
Other studies have found pomegranate juice is high
in antioxidants and contains compounds that can control the growth of breast and prostate cancers humans, said the researchers.
Chen said the results of the study suggest that:
"Pomegranate intake may be a viable strategy for
preventing breast cancer."
According to a report by Cancer Research UK, Chen said he and his team were surprised
by the findings, explaining that they had previously found other fruits, such as grapes, were also able to inhibit aromatase,
"But phytochemicals in pomegranates and in grapes are different", he said.
Experts are cautioning that
further studies are needed before we can be sure that UB is effective against hormone-dependent breast cancer in humans: women
should not start consuming lots of pomegranates on the strength of this study.
This was an in vitro (test tube)
study, and sometimes such findings don't translate to animal and human studies: for instance it might turn out that these
substances aren't well absorbed in the body by just eating pomegranates.
Dr Laura Bell, science information
officer at Cancer Research UK, told the press that:
"It's too big a leap to conclude from this early-stage
research that eating pomegranates could help prevent hormone-dependent breast cancer as the study was done using large amounts
of purified chemicals on cells grown in the lab."
"In terms of cancer prevention, most foods contain
many natural chemicals and we need to understand the combined effect of these when processed in the body to guess what influence,
if any, a specific food may have on your chance of developing cancer," she explained, adding that numerous large studies
have shown that:
"By eating a healthy balanced diet high in fibre, fruit and vegetables and low in red and
processed meat, saturated fat and salt, you can help to reduce your risk of several different types of cancer."
Breast cancer drugs like anastrozole (Arimidex from AstraZeneca) are also designed to block the action of aromatase.
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=175411
URMC Study Links
Vitamin D, Race, And Cardiac Deaths
Vitamin D deficiency may contribute to a higher number of heart and stroke-related deaths among black Americans compared
to whites, according to a University of Rochester Medical Center study.
The journal Annals of Family
Medicine is publishing the study in the January-February edition, which goes online Jan. 11, 2010.
Researchers sought to understand the well-documented disparity between blacks and whites in cardiovascular
deaths. They turned to vitamin D because growing evidence links low serum levels of D to many serious illnesses including
diabetes, hypertension, kidney and heart disease.
Lead author Kevin Fiscella, M.D., said a complex host of genetic
and lifestyle factors among blacks may explain why this population group has lower vitamin D levels across the lifespan than
other races.
People get vitamin D through their diets, sun exposure, and oral supplements. Genetic factors common
to blacks sometimes preclude vitamin D absorption, such as a higher incidence of lactose intolerance, which can eliminate
vitamin-D fortified milk from the diet, and darker skin pigment that significantly reduces vitamin D synthesis.
"Therefore, our study suggests that the next step would be to intervene to boost vitamin D levels safely, with supplements,"
said Fiscella, a national expert on disparities in health care and a professor of Family Medicine and Community and Preventive
Medicine at URMC.
With funding through the National Heart Lung and Blood Institute, Fiscella and colleagues studied
a sample of more than 15,000 American adults. The data included measurements of blood levels of vitamin D and death rates
due to cardiovascular disease. Researchers also looked at other factors that contribute to heart health, such as body mass
index, smoking status and levels of C-reactive protein.
Overall, the analysis showed that, as expected, a vitamin
D deficiency was associated with higher rates of death among all people in the sample. In fact, those adults with the worst
deficiency had a 40 percent higher risk of death from cardiac illness. This suggests that vitamin D may be a modifiable, independent
risk factor for heart disease, Fiscella said.
Most striking, however, was that when researchers adjusted the statistics
to look at race, blacks had a 38 percent higher risk of death than whites. As vitamin D levels rose, however, the risk of
death was reduced. The same was true when researchers analyzed the effect of poverty on cardiovascular death rates among blacks,
which suggests that vitamin D deficiency and poverty each exert separate risk factors, the study said.
A review
article published in September 2009 in The American Journal of Medicine, noted that Vitamin D deficiency is a worldwide health
problem. In the U.S., inadequate Vitamin D has been reported in about 36 percent of otherwise
healthy young adults and about 57 percent of general medicine hospitalized patients.
Vitamin D is metabolized
in the liver and converted to 25 hydroxyvitamin D or 25(OH) D, the form used to determine a person's status through a
blood test. Deficiency is usually defined by levels of less than 20 nanograms per milliliter; 30 ng/ml is viewed as sufficient.
The mean blood level in the study sample was 29.5 ng/ml.
Most of the body's tissues and cells have vitamin
D receptors, making it a potent regulator of cell activity and growth. A deficiency contributes to inflammation associated
with heart disease, many cancers and poor bone health.
Fiscella cautions, however, that not all observational
studies of vitamin deficiency are borne out by subsequent clinical trials. For example, previous observational studies of
vitamin E and beta-carotene that were associated with poor heart health did not hold up in later clinical studies. The need
to further assess the vitamin D connection to heart disease is convincing, however, particularly among blacks, he added.
Other at-risk people include the obese and the elderly, (particularly housebound or nursing home residents), because
vitamin D levels decline with age. And although more sun exposure can boost levels of D, skin cancer is also an increasing
risk to many people. Therefore, medical authorities usually recommend increased dietary intake and/or supplementation as the
best way to correct a deficiency.
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=175244
A Role For Calcium
In Taste Perception
Calcium may not come to mind when you think of tasty foods, but in a study appearing in the January 8 issue of JBC,
Japanese researchers have provided the first demonstration that calcium channels on the tongue
are the targets of compounds that can enhance taste.
In addition to molecules that directly trigger specific
taste buds (salty, sweet etc.), there are other substances which have no flavor of their own but can enhance the flavors they
are paired with (known as kokumi taste in Japanese cuisine).
Exploiting this enhancement could have practical
uses in food modulation; for example, creating healthy foods that contain minimal sugar or salt but still elicit strong taste.
At the moment, though, the mode of action for these substances is poorly understood.
However, Yuzuru Eto and colleagues
examined whether calcium channels - which sense and regulate the levels of calcium in the body - might be the mechanism involved;
they noted that calcium channels are closely related to the receptors that sense sweet and umami (savory) tastes and that
glutathione (a common kokumi taste element) is known to interact with calcium channels.
To test their possibility,
they created several small molecules that resembled glutathione and analyzed how well these compounds activated calcium channels
in cell samples. Next, they diluted the same test substances in flavored water (salt water, sugar water, etc.) and asked volunteers
(all trained in discriminating tastes) to rate how strong the flavors were.
The results provided a strong correlation;
the molecules that induced the largest activity in calcium receptors also elicited the strongest flavor enhancement in the
taste tests.
For further confirmation, the researchers tested several other known calcium channel activators,
including calcium, and found all exhibited some degree of flavor enhancement, while a synthetic calcium channel blocker could
suppress flavors.
This study provides new insight into areas of taste biology; the authors also note that calcium
channels are found in the gastro-intestinal tract as well, suggesting they may be important in other aspects of eating, such
as food digestion and absorption.
From the Article: "Involvement of the Calcium-sensing Receptor in Human
Taste Perception" by Takeaki Ohsu, Yusuke Amino, Hiroaki Nagasaki, Tomohiko Yamanaka, Sen Takeshita, Toshihiro Hatanaka,
Yutaka Maruyama, Naohiro Miyamura and Yuzuru Eto. Article link: http://www.jbc.org/content/285/2/1016.abstract
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=175552
Can Sweeteners Be Blamed For Rise In Obesity?
US researchers have claimed that a cheap form of sugar used
in thousands of food products and soft drinks can damage human metabolism and is fuelling the obesity crisis. Dangerous growth
of fat cells
The study by a team at the University of California claimed
fructose, a sweetener derived from corn, can cause
dangerous growths of fat cells around vital organs has increasingly been used as a substitute for more expensive types
of sugar in yoghurts, cakes, salad dressing and cereals.
Over 10 weeks, 16 volunteers
on a strictly controlled diet, including high levels of fructose, produced new fat cells
around their heart, liver and other digestive organs. It was reported that they also showed signs of food-processing abnormalities
linked to diabetes and heart disease. Another group of volunteers on the same diet,
but with glucose sugar replacing fructose, did not have these problems.
People in both
groups put on a similar amount of weight. However, the researchers said the levels of weight gain among the fructose consumers
would be greater over the long term. Fructose is not responsible for obesity
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=175698
Vitamin C Reverses Abnormalities Caused By Werner Syndrome Gene, Including Cancer, Obesity, Diabetes, Heart Failure
And High Cholesterol
A new research discovery published in the January 2010 print issue of the FASEB
Journal suggests that treatments for disorders that cause accelerated aging, particularly Werner's syndrome, might
come straight from the family medicine chest. In the research report, a team of Canadian scientists show that vitamin C stops
and even reverses accelerated aging in a mouse model of Werner's syndrome, but the discovery may also be applicable to
other progeroid syndromes. People with Werner's syndrome begin to show signs of accelerated aging in their 20s and develop
age-related diseases and generally die before the age of 50.
"Our study clearly indicates that a healthy
organism or individuals with no health problems do not require a large amount of vitamin C in order to increase their lifespan,
especially if they have a balanced diet and they exercise," said Michel Lebel, Ph.D., co-author of the study from the
Centre de Recherche en Cancerologie in Quebec, Canada. "An organism or individual with a mutation in the WRN gene or
any gene affected by the WRN protein, and thus predisposes them to several age-related diseases, may benefit from a diet with
the appropriate amount of vitamin C."
Scientists treated both normal mice and mice with a mutation in the
gene responsible for Werner's syndrome (WRN gene) with vitamin C in drinking water. Before treatment, the mice with a
mutated WRN gene were fat, diabetic, and developing heart disease and cancer. After treatment, the mutant mice were as healthy
as the normal mice and lived a normal lifespan. Vitamin C also improved how the mice stored and burned fat, decreased tissue
inflammation and decreased oxidative stress in the WRN mice. The healthy mice did not appear to benefit from vitamin C.
"Vitamin C has become one of the most misunderstood substances in our medicine cabinets and food," said
Gerald Weissmann, M.D., Editor-in-Chief of the FASEB Journal. "This study and others like it help explain how
and why this chemical can help to defend some, but certainly not all, people from premature senescence."
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=175166
Study: Statin compliance would cut stroke,
heart attack deaths
British researchers
said that encouraging high-risk patients who have already been prescribed cholesterol-lowering drugs to continue taking them
could prevent twice as many stroke and heart attack deaths as prescribing the drugs to more
people. The report, in the Journal of Epidemiology and Community
Health, said only about half of patients on statins continue taking them over the long term. Reuters
http://www.reuters.com/article/idUSTRE60B00U20100112
Omega-3 fatty acids linked to slower rate of telomeric aging
Among patients with coronary artery disease, those with higher intake of marine omega-3
fatty acids have a slower rate of telomere shortening—a novel marker of biologic age, reports a study in the January 20, 2010, issue of The Journal of the American Medical Association.
Symptoms Help Little in Detecting Early-Stage Ovarian Cancer
Contrary to recommendations in
a 2007 consensus statement, symptoms offer little help in diagnosing early-stage ovarian cancer, reports a study in the Journal of the National Cancer Institute.
The study
included some 800 women diagnosed with epithelial ovarian cancer and some 1300 population-based controls. All women were interviewed
about the presence of certain symptoms (e.g., abdominal
pain, bloating, or urinary urgency)
in the year before their diagnosis (cases) or a corresponding reference date (controls).
Women with cancer were about 10 times as likely as controls to report the symptoms defined in the consensus statement.
However, the symptoms did little to distinguish between early- and late-stage cancers. The positive predictive value for any
cancer was low, with that for early-stage disease being less than 0.5%.
The authors say their study "argues for a cautious approach to the use of symptom patterns to trigger extensive
medical evaluation for ovarian cancer.
Conclusion:
Use of symptoms to trigger medical evaluation for ovarian cancer is
likely to result in diagnosis of the disease in only one of
100 women in the general population with such symptoms.
http://jnci.oxfordjournals.org/cgi/content/abstract/djp500
Does Soy Consumption Lower Risk for Endometrial
and Ovarian Cancers?
Women's Health
Meta-analysis showed that women with highest soy intake had lower risk for endometrial and ovarian cancers than did women with lowest soy consumption.
Soy: Safe and Perhaps Even Beneficial for Breast Cancer Survivors
Women's Health
In
a Chinese study, dietary soy intake was inversely related to breast cancer recurrence and mortality.
Shu XO et al. JAMA 2009 Dec 9; 302:2437
High-Dose
Statins Before Percutaneous Coronary Intervention
In statin-naive
patients, a single loading dose of atorvastatin within 24 hours before PCI significantly reduced the rate of periprocedural
MI.
Several studies have demonstrated that patients who receive statins before percutaneous coronary
intervention are less likely to have a periprocedural MI than are those who do not receive preprocedural statins (JW Cardiol Aug 19 2009). In this two-center, placebo-controlled, randomized trial, investigators in
Italy examined whether this beneficial effect could be achieved with a single 80-mg dose of atorvastatin administered on the
day of the procedure.
A total of 668 statin-naive patients with de novo lesions underwent randomization and
treatment with stenting. The primary endpoint of creatine kinase-MB elevation >3 times the upper limit of normal (ULN)
occurred in 9.5% of statin-treated patients and in 15.8% of controls (odds ratio, 0.56; P=0.014). Troponin I was elevated in 26.6% of the statin group versus
39.1% of the control group (OR, 0.56; P<0.001). In a post hoc analysis, the benefit of atorvastatin was more pronounced in patients with high baseline
C-reactive protein levels; in this group, the rate of CK-MB >3 times the ULN was significantly lower in control patients
than in statin-treated patients (16.5% vs. 4.6%).
Comment: These
results confirm those of other studies that demonstrate a cardioprotective effect of statins for periprocedural MI and extend
the observed benefit to a single high dose administered on the day of procedure, suggesting a pleiotropic anti-inflammatory
mechanism. The mean delay between drug administration and PCI is not provided, and the clinical significance of small enzyme
elevations post-PCI has been debated. Nonetheless, these findings should encourage interventionalists to treat all of their
patients with statins before PCI.
Overweight Older Adults May Live Longer Than Their Normal-Weight Peers
Among the elderly, having a BMI in the overweight range (25.0 to 29.9) may confer a lower mortality risk than having
one in the normal range (18.5 to 24.9), according to an observationalcohort study in
the Journal of the American Geriatrics Society.
Researchers followed a cohort of some 9000 western Australian
men and women aged between 70 and 75 at baseline, when their BMIs were
measured. Over a mean observation period of roughly 9 years, people with BMIs in the overweight range had a mortality risk
13% lower than those with BMIs in the normal range. In fact, the mortality risk at the lower end of the normal range was almost
twice that of the overweight group. The effect remained even after adjustment for the subjects' state of health at entry
into the study.
The authors conclude that the World Health Organization's
thresholds for overweight and obesity in the elderly "are overly restrictive
CONCLUSION: These results lend further credence to claims that the BMI thresholds
for overweight and obese are overly restrictive for older people. Overweight older people are not at greater mortality risk
than those who are normal weight. Being sedentary was associated with a greater risk of mortality in women than in men.
http://www3.interscience.wiley.com/cgi-bin/fulltext/123265340/HTMLSTART?CRETRY=1&SRETRY=0
Catheter ablation is better than drugs
in treating AF
U.S. researchers found that 66% of patients with paroxysmal or intermittent atrial fibrillation
who had catheter ablation showed
no symptoms of the condition a year after treatment compared with 16% of those who took drugs. The study was published in
the Journal of the American Medical Association. Reuters (1/26)
Survey
finds 57% of diabetics skip medication
An
Internet survey of 500 people with diabetes,
published in Diabetes Care, showed 57% occasionally choose not to take their insulin shots, and one in five skips shots regularly.
Those most likely to skip the shots include younger, better-educated and low-income patients, those with Type 2 diabetes,
and people prescribed multiple daily injections. USA TODAY (1/25)
More Evidence Against Too-Intensive Glucose Control in Type 2 Diabetes
The most intensive glucose control is associated with increased risk for death, according
to aretrospective cohort study published online
in the Lancet.
Using a U.K.
general practice database, researchers identified two diabetic cohorts together comprising some 48,000 patients whose treatments
had been intensified. One cohort started treatment with oral glucose-lowering monotherapy and switched to a combination therapy using a sulfonylurea plus metformin.
The other cohort switched from oral agents alone to insulin with or without oral agents.
During the 5 years after changing therapy, the investigators noted a U-shaped curve in both cohorts with respect
to all-cause mortality and levels of glycated hemoglobin — patients in the lowest decile of glycated hemoglobin (median
HbA1c, 6.4%) and the highest (10.6%) had significantly higher mortality rates than those in the reference decile
(7.5%).
Low and high mean HbA1c values
were associated with increased all-cause mortality and cardiac events. If confirmed, diabetes guidelines might need revision
to include a minimum HbA1c value.
Cardiovascular Benefit of Glycemic Control
Is Limited to Those with Low Comorbidity
Does an HbA1c level of 7% remain an appropriate goal?
The effect of glycemic control on preventing adverse
cardiovascular events has been difficult to demonstrate, possibly because such effects are limited to particular patient subgroups.
To determine whether achieving glycosylated hemoglobin (HbA1c) targets of 7% versus 6.5% had differential effects
by comorbidity, industry-sponsored researchers studied 2613 Italian patients with type 2 diabetes who received care from general practitioners or
in diabetes clinics. Comorbidity was
measured by questionnaire and was dichotomized at a level that was associated with excess mortality. Comorbidities includedheart disease, lung disease, arthritis, genitourinary disease, vision loss, adverse gastrointestinal conditions, and foot disease.
Among patients who had HbA1c levels
6.5%, 5-year incidence of adverse cardiovascular events was lower
for those with low comorbidity (hazard ratio, 0.6) than for those with high comorbidity (HR,
0.9) in analyses adjusted for age and sex. For an HbA1c target
level of 7%, the same finding was noted (i.e., lower incidence of adverse cardiovascular events only among those with low
comorbidity).
Comment: When
individual randomized trials have
been analyzed in systematic reviews, intensive
control (HbA1c <7% but not <6.5%) modestly lowered incidence
of adverse cardiovascular events (mainly nonfatal myocardial
infarction) at a cost of excess severe hypoglycemia. Results of this observational
study suggest that cardiovascular benefits might accrue only to those without substantial
comorbidity. An editorialist concludes that 7% remains an appropriate goal to prevent adverse microvascular, neurological,
and, possibly, cardiovascular events. However, for many patients with substantial comorbidity, the overall benefits
of even a 7% goal might not exceed the burdens or harms associated with trying to achieve that goal.
CONCLUSION: Patients with the high levels of comorbidity common in type 2 diabetes may receive diminished
cardiovascular benefit from intensive blood glucose control. Comorbidity should be considered when tailoring glucose-lowering
therapy in patients with type 2 diabetes.
http://www.ncbi.nlm.nih.gov/pubmed/20008761?dopt=Abstract
The hidden danger in acid-suppressing drugs
Acid-suppressing
drug use substantially increased the likelihood of recurrent pneumonia in high-risk elderly patients. The association was
confined to patients initiating PPI/H2s after hospital discharge. These findings should be
considered when deciding to prescribe this drug category in patients with a recent history of pneumonia.
Conclusion
Acid-suppressing drug use substantially increased
the likelihood of recurrent pneumonia in high-risk elderly patients. The association was confined to patients initiating PPI/H2s
after hospital discharge. Our findings should be considered when deciding to prescribe these drugs in patients with a recent
history of pneumonia.
http://www.amjmed.com/article/S0002-9343(09)00863-8/fulltext
The American Journal of Medicine
AHA publishes 7 secrets to long, healthy life
The American Heart Association says 50-year-olds who follow seven basic
health guidelines -- including eating a healthy diet, regular exercise and not smoking --
could live another 40 years free of stroke and heart disease. The AHA offers an online quiz so people can see how close
they are to the ideal and get tips for improving if they fall short. Yahoo!/The Associated Press
http://news.yahoo.com/s/ap/20100120/ap_on_he_me/us_heart_health/print;_ylt=AvpKWhroxAJtufRAc.ZkzNiF1LJ_;_ylu=X3oDMTBycjdqNWs0BHBvcwMxNQRzZWMDYm90dG9tBHNsawNwcmludA--
Study: Kidney stones are more frequent in obese people
People
who are obese are more likely to develop kidney stones than are normal-weight people, a study in the Journal of Urology indicates.
Researchers looked at records for more than 95,000 people and found that people who were of normal weight or overweight had
a one in 40 chance of being diagnosed with kidney stones compared with a one in 20 chance for obese people. The severity of
the obesity didn't seem to matter, data showed. Reuters
Severe psoriasis increases risk of death from heart disease,
stroke
A
U.S. study published in the European Heart Journal found people with the severe form of psoriasis have a 60% higher risk of
death from heart disease or stroke compared with people without the disease. More research is needed to determine the reasons
for the connection and whether treatment can reduce the risk, the researchers said. Reuters
What's almost as good as pravastatin? Red yeast rice
This
study concluded that red yeast rice was approximately as well tolerated as pravastatin and achieved comparable levels of low-density
lipoprotein-cholesterol reduction in a population previously intolerant to statins.
In conclusion, red yeast rice was tolerated as well as pravastatin and
achieved a comparable reduction of low-density lipoprotein cholesterol in a population previously intolerant to statins.
The American Journal of Cardiology
http://www.ajconline.org/article/S0002-9149(09)02325-X/fulltext
Tigagrelor vs. clopidogrel for acute coronary syndromes: A clear
winner
Ticagrelor
seems to be a better option than clopidogrel for patients with acute coronary syndromes for whom an early invasive strategy
is
The platelet inhibitor ticagrelor is superior to clopidogrel
among patients with acute coronary syndromes who are scheduled to undergo invasive management,
according to a prespecified subanalysis of the industry-funded, phase III PLATO study. The findings appear online in the Lancet.
Nearly
13,500 patients with acute coronary syndromes, with or without ST-segment elevation and for whom early invasive treatment
was planned, were randomized to receive ticagrelor or clopidogrel for 6 to 12 months. By 1 year, the primary endpoint —
a composite of cardiovascular death, MI, or stroke — had occurred significantly less often with ticagrelor than with
clopidogrel (9% vs. 11%). Total major bleeding did not differ significantly between the groups.
A commentator
concludes: "These compelling results support ticagrelor as a new standard of care in acute coronary syndromes."
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)62191-7/fulltext
One in Five U.S. Adolescents
Have Abnormal Lipid Levels
Roughly 20% of U.S. youths aged 12 to 19 have at least one abnormal lipid level, with overweight and obese teens
being most at risk, according to an analysis of NHANES data published in MMWR.
In particular, abnormal
lipid levels were noted in 14% of normal-weight, 22% of overweight, and 43% of obese adolescents.
An editorial
note points out that the American Academy of Pediatrics currently recommends lipid screening
among teens with certain cardiovascular risk factors, including overweight or obesity. The
note urges clinicians to be aware of both the screening guidelines and appropriate interventions (e.g., lifestyle counseling,
dietary changes) to help minimize teens' risk for cardiovascular disease in adulthood.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5902a1.htm
ARBs Associated with Reduced Dementia and Alzheimer Disease Risk
Angiotensin-receptor blockers (ARBs) are associated with reduced risk for dementia and Alzheimer
disease, according to a BMJ study.
Researchers analyzed Veterans Affairs records of 800,000
mostly male patients aged 65 and older with cardiovascular disease. Over the 4-year observation
period, patients taking ARBs were less likely to develop dementia or Alzheimer disease, to be admitted to a nursing home,
or to die than were patients taking the ACE-inhibitor lisinopril or other cardiovascular drugs,
such as beta-blockers or calcium channel antagonists. Patients taking both ARBs and ACE-inhibitors saw a further risk reduction.
The authors
suggest that ARBs may protect against cognitive decline by limiting neuronal damage linked to stroke and vascular problems.
Conclusions
Angiotensin receptor blockers are associated with a significant reduction in the incidence and progression of
Alzheimer’s disease and dementia compared with angiotensin converting enzyme inhibitors or other cardiovascular
drugs in a predominantly male population.
http://www.bmj.com/cgi/content/full/340/jan12_1/b5465
Is It Okay for Patients with Peptic Ulcer
Bleeding to Continue Low-Dose Aspirin?
For
patients at cardiovascular risk, the short-term survival advantage of continuing aspirin therapy outweighed the bleeding risk.
Sung
JJY et al. Ann Intern Med 2009 Dec 1;
How can statins help cancer patients?
This study suggests that the use of statins is associated with a significant
reduction in the occurrence of venous thromboembolism. This pleiotropic effect warrants
further investigation. The American Journal of Medicinehttp://www.amjmed.com/article/S0002-9343(09)00706-2/fulltext
Obesity's effect on quality of life
is equal to smoking
U.S. researchers reported that obesity can
affect a person's quality of life just as much as smoking. The study, published in the American
Journal of Preventive Medicine, included 3.5 million adults and found quality-adjusted life years lost to obesity are
equal to or exceed those lost to smoking. Yahoo!/HealthDay News
Overweight men have higher risk of stroke,
heart attack
Researchers who followed more than 1,700 Swedish
men for 30 years found those who were overweight were 52% more likely to have heart attacks and strokes and those who were
obese had almost double the risk, compared with normal-weight men. These men had an increased risk even though they didn't
have metabolic syndrome, which the study in Circulation noted also raised the risk of heart
attack and stroke, even among participants who weren't overweight. Reuters
Dietary effect on diabetes risk varies by sex, ethnicity
People who eat a diet high in meat and fat generally
have a higher risk of diabetes but the effects of such a diet may vary by sex and ethnicity,
a study in Diabetes Care found. Researchers said data showed that the protective effects of diets high in vegetables also
varied by sex and ethnicity. Reuters
Ginkgo Does Not Prevent or
Slow Cognitive Decline in Older Adults
Ginkgo
biloba extract does not prevent or delay cognitive decline in older adults, according to a JAMA
study.
Some 3000 U.S. adults (aged 72 to 96) with normal cognition
or mild cognitive impairment were randomized to twice-daily 120 mg of ginkgo or placebo. During
a median 6 years' follow-up, the two groups did not differ in annually measured rates of overall cognitive decline, or
in rates of decline in specific areas such as memory, language, or executive function.
JAMA article
Does Exercise Lengthen Our Lives by Lengthening
Our Cells' Lives?
Exercising
was beneficial for preserving telomeres in both humans and mice.
Werner
C et al. Circulation 2009 Dec 15; 120:2438
C-reactive protein levels: Correlation
but no causality for heart attack, stroke and cancer?
C-reactive protein (CRP) concentration has continuous associations
with the risk of coronary heart disease, ischaemic stroke, vascular mortality, and death from
several cancers and lung disease that are each of broadly similar size. The relevance of CRP
to such a range of disorders is unclear. Associations with ischaemic vascular disease depend considerably on conventional
risk factors and other markers of inflammation. The Lancet
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61717-7/abstract
Smoking Cessation Associated with Short-Term Increase in Diabetes Risk
Adults who quit smoking face increased risk for type 2 diabetes during the first several
years after quitting, according to an Annals of Internal Medicine study.
Researchers
followed nearly 11,000 middle-aged adults for roughly 9 years, during which about 12% developed diabetes.
Compared with adults who never smoked, those who continued smoking during follow-up had a roughly 30% elevated risk for diabetes, while those who quit smoking by year 3 had almost a 75% increase in risk. The
elevated risk among these new quitters seemed to be mediated by adverse metabolic changes, including weight gain and systemic inflammation.
The authors write: "Of course, smoking cessation
has many beneficial health effects that outweigh this short-term risk. Nonetheless, physicians should be aware of this elevated
risk and should consider countermeasures [e.g., lifestyle counseling, aggressive weight management], especially for heavy
smokers."
Conclusion: Cigarette smoking predicts incident type 2 diabetes, but smoking
cessation leads to higher short-term risk. For smokers at risk for diabetes, smoking cessation should be coupled with strategies
for diabetes prevention and early detection.
Annals
of Internal Medicine article
http://www.annals.org/content/152/1/10.abstract
