01 Mar 2008
If you are a loud snorer there is a good chance your risk of stroke and heart disease is higher compared to people who do not snore, say Hungarian scientists after a new study on 12,643 participants.
You can read about this in the journal Sleep.
The authors explain that everybody snores to some extent at some period in their lives.
Estimates indicate that approximately 40% of men and 24% of women snore regularly.
Although previous studies had indicated there may be a link between habitual snoring and stroke and heart attack risk, this one has more compelling evidence.
The scientists interviewed 12,643 people at home about their snoring - they The represented 0.16% of the Hungarian population over the age of 18 years according to age, sex, and 150 sub-regions of the country.
The scientists report that, according to their study, 37% of men and 21% of women reported loud snoring with breathing pauses. 26% of the respondents reported having hypertension (high blood pressure), 3% had had myocardial infarction and 4% a stroke.
They found that a loud snorer has a 67% higher risk of having a stroke compared to people who do not snore, the risk of heart attack is 34% higher for loud snorers. It seems that quiet snorers do not run a higher risk of heart disease and/or stroke compared to people who do not snore, the scientists said.
The authors concluded "Snoring is frequent in the Hungarian adult population, and loud snoring with breathing pauses, in contrast with quiet snoring, is associated with an increased risk of cardiovascular disease and increased health-care utilization."
"Cardiovascular Disease and Health-Care Utilization in Snorers: a Population Survey"
Andrea Dunai, MD, Andras P. Keszei, MD, PhD, Maria S. Kopp, MD,PhD, Colin M. Shapiro, MBBCh, PhD, FRCPC, Istvan Mucsi, MD, PhD, Marta Novak, MD, PhD
SLEEP Volume 31, Issue 03, Pages 411-416
Click here to view abstract online
Showing posts with label Cardiovascular Risk. Show all posts
Showing posts with label Cardiovascular Risk. Show all posts
Sunday, March 2, 2008
Tuesday, February 12, 2008
Factors Favoring Longevity; Disability at 100
Physician's First Watch for February 12, 2008
David G. Fairchild, MD, MPH, Editor-in-Chief
Factors Favoring Longevity; Disability at 100
Exceptional longevity is neither so elusive nor as disabling as was once thought, according to two studies in Archives of Internal Medicine.
Researchers in the first study examined the factors associated with living to age 90 and beyond in a cohort of the Physicians' Health Study followed for some 25 years. Among men born before 1916, the presence of one of five risk factors at age 70 reduced the adjusted odds of survival to age 90. The risk factors (and their associated hazard ratios for dying before 90) were smoking (
2.10), diabetes (1.86), obesity (1.44), and hypertension (1.28). Regular exercise conferred a 30% lower mortality risk.
In the second study, researchers studied disease and disability among centenarians and found that about a third had suffered from a disabling condition like COPD, diabetes, or dementia for over 15 years and that most required either minimal or no assistance in their daily lives.
An editorialist offers wryly that, although the successfully aged may have undefined reserves, "an alternative explanation might be that their primary care physicians aggressively treated their chronic illnesses rather than assume ageist nihilism about treating the oldest old."
Archives of Internal Medicine article on longevity in men (Free abstract; full text requires subscription)
Archives of Internal Medicine article on longevity and disability (Free abstract; full text requires subscription)
Archives of Internal Medicine editorial (Subscription required)
David G. Fairchild, MD, MPH, Editor-in-Chief
Factors Favoring Longevity; Disability at 100
Exceptional longevity is neither so elusive nor as disabling as was once thought, according to two studies in Archives of Internal Medicine.
Researchers in the first study examined the factors associated with living to age 90 and beyond in a cohort of the Physicians' Health Study followed for some 25 years. Among men born before 1916, the presence of one of five risk factors at age 70 reduced the adjusted odds of survival to age 90. The risk factors (and their associated hazard ratios for dying before 90) were smoking (
2.10), diabetes (1.86), obesity (1.44), and hypertension (1.28). Regular exercise conferred a 30% lower mortality risk.
In the second study, researchers studied disease and disability among centenarians and found that about a third had suffered from a disabling condition like COPD, diabetes, or dementia for over 15 years and that most required either minimal or no assistance in their daily lives.
An editorialist offers wryly that, although the successfully aged may have undefined reserves, "an alternative explanation might be that their primary care physicians aggressively treated their chronic illnesses rather than assume ageist nihilism about treating the oldest old."
Archives of Internal Medicine article on longevity in men (Free abstract; full text requires subscription)
Archives of Internal Medicine article on longevity and disability (Free abstract; full text requires subscription)
Archives of Internal Medicine editorial (Subscription required)
Thursday, February 7, 2008
Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes
Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes
N Engl J Med 2008 Feb 7; 358:580.
Peter Gæde, M.D., D.M.Sc., Henrik Lund-Andersen, M.D., D.M.Sc., Hans-Henrik Parving, M.D., D.M.Sc., and Oluf Pedersen, M.D., D.M.Sc.
ABSTRACT
Background
Intensified multifactorial intervention — with tight glucose regulation and the use of renin–angiotensin system blockers, aspirin, and lipid-lowering agents — has been shown to reduce the risk of nonfatal cardiovascular disease among patients with type 2 diabetes mellitus and microalbuminuria. We evaluated whether this approach would have an effect on the rates of death from any cause and from cardiovascular causes.
Methods
In the Steno-2 Study, we randomly assigned 160 patients with type 2 diabetes and persistent microalbuminuria to receive either intensive therapy or conventional therapy; the mean treatment period was 7.8 years. Patients were subsequently followed observationally for a mean of 5.5 years, until December 31, 2006. The primary end point at 13.3 years of follow-up was the time to death from any cause.
Results
Twenty-four patients in the intensive-therapy group died, as compared with 40 in the conventional-therapy group (hazard ratio, 0.54; 95% confidence interval [CI], 0.32 to 0.89; P=0.02). Intensive therapy was associated with a lower risk of death from cardiovascular causes (hazard ratio, 0.43; 95% CI, 0.19 to 0.94; P=0.04) and of cardiovascular events (hazard ratio, 0.41; 95% CI, 0.25 to 0.67; P<0.001). One patient in the intensive-therapy group had progression to end-stage renal disease, as compared with six patients in the conventional-therapy group (P=0.04). Fewer patients in the intensive-therapy group required retinal photocoagulation (relative risk, 0.45; 95% CI, 0.23 to 0.86; P=0.02). Few major side effects were reported.
Conclusions
In at-risk patients with type 2 diabetes, intensive intervention with multiple drug combinations and behavior modification had sustained beneficial effects with respect to vascular complications and on rates of death from any cause and from cardiovascular causes.
N Engl J Med 2008 Feb 7; 358:580.
Peter Gæde, M.D., D.M.Sc., Henrik Lund-Andersen, M.D., D.M.Sc., Hans-Henrik Parving, M.D., D.M.Sc., and Oluf Pedersen, M.D., D.M.Sc.
ABSTRACT
Background
Intensified multifactorial intervention — with tight glucose regulation and the use of renin–angiotensin system blockers, aspirin, and lipid-lowering agents — has been shown to reduce the risk of nonfatal cardiovascular disease among patients with type 2 diabetes mellitus and microalbuminuria. We evaluated whether this approach would have an effect on the rates of death from any cause and from cardiovascular causes.
Methods
In the Steno-2 Study, we randomly assigned 160 patients with type 2 diabetes and persistent microalbuminuria to receive either intensive therapy or conventional therapy; the mean treatment period was 7.8 years. Patients were subsequently followed observationally for a mean of 5.5 years, until December 31, 2006. The primary end point at 13.3 years of follow-up was the time to death from any cause.
Results
Twenty-four patients in the intensive-therapy group died, as compared with 40 in the conventional-therapy group (hazard ratio, 0.54; 95% confidence interval [CI], 0.32 to 0.89; P=0.02). Intensive therapy was associated with a lower risk of death from cardiovascular causes (hazard ratio, 0.43; 95% CI, 0.19 to 0.94; P=0.04) and of cardiovascular events (hazard ratio, 0.41; 95% CI, 0.25 to 0.67; P<0.001). One patient in the intensive-therapy group had progression to end-stage renal disease, as compared with six patients in the conventional-therapy group (P=0.04). Fewer patients in the intensive-therapy group required retinal photocoagulation (relative risk, 0.45; 95% CI, 0.23 to 0.86; P=0.02). Few major side effects were reported.
Conclusions
In at-risk patients with type 2 diabetes, intensive intervention with multiple drug combinations and behavior modification had sustained beneficial effects with respect to vascular complications and on rates of death from any cause and from cardiovascular causes.
Saturday, February 2, 2008
Diabetes Increases Risk Of Heart Disease Death For Women
Diabetes Increases Risk Of Heart Disease Death For Women
Medical News Today
02 Feb 2008
The word is out: women are at risk for heart disease, just like men. In fact, roughly twice as many women in this country will die of heart disease, stroke, and other cardiovascular diseases than from all forms of cancer combined, including breast cancer, according to the American Heart Association.
Risk factors for heart disease and stroke have long been identified. Several risk factors cannot be controlled by the individual, such as sex, increasing age and a family history of heart disease.
Others can be modified and include:
Smoking-- High blood pressure and cholesterol
Diabetes
Sedentary lifestyle
Body weight
Diabetes continues to be a growing problem in the United States for both men and women. A study published in the December 2007 issue of the European Heart Journal reveals that diabetes is a stronger risk factor for heart disease death in women than in men."The reason for the higher relative risk of coronary heart disease in women with diabetes than in men with diabetes is still unclear," explains Ane Cecilie Dale, M.D., the study's lead researcher and head of the Department of Circulation and Medical Imaging at the Norwegian University of Science and Technology in Trondheim. "But research in this field continues to go on."
According to the U.S. Food and Drug Administration, diabetes affects approximately 8.9 percent of American women. The occurrence of diabetes is significantly higher among African American, Hispanic/Latino, American Indian, and Asian/Pacific Islander women than in white women.
Women with diabetes have a two to four times higher risk of dying from heart disease and stroke compared to women without diabetes, according to data from the American Heart Association. Women with diabetes are often overweight and suffer from high blood pressure, also known as hypertension, and high cholesterol levels, which can add to the risk.
"Women with diabetes need to be aware of the associated risk of heart disease. The most important thing to do for all persons with diabetes to protect themselves from heart disease and other diabetes complications is to have a good glucometabolic control with a blood glucose as near normal as possible," Dale said. "They also need to control other risk factors like hypertension and blood cholesterol levels. In addition it is important to quit smoking, have a healthy diet and practice regularly exercise."
Considering how complex the management of diabetes and heart diseases risks are, women should talk to their health care providers to develop a plan of action.
Without the support of health care professionals, patients can easily feel overwhelmed.
February is American Heart Month.
For tips on reducing your heart disease risk, visit the American Heart Association Web site: http://http:/www.heart.org.
For diabetes information, visit the American Diabetes Association: http://www.diabetes.org.
WomenHeart, the National Coalition for Women with Heart Disease, provides patients with education and grassroots support networks. WomenHeart is online at http://www.womenshealthresearch.org.S
Society for Women's Health Research (SWHR)1025 Connecticut Ave. NW, Ste. 701Washington, DC 20036United Stateshttp://www.womenshealthresearch.org
Medical News Today
02 Feb 2008
The word is out: women are at risk for heart disease, just like men. In fact, roughly twice as many women in this country will die of heart disease, stroke, and other cardiovascular diseases than from all forms of cancer combined, including breast cancer, according to the American Heart Association.
Risk factors for heart disease and stroke have long been identified. Several risk factors cannot be controlled by the individual, such as sex, increasing age and a family history of heart disease.
Others can be modified and include:
Smoking-- High blood pressure and cholesterol
Diabetes
Sedentary lifestyle
Body weight
Diabetes continues to be a growing problem in the United States for both men and women. A study published in the December 2007 issue of the European Heart Journal reveals that diabetes is a stronger risk factor for heart disease death in women than in men."The reason for the higher relative risk of coronary heart disease in women with diabetes than in men with diabetes is still unclear," explains Ane Cecilie Dale, M.D., the study's lead researcher and head of the Department of Circulation and Medical Imaging at the Norwegian University of Science and Technology in Trondheim. "But research in this field continues to go on."
According to the U.S. Food and Drug Administration, diabetes affects approximately 8.9 percent of American women. The occurrence of diabetes is significantly higher among African American, Hispanic/Latino, American Indian, and Asian/Pacific Islander women than in white women.
Women with diabetes have a two to four times higher risk of dying from heart disease and stroke compared to women without diabetes, according to data from the American Heart Association. Women with diabetes are often overweight and suffer from high blood pressure, also known as hypertension, and high cholesterol levels, which can add to the risk.
"Women with diabetes need to be aware of the associated risk of heart disease. The most important thing to do for all persons with diabetes to protect themselves from heart disease and other diabetes complications is to have a good glucometabolic control with a blood glucose as near normal as possible," Dale said. "They also need to control other risk factors like hypertension and blood cholesterol levels. In addition it is important to quit smoking, have a healthy diet and practice regularly exercise."
Considering how complex the management of diabetes and heart diseases risks are, women should talk to their health care providers to develop a plan of action.
Without the support of health care professionals, patients can easily feel overwhelmed.
February is American Heart Month.
For tips on reducing your heart disease risk, visit the American Heart Association Web site: http://http:/www.heart.org.
For diabetes information, visit the American Diabetes Association: http://www.diabetes.org.
WomenHeart, the National Coalition for Women with Heart Disease, provides patients with education and grassroots support networks. WomenHeart is online at http://www.womenshealthresearch.org.S
Society for Women's Health Research (SWHR)1025 Connecticut Ave. NW, Ste. 701Washington, DC 20036United Stateshttp://www.womenshealthresearch.org
Saturday, January 19, 2008
Aspirin 'resistance' linked to increased CV morbidity
Aspirin 'resistance' linked to increased CV morbidity
By Caroline Price
18 January 2008
Br Med J 2008; Advance online publication
MedWire News: Patients who do not respond to aspirin therapy are at increased long-term risk for cardiovascular (CV) morbidity, the results of a systematic review and meta-analysis show.
Such patients, labeled "aspirin resistant," had an approximately four-fold increased risk for nonfatal and fatal cardiovascular, cerebrovascular, or vascular events when taking aspirin compared with those classified as sensitive to aspirin.
"Not only did aspirin resistance have an effect on clinical outcome but this risk was not ameliorated by currently used adjunct antiplatelet therapies," the study authors note.
It is not clear why a significant number of CV disease patients derive no benefit from aspirin therapy, nor how these patients may be identified, explain Michael Buchanan (McMaster University, Hamilton, Ontario, Canada) and colleagues.
Such patients have been termed aspirin resistant because their platelets are not affected in the same way as platelets from individuals who seem to benefit from aspirin therapy. Yet it remains unknown whether these patients simply receive too low an aspirin dose, are not compliant, have differing abilities to absorb aspirin, or have an underlying genetic disposition that makes aspirin ineffective. Furthermore, few studies have addressed the impact of aspirin resistance on clinical outcomes.
To look for any relationship between aspirin resistance and clinical outcomes, Buchanan and team reviewed the literature and conducted a meta-analysis on 20 studies involving 2930 patients with CV disease who were receiving aspirin as an antithrombotic. Patients were classified as aspirin resistant if their platelet response was not inhibited in vitro by aspirin.
Overall, 810 (28%) patients were classified as aspirin resistant. These patients, regardless of underlying clinical symptoms, had a greater risk for death, acute coronary syndrome, failure in vascular intervention, or a new cerebrovascular event.
Indeed, 39% of aspirin-resistant compared with 16% of aspirin-sensitive patients had any cardiovascular event, giving an odds ratio of 3.85 (p<0.001).
The odds ratios for acute coronary syndrome, graft failure, and new cerebrovascular event in aspirin resistant compared with aspirin sensitive patients were 4.06, 4.35, and 3.78, respectively.
Moreover, the odds ratio for mortality for aspirin resistant patients was 5.99 (p<0.003).
A planned sensitivity analysis revealed no evidence of a dose-response relationship between aspirin resistance and any cardiovascular outcome among patients who received aspirin alone or who received a second antiplatelet. Furthermore, patients who were aspirin resistant had no benefit from concomitant therapy with clopidogrel or tirofiban, or both.
Italian cardiologists Giuseppe Biondi-Zoccai (University of Turin) and Marzia Lotrionte (Catholic University, Rome) commented in an accompanying editorial that further trials are needed to clarify whether aspirin resistance is just a nonmodifiable risk factor, or whether more aggressive antithrombotic regimens will benefit patients with aspirin resistance.
However, they cautioned that although clinical trials will help "fill in the gaps," there may be another factor generating interest in aspirin resistance.
"Drug companies may be keen to downgrade aspirin from its leading role as an effective drug in CV disease so that they can substitute it with much more expensive but marginally more effective alternatives," they stated.
Journal
By Caroline Price
18 January 2008
Br Med J 2008; Advance online publication
MedWire News: Patients who do not respond to aspirin therapy are at increased long-term risk for cardiovascular (CV) morbidity, the results of a systematic review and meta-analysis show.
Such patients, labeled "aspirin resistant," had an approximately four-fold increased risk for nonfatal and fatal cardiovascular, cerebrovascular, or vascular events when taking aspirin compared with those classified as sensitive to aspirin.
"Not only did aspirin resistance have an effect on clinical outcome but this risk was not ameliorated by currently used adjunct antiplatelet therapies," the study authors note.
It is not clear why a significant number of CV disease patients derive no benefit from aspirin therapy, nor how these patients may be identified, explain Michael Buchanan (McMaster University, Hamilton, Ontario, Canada) and colleagues.
Such patients have been termed aspirin resistant because their platelets are not affected in the same way as platelets from individuals who seem to benefit from aspirin therapy. Yet it remains unknown whether these patients simply receive too low an aspirin dose, are not compliant, have differing abilities to absorb aspirin, or have an underlying genetic disposition that makes aspirin ineffective. Furthermore, few studies have addressed the impact of aspirin resistance on clinical outcomes.
To look for any relationship between aspirin resistance and clinical outcomes, Buchanan and team reviewed the literature and conducted a meta-analysis on 20 studies involving 2930 patients with CV disease who were receiving aspirin as an antithrombotic. Patients were classified as aspirin resistant if their platelet response was not inhibited in vitro by aspirin.
Overall, 810 (28%) patients were classified as aspirin resistant. These patients, regardless of underlying clinical symptoms, had a greater risk for death, acute coronary syndrome, failure in vascular intervention, or a new cerebrovascular event.
Indeed, 39% of aspirin-resistant compared with 16% of aspirin-sensitive patients had any cardiovascular event, giving an odds ratio of 3.85 (p<0.001).
The odds ratios for acute coronary syndrome, graft failure, and new cerebrovascular event in aspirin resistant compared with aspirin sensitive patients were 4.06, 4.35, and 3.78, respectively.
Moreover, the odds ratio for mortality for aspirin resistant patients was 5.99 (p<0.003).
A planned sensitivity analysis revealed no evidence of a dose-response relationship between aspirin resistance and any cardiovascular outcome among patients who received aspirin alone or who received a second antiplatelet. Furthermore, patients who were aspirin resistant had no benefit from concomitant therapy with clopidogrel or tirofiban, or both.
Italian cardiologists Giuseppe Biondi-Zoccai (University of Turin) and Marzia Lotrionte (Catholic University, Rome) commented in an accompanying editorial that further trials are needed to clarify whether aspirin resistance is just a nonmodifiable risk factor, or whether more aggressive antithrombotic regimens will benefit patients with aspirin resistance.
However, they cautioned that although clinical trials will help "fill in the gaps," there may be another factor generating interest in aspirin resistance.
"Drug companies may be keen to downgrade aspirin from its leading role as an effective drug in CV disease so that they can substitute it with much more expensive but marginally more effective alternatives," they stated.
Journal
Wednesday, January 16, 2008
Calcium Supplements in Older Women Possibly Linked to More Cardiovascular Events
Blog observations about this study:
Calcium supplementation may adversely affect cardiovascular health in older women.
New Zealand researchers randomized nearly 1500 postmenopausal women to either 1 g of calcium or placebo daily; they then measured cardiovascular events over the ensuing 5 years
Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial
Mark J Bolland, research fellow1, P Alan Barber, senior lecturer1, Robert N Doughty, associate professor1, Barbara Mason, research officer1, Anne Horne, research fellow1, Ruth Ames, research officer1, Gregory D Gamble, research fellow1, Andrew Grey, associate professor1, Ian R Reid, professor1
Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
Correspondence to: I R Reid i.reid@auckland.ac.nz
Abstract
Objective
To determine the effect of calcium supplementation on myocardial infarction, stroke, and sudden death in healthy postmenopausal women.
Design
Randomised, placebo controlled trial.
Setting
Academic medical centre in an urban setting in New Zealand.
Participants
1471 postmenopausal women (mean age 74): 732 were randomised to calcium supplementation and 739 to placebo.
Main outcome measures
Adverse cardiovascular events over five years: death, sudden death, myocardial infarction, angina, other chest pain, stroke, transient ischaemic attack, and a composite end point of myocardial infarction, stroke, or sudden death.
Results
Myocardial infarction was more commonly reported in the calcium group than in the placebo group (45 events in 31 women v 19 events in 14 women, P=0.01). The composite end point of myocardial infarction, stroke, or sudden death was also more common in the calcium group (101 events in 69 women v 54 events in 42 women, P=0.008). After adjudication myocardial infarction remained more common in the calcium group (24 events in 21 women v 10 events in 10 women, relative risk 2.12, 95% confidence interval 1.01 to 4.47). For the composite end point 61 events were verified in 51 women in the calcium group and 36 events in 35 women in the placebo group (relative risk 1.47, 0.97 to 2.23). When unreported events were added from the national database of hospital admissions in New Zealand the relative risk of myocardial infarction was 1.49 (0.86 to 2.57) and that of the composite end point was 1.21 (0.84 to 1.74). The respective rate ratios were 1.67 (95% confidence intervals 0.98 to 2.87) and 1.43 (1.01 to 2.04); event rates: placebo 16.3/1000 person years, calcium 23.3/1000 person years. For stroke (including unreported events) the relative risk was 1.37 (0.83 to 2.28) and the rate ratio was 1.45 (0.88 to 2.49).
Conclusion
Calcium supplementation in healthy postmenopausal women is associated with upward trends in cardiovascular event rates. This potentially detrimental effect should be balanced against the likely benefits of calcium on bone.
Calcium supplementation may adversely affect cardiovascular health in older women.
New Zealand researchers randomized nearly 1500 postmenopausal women to either 1 g of calcium or placebo daily; they then measured cardiovascular events over the ensuing 5 years
Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial
Mark J Bolland, research fellow1, P Alan Barber, senior lecturer1, Robert N Doughty, associate professor1, Barbara Mason, research officer1, Anne Horne, research fellow1, Ruth Ames, research officer1, Gregory D Gamble, research fellow1, Andrew Grey, associate professor1, Ian R Reid, professor1
Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
Correspondence to: I R Reid i.reid@auckland.ac.nz
Abstract
Objective
To determine the effect of calcium supplementation on myocardial infarction, stroke, and sudden death in healthy postmenopausal women.
Design
Randomised, placebo controlled trial.
Setting
Academic medical centre in an urban setting in New Zealand.
Participants
1471 postmenopausal women (mean age 74): 732 were randomised to calcium supplementation and 739 to placebo.
Main outcome measures
Adverse cardiovascular events over five years: death, sudden death, myocardial infarction, angina, other chest pain, stroke, transient ischaemic attack, and a composite end point of myocardial infarction, stroke, or sudden death.
Results
Myocardial infarction was more commonly reported in the calcium group than in the placebo group (45 events in 31 women v 19 events in 14 women, P=0.01). The composite end point of myocardial infarction, stroke, or sudden death was also more common in the calcium group (101 events in 69 women v 54 events in 42 women, P=0.008). After adjudication myocardial infarction remained more common in the calcium group (24 events in 21 women v 10 events in 10 women, relative risk 2.12, 95% confidence interval 1.01 to 4.47). For the composite end point 61 events were verified in 51 women in the calcium group and 36 events in 35 women in the placebo group (relative risk 1.47, 0.97 to 2.23). When unreported events were added from the national database of hospital admissions in New Zealand the relative risk of myocardial infarction was 1.49 (0.86 to 2.57) and that of the composite end point was 1.21 (0.84 to 1.74). The respective rate ratios were 1.67 (95% confidence intervals 0.98 to 2.87) and 1.43 (1.01 to 2.04); event rates: placebo 16.3/1000 person years, calcium 23.3/1000 person years. For stroke (including unreported events) the relative risk was 1.37 (0.83 to 2.28) and the rate ratio was 1.45 (0.88 to 2.49).
Conclusion
Calcium supplementation in healthy postmenopausal women is associated with upward trends in cardiovascular event rates. This potentially detrimental effect should be balanced against the likely benefits of calcium on bone.
Sunday, January 13, 2008
Risk Of Cardiovascular Mortality Secondary To Androgen Deprivation Therapy For Localized Prostate Cancer
Commentary:
The use of ADT appears to be associated with an increased risk of death from cardiovascular causes in patients undergoing radical prostatectomy for localized prostate cancer.
Risk Of Cardiovascular Mortality Secondary To Androgen Deprivation Therapy For Localized Prostate Cancer
October 17, 2007 issue of the Journal of the National Cancer Institute
13 Jan 2008
UroToday.com - Androgen deprivation therapy (ADT) is associated with metabolic syndrome, which includes the development of type II diabetes mellitus and coronary artery disease. In the October 17, 2007 issue of the Journal of the National Cancer Institute evaluated whether ADT induced metabolic changes result in an increased risk of cardiovascular (CV) death.
The longitudinal, observational prostate cancer registry CaPSURE was used to study a cohort of 4,892 men. Of these, 1,015 patients were treated with ADT with local therapy and 3,977 men were not treated with ADT. ADT was used in 266 patients who had RP and in 749 men who received nonsurgical treatment. The primary endpoint of the study was death due to CV causes.
This was defined as myocardial infarction, sudden cardiac arrest, coronary artery disease, cardiac ischemia, arrhythmia, pulmonary embolism, or stroke.
Median patient age was 64 years and median followup was 3.8 years. Patients receiving radiotherapy, cryotherapy or brachytherapy as primary treatment in combination with ADT were older than men who had RP. The overall median duration of ADT therapy was 4.1 months. The proportion of patients with baseline hypertension and heart disease were similar among those who did and did not receive ADT. The proportion of patients with baseline diabetes was statistically higher in patients using ADT than in patients not using ADT. Analysis of patients treated with RP, both ADT and older age were associated with significantly increased risks of death from CV causes, but the presence of baseline heart disease or diabetes was not. This risk of CV death was evident in patients younger and older than 65 years. The cumulative incidence of death from CV causes among the younger patients using ADT was 3.6%, as compared to 1.2% in those not using ADT. Among patients treated with radiotherapy, brachytherapy or cryotherapy, only older age was associated with an increased risk of death from CV disease. Patients older than age 65 years who were treated with RP and ADT also had higher 5-year estimates of death from CV causes. In multivariable analysis among patients treated with RP, ADT use was associated with increased risk of death from any cause.
Older age, Gleason score greater than 8 and presence of baseline diabetes were also associated with an increased risk of death from any cause. Among those who did not undergo RP, a shorter time to all-cause mortality was not associated with ADT use, but was associated with advancing age.
To access the latest urology news releases from UroToday, go to: http://www.urotoday.com/
Saturday, January 12, 2008
Statin therapy in diabetics supported
Statin therapy in diabetics supported
By Caroline Price
11 January 2008
Lancet 2008; 371: 117-125
MedWire News: Meta-analysis findings demonstrate that statin therapy should be considered in all individuals with diabetes if they are deemed at "sufficiently high" risk for vascular events, conclude the Cholesterol Treatment Trialists' (CTT) Collaborators in The Lancet.
An earlier CTT meta-analysis of 14 randomized trials of statin therapy showed that lowering low-density lipoprotein (LDL) cholesterol by 1 mmol/l reduces the risk of vascular events (myocardial infarction or coronary death, stroke, or coronary revascularization) by around one-fifth in a broad range of high-risk individuals, largely irrespective of baseline lipid levels and conditions, including diabetes.
For the current study, the CTT investigators conducted pre-specified analyses of the same 14 trials to determine whether individuals with diabetes derive the same benefits from statins as those without.
Uncertainties remain over the effects of statins in diabetic individuals on major coronary events, stroke, and the need for revascularization, and whether their benefits are worthwhile in those without a history of occlusive vascular disease, the team explains.
The researchers report that there were 3247 major vascular events over a mean follow-up of 4.3 years among the 18,686 participants who had diabetes.
These participants had a 9% reduction in all-cause mortality per mmol/l decrease in LDL cholesterol (relative risk [RR]=0.91, p=0.02). This reduction was similar in magnitude to the 13% RR reduction per mmol/l decrease in LDL cholesterol RR=0.87, p<0.0001) in the remaining 71,370 patients without diabetes, the researchers say.
The reduction in all-cause mortality reflected significant reductions in vascular mortality (0.87, p=0.008) and death due to coronary heart disease (0.88, p=0.03) per mmol/l reduction in LDL cholesterol in the diabetic individuals, with no significant effect on vascular mortality (RR=0.97).
There was a significant 21% reduction in major vascular events per mmol/l decrease in LDL cholesterol in both participants with and without diabetes.
Statin therapy was also associated with significant reductions in MI or coronary death, coronary revascularization, and stroke among the diabetic participants.
Finally, the proportional risk reductions for major vascular events among diabetic individuals were similar irrespective of history of vascular disease, gender, age, treated hypertension, body mass index, systolic or diastolic blood pressure, smoking history, and renal function.
The authors comment that the consistency of the reduction in major vascular events suggests that the benefit is likely to hold true in other populations with diabetes.
"Consequently, the absolute benefits in any specific population of patients may be best estimated by application of a reduction of about a fifth per mmol/l LDL cholesterol reduction to the relevant age-specific and sex-specific rates for that population," they write.
Journal
By Caroline Price
11 January 2008
Lancet 2008; 371: 117-125
MedWire News: Meta-analysis findings demonstrate that statin therapy should be considered in all individuals with diabetes if they are deemed at "sufficiently high" risk for vascular events, conclude the Cholesterol Treatment Trialists' (CTT) Collaborators in The Lancet.
An earlier CTT meta-analysis of 14 randomized trials of statin therapy showed that lowering low-density lipoprotein (LDL) cholesterol by 1 mmol/l reduces the risk of vascular events (myocardial infarction or coronary death, stroke, or coronary revascularization) by around one-fifth in a broad range of high-risk individuals, largely irrespective of baseline lipid levels and conditions, including diabetes.
For the current study, the CTT investigators conducted pre-specified analyses of the same 14 trials to determine whether individuals with diabetes derive the same benefits from statins as those without.
Uncertainties remain over the effects of statins in diabetic individuals on major coronary events, stroke, and the need for revascularization, and whether their benefits are worthwhile in those without a history of occlusive vascular disease, the team explains.
The researchers report that there were 3247 major vascular events over a mean follow-up of 4.3 years among the 18,686 participants who had diabetes.
These participants had a 9% reduction in all-cause mortality per mmol/l decrease in LDL cholesterol (relative risk [RR]=0.91, p=0.02). This reduction was similar in magnitude to the 13% RR reduction per mmol/l decrease in LDL cholesterol RR=0.87, p<0.0001) in the remaining 71,370 patients without diabetes, the researchers say.
The reduction in all-cause mortality reflected significant reductions in vascular mortality (0.87, p=0.008) and death due to coronary heart disease (0.88, p=0.03) per mmol/l reduction in LDL cholesterol in the diabetic individuals, with no significant effect on vascular mortality (RR=0.97).
There was a significant 21% reduction in major vascular events per mmol/l decrease in LDL cholesterol in both participants with and without diabetes.
Statin therapy was also associated with significant reductions in MI or coronary death, coronary revascularization, and stroke among the diabetic participants.
Finally, the proportional risk reductions for major vascular events among diabetic individuals were similar irrespective of history of vascular disease, gender, age, treated hypertension, body mass index, systolic or diastolic blood pressure, smoking history, and renal function.
The authors comment that the consistency of the reduction in major vascular events suggests that the benefit is likely to hold true in other populations with diabetes.
"Consequently, the absolute benefits in any specific population of patients may be best estimated by application of a reduction of about a fifth per mmol/l LDL cholesterol reduction to the relevant age-specific and sex-specific rates for that population," they write.
Journal
Tuesday, January 8, 2008
Combined Impact of Health Behaviours and Mortality in Men and Women: The EPIC-Norfolk Prospective Population Study
Combined Impact of Health Behaviours and Mortality in Men and Women: The EPIC-Norfolk Prospective Population Study
Kay-Tee Khaw, Nicholas Wareham, Sheila Bingham, Ailsa Welch, Robert Luben, Nicholas Day
Background
There is overwhelming evidence that behavioural factors influence health, but their combined impact on the general population is less well documented. We aimed to quantify the potential combined impact of four health behaviours on mortality in men and women living in the general community.
Methods and Findings
We examined the prospective relationship between lifestyle and mortality in a prospective population study of 20,244 men and women aged 45–79 y with no known cardiovascular disease or cancer at baseline survey in 1993–1997, living in the general community in the United Kingdom, and followed up to 2006. Participants scored one point for each health behaviour: current non-smoking, not physically inactive, moderate alcohol intake (1–14 units a week) and plasma vitamin C >50 mmol/l indicating fruit and vegetable intake of at least five servings a day, for a total score ranging from zero to four. After an average 11 y follow-up, the age-, sex-, body mass–, and social class–adjusted relative risks (95% confidence intervals) for all-cause mortality(1,987 deaths) for men and women who had three, two, one, and zero compared to four health behaviours were respectively, 1.39 (1.21–1.60), 1.95 (1.70–-2.25), 2.52 (2.13–3.00), and 4.04 (2.95–5.54)
Conclusions
Four health behaviours combined predict a 4-fold difference in total mortality in men and women, with an estimated impact equivalent to 14 y in chronological age
LINK:
"http://medicine.plosjournals.org/perlserv/?request=index-html&issn=1549-1676
Kay-Tee Khaw, Nicholas Wareham, Sheila Bingham, Ailsa Welch, Robert Luben, Nicholas Day
Background
There is overwhelming evidence that behavioural factors influence health, but their combined impact on the general population is less well documented. We aimed to quantify the potential combined impact of four health behaviours on mortality in men and women living in the general community.
Methods and Findings
We examined the prospective relationship between lifestyle and mortality in a prospective population study of 20,244 men and women aged 45–79 y with no known cardiovascular disease or cancer at baseline survey in 1993–1997, living in the general community in the United Kingdom, and followed up to 2006. Participants scored one point for each health behaviour: current non-smoking, not physically inactive, moderate alcohol intake (1–14 units a week) and plasma vitamin C >50 mmol/l indicating fruit and vegetable intake of at least five servings a day, for a total score ranging from zero to four. After an average 11 y follow-up, the age-, sex-, body mass–, and social class–adjusted relative risks (95% confidence intervals) for all-cause mortality(1,987 deaths) for men and women who had three, two, one, and zero compared to four health behaviours were respectively, 1.39 (1.21–1.60), 1.95 (1.70–-2.25), 2.52 (2.13–3.00), and 4.04 (2.95–5.54)
Conclusions
Four health behaviours combined predict a 4-fold difference in total mortality in men and women, with an estimated impact equivalent to 14 y in chronological age
LINK:
"http://medicine.plosjournals.org/perlserv/?request=index-html&issn=1549-1676
Friday, January 4, 2008
Recent respiratory infection and risk of cardiovascular disease: case-control study through a general practice database.
Recent respiratory infection and risk of cardiovascular disease: case-control study through a general practice database.
European Heart Journal
Volume 29, Number 1 : January 2008
Aims: Respiratory infection may be associated with an increased risk of major cardiovascular events. This case-control study describes associations with these events of respiratory infection.
Methods and results: The IMS Disease Analyzer Mediplus primary care database was used to identify all cases of first-time diagnosis of myocardial infarction (MI) or stroke and single matched controls. Details were extracted on visits for respiratory infection over the preceding year. A total of 11 155 MI cases and 9208 stroke cases were identified. For MI and stroke respectively, there were 326 and 260 respiratory infections during the month preceding the index date. There was strong evidence of an increased risk of both events in the 7 days following infection, for MI adjusted odds ratio (OR) 2.10 (95% confidence interval 1.38–3.21), for stroke OR 1.92 (95% confidence interval 1.24–2.97). The strength of these associations fell over time. The associations for MI occurred at all levels of initial underlying cardiovascular risk.
Conclusions: There are strong associations between recent respiratory infection and major cardiovascular events, for MI at all levels of underlying risk. The benefits of reducing respiratory infection either through immunization or treating or preventing infection may be substantial.
European Heart Journal
Volume 29, Number 1 : January 2008
Aims: Respiratory infection may be associated with an increased risk of major cardiovascular events. This case-control study describes associations with these events of respiratory infection.
Methods and results: The IMS Disease Analyzer Mediplus primary care database was used to identify all cases of first-time diagnosis of myocardial infarction (MI) or stroke and single matched controls. Details were extracted on visits for respiratory infection over the preceding year. A total of 11 155 MI cases and 9208 stroke cases were identified. For MI and stroke respectively, there were 326 and 260 respiratory infections during the month preceding the index date. There was strong evidence of an increased risk of both events in the 7 days following infection, for MI adjusted odds ratio (OR) 2.10 (95% confidence interval 1.38–3.21), for stroke OR 1.92 (95% confidence interval 1.24–2.97). The strength of these associations fell over time. The associations for MI occurred at all levels of initial underlying cardiovascular risk.
Conclusions: There are strong associations between recent respiratory infection and major cardiovascular events, for MI at all levels of underlying risk. The benefits of reducing respiratory infection either through immunization or treating or preventing infection may be substantial.
Subscribe to:
Posts (Atom)