ACCORD Trial Researchers Halt Intensive Glucose-Lowering After Increased Deaths
Researchers exploring the benefits of intensive versus standard glucose-lowering therapy have decided to end the trial's intensive treatment arm after interim analyses found higher mortality there.
The ACCORD researchers randomized 10,250 patients with type 2 diabetes averaging 10 years' duration and at high risk for cardiovascular disease to one of two treatment arms: the standard arm had a hemoglobin A1c target between 7% and 7.9%, and the intensive arm targeted levels under 6%. The trial's data and safety monitoring board recommended ending the intensive arm when it found increased all-cause mortality.
In a Wednesday news conference, researchers said that although the rates of nonfatal cardiovascular events were lower during intensive treatment, "if a heart attack did occur, it was more likely to be fatal." They also said that none of the study drugs used, including rosiglitazone, was conclusively implicated in the increased mortality.
Link: National Institutes of Health press release (Free)
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.
Wednesday, February 6, 2008
Incidence of Death and Acute Myocardial Infarction Associated With Stopping Clopidogrel After Acute Coronary Syndrome
Incidence of Death and Acute Myocardial Infarction Associated With Stopping Clopidogrel After Acute Coronary Syndrome
P. Michael Ho, MD, PhD; Eric D. Peterson, MD, MPH; Li Wang, MS; David J. Magid, MD, MPH; Stephan D. Fihn, MD, MPH; Greg C. Larsen, MD; Robert A. Jesse, MD, PhD; John S. Rumsfeld, MD, PhD
JAMA. 2008;299(5):532-539.
Context
It is unknown whether patients are at increased short-term risk for adverse events following clopidogrel cessation.
Objective
To assess the rates of adverse events after stopping treatment with clopidogrel in a national sample of patients with acute coronary syndrome (ACS).
Design, Setting, and Patients
Retrospective cohort study of 3137 patients with ACS discharged from 127 Veterans Affairs hospitals between October 1, 2003, and March 31, 2005, with posthospital treatment with clopidogrel.
Main Outcome Measure
Rate of all-cause mortality or acute myocardial infarction (AMI) after stopping treatment with clopidogrel.
Results
Mean (SD) follow-up after stopping treatment with clopidogrel was 196 (152) days for medically treated patients with ACS without stents (n = 1568) and 203 (148) days for patients with ACS treated with percutaneous coronary intervention (PCI) (n = 1569). Among medically treated patients, mean (SD) duration of clopidogrel treatment was 302 (151) days and death or AMI occurred in 17.1% (n = 268) of patients, with 60.8% (n = 163) of events occurring during 0 to 90 days, 21.3% (n = 57) during 91 to 180 days, and 9.7% (n = 26) during 181 to 270 days after stopping treatment with clopidogrel. In multivariable analysis including adjustment for duration of clopidogrel treatment, the first 90-day interval after stopping treatment with clopidogrel was associated with a significantly higher risk of adverse events (incidence rate ratio [IRR], 1.98; 95% confidence interval [CI], 1.46-2.69 vs the interval of 91-180 days). Similarly, among PCI-treated patients with ACS, mean (SD) duration of clopidogrel treatment was 278 (169) days and death or AMI occurred in 7.9% (n = 124) of patients, with 58.9% (n = 73) of events occurring during 0 to 90 days, 23.4% (n = 29) during 91 to 180 days, and 6.5% (n = 8) during 181 to 270 days after stopping clopidogrel treatment. In multivariable analysis including adjustment for duration of clopidogrel treatment, the first 90-day interval after stopping clopidogrel treatment was associated with a significantly higher risk of adverse events (IRR, 1.82; 95% CI, 1.17-2.83).
Conclusions
'
P. Michael Ho, MD, PhD; Eric D. Peterson, MD, MPH; Li Wang, MS; David J. Magid, MD, MPH; Stephan D. Fihn, MD, MPH; Greg C. Larsen, MD; Robert A. Jesse, MD, PhD; John S. Rumsfeld, MD, PhD
JAMA. 2008;299(5):532-539.
Context
It is unknown whether patients are at increased short-term risk for adverse events following clopidogrel cessation.
Objective
To assess the rates of adverse events after stopping treatment with clopidogrel in a national sample of patients with acute coronary syndrome (ACS).
Design, Setting, and Patients
Retrospective cohort study of 3137 patients with ACS discharged from 127 Veterans Affairs hospitals between October 1, 2003, and March 31, 2005, with posthospital treatment with clopidogrel.
Main Outcome Measure
Rate of all-cause mortality or acute myocardial infarction (AMI) after stopping treatment with clopidogrel.
Results
Mean (SD) follow-up after stopping treatment with clopidogrel was 196 (152) days for medically treated patients with ACS without stents (n = 1568) and 203 (148) days for patients with ACS treated with percutaneous coronary intervention (PCI) (n = 1569). Among medically treated patients, mean (SD) duration of clopidogrel treatment was 302 (151) days and death or AMI occurred in 17.1% (n = 268) of patients, with 60.8% (n = 163) of events occurring during 0 to 90 days, 21.3% (n = 57) during 91 to 180 days, and 9.7% (n = 26) during 181 to 270 days after stopping treatment with clopidogrel. In multivariable analysis including adjustment for duration of clopidogrel treatment, the first 90-day interval after stopping treatment with clopidogrel was associated with a significantly higher risk of adverse events (incidence rate ratio [IRR], 1.98; 95% confidence interval [CI], 1.46-2.69 vs the interval of 91-180 days). Similarly, among PCI-treated patients with ACS, mean (SD) duration of clopidogrel treatment was 278 (169) days and death or AMI occurred in 7.9% (n = 124) of patients, with 58.9% (n = 73) of events occurring during 0 to 90 days, 23.4% (n = 29) during 91 to 180 days, and 6.5% (n = 8) during 181 to 270 days after stopping clopidogrel treatment. In multivariable analysis including adjustment for duration of clopidogrel treatment, the first 90-day interval after stopping clopidogrel treatment was associated with a significantly higher risk of adverse events (IRR, 1.82; 95% CI, 1.17-2.83).
Conclusions
'
Tuesday, February 5, 2008
Interpreting risks and ratios in therapy trials
Australian Prescriber - Interpreting risks and ratios in therapy trials
Summary
To appreciate the significance of clinical trial results, clinicians need to understand the mathematical language used to describe treatment effects. When comparing intervention and control groups in a trial, results may be reported in terms of relative or absolute risk (or probability), or as more statistically sophisticated entities based on odds and hazard ratios. When events in the intervention group are significantly less frequent than in the control group, then relative risk, odds ratio and hazard ratio (and their confidence intervals) will be less than 1.0. If the converse holds true, these values will be greater than 1.0.
Summary
To appreciate the significance of clinical trial results, clinicians need to understand the mathematical language used to describe treatment effects. When comparing intervention and control groups in a trial, results may be reported in terms of relative or absolute risk (or probability), or as more statistically sophisticated entities based on odds and hazard ratios. When events in the intervention group are significantly less frequent than in the control group, then relative risk, odds ratio and hazard ratio (and their confidence intervals) will be less than 1.0. If the converse holds true, these values will be greater than 1.0.
Pharmacological interventions for hypertensive emergencies - Cochrane Reviews, 01/24/08
Pharmacological interventions for hypertensive emergencies
Review
MI Perez, VM Musini
Cochrane Database of Systematic Reviews 2008 Issue 1 (Status: New) Copyright © 2008 The Cochrane Collaboration.
Abstract
Background
Hypertensive emergencies, marked hypertension associated with acute end-organ damage, are life-threatening conditions. Many anti-hypertensive drugs have been used in these clinical settings. The benefits and harms of such treatment and the best first-line treatment are not known.
Objectives
To answer the following two questions using randomized controlled trials (RCTs):
1) does anti-hypertensive drug therapy as compared to placebo or no treatment affect mortality and morbidity in patients presenting with a hypertensive emergency?
2) Does one first-line antihypertensive drug class as compared to another antihypertensive drug class affect mortality and morbidity in these patients?
Search strategy
Electronic sources: MEDLINE, EMBASE, Cochrane clinical trial register. In addition, we searched for references in review articles and trials. We attempted to contact trialists. Most recent search August 2007.
Selection criteria
All unconfounded, truly randomized trials that compare an antihypertensive drug versus placebo, no treatment, or another antihypertensive drug from a different class in patients presenting with a hypertensive emergency.
Data collection and analysis
Quality of concealment allocation was scored. Data on randomized patients, total serious adverse events, all-cause mortality, non-fatal cardiovascular events, withdrawals due to adverse events, length of follow-up, blood pressure and heart rate were extracted independently and cross checked.
Main results
Fifteen randomized controlled trials (representing 869 patients) met the inclusion criteria.
Two trials included a placebo arm. All studies (except one) were open-label trials. Seven drug classes were evaluated in those trials: nitrates (9 trials), ACE-inhibitors (7), diuretics (3), calcium channel blockers (6), alpha-1 adrenergic antagonists (4), direct vasodilators (2) and dopamine agonists (1).
Mortality event data were reported in 7 trials. No meta-analysis was performed for clinical outcomes, due to insufficient data. The pooled effect of 3 different anti-hypertensive drugs in one placebo-controlled trial showed a statistically significant greater reduction in both systolic [WMD -13, 95%CI -19,-7] and diastolic [WMD -8, 95%CI, -12,-3] blood pressure with antihypertensive therapy.
Authors' conclusions
There is no RCT evidence demonstrating that anti-hypertensive drugs reduce mortality or morbidity in patients with hypertensive emergencies. Furthermore, there is insufficient RCT evidence to determine which drug or drug class is most effective in reducing mortality and morbidity. There were some minor differences in the degree of blood pressure lowering when one class of antihypertensive drug is compared to another. However, the clinical significance is unknown. RCTs are needed to assess different drug classes to determine initial and longer term mortality and morbidity outcomes.
Plain language summary
Hypertensive emergencies occur when high blood pressure is associated with the presence of acute end organ damage, such as heart attack or stroke. There is controversy as to when and which blood pressure drugs to use in these situations. This review looked for all studies where patients were randomized to one or more treatments to measure the effects of such therapies. The questions of the review were to see whether drug treatments affected death or cardiovascular morbidity or whether there were differences between drug treatments. The available evidence was insufficient to answer these questions.
Review
MI Perez, VM Musini
Cochrane Database of Systematic Reviews 2008 Issue 1 (Status: New) Copyright © 2008 The Cochrane Collaboration.
Abstract
Background
Hypertensive emergencies, marked hypertension associated with acute end-organ damage, are life-threatening conditions. Many anti-hypertensive drugs have been used in these clinical settings. The benefits and harms of such treatment and the best first-line treatment are not known.
Objectives
To answer the following two questions using randomized controlled trials (RCTs):
1) does anti-hypertensive drug therapy as compared to placebo or no treatment affect mortality and morbidity in patients presenting with a hypertensive emergency?
2) Does one first-line antihypertensive drug class as compared to another antihypertensive drug class affect mortality and morbidity in these patients?
Search strategy
Electronic sources: MEDLINE, EMBASE, Cochrane clinical trial register. In addition, we searched for references in review articles and trials. We attempted to contact trialists. Most recent search August 2007.
Selection criteria
All unconfounded, truly randomized trials that compare an antihypertensive drug versus placebo, no treatment, or another antihypertensive drug from a different class in patients presenting with a hypertensive emergency.
Data collection and analysis
Quality of concealment allocation was scored. Data on randomized patients, total serious adverse events, all-cause mortality, non-fatal cardiovascular events, withdrawals due to adverse events, length of follow-up, blood pressure and heart rate were extracted independently and cross checked.
Main results
Fifteen randomized controlled trials (representing 869 patients) met the inclusion criteria.
Two trials included a placebo arm. All studies (except one) were open-label trials. Seven drug classes were evaluated in those trials: nitrates (9 trials), ACE-inhibitors (7), diuretics (3), calcium channel blockers (6), alpha-1 adrenergic antagonists (4), direct vasodilators (2) and dopamine agonists (1).
Mortality event data were reported in 7 trials. No meta-analysis was performed for clinical outcomes, due to insufficient data. The pooled effect of 3 different anti-hypertensive drugs in one placebo-controlled trial showed a statistically significant greater reduction in both systolic [WMD -13, 95%CI -19,-7] and diastolic [WMD -8, 95%CI, -12,-3] blood pressure with antihypertensive therapy.
Authors' conclusions
There is no RCT evidence demonstrating that anti-hypertensive drugs reduce mortality or morbidity in patients with hypertensive emergencies. Furthermore, there is insufficient RCT evidence to determine which drug or drug class is most effective in reducing mortality and morbidity. There were some minor differences in the degree of blood pressure lowering when one class of antihypertensive drug is compared to another. However, the clinical significance is unknown. RCTs are needed to assess different drug classes to determine initial and longer term mortality and morbidity outcomes.
Plain language summary
Hypertensive emergencies occur when high blood pressure is associated with the presence of acute end organ damage, such as heart attack or stroke. There is controversy as to when and which blood pressure drugs to use in these situations. This review looked for all studies where patients were randomized to one or more treatments to measure the effects of such therapies. The questions of the review were to see whether drug treatments affected death or cardiovascular morbidity or whether there were differences between drug treatments. The available evidence was insufficient to answer these questions.
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
Friday, February 1, 2008
The Association Between Physical Activity in Leisure Time and Leukocyte Telomere Length, January 28, 2008, Cherkas et al. 168 (2): 154
Arch Intern Med -- Abstract: The Association Between Physical Activity in Leisure Time and Leukocyte Telomere Length, January 28, 2008, Cherkas et al. 168 (2): 154
A sedentary lifestyle (in addition to smoking, high body mass index, and low socioeconomic status) has an effect on LTL and may accelerate the aging process. This provides a powerful message that could be used by clinicians to promote the potentially antiaging effect of regular exercise.
A sedentary lifestyle (in addition to smoking, high body mass index, and low socioeconomic status) has an effect on LTL and may accelerate the aging process. This provides a powerful message that could be used by clinicians to promote the potentially antiaging effect of regular exercise.
The combined influence of leisure-time physical activity and weekly alcohol intake on fatal ischaemic heart disease and all-cause mortality -- Pedersen et al. 29 (2): 204 -- European Heart Journal
The combined influence of leisure-time physical activity and weekly alcohol intake on fatal ischaemic heart disease and all-cause mortality -- Pedersen et al. 29 (2): 204 -- European Heart Journal
Physically active individuals who drink moderately have a lower risk for fatal ischemic heart disease (IHD) and all-cause mortality than those who abstain and are physically inactive, Danish researchers report.
Physically active individuals who drink moderately have a lower risk for fatal ischemic heart disease (IHD) and all-cause mortality than those who abstain and are physically inactive, Danish researchers report.
COX-2 inhibitor may disrupt heart rhythm
MedWire News - Cardiology - COX-2 inhibitor may disrupt heart rhythm
Gene Linked To Increased Risk Of Developing Inflammatory Arthritis May Also Increase Patients' Risk Of Dying From Cardiovascular Disease
Gene Linked To Increased Risk Of Developing Inflammatory Arthritis May Also Increase Patients' Risk Of Dying From Cardiovascular Disease
Gene Linked To Increased Risk Of Developing Inflammatory Arthritis May Also Increase Patients' Risk Of Dying From Cardiovascular Disease
Medical News Today News Article: "Gene Linked To Increased Risk Of Developing Inflammatory Arthritis May Also Increase Patients' Risk Of Dying From Cardiovascular Disease
01 Feb 2008
People with rheumatoid arthritis (RA), an inflammatory autoimmune disease, tend to die younger and, largely from cardiovascular disease (CVD). One explanation for this increasingly recognized fact is that inflammation promotes atherosclerosis. A marker of inflammation, elevation of the C-reactive protein (CRP) level has been shown to predict CVD in the general population. However, other highly inflammatory diseases - Crohn's, for example - do not carry the same high risk of premature death from heart disease.
To identify other possible suspects, researchers in the United Kingdom investigated whether genetic variants linked to the likelihood of developing RA might also make patients more likely to die from CVD. Led by Dr. Tracey M. Farragher at the University of Manchester and funded by the Arthritis Research Campaign (arc), the study focused on two genes - HLA-DRB1and PTPN22 - and their interactions with known RA risk factors. The evidence, presented in the February 2008 issue of Arthritis & Rheumatism (http://www.interscience.wiley.com/journal/arthritis), implicates HLA-DRB1 genotypes, already associated with RA susceptibility and severity, as a predictor of premature death from CVD for inflammatory arthritis patients. For RA patients in particular, having the shared epitope (SE) - a group of HLA-DRB1 alleles with kindred amino acid traits - plus anti-cyclic citrullinated peptide (anti-CCP) antibodies and current smoking is an especially deadly combination."
01 Feb 2008
People with rheumatoid arthritis (RA), an inflammatory autoimmune disease, tend to die younger and, largely from cardiovascular disease (CVD). One explanation for this increasingly recognized fact is that inflammation promotes atherosclerosis. A marker of inflammation, elevation of the C-reactive protein (CRP) level has been shown to predict CVD in the general population. However, other highly inflammatory diseases - Crohn's, for example - do not carry the same high risk of premature death from heart disease.
To identify other possible suspects, researchers in the United Kingdom investigated whether genetic variants linked to the likelihood of developing RA might also make patients more likely to die from CVD. Led by Dr. Tracey M. Farragher at the University of Manchester and funded by the Arthritis Research Campaign (arc), the study focused on two genes - HLA-DRB1and PTPN22 - and their interactions with known RA risk factors. The evidence, presented in the February 2008 issue of Arthritis & Rheumatism (http://www.interscience.wiley.com/journal/arthritis), implicates HLA-DRB1 genotypes, already associated with RA susceptibility and severity, as a predictor of premature death from CVD for inflammatory arthritis patients. For RA patients in particular, having the shared epitope (SE) - a group of HLA-DRB1 alleles with kindred amino acid traits - plus anti-cyclic citrullinated peptide (anti-CCP) antibodies and current smoking is an especially deadly combination."
Subscribe to:
Posts (Atom)