HHAL MEDICAL NEWS MARCH 2011
High-fiber diet lowers lifetime risk of heart disease, study says
Researchers found that people ages 20 to 59 with the highest intake of a fiber-rich
diet were significantly less likely to suffer cardiovascular disease throughout their lives compared with those
with the lowest fiber consumption. The study, which was presented at the American Heart Association meeting in Atlanta, found
a similar pattern among older adults ages 60 to 79, but the link was not as strong. United Press International,USA TODAY
More potassium might reduce stroke risk, meta-analysis finds
A meta-analysis of 11 studies, published in the Journal of the American College of Cardiology, suggests
each additional consumption of 1,640 milligrams of potassium every day corresponds to a 21% drop in stroke risk. Overall,
researchers found no strong connection between potassium intake and heart disease risk. Reuters
Alcohol Favorably Affects Biomarkers Associated
with CHD Risk
Risks for coronary heart disease were similar for drinkers of beer, wine,
or spirits.
Moderate alcohol consumption is associated with lower risk for coronary heart
disease (CHD). In this systematic review of alcohol intervention studies, investigators assessed theeffects of alcohol consumption on biological markers associated with
CHD risk in patients who did not have preexisting cardiovascular disease. Overall, 44 studies
had data that allowed pooled analyses. In these studies, volunteers ingested specific daily doses of alcohol (studies that
allowed patients to drink "usual alcohol" in addition to study alcohol were excluded); blood biomarker levels were
measured during periods of alcohol use and of no alcohol use.
A significant dose-response
relation was observed between alcohol consumption and HDL cholesterol levels: Average HDL levels rose by 6.4 mg/dL after 1 to 2 drinks, by 9.1 mg/dL after
2 to 4 drinks, and by 12.5 mg/dL after 5 drinks. Alcohol consumption similarly
raised apolipoprotein A1 levels (a favorable effect), but did not affect total cholesterol, LDL cholesterol, triglyceride,
or lipoprotein(a) levels. In addition, alcohol consumption significantly lowered fibrinogen levels and raised adiponectin
levels (also favorable effects). Alcohol consumption did not affect levels of multiple inflammatory markers, including C-reactive protein. Results of analyses stratified by beverage type (i.e., beer, wine, or spirits) were similar to the combined results.
Original article
Brien SE et al. BMJ 2011 Feb
22; 342:d636
Alcohol Lowers Risk for CHD and Mortality
Coronary heart disease and 11-year all-cause mortality were lower with 1
or 2 drinks daily.
In this systematic
review and meta-analysis of 84 prospective cohort studies with >1 million participants, investigators assessed
the effect
of alcohol consumption on cardiovascular (CV) disease–related mortality, incidence of and mortality from coronary
heart disease (CHD), and incidence of and mortality from stroke. Mean follow-up was 11 years.
After
adjustment for multiple confounders, active drinkers had significantly lower risks for CV disease–related mortality
(relative risk, 0.75), incident CHD (RR, 0.71), and CHD-related mortality
(RR, 0.75) than did nondrinkers. In contrast, alcohol consumption was not associated with lower risk for incident stroke and
stroke-related mortality. In dose-response analyses, the lowest risks for CV disease–related mortality, incident CHD,
and CHD-related mortality occurred at an alcohol consumption level of 1 to 2 drinks daily, whereas the lowest risks for incident
stroke and stroke-related mortality occurred at 1 drink daily. Finally,
in the 31 studies that provided data on all-cause mortality, active drinkers had significantly lower risk for all-cause mortality
(RR, 0.87) than did nondrinkers. Insufficient data were available to provide risk estimates for beer, wine, and spirits individually.
Original article
Long-Term Use of Proton-Pump Inhibitors May Lower Magnesium Levels
Using a proton-pump inhibitor for extended
periods may cause low serum magnesium levels, the FDA cautioned yesterday. The agency issued
the alert after reviewing more than 50 cases of hypomagnesemia in patients taking PPIs over long periods, usually a year or
more.
Possible adverse effects of hypomagnesemia include tetany, arrhythmias, and seizures.
The alert primarily applies to prescription PPIs, which are indicated for long-term use. The FDA says there is little risk
from over-the-counter PPIs when taken as directed for 14 days.
Before prescribing a PPI
for a long period, clinicians should consider baseline magnesium testing as well as occasional testing throughout treatment.
Periodic magnesium testing is also advised in patients concurrently taking digoxin, because
low magnesium in these patients carries a greater risk for serious side effects.
The
FDA said that long-term PPI use may affect intestinal absorption of magnesium, although the mechanism is unknown.
FDA MedWatch alert (Free)
Automated vs. Manual BP Monitoring for Systolic Hypertension
Automated blood pressure monitoring was
more accurate.
Myers MG et al. BMJ 2011 Feb 7; 342:d286
At-Home Use of
Bulb Syringes May Reduce Clinic Visits for Earwax
Home use of a bulb syringe may help relieve earwax occlusion
more effectively than a clinical procedure, according to an Annals
of Family Medicine study.
Researchers
randomized some 240 adults in the U.K. either to ear drops and home use of a bulb syringe or to ear drops and irrigation by
a clinic nurse. Patients were reassessed after 2 weeks, and those with persistent occlusions had their ears irrigated at the
clinic.
At 2 years' follow-up, patients initially managed clinically returned to the clinic
for earwax concerns more often than the home-treatment group (73% vs. 60%).
The authors conclude:
"Rather than routine attendance with a clinician, self-treatment with drops and then self-irrigation may offer a significantly
less costly alternative."
Annals
of Family Medicine article
Antihypertensive Treatment in Patients
Without Hypertension
Morbidity and mortality were lowered — but only in patients with known cardiovascular disease.
Antihypertensive drugs are used widely in patients who have cardiovascular disease (CVD) but not hypertension.
In this meta-analysis of 25 randomized trials of antihypertensive medications, researchers examined
data for 64,162 nonhypertensive patients (mean age range, 55–68; mean follow-up, 1.5–63.0 months). Participants
in 23 studies met criteria for CVD, such as recent myocardial infarction (MI) or congestive heart failure (CHF). In two studies, patients had only
multiple CVD risk factors.
Pooled relative risk reductions for patients with
known CVD were 23% for stroke, 20% for MI, 29% for CHF events, 17% for CVD-related mortality, and 13% for all-cause mortality. The absolute risk reduction per 1000 people ranged from 43.6 for CHF events to 7.7 for stroke events, with a corresponding NNT (number needed to
treat for 1 patient to benefit) of 20–130. The absolute risk reduction for all-cause mortality was 13.7 per 1000 people,
for an NNT of 73. No significant benefit was found in the two small trials in which participants had no known CVD.
Thompson
AM et al. JAMA 2011
Mar 2; 305:913
Ventura HO and Lavie CJ. JAMA 2011 Mar 2; 305:940
High HDL might reduce colon cancer risk, research shows
A study published in the journal Gut found that every boost of 16.6 milligrams per deciliter
in high-density lipoprotein cholesterol resulted in a 22% decrease in colon cancer risk,
while an increase of 32 milligrams per deciliter in blood fat apolipoprotein A reduced the risk by 18%. Researchers said further
study is needed to confirm the link and determine a cause. HealthDay News
Sweetened beverages are tied to higher blood pressure in study
Data from the international INTERMAP study found that each additional
sugar-sweetened soda or fruit drink consumed per day increased systolic blood pressure by 1.6 mmHg, with a stronger
link seen in people who consumed more salt. The study in the journal Hypertension also found that people with a higher daily
consumption of sweetened drinks were more likely to eat a less healthy diet in general. ABC News/MedPage Today
Serum α-Carotene Concentrations and
Risk of Death Among US Adults
The Third National Health and Nutrition Examination
Survey Follow-up Study
Chaoyang Li, MD, PhD; Earl
S. Ford, MD, MPH; Guixiang Zhao, MD, PhD; Lina S. Balluz, MPH, ScD; Wayne H. Giles, MD, MS;Simin Liu, MD, ScD
Arch Intern Med. 2011;171(6):507-515. doi:10.1001/archinternmed.2010.440
Background Much research has been conducted relating total carotenoids—and
β-carotene in particular—to risk of cancer and cardiovascular disease (CVD). Limited data are
emerging to implicate the important role of α-carotene in the development
of CVD or cancer.
Methods We assessed the direct
relationship between α-carotene concentrations and risk of death among 15 318 US adults20 years
and older who participated in the Third National Health and Nutrition Examination Survey Follow-up Study.
We used Cox proportional hazard regression analyses to estimate the relative risk for death
from all causes and selected causes associated with serum α-carotene concentrations.
Results Compared with participants with serum α-carotene concentrations
of 0 to 1 µg/dL (to convert to micromoles per liter, multiply by 0.01863), those with higher serum levels had
a lower risk of death from all causes (P < .001 for linear trend): the relative risk
for death was 0.77 (95% confidence interval, 0.68-0.87) among those with α-carotene concentrations
of 2 to 3 µg/dL, 0.73 (0.65-0.83) among those with concentrations of 4 to 5 µg/dL, 0.66 (0.55-0.79) among
those with concentrations of 6 to 8 µg/dL, and 0.61 (0.51-0.73) among those with concentrations of 9
µg/dL or higher after adjustment for potential confounding variables. We also found
significant associations between serum α-carotene concentrations and risk of death from CVD (P = .007), cancer
(P = .02), and all other causes (P < .001). The association between
serum α-carotene concentrations and risk of death from all causes was significant in most subgroups stratified
by demographic characteristics, lifestyle habits, and health risk factors.
Conclusions Serum α-carotene concentrations were inversely
associated with risk of death from all causes, CVD, cancer, and all other causes. These findings support
increasing fruit and vegetable consumption as a means of preventing premature death.
Study ties education to blood pressure levels
A 30-year study in the journal BMC Public Health of about 4,000 people found men and women
with higher education had systolic blood pressure readings that were 2.26 mmHg and 3.26 mmHg lower, respectively, than their
counterparts with less education. Researchers found, after making statistical adjustments, that women had a 2.53 mmHg benefit,
while men had a 0.34 mmHg benefit after 30 years. Google/The Press Association (U.K.)
Vitamin D and ICU survivors
The average 25(OH)D level was 24.6 ng/mL (normal range 30–100) with 38% of patients falling in the vitamin
D–deficient category (<20 ng/mL). ICU survivors had a significantly lower rate of vitamin D deficiency compared with
nonsurvivors (28% versus 53%). Twenty-nine percent of vitamin D–replete patients were in ICU 3 days or more, whereas
58% of patients with vitamin D deficiency stayed in ICU 3 days or longer. This difference was highly significant translating
to twofold increased risk (2.0 Relative Risk [RR]) for 3-day or longer stay in ICU for patients with vitamin D deficiency.
Moreover, the risk of death was significantly higher in ICU patients with vitamin D deficiency (RR 1.81).
ICU survivors had a significantly lower rate of vitamin D deficiency (28%)
than did nonsurvivors (53%) in this study of 136 veterans. Replenishing vitamin D may have significant impact on survival,
but first vitamin D status needs to be routinely checked in ICU patients. Journal of the American Medical Directors Association
Mediterranean diet might reduce risk of metabolic syndrome
Greek researchers linked a Mediterranean diet, composed mainly of
fruits, vegetables and very little meat, to a 31% lower risk of metabolic syndrome. People who adhered to the diet
were able to reduce their waistline, blood pressure and blood sugar, according to a meta-analysis of 50 studies, published
in the Journal of the American College of Cardiology. The Wall Street Journal, Reuters
Study: Exercise, sex can increase risk of heart attack
People had a 3.5-fold higher risk of suffering a heart attack or sudden cardiac death while
exercising than when they were not, according to a meta-analysis of 14 studies published in the Journal of the American Medical
Association. The researchers also found people had a 2.7-fold increased risk of experiencing a heart attack during or immediately
after having sex, compared with when they were not having sex. Reuters
Surrogate markers of cardiovascular disease in CKD: What's under the hood?
Clinical cardiovascular outcomes, such as heart attack and stroke,
are exceedingly common in chronic kidney disease patients, resulting from prolonged exposure to many risk factors.
With emphasis on patients with chronic kidney disease, this article reviews the role of non-invasive tests to estimate a person's
cardiovascular burden, including ankle-brachial index, carotid ultrasound, aortic pulse wave velocity, and echocardiography.
American Journal of Kidney Diseases
What swimming can do in vascular risk
The authors report that present findings are consistent with the notion that habitual swimming exercise may be an effective endurance exercise for preventing loss in central arterial compliance.
The American Journal of Cardiology
Study links A-Fib to dementia risk in stroke survivors
A meta-analysis of 15 studies, published in the journal Neurology, found that stroke survivors with atrial fibrillation had a 2.4-fold increased risk of dementia compared with counterparts without
heart disease. However, an expert said the meta-analysis included a broad range of studies and did not control for
possible confounding factors, such as the presence of aphasia, which can affect cognitive functioning. U.S. News & World Report/HealthDay News
Study: Rapid cognitive decline precedes Alzheimer's
Researchers reported in the Archives of Neurology that patients who developed dementia or Alzheimer's
disease during a 16-year follow-up experienced a more than 15-fold accelerated cognitive decline five to six years before
the actual onset of the conditions, while those who did not develop the diseases experienced little cognitive decline. They
also found increased cognitive decline precedes mild cognitive impairment, a precursor of Alzheimer's disease. HealthDay News
A new insulin treatment: Less often, more control
Insulin degludec provides comparable glycaemic control
to insulin glargine without additional adverse events and might reduce dosing frequency due to its ultra-long action profile.
The Lancet
Get aggressive with combination lipid therapy
Most patients with coronary artery disease achieve the minimal LDL cholesterol goal of 100
mg/dl, but few achieve the more aggressive goals of <70 mg/dl. Many high-risk patients have elevated levels of triglycerides
or low levels of HDL cholesterol despite treatment. These authors report that combination lipid-lowering therapy offers a
significant opportunity to more aggressively treat lipids to achieve the recommended clinical levels. The American Journal of Cardiology
Measuring sarcopenia
By asking adults 55+ years that currently had sarcopenia (loss
of skeletal muscle mass), about the effect of sarcopenia on their lives, a new patient-reported outcomes measure called the
Age-Related Muscle Loss Questionnaire was developed and refined to include 14 items. This measure will enable clinicians
to assess the impact of reduced muscle strength in their patients with sarcopenia. Journal of the American Medical Directors Association
Lifecourse trends in adolescent obesity
Adult outcomes of adolescent obesity and overweight vary in accordance with the severity and
persistence of adiposity, suggesting a potential scope for lifestyle interventions.
Conclusions
Substantial shifts in overweight and obesity occur between adolescence and young adulthood; the extent of continuity
depends on both the severity and persistence of adiposity in adolescence. Few adolescents who peak into obesity or are persistently
overweight achieve a normal weight in young adulthood. Resolution is more common in those who are less persistently overweight
as teenagers, suggesting scope for lifestyle interventions in this subgroup.
http://www.jahonline.org/article/S1054-139X(10)00311-3/fulltext
What can help dry mouth and improve nutritional intake?
Xerostemia (dry mouth) is a common complaint among nursing home residents,
and it impacts their nutritional intake by affecting ability to taste food and swallow. This pilot study tested whether serving
lemon-lime sorbet just before lunch benefited their food consumption. Those served
sorbet salivated more and consumed more food during the treatment weeks.
Conclusion
The intervention has the potential to increase salivation, decrease
complaints of xerostomia, and increase food intake in institutionalized elders with drug-induced xerostomia. The new knowledge
gained from this study will lead to further research and testing of the intervention with the long-term goal of transforming
the “care-as-usual” approach to meal service in nursing homes.
http://www.jamda.com/article/S1525-8610(10)00205-7/abstract
Study looks at risk factors for atrial fibrillation
A study of about 14,600 people found almost 57% of 1,520 atrial fibrillation
cases that developed during the 17-year follow-up were due to high
blood pressure, diabetes and other heart
disease risk factors. More than 80% of blacks had at least one risk factor compared with 60% of whites, according
to the study in Circulation. The lead researcher said a heart-healthy lifestyle can help cut the risk for A-fib.
http://health.usnews.com/health-news/diet-fitness/heart/articles/2011/03/28/healthy-lifestyles-could-halve-cases-of-dangerous-irregular-heartbeat
Study: Some patients with type 1 diabetes avoid complications
A study of 351 patients who had lived with type 1 diabetes
for 50 years found 87% of them did not develop kidney disease,
52% had no cardiovascular disease, 43% had no eye disease and 39% did not suffer nerve damage.
Researchers reported in the journal Diabetes Care that lower complication rates were not
connected to blood sugar levels, but that patients with high levels of two proteins known
as advanced glycation end products were seven times as likely to develop a complication. WebMD
Severe hypertriglyceridemia. Who and what medication?
Severe hypertriglyceridemia is rare among adults
in the U.S., and the use of pharmacologic intervention is low among individuals with this condition. The American Journal of Cardiology
A growing amount of evidence has supported an association between elevated triglyceride
levels and cardiovascular disease. However, little information regarding co-morbidities,
levels of other cholesterol types, or medication use among adults with severe hypertriglyceridemia (SHTG; (500 to 2,000 mg/dl)
is available. We examined the data from 5,680 subjects, ≥20 years old, who had participated in the National Health and
Nutrition Examination Survey from 2001 and 2006, to evaluate the epidemiology of adults with SHTG. Approximately 1.7% of the
sample had SHTG, equating to roughly 3.4 million Americans. The participants with SHTG tended to be men (75.3%), non-Hispanic
whites (70.1%), and aged 40 to 59 years (58.5%). More than 14% of those with SHTG reported having diabetes mellitus, and 31.3%
reported having hypertension. Only 14% of the subjects with SHTG reported using statins, and 4.0% reported using fibrates.
The factors significantly associated with having SHTG included high-density lipoprotein <40 mg/dl (odds ratio [OR) 11.45,
95% confidence interval [CI] 6.28 to 20.86), non–high-density lipoprotein 160 to 189 mg/dl (OR 9.74, 95% CI 1.68 to
56.40) or non–high-density lipoprotein ≥190 mg/dl (OR 24.99, 95% CI 3.90 to 160.31), diabetes mellitus (OR 3.04,
95% CI 1.45 to 6.37), and chronic renal disease (OR 7.32, 95% CI 1.45 to 36.94). In conclusion, SHTG is rare among adults
in the United States and the use of pharmacologic intervention is low among those with SHTG.
Little information is
published regarding the epidemiology of adults with severe hypertriglyceridemia (SHTG; 500 to 2,000 mg/dl). Descriptive data
on this condition are of public health importance, given that elevated serum triglycerides (TG) are associated with an increased
risk of coronary heart disease and pancreatitis.1 Using data obtained from the National Health and Nutrition Examination
Survey (NHANES) from 2001 to 2006, our objectives were to estimate the distribution of high TG levels in the United States
adult population, assess the distribution of TG levels as they relate to the use of dyslipidemic agents, and evaluate the
association between SHTG and personal characteristics and habits, levels of other cholesterol types, co-morbidities, and medication
use.
http://www.ajconline.org/article/S0002-9149(10)02418-5/fulltext
http://www.ajconline.org/article/S0002-9149(10)02418-5/fulltext#back-bib1
Atorvastatin
Linked to Small Increase in Risk for Type 2 Diabetes
Atorvastatin
seems to carry a "slight increase in the risk" for new-onset type 2 diabetes,
according to an analysis of three large trials published in the Journal of the American College of Cardiology. (The trials, as well as this analysis, were sponsored by atorvastatin's manufacturer.)
Researchers
were responding to a 2010 Lancet meta-analysis,
which found a small but measurable risk for new-onset diabetes after all statin use. The current analysis
focuses on atorvastatin's effects in the TNT, IDEAL, and SPARCL trials. It found that atorvastatin, when compared with
placebo in the SPARCL trial, carries a higher risk for diabetes. In the other trials, there was a slightly increased risk
when an 80-mg dose was compared with lower doses (10-mg atorvastatin in TNT, 20-mg simvastatin in IDEAL), but the differences
did not achieve statistical significance.
The JACC authors conclude
(as did the authors of the Lancet meta-analysis)
that the benefits of statins "far outweigh the risks."
JACC article
Osteoarthritis of the Hip or Knee Raises
Mortality Risk
Excess all-cause mortality
was observed in OA patients.
Little is known about causes of death in people with hip
or knee osteoarthritis (OA). In this population-based cohort study, investigators assessed all-cause and disease-specific
mortality in 1163 patients (age, 35) with symptomatic, x-ray–confirmed
hip or knee OA who were seen in general practices in southwest England.
After median follow-up
of 14 years, excess all-cause mortality was observed in patients with OA compared with the general population. Similarly,
excess cardiovascular-, cancer-, and dementia-associated mortality was observed in OA patients compared with the general population.
Several baseline characteristics of OA patients were associated independently with higher all-cause mortality: advanced age,
male sex (hazard ratio, 1.6), diabetes (HR, 2.0), cancer (HR, 2.3), cardiovascular disease (HR, 1.4), and walking disability (HR, 1.5). In fact,
mortality rose with increasing severity of walking disability.
Comment: In this study, patients with hip or knee OA had higher risk for death than did the general population. The authors
speculate that less physical activity, smoldering inflammation, and use of nonsteroidal anti-inflammatory drugs (and resultant
higher cardiovascular risk) might account for the elevated risk. Although these results suggest that patients with OA should
be more physically active, the pain and disability of OA and practical
Nüesch E et al. BMJ 2011 Mar
8; 342:d1165
Measures of Adiposity Add Little to Standard
Predictors of Cardiovascular Risk
Waist-to-hip ratio and body-mass index were equally predictive.
The Emerging Risk Factors Collaboration. Lancet 2011 Mar 26; 377:1085
Is It Time to Smell the Coffee?
In a prospective cohort study among Swedish women, drinking little or no coffee was associated with higher stroke
risk.
Gastric Bypass Surgery Improves Cardiac
Function
Surgery was associated with
marked improvement in left ventricular hypertrophy.
Can
bariatric surgery improve heart function, thereby lowering obesity-associated risks for heart failure, atrial fibrillation, and cardiovascular death? In this prospective study from Utah, cardiovascular outcomes in 423 severely obese patients
who underwent gastric bypass surgery were compared with those in 733 severely obese patients who did not.
At
2-year follow-up, gastric bypass patients had lost an average of 44 kg, versus 3 kg in the reference group. Gastric bypass
surgery was associated with improved blood pressure, heart rate, and cholesterol panels and with reductions in left ventricular
(LV) mass index (a measure of LV hypertrophy) and right ventricular size on echocardiography. The proportion of gastric bypass
patients who met criteria for LV hypertrophy decreased significantly but remained high (from 64% at baseline to 56% at 2 years);
measures of left and right ventricular function (e.g., fractional shortening) also improved, although ejection fractions were
not significantly different (63% at baseline and 65% at 2 years). Left atrial size was stable in gastric bypass patients and
increased in those who did not have surgery.
Owan T et al. J Am Coll Cardiol 2011
Feb 8; 57:732
http://www.ncbi.nlm.nih.gov/pubmed/21292133?dopt=Abstract
Does Waist Circumference Measure Up?
Independent of body-mass index, increases in waist circumference predicted changes
in cardiovascular disease risk factors in postmenarcheal white adolescents.
Cross-sectional studies suggest that visceral fat, measured by magnetic resonance imaging, is positively
related to cardiovascular risk factors in children and adolescents. To determine whether changes in waist circumference —
an indirect measure of central adiposity — predicts longitudinal change in cardiovascular risk factors, investigators
analyzed data from 2379 black and white girls (age range, 9–10 years) enrolled in the National Heart, Lung, and Blood
Institute Growth and Health Study in 1987–1988. Girls who had at least two postmenarcheal study visits during the 10
years of follow-up were included in the analysis.
After adjustment for body-mass
index (BMI) z score, steeper age-related increases in waist circumference
were significantly associated with greater increases in LDL cholesterol, systolic and diastolic blood pressure, and
insulin resistance (homeostasis model assessment) in white but not black girls. Changes in
waist circumference were not related to changes in HDL cholesterol, triglycerides, insulin, or glucose concentrations in either
white or black girls.
http://www.ncbi.nlm.nih.gov/pubmed/21147855?dopt=Abstract
BMI, Other Adiposity Measures Don't Add Much to Cardiovascular Risk Prediction
Measures of adiposity do not greatly improve cardiovascular
risk prediction beyond that provided by blood pressure, diabetes history, and lipid
profile, according to a study in the Lancet.
Researchers
assessed data on 220,000 patients free of cardiovascular disease in 58 prospective cohorts. Over a mean 5.7 years'
follow-up, some 14,000 cardiovascular events occurred.
After adjustment for age, sex,
smoking status, systolic blood pressure, diabetes history, and total and HDL cholesterol,
increasing increments of BMI, waist-to-hip ratio, and waist circumference were individually associated with roughly
similar increases in cardiovascular risk (with hazard ratios ranging from 1.07 to 1.12). In addition, adding these adiposity
measures to a cardiovascular risk prediction model that included traditional risk factors did not improve the model's risk
discrimination.
Commentators note: "The study dispelled previous hope that
assessment of body size could replace the cost, time, and inconvenience of blood lipids assay."
Lancet article
What Happens If You Tell Your Patients
That They Are Obese?
They have more realistic perceptions of their weight and greater desire to lose weight.
Post
RE et al. Arch Intern Med 2011
Feb 28; 171:316
Are Diet and IQ Linked in Children?
A healthy diet was positively associated with IQ at age 8 years.
Northstone K et al. J Epidemiol Community Health 2011 Feb 7;
Bad News for Screen Junkies
Even after accounting for physical activity levels, spending a lot of
discretionary time in front of a television or computer is an independent predictor of cardiovascular events.
Stamatakis
E et al. J Am Coll Cardiol 2011
Jan 18; 57:292
Tiotropium Outperforms Salmeterol in Moderate COPD
The anticholinergic
drug tiotropium is more effective at forestalling exacerbations in chronic obstructive pulmonary disease than the beta-2 agonist salmeterol, according
to a New England Journal of Medicine study.
International
researchers (including employees of tiotropium's manufacturer) randomized some 7400 patients with moderate-to-severe COPD.
All had experienced at least one exacerbation in the previous year. Half received tiotropium once daily and half received
salmeterol twice daily for 1 year. Patients were allowed to continue taking non-study COPD drugs.
The
amount of time taken for the first 25% of each treatment group to have a first exacerbation — the primary outcome
— was some 40 days longer in tiotropium recipients (187 vs. 145 days). Risks for moderate
or severe exacerbations were also lower on tiotropium.
NEJM article
Pioglitazone
Use Linked to Lower Risk for Diabetes
Pioglitazone use among patients with impaired glucose tolerance is associated with a reduced likelihood of developing diabetes,
according to an industry-funded study in the New England Journal of Medicine.
Researchers
randomized roughly 600 patients with impaired glucose tolerance to daily pioglitazone or
placebo. After a median 2.4 years' follow-up, patients taking pioglitazone were less likely to develop diabetes than patients
receiving placebo (5.0% vs. 16.7%). The number needed to treat to prevent one case of diabetes over 1 year was 18.
The
pioglitazone group was at increased risk for edema and weight gain, but unlike previous studies, this trial found no significant between-group difference
in the number of cardiovascular events or fractures.
NEJM article
Prevention of Microalbuminuria
with Olmesartan
This drug delayed onset slightly but did not change overall
incidence.
In patients with diabetes mellitus (DM), microalbuminuria predicts
early development of nephropathy and cardiovascular (CV) disease; treatment with angiotensin-converting–enzyme (ACE)
inhibitors or angiotensin-receptor blockers (ARBs) is recommended for patients with established microalbuminuria. In this
trial, investigators assessed the value of the ARB olmesartan (Benicar) for preventing development of microalbuminuria. The drug's maker funded the study,
and most of the authors had financial relationships with the company.
About 4400 patients (mean age, 58) with type 2 DM,
normoalbuminuria, and mean blood pressure of 136/81 mm Hg were randomized to daily olmesartan (40 mg) or placebo, with unrestricted
use of antihypertensives other than ARBs or ACE
inhibitors. Most patients in both groups achieved blood pressures <130/80 mm Hg. During
median follow-up of 3.2 years, the incidence of microalbuminuria did not differ significantly between the olmesartan and placebo
groups (8.2% vs. 9.8%), but onset was delayed significantly in the olmesartan group (median, 722 days vs. 576 days). Mean glomerular filtration rate declined more with olmesartan than with placebo (–5
vs. –1 mL/minute/1.73 m2). In a secondary endpoint, significantly more olmesartan patients died from any
CV cause (0.7% vs. 0.1%).
http://www.ncbi.nlm.nih.gov/pubmed/21388309?dopt=Abstract
CRP Itself Is Unlikely to Cause Coronary
Heart Disease
Genetically elevated C-reactive protein was
not associated with CHD.
C Reactive Protein Coronary
Heart Disease Genetics Collaboration (CCGC).
BMJ 2011 Feb 15; 342:d548 Keavney B. BMJ 2011
Feb 15; 342:d144
Statin Use After Intracerebral Hemorrhage
Under most circumstances, the risks of statin treatment after intracerebral hemorrhage outweigh the potential benefits.
Westover
MB et al. Arch Neurol 2011
Jan 10;
New Analyses of Data from the Prostate
Cancer Screening Trials
Prostate-specific antigen screening is imperfect, has expensive consequences,
and saves relatively few lives.
Crawford
ED et al. J Clin Oncol 2011
Feb 1; 29:355
Shteynshlyuger A and Andriole GL. J
Urol 2011 Mar 185:828
Loeb
S et al. J Clin Oncol 2011
Feb 1; 29:464
Men Have Higher Risk for VTE Recurrence
Than Do Women
After a first unprovoked
occurrence of venous thromboembolism, a patient's sex might factor into decisions about long-term anticoagulation.
Douketis
J et al. BMJ 2011
Feb 24; 342:d813
