Daily Doses of a New Probiotic Reduces 'Bad' and Total Cholesterol

Two daily doses of a probiotic lowered key cholesterol-bearing molecules in the blood as well as "bad" and total cholesterol, in a study presented at the American Heart Association's Scientific Sessions 2012.

Probiotics are live microorganisms (naturally occurring bacteria in the gut) thought to have beneficial effects; common sources are yogurt or dietary supplements.

In previous studies, a formulation of the bacteria, known as Lactobacillus reuteri NCIMB 30242, has lowered blood levels of LDL or "bad" cholesterol.

Such treatments are drawing increasing medical attention as researchers unravel how supplementing gut bacteria (microbiome) with probiotics can play a role in health and certain chronic diseases such as heart disease, said Mitchell L. Jones, M.D., Ph.D., lead author of the study and a research assistant in the Faculty of Medicine at McGill University in Montreal.

Researchers investigated whether the same probiotic could lower LDL and reduce blood levels of cholesterol esters -- molecules of cholesterol attached to fatty acids, a combination that accounts for most total blood cholesterol and has been tied to cardiovascular disease risk.

Researchers tracked cholesterol esters bound to saturated fat, which have been linked to dangerous arterial plaque buildup and occur at higher levels in coronary artery disease patients.

The study involved 127 adult patients with high cholesterol. About half the participants took L. reuteriNCIMB 30242 twice a day, while the rest were given placebo capsules.

Those taking the probiotic had LDL levels 11.6 percent lower than those on placebo after nine weeks. Furthermore, cholesterol esters were reduced by 6.3 percent and cholesterol ester saturated fatty acids by 8.8 percent, compared with the placebo group.

For the first time, research shows that the probiotic formulation can reduce cholesterol esters "and in particular reduce the cholesterol esters associated with 'bad' saturated fatty acids in the blood," said Jones, co-founder and chief science officer of Micropharma, the company that formulated the probiotic.

Furthermore, people taking the probiotic had total cholesterol reduced by 9.1 percent. HDL "good" cholesterol and blood triglycerides, a dangerous form of fat in the blood, were unchanged.

Scientists have proposed that Lactobacillus bacteria alone may impact cholesterol levels in several ways, including breaking apart molecules known as bile salts. L. reuteri NCIMB 30242 was fermented and formulated to optimize its effect on cholesterol and bile salts.

Based on correlations between LDL reduction and bile measurements in the gut, the study results suggest the probiotic broke up bile salts, leading to reduced cholesterol absorption in the gut and less LDL.

The probiotic worked at doses of just 200 milligrams a day, far lower than those for soluble fiber or other natural products used to reduce cholesterol.

"Most dietary cholesterol management products require consumption between 2 to 25 grams a day," Jones said.

Patients appear to tolerate the probiotic well and the probiotic strain L. reuteri has a long history of safe use, he said.

Because of the small number of patients involved in the study, researchers aren't sure if the impact of the probiotic differs between men and women or among ethnic groups.

American Heart Association. "Daily doses of a new probiotic reduces 'bad' and total cholesterol." ScienceDaily, 5 Nov. 2012. Web. 18 Dec. 2012.

Multivitamins Fail, But Novel Lipid Tx Promising

 Day two at the American Heart Association meeting featured the latest findings from researchers for the Physicians' Health Study II and promising, but very early results, from a study of an investigational lipid-lowering antibody treatment, a pair of findings highlighted in this exclusive InFocus video report.

Harvard's Elliott Antman, MD, who chaired the scientific program here, said it is not surprising that daily vitamin therapy did not reduce the risk of cardiovascular events in a population of healthy men, who also happen to be physicians. And, he noted, that the same researchers recently reported that the daily vitamins did slightly reduce the risk for developing cancer.

More promising findings came from studies of an investigational antibody treatment for dyslipidemia -- a PCSK9 inhibitor known now as AMG 145 -- that achieved significant reductions in LDL among patients who can't tolerate statin therapy and those with heterozygous familial hypercholesterolemia. The antibody treatment is given subcutaneously and that may present a challenge, Antman told Peggy Peck, MedPage Today Editor-in-Chief.

From the American Heart Association:

• AHA Science News: Scientific Sessions 2012

Daily Multivitamin Use Among Men Does Not Reduce Risk of Major Cardiovascular Events, Study Suggests

In a randomized study that included nearly 15,000 male physicians who were middle-aged or older, daily multivitamin use for more than 10 years of treatment and follow-up did not result in a reduction of major cardiovascular events, heart attack, stroke, or death from cardiovascular disease, according to a study appearing in November 7 issue of JAMA, a theme issue on cardiovascular disease.

"Despite uncertainty regarding the long-term health benefits of vitamins, many U.S. adults take vitamin supplements to prevent chronic diseases or for general health and well-being," according to background information in the article. Individuals who believe they are deriving benefits from supplements may be less likely to engage in other preventive health behaviors. "Although multivitamins are used prevent vitamin and mineral deficiency, there is a perception that multivitamins may prevent cardiovascular disease (CVD). Observational studies have shown inconsistent associations between regular multivitamin use and CVD, with no long-term clinical trials of multivitamin use."

Howard D. Sesso, Sc.D., M.P.H., of Brigham and Women's Hospital and Harvard Medical School, Boston, and colleagues analyzed data regarding multivitamin use and major cardiovascular events from the Physicians' Health Study (PHS) II, a large-scale trial testing the effects of long-term use of a common multivitamin on the risk of major cardiovascular events and cancer. The Physicians' Health Study II is a randomized, placebo-controlled trial that began in 1997 with continued treatment and follow-up through June 1, 2011. A total of 14,641 male U.S. physicians initially 50 years of age or older (average, 64 years), including 754 men with a history of CVD at randomization, were enrolled. This analysis measured the composite end point of major cardiovascular events, including nonfatal myocardial infarction (MI; heart attack), nonfatal stroke, and death from CVD. Secondary outcomes included heart attack and stroke individually. Participants were randomized to multivitamin (n = 7,317) or placebo (n = 7,324).

During a median (midpoint) follow-up of 11.2 years, 1,732 men had major cardiovascular events, including 652 cases (first events) of heart attack and 643 cases of stroke, and 829 men had cardiovascular death, with some men experiencing multiple events. A total of 2,757 (18.8 percent) men died during follow-up (multivitamin, n = 1,345; placebo, n = 1,412). In an analysis of the rate of events for men in each group, the researchers found that there was no significant effect of a daily multivitamin on major cardiovascular events, or total MI or total stroke. Taking a daily multivitamin was not significantly associated with a reduction in CVD mortality. There were fewer total deaths among multivitamin users, but this difference was not statistically significant.

The authors also found no significant effect of a daily multivitamin on rates of congestive heart failure, angina, and coronary revascularization. Also, the effect of a daily multivitamin on total MI, total stroke, and other cardiovascular end points did not differ between men with and without CVD at the beginning of the study.

"The PHS II represents to our knowledge the only large-scale, randomized, double-blind, placebo-controlled trial testing the long-term effects of a commonly available multivitamin in the prevention of chronic disease," the authors write. "These data do not support multivitamin use to prevent CVD, demonstrating the importance of long-term clinical trials of commonly used nutritional supplements. Whether to take a daily multivitamin requires consideration of an individual's nutritional status, because the aim of supplementation is to prevent vitamin and mineral deficiency, plus consideration of other potential effects, including a modest reduction in cancer and other important outcomes in PHS II that will be reported separately."

Editorial: Multivitamins in Prevention of Cardiovascular Disease

In an accompanying editorial, Eva M. Lonn, M.D., M.Sc., of McMaster University and Hamilton General Hospital, Hamilton, Ontario, Canada, writes that "robust data from multiple trials clearly confirm that CVD cannot be prevented or treated with vitamins."

"Nonetheless, many people with heart disease risk factors or previous CVD events lead sedentary lifestyles, eat processed or fast foods, continue to smoke, and stop taking lifesaving prescribed medications, but purchase and regularly use vitamins and other dietary supplements, in the hope that this approach will prevent a future myocardial infarction or stroke. This distraction from effective CVD prevention is the main hazard of using vitamins and other unproven supplements. The message needs to remain simple and focused: CVD is largely preventable, and this can be achieved by eating healthy foods, exercising regularly, avoiding tobacco products, and, for those with high risk factor levels or previous CVD events, taking proven, safe, and effective medications."

JAMA and Archives Journals. "Daily multivitamin use among men does not reduce risk of major cardiovascular events, study suggests." ScienceDaily, 5 Nov. 2012. Web. 18 Dec. 2012.

Aromatherapy: Two Hours Is Too Much

Aromatherapy can help patients relax by initially reducing heart rate and blood pressure significantly, but those benefits may be reversed if exposure lasts more than an hour, researchers found.

Presence of essential oil vapor -- the vapor from aromatherapy -- was significantly associated with reduced blood pressure and heart rate from 15 minutes to 60 minutes after exposure (P<0 .05=".05" a="a" according="according" among="among" and="and" chuang="chuang" colleagues.="colleagues." healthy="healthy" in="in" kai-jen="kai-jen" medical="medical" of="of" p="p" phd="phd" sample="sample" spa="spa" taipei="taipei" taiwan="taiwan" to="to" university="university" workers="workers">

However, exposure to the oil vapor for periods of 90 to 120 minutes was significantly associated with increased blood pressure and heart rate (P<0 .05=".05" em="em" in="in" online="online" style="border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;" the="the" they="they" wrote="wrote">European Journal of Preventive Cardiology

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"The inhalation of air pollutants has been reported to induce pulmonary oxidative stress, inflammation, and autonomic dysfunction," they noted, adding that those "biological processes may also be applied to the adverse effects of the total volatile organic compound exposure on cardiovascular health."

The researchers analyzed associations between heart and blood pressure with oil vapors generated by an aromatherapy machine known as an ultrasonic atomizer in 100 healthy, nonsmoking Taiwanese spa workers. Participants were mostly female (51%); younger (average age 22.5); and had an average heart rate of 71.2 beats/minute, an average systolic blood pressure of 123.5 mmHg, and an average diastolic blood pressure of 84.1 mmHg.

Each participant received a baseline screening and was exposed to essential oil vapor for 2 hours at three study site visits. During the 2-hour exposures, participant blood pressure and heart rate were recorded at 15-minute intervals. The researchers also measured levels of volatile organic compound -- the aromatherapy oils -- in the environment during the 2-hour period at 1-minute intervals.

Average levels of volatile organic compounds were 82.2 parts per billion, and levels of aromatherapy oils, blood pressure, heart rate, and study room humidity and temperature did not vary significantly between visits.

Mean declines in blood pressure and heart rate were greatest at 45 minutes into the aromatherapy sessions, with systolic blood pressure lowered by an average 2.10 mmHg (95% CI -1.40 to -2.80), diastolic blood pressure lowered by an average 1.30 mmHg (95% CI -0.70 to -1.90), and heart rate lowered by an average 2.21 beats/minute (95% CI -1.61 to -2.81), which were significant at P<0 .05.=".05." p="p">

Declines in systolic blood pressure and heart rate were smallest at 15 minutes, while diastolic blood pressure declines were smallest at 60 minutes.

At 90 minutes to 120 minutes, heart rate and blood pressure were significantly higher (P<0 --="--" .05=".05" 0.66="0.66" 0.79="0.79" 0.93="0.93" 1.70="1.70" 1.79="1.79" 120="120" 2.19="2.19" 2.47="2.47" 2.86="2.86" 3.59="3.59" all="all" and="and" at="at" beats="beats" blood="blood" by="by" ci="ci" diastolic="diastolic" elevated="elevated" heart="heart" highest="highest" mean="mean" minute="minute" minutes="minutes" mmhg="mmhg" p="p" pressure="pressure" raised="raised" rate="rate" systolic="systolic" to="to" was="was" were="were">

They concluded that 1-hour aromatherapy exposure "could be a useful method of stress relief," but that prolonged exposure for over an hour "may be harmful to cardiovascular health in young, healthy subjects."

They added that future studies could measure long-term cardiopulmonary and psychological outcomes of vaporized essential oil exposure.

The authors noted that the study was limited by missing measures for other possible environmental air pollutants, limited intra-individual measures, additional unmeasured confounders, relevance of short-term heart rate and blood pressure effects on long-term outcomes, and limited numbers of measures from participants.

Tomado de Medpagetoday.com  : Chuang KJ, et al "The effect of essential oil on heart rate and blood pressure among solus por aqua workers" Eur J Prev Cardiol 2012; DOI: 10.1177/2047487312469474.

Sleep Duration Affects Hunger Differently in Men and Women

A new study suggests that increasing the amount of sleep that adults get could lead to reduced food intake, but the hormonal process differs between men and women.

"Restricting sleep in healthy, normal weight participants has limited effects on metabolic risk factors and may affect food intake regulating hormones differently in men and women," said Marie-Pierre St-Onge, PhD, FAHA, the study's principal investigator. "We were surprised by the lack of a significant effect of sleep on glucose and insulin, leptin, and sex differences in the hunger-stimulating hormone ghrelin and the satiety hormone GLP-1."

The study, appearing in the November issue of the journal Sleep, tracked the sleep duration, glucose dysregulation, and hormonal regulation of appetite in 27 normal weight, 30- to 45-year-old men and women. Participants provided fasting blood draws, and they were studied under two sleep conditions: Short (4 hours) or habitual (9 hours). Short sleep increased total ghrelin levels in men but not women and reduced GLP-1 levels in women but not in men, a sex difference that has not been reported before. The results suggest that the common susceptibility to overeat during short sleep is related to increased appetite in men and reduced feelings of fullness in women.

"Our results point to the complexity of the relationship between sleep duration and energy balance regulation," St-Onge said. "The state of energy balance, whether someone is in a period of weight loss or weight gain, may be critical in the metabolic and hormonal responses to sleep restriction."

According to the authors, this is the largest controlled clinical investigation of the effects of sleep reduction on hormonal regulation of food intake. The results support a causal role of sleep duration on energy intake and weight control.

American Academy of Sleep Medicine (AASM). "Sleep duration affects hunger differently in men and women." ScienceDaily, 29 Nov. 2012. Web. 5 Dec. 2012.

Target for Obesity Drugs Comes Into Focus

      Researchers at the University of Michigan have determined how the hormone leptin, an important regulator of metabolism and body weight, interacts with a key receptor in the brain.

Leptin is a hormone secreted by fat tissue that has been of interest for researchers in obesity and Type 2 diabetes since it was discovered in 1995. Like insulin, leptin is part of a regulatory network that controls intake and expenditure of energy in the body, and a lack of leptin or resistance to it has been linked to obesity in people.

Although there can be several complex reasons behind leptin resistance, in some cases the underlying cause is malfunction of the leptin receptor in the brain. An understanding of how leptin and its receptor interact could lead to new treatments for obesity and metabolic disorders, but the structure of this signaling complex has evaded researchers for years.

Georgios Skiniotis, a faculty member at the Life Sciences Institute and assistant professor in biological chemistry at the U-M Medical School, employed electron microscopy to obtain the first picture of the interaction between leptin and its receptor.

Skiniotis also traced similarities between the leptin receptor and other receptors of the same family, which may provide insight into new targets for treatment of other hormone-related diseases.

"It is exciting not only because it might help with developing new drugs," Skiniotis said. "We now better understand the design and mechanisms of signaling through this class of receptors, which brings us to a whole new set of intriguing questions."

In the paper "Ligand-Induced Architecture of the Leptin Receptor Signaling Complex," published electronically ahead of print on Oct. 11 in Molecular Cell, Skiniotis and his co-authors explain how the receptor is formed by two hinged legs that can swivel until they encounter leptin, which binds to the legs and makes them rigid.

Once the two legs of a receptor become rigid by binding to leptin, they signal to an enzyme called the Janus kinase. A number of drugs have been studied for treatments related to the Janus kinases; inhibiting it may lead to improvement of conditions like rheumatoid arthritis, psoriasis and metabolic disorders that are linked to inflammation.

Alan Saltiel, director of the Life Sciences Institute and a widely cited researcher who works on diabetes, obesity and metabolic disorders, sees a range of possibilities in the work of Skiniotis.

"This study may help solve an important issue we've been struggling with for some time," he said. "Since leptin is a master regulator of appetite, understanding why resistance to its effects develops in obesity has been a major obstacle to discovering new drugs for obesity and diabetes. Developing a clear picture of how leptin can bind to its receptor may be the first step in overcoming leptin resistance."

Tomado de: University of Michigan. "Target for obesity drugs comes into focus." ScienceDaily, 11 Oct. 2012. Web. 28 Nov. 2012.

New Antibiotic Cures Disease by Disarming Pathogens, Not Killing Them

 A new type of antibiotic can effectively treat an antibiotic-resistant infection by disarming instead of killing the bacteria that cause it. Researchers report their findings in the October 2 issue of mBio®, the online open-access journal of the American Society for Microbiology.

"Traditionally, people have tried to find antibiotics that rapidly kill bacteria. But we found a new class of antibiotics which has no ability to kill Acinetobacter that can still protect, not by killing the bug, but by completely preventing it from turning on host inflammation," says Brad Spellberg of the UCLA Medical Center and David Geffen School of Medicine, a researcher on the study.

New drugs are badly needed for treating infections with the bacteriumAcinetobacter baumannii, a pathogen that most often strikes hospital patients and immune- compromised individuals through open wounds, breathing tubes, or catheters. The bacterium can cause potentially lethal bloodstream infections. Strains of A. baumannii have acquired resistance to a wide range of antibiotics, and some are resistant to every FDA-approved antibiotic, making them untreatable.

Spelling and his colleagues found that in laboratory mice it was possible to mitigate the potentially lethal effects of the bacterium by blocking one of its toxic products rather than killing it.

"We found that strains that caused the rapidly lethal infections shed lipopolysaccharide [also called LPS or endotoxin] while growing. The more endotoxin shed, the more virulent the strain was," says Spellberg. This pinpointed a new therapy target for the researchers: the endotoxin these bacteria shed in the body.

Blocking the synthesis of the endotoxin with a small molecule called LpxC-1 prevented infected mice from getting sick. Unlike traditional antibiotics, Spellberg says, LpxC-1 doesn't kill the bacteria, it just shuts down the manufacture of the endotoxin and stops the body from mounting the inflammatory immune response to it that is the actual cause of death in seriously ill patients.

Spellberg says this is a direction few researchers have taken when exploring ways to treat infections but that it could make the difference in finding an effective drug. The results also highlight how important it is to find new, physiologically relevant ways of screening potential antibiotics for pathogens with a high degree of resistance, write the authors. Molecules like LpxC-1 that inhibit rather than kill bacteria wouldn't pass muster with traditional antibiotic screens that are based on killing effectiveness.

Liise-anne Pirofski of the Albert Einstein College of Medicine and a reviewer of the study for mBio® says neutralizing virulence factors is showing a lot of promise as an alternative route for treating infections. "There's a growing movement in infectious disease therapy to control the host inflammation response in treatment rather than just 'murdering' the organism," says Pirofski. "This is a very elegant and important validation that this approach can work -- at least in mice."

American Society for Microbiology. "New antibiotic cures disease by disarming pathogens, not killing them." ScienceDaily, 2 Oct. 2012. Web. 8 Nov. 2012.

Exercise Does a Body -- And a Mind -- Good

We've heard it time and time again: exercise is good for us. And it's not just good for physical health -- research shows that daily physical activity can also boost our mental health. But what actually accounts for the association between exercise and mental health?

A new article in Clinical Psychological Science, a journal of the Association for Psychological Science, explores whether certain psychosocial factors may help to explain the benefits of daily physical activity for adolescents' mental health.

Karin Monshouwer of the Trimbos Institute in the Netherlands and colleagues at Trimbos and VU University Medical Center specifically wanted to examine two existing explanations for the link between exercise and mental health. The self-image hypothesis suggests that physical activity has positive effects on body weight and body structure, leading to positive feedback from peers and improved self-image, and ultimately improving mental health. The social interaction hypothesis, on the other hand, holds that it's the social aspects of physical activity -- such as social relationships and mutual support among team members -- that contribute to the positive effects of exercise on mental health.

Monshouwer and her colleagues surveyed over 7000 Dutch students, ages 11 to 16. The adolescents completed validated surveys aimed at assessing their physical activity, mental health problems, body weight perception, and participation in organized sports. The researchers also gathered data on the adolescents' age, gender, and socioeconomic status; whether they lived at home with their parents; and whether they lived in an urban area.

The researchers found that adolescents who were physically inactive or who perceived their bodies as either "too fat" or "too thin" were at greater risk for both internalizing problems (e.g., depression, anxiety) and externalizing problems (e.g., aggression, substance abuse). Adolescents who participated in organized sports, on the other hand, were at lower risk for mental health problems.

Confirming both the self-image hypothesis and the social interaction hypothesis, adolescents' body weight perception (i.e., "too heavy," "good," or "too thin") and sports club membership each partially accounted for the relationship between physical activity and mental health, even after taking adolescents' backgrounds into account.

These results suggest that certain psychosocial factors -- body image and social interaction -- may help to explain at least part of the connection between physical activity and mental health. The researchers acknowledge, however, that other factors, such as the physiological effects of exercise, are probably also at work.

"We think that these findings are important for policymakers and anyone who works in healthcare or prevention. Our findings indicate that physical activity may be one effective tool for the prevention of mental health problems in adolescence," says Monshouwer.

Monshouwer and her colleagues hope that future studies will be able to examine similar questions while following participants over time. Such longitudinal studies could help researchers to understand how physical activity type and context might influence the relationship between exercise and mental health.

Association for Psychological Science. "Exercise does a body -- and a mind -- good."ScienceDaily, 25 Sep. 2012. Web. 5 Nov. 2012

Estatinas y riesgo de diabetes: más datos

      La utilización de estatinas se relacionó con un leve incremento de las concentraciones de glucosa en ayunas de pacientes con más riesgo de diabetes de tipo 2 en un nuevo estudio de observación [1].

     El estudio, publicado en la versión en línea de BMJ el 13 de septiembre de 2012, fue realizado por la Dra. Nina Rautio (Pirkanmaa Hospital, Tampere, Finlandia) y sus colaboradores. Llegaron a la conclusión de que sus hallazgos indican que la utilización de estatinas «podría tener efectos desfavorables en el metabolismo de la glucosa y… obstaculizar los efectos útiles de la intervención en el estilo de vida de personas con gran riesgo de diabetes de tipo 2».

La intervención intensiva en el estilo de vida es clave

Rautio dijo a heartwire que los resultados no se debieran interpretar como un motivo para desalentar el empleo de estatinas en las personas con más riesgo de ECV o con ECV establecida. Sin embargo, hizo hincapié en que los pacientes con alto riesgo de diabetes se beneficiarían de una intervención más intensiva en el estilo de vida. «Los profesionales sanitarios debieran invertir más de su tiempo en cambiar el estilo de vida, sobre todo de los usuarios de estatinas, en una dirección más saludable — es decir, dieta sana, no tabaquismo y actividad física.

Añadió: «Se ha demostrado que la diabetes de tipo 2 es evitable en personas con muy alto riesgo si se modifican los estilos de vida. Si un paciente se preocupa por los posibles efectos nocivos del tratamiento con estatinas, debe consultar a un médico en torno a esta cuestión y no suspender el tratamiento por sí mismos».

Al comentar sobre el estudio a heartwire, el experto en lípidos, Dr. Roger Blumenthal (Johns Hopkins University Medical Center, Baltimore, MD) dijo: «Este estudio muy interesante realizado por Rautio et al está basado en datos de observación y esta es su principal limitación. Termina diciendo que las ventajas del tratamiento con estatinas para la prevención de las enfermedades cardiovasculares en las personas con un incremento del riesgo de diabetes de tipo 2 son de todas formas indudables. Estoy de acuerdo con esta última afirmación».

Ventajas netas

     Sin embargo, Blumenthal admitió que las estatinas pueden acompañarse de un incremento moderado de la glucemia en pacientes con múltiples componentes del síndrome metabólico. No obstante, citó el análisis reciente del estudioJUPITER (Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin, el cual demostró una ventaja global neta indudable a una media de seguimiento de dos años.

Terminó diciendo: «El mensaje para los médicos es que los pacientes que tienen múltiples componentes del síndrome metabólico deben intentar mejorar más sus hábitos de estilo de vida para combatir el posible incremento de la glucosa cuando se inicia una estatina. Este estudio señala que las estatinas pueden tener efectos desfavorables sobre el metabolismo de la glucosa en determinadas personas, de manera que el cumplimiento de las mejoras en el estilo de vida será muy importante. Esperamos que en el futuro se lleven a cabo más estudios prospectivos sobre este tema».

En el estudio actual los investigadores realizaron un seguimiento a 2798 pacientes con alto riesgo de diabetes durante un año. Se les dio asesoría para modificar el estilo de vida; se determinó la glucemia en ayunas al inicio y a un año.

Los resultados demostraron que 484 individuos (17,3%) utilizaban estatinas al inicio. De estos pacientes, 7,5% presentaron diabetes de tipo 2 durante el seguimiento en comparación con 6,5% de los que no tomaron estatinas, una diferencia no importante.

Incremento de la glucemia en ayunas

     Sin embargo, la glucemia en ayunas se incrementó 0,08 mmol/l en los usuarios de estatinas pero se mantuvo sin cambio en los no usuarios. Esta fue una diferencia importante y persistió así después del ajuste con respecto a edad, género sexual, glucemia en ayunas inicial, presentación de ECV, uso de antihipertensivos o de coronariopatía, peso corporal y modificación del peso a un año.

Los investigadores señalan: «A nuestro entender, este es el primer estudio en el que se analiza la relación de la modificación del estilo de vida sobre el riesgo de diabetes de tipo 2 según el empleo de estatinas. Esta cuestión tiene suma importancia clínica, ya que ahora sabemos que la diabetes de tipo 2 es evitable mediante cambios en el estilo de vida».

Señalaron que un incremento de la glucemia en ayunas en usuarios de estatinas indica el agravamiento de la capacidad de secreción de insulina, pero añadió que los valores de glucosa a dos horas, que reflejan sensibilidad a la insulina, tuvieron una reducción similar en usuarios y no usuarios de estatinas.

Rautio señaló que este estudio se basó en la autonotificación por los pacientes y tuvo un periodo de seguimiento relativamente breve, añadiendo: «Se debe investigar la utilidad de la intervención en el estilo de vida con más detalle en usuarios y en no usuarios de estatinas mediante un estudio concebido en forma apropiada

Tomado de:theheart.org

Original en  heartwire; 21 sep. 2012

Rapid and point-of-care tests accurate, convenient for hepatitis C screening

Rapid and point-of-care screening tests for hepatitis C have a high accuracy and quick turnaround time, suggest results of a systematic review and meta-analysis.

The researchers say that these tests "could play a substantial role in expanded global screening initiatives, which would eventually impact the control of hepatitis C virus(HCV) infection at the population level."

Writing in the Annals of Internal Medicine, Nitika Pant Pai (McGill University Health Centre, Montreal, Quebec, Canada) and colleagues explain that many people infected with hepatitis C remain undiagnosed. It has been suggested that rapid diagnostic tests (RDTs) and point-of-care tests (POCTs) are a time- and cost-saving alternative to conventional laboratory tests. However, their global uptake depends on their performance.

To investigate further, Pant Pai and team performed a meta-analysis of 19 studies assessing the diagnostic accuracy of POCTs and RDTs to screen for hepatitis C in adults.

They found that POCTs of blood (serum, plasma, or whole) had the highest accuracy, followed by RDTs of serum or plasma and POCTs of oral fluids. Indeed, the sensitivity of POCTs of blood was around 99%, followed by 98% for RDTs of serum or plasma, and 98% for POCTs of oral fluid.

Specificity of POCTs of blood was also high, at more than 99%, followed by 98.6% for RDTs of serum or plasma and 98.2% for POCTs of oral fluid.

"First generation point-of-care tests are convenient, effective and informative for clinical decision making," say Pant Pai et al. "These tests don't usually require specialized equipment, they can provide results within 30 minutes, or maximally within one patient visit or one working day, and many do not require electricity."

They add that, in light of the tests' accuracy and an "urgent need to increase hepatitis C screening in marginalized and at-risk populations and in endemic HCV settings," these tests may be useful in expanding first-line screening for hepatitis C.

Por Nikki Withers medwireNews

Tomado de:news-medical.net

Visceral fat, not adiposity, marker of prediabetes, type 2 diabetes in obese adults

     Among obese adults, excess visceral fat and insulin resistance — not necessarily adiposity — are independently associated with incident prediabetes and type 2 disease.

     Ian J. Neeland, MD, of the University of Texas Southwestern Medical Center, and colleagues conducted a study involving 732 obese adults (BMI ≥30) aged 30 to 65 years without diabetes or cardiovascular disease. Patients were enrolled in the Dallas Heart Study between 2000 and 2002.

     The following measurements were obtained: BMI (using DXA and MRI); circulating adipokines and biomarkers of insulin resistance; dyslipidemia and inflammation; and subclinical atherosclerosis and cardiac structure and function (using CT and MRI), according to the study.

     The primary outcome was diabetes incidence during a median 7 years of follow-up. Researchers also determined the incidence of composite prediabetes or diabetes in a subgroup of 512 patients with normal fasting glucose at baseline.

     More than 10% of patients developed diabetes (11.5%) during the study. Results of a multivariable analysis revealed that several factors were independently associated with diabetes, including: higher baseline visceral fat mass (OR=2.4; 95% CI, 1.6-3.7); fructosamine level (OR=2.0; 95% CI, 1.4-2.7); fasting glucose level (OR=1.9; 95% CI, 1.4-2.6); family history of diabetes (OR=2.3; 95% CI, 1.3-4.3); systolic BP (OR=1.3; 95% CI, 1.1-1.5); and weight gain during follow-up (OR=1.06; 95% CI, 1.02-1.10).

     However, BMI, total body fat and abdominal subcutaneous fat were not associated with diabetes. Results from the subgroup analysis demonstrated that the composite of prediabetes or type 2 diabetes occurred among 39.1% of patients and was independently associated with baseline levels of: visceral fat mass, fasting glucose, insulin and fructosamine; older age; non-white race; family history of disease; and weight gain during follow-up (P<.05 for each).

     Similarly, however, there was no association with general adiposity measurements, they wrote.“These findings suggest that clinically measurable markers of adipose tissue distribution and insulin resistance may be useful in prediabetes and diabetes risk discrimination among obese individuals and support the notion of obesity as a heterogeneous disorder with distinct adiposity subphenotypes.”

Neeland IJ. JAMA. 2012;308:1150-1159.

Tomado de  Healio.com

IV Ampicillin Found Effective for VRE UTI

     Intravenous ampicillin is an effective first-line treatment for urinary tract infections caused by vancomycin-resistant enterococci, according to a review from Shands Hospital at the University of Florida in Gainesville.

     Although linezolid and daptomycin are sometimes used elsewhere to treat these infections, the hospital staff decided in 2000 to use intravenous ampicillin as the vancomycin-resistant enterococci (VRE) UTI treatment of choice. To prevent resistance, staff there wanted to keep newer, more powerful antibiotics in reserve for more complex infections, Shands infectious disease specialist Ken Klinker, Pharm.D., reported at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

     The hospital staff reasoned that the high urine concentrations achieved by ampicillin would overwhelm VRE despite possible resistance to the antibiotic, Dr. Klinker said. The approach led to clinical cures in 64 of 70 patients (91%) and microbiologic cures in 40 of the 46 (87%) who had repeat urine cultures.  

     Patients received a median ampicillin dose of 4 g/day for an average of 4.25 days. When possible, they were then switched to oral ampicillin or amoxicillin.

Ampicillin "seems to work for us and has for many years," said coinvestigator and pharmacist Sam Borgert, also an infectious disease specialist at Shands. "Ampicillin should be considered a viable treatment option for patients with VRE UTI," the investigators concluded when presenting their findings.

    Most of the patients had grown out at least 10⁵ CFU/mL on urine culture and were clinically symptomatic. Enterococcus faecium was the predominant pathogen, and it tested almost uniformly resistant to ampicillin.

    The median age in the study was 60.5 years and median Charlson Comorbidity Index score was 6. Just over half of the participants were women.

A total of 48 patients had Foley catheters at baseline. Thirty-three of the 34 (97%) who had their catheter exchanged or removed cleared the infection. The cure rate was 57% (8 of 14) among patients who retained their catheter.

    "We can’t discern between drug therapy and catheter removal in terms of what drove the results. It’s probably a combination of both," Dr. Klinker said at the conference, which was sponsored by the American Society for Microbiology.

The few patients who failed ampicillin responded to alternate VRE therapies.

Dr. Klinker and Mr. Borgert said that they have no relevant disclosures.

TOMADO DE: internalmedicinenews.com. by ALEXANDER OTTO, Internal Medicine News Digital Network

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Progesterone Test Can Predict Viability of Pregnancy, Study Finds

 Measuring progesterone levels in women with pain or bleeding during early pregnancy is a useful way to help discriminate between a viable and a non-viable pregnancy, finds a study published on bmj.com today.

The results suggest that a low level of progesterone in these women can rule out a viable pregnancy in the vast majority of cases.

Vaginal bleeding or pain occurs in around a third of women in early pregnancy. Doctors use ultrasound to test whether it is a viable pregnancy or a non-viable pregnancy, such as a miscarriage or an ectopic pregnancy, but this can sometimes be inconclusive.

Some studies have suggested that a single progesterone measurement in early pregnancy may be a useful test, but results are conflicting.

So a team of UK and Dutch researchers set out to determine the accuracy with which a single progesterone measurement in early pregnancy can discriminate between a viable and a non-viable pregnancy.

They analysed the results of 26 studies involving 9,436 pregnant women. Seven studies looked at women with pain or bleeding and an inconclusive ultrasound assessment, while 19 studies looked at women with pain or bleeding alone.

Differences in study quality were taken into account to identify and minimise bias.

The results show that a single low progesterone measurement for women in early pregnancy presenting with bleeding or pain can discriminate between a viable and a non-viable pregnancy when an ultrasound investigation proves to be inconclusive.

For women with pain or bleeding who did not have an ultrasound, the progesterone test was less accurate in predicting viability of a pregnancy.

The researchers stress that low progesterone levels may occur in some viable pregnancies and, as such, "the test should be complemented by another test to increase its diagnostic accuracy."

They also suggest that "this test is highly accurate when complemented by ultrasound and could be added to the existing algorithms for the evaluation of women with pain or bleeding in early pregnancy as it can accelerate diagnosis."

BMJ-British Medical Journal. "Progesterone test can predict viability of pregnancy, study finds."ScienceDaily, 27 Sep. 2012. Web. 4 Oct. 2012.

Cardiac Benefits of Red Wine Not From the Alcohol

Drinking moderate amounts of nonalcoholic red wine -- but not its intoxicating equivalent -- lowered blood pressure in men with a high cardiovascular risk, a randomized, crossover study showed.

After 4 weeks of drinking the nonalcoholic wine, blood pressure fell by an average of 5.8/2.3 mm Hg (P menor 0.02), according to Ramon Estruch, PhD, of the University of Barcelona in Spain, and colleagues.

In contrast, drinking standard red wine for 4 weeks and gin during another 4-week period had no significant effect, although blood pressure did decrease a bit with the wine, the researchers reported online in Circulation Research. The changes in blood pressure with nonalcoholic red wine correlated significantly with changes in plasma nitric oxide, which increased by 4.1 µmol/L (P=0.041). Nitric oxide levels were not affected by the alcoholic beverages.

"Therefore, the blood pressure-lowering and nitric oxide-raising effects should be attributed to the red wine polyphenols and not to alcohol, which seems to counteract the effects of the nonalcoholic fraction of red wine," Estruch and colleagues wrote. "The daily consumption of dealcoholized red wine could be useful for the prevention of low-to-moderate hypertension," they concluded.

Moderate alcohol consumption has been associated with reduced cardiovascular risk, and red wine in particular is believed to be protective because of the high polyphenol content.

In vitro and experimental studies have suggested that the polyphenols found in red wine might lower blood pressure and increase endothelial nitric oxide, but the effects in humans had remained unclear.

The current study included 67 men (mean age 60) who had a high cardiovascular risk, defined as the presence of diabetes or at least three cardiovascular risk factors. After a 2-week, alcohol-free, run-in period, the men were randomized to complete three 4-week intervention periods -- without washout periods in between -- while maintaining a constant diet:

• 30 grams of alcohol per day in the form of red wine (about 9 ounces)
• About 9 ounces of nonalcoholic red wine per day
• 30 grams of alcohol per day in the form of gin (about 3.4 ounces)

The nonalcoholic and alcoholic red wines contained similar amounts of polyphenols. Gin does not contain polyphenols. During the study, there were no significant changes in body mass index, waist-to-hip ratio, or heart rate. The only significant changes observed were in systolic and diastolic blood pressure and plasma nitric oxide when the men were consuming nonalcoholic red wine. The researchers found significant differences in blood pressure and nitric oxide when comparing the nonalcoholic red wine group with the gin group. 

Although the reduction in blood pressure with nonalcoholic red wine was modest, decreases of 4 or 2 mm Hg in systolic or diastolic blood pressure, respectively, have been associated with a 14% relative reduction in the risk of coronary heart disease and a 20% relative reduction in stroke risk, lending clinical significance to the findings, according to the authors. The results of the study were largely the same when excluding individuals with hypertension and those taking antihypertensives, the researchers reported.

They acknowledged some limitations of the study, including the lack of information on the effects of longer-term consumption of the various drinks, the lack of measurements of endothelial function, and the inability to pinpoint the specific substances in red wine responsible for the observed effects.

Tomado de MedPage Today

Acanthosis Nigricans Severity Helps Predict Diabetes Risk

 Patients with a high grade of acanthosis nigricans should be screened for insulin resistance, according to Dr. Sandhya Venkatswami.

His cross-sectional study found that 47 of 150 acanthosis nigricans patients (31%) were insulin resistant, with an acanthosis nigricans grade of 3 or 4 being more predictive of the condition.

We suggest that all patients with severe AN [acanthosis nigricans] grades should be evaluated for IR [insulin resistance] and thereby prevent further complications," wrote Dr. Venkatswami, who presented his findings during a poster session at the American Academy of Dermatology’s Summer Academy Meeting.

While previous studies have found acanthosis nigricans to be a marker for prediabetes, Dr. Venkatswami’s study found that taking severity into account helps to further identify patients who may be at risk.

He and his fellow investigators enrolled 150 consecutive patients with acanthosis nigricans of the neck (25 males), aged 18-64 years. The patients were graded according to acanthosis nigricans severity on a scale of I-IV.

Grade I was defined as acanthosis nigricans that was only visible on close inspection (21 patients); grade II was defined as acanthosis nigricans confined to the base of the skull (58 patients); grade III was defined as acanthosis nigricans that extended laterally to the posterior border of the sternocleidomastoid but was not visible when the patient was facing forward (48 patients); and grade IV was defined as acanthosis nigricans that was visible when the patient was facing forward, as the acanthosis nigricans encircled the neck (23 patients), said Dr. Venkatswami of the department of dermatology, Sri Ramachandra University, Chennai, India.

One patient with grade I acanthosis nigricans was found to be insulin resistant; 10 patients with grade II acanthosis nigricans were found to be insulin resistance; 20 patients with grade III acanthosis nigricans were insulin resistant; and 16 patients with grade IV showed a resistance to insulin.

Secondary study findings showed that patients with higher grades of texture of acanthosis nigricans were also more likely to be insulin resistant. That is, those with visible and extremely coarse "hills and valleys."

"AN lesions are asymptomatic and usually ignored by the patients unless they are of cosmetic concern. However, this is of clinical importance in diagnosing prediabetes," he noted in his poster.

Further studies will look to see if behavior modifications will help lower the risk for diabetes in patients with the condition.

Dr. Venkatswami did not disclose having any conflicts of interest.

Tomado de internalmedicinenews.com

Low HDL Cholesterol Ups Risk of Diabetic Nephropathy

In type 2 diabetes, HDL-C independent risk factor for diabetic nephropathy but not retinopathy

High-density lipoprotein cholesterol (HDL-C) is an independent risk factor for the development of diabetic nephropathy, but not retinopathy, in patients with type 2 diabetes, according to research published online Aug. 13 in Diabetes Care.

Jamie Morton, M.B.B.S., of The Heart Research Institute in Sydney, and colleagues followed 11,140 patients in the Action in Diabetes and Vascular Disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) study, the participants of which had type 2 diabetes and at least one additional vascular risk factor. The ADVANCE study was designed to evaluate the association between HDL-C and microvascular disease (composite of renal and retinal events).

     Over a median follow-up of five years, the researchers found that 28 percent of patients experienced a renal event and 6 percent experienced a retinal event. Compared with those in the highest third, patients in the lowest third of HDL-C levels had a 19 percent higher risk of renal events (17 percent higher risk of combined renal and retinal microvascular events). There was no association between HDL-C and retinal events (P = 0.9).

     

     "In conclusion, in a large population of patients with type 2 diabetes and after adjustment for a wide variety of confounders, low HDL-C level was shown to be an independent risk factor for the development and progression of diabetic nephropathy," the authors write. "Measurement of this lipid fraction may be useful in tailoring screening and therapeutic strategies."

Several authors disclosed financial ties to Servier, which partially funded the study.

Tomado de physiciansbriefing.com