Obesity linked to coronary artery calcification in patients without diabetes

     Coronary artery calcification was linked to obesity, but not impaired fasting glucose, according to results from a community-based study of the offspring and third-generation cohorts of the initial Framingham Heart Study.

     “In the US population, approximately one in three nondiabetic adults has impaired fasting glucose (IFG) and one in three has obesity. IFG is known to be related to all components of the metabolic syndrome, including strong associations with obesity,” researchers wrote.

     Using multidetector computed tomography in 3,054 patients (mean age of 50 years; 49% women; 29% impaired fasting glucose [IFG] and 25% obese), researchers compared the coronary artery calcification (CAC) of patients with normal fasting glucose and IFG. Comparisons were also completed on the CAC of patients with and without obesity. Researchers aimed to determine if CAC differences were independent of important confounders.

Martin K. Rutter, MD, from the cardiovascular research group within the School of Biomedicine at the University of Manchester in the United Kingdom, and colleagues said the relationships of IFG and obesity to CAC in the general population has been ambiguous until now.

“Although this is cross-sectional observational data, our work may have public health implications because it has suggested the possible importance of targeting obesity over IFG for preventing subclinical atherosclerosis in the general population,” the researchers wrote.

Data confirmed that high CAC was significantly related to IFG in an age- and sex-adjusted model (OR=1.4; 95% CI, 1.1–1.7), and after additional adjustments for obesity, high CAC still showed a relation to IFG (OR=1.3; 95% CI, 1–1.6).

However, IFG was not associated with high CAC in multivariable-adjusted models before (OR=1.2; 95% CI, 0.9–1.4) or after adjustment for obesity, they wrote.

Moreover, obesity was linked to higher CAC in age- and sex-adjusted models (OR=1.6; 95% CI, 1.3–2.0) and in multivariable models, including IFG (OR=1.4; 95% CI, 1.1–1.7), according to data.

Finally, researchers used a spline regression model to explore the nonlinear relationships linking CAC with BMI, fasting glucose and waist circumference.

“This suggested that there is a J-shaped multivariable-adjusted relationship between BMI and CAC with significant nonlinearity in the nonobese BMI range.”

Despite consistent evidence for improved risk prediction by CAC, Rutter and colleagues said that CHD screening using CAC currently is not recommended to improve clinical outcomes.

Rutter M. Diabetes Care. 2012; doi: 10.2337/dc11-1950.

Tomado de: healio.com

Podcast: Semen's Secret, Antibiotic Weight Gain, and More

Podcast: Semen's Secret, Antibiotic Weight Gain, and More - ScienceNOW






Tomado de ScienceNOW.com

Disarming Darth Vader

Removing virulence factors from pathogenic bacteria could be a new way to fight infections, by taming rather than killing them. Also: thanks to epigenetics, learned behaviors may be inherited.

'Naked Darth Vader' Approach Defangs Bacteria

Canadian researchers have found a bacterial virulence factor that, when removed, made pathogenic Brucella species relatively tame, according to a study in the journal Chemistry & Biology.

The protein VirB8 is a "key part of the virulence mechanism of human and animal Brucella species of bacteria," said lead author Christian Baron, PhD, of the University of Montreal, in a statement.

He compared targeting the protein with the removal of the Star Wars villain Darth Vader's armor and lightsaber, noting that without those tools, the Sith lord would be much easier to attack -- just as bacteria without virulence would essentially be rendered harmless.

Baron and co-authors noted that this alternative treatment route could slow or halt the growing problem of bacterial drug resistance, and that their findings could open new doors to microbial virulence mechanisms.

Tomado de: LAb Notes at Medpagetoday.com

Statins Equally Effective in Men and Women

Both sexes gain from statins for secondary prevention of cardiovascular events, a meta-analysis found, though pooling enough data to prove that there is a statistically significant benefit in women appears to be a challenge.

Both sexes saw a similar, significant overall cardiovascular benefit from the lipid-lowering drugs in high-quality clinical trials, Jose Gutierrez, MD, MPH, of Columbia University in New York City, and colleagues reported.

All-cause mortality and stroke benefits weren't as significant for women as they were for men, but interaction terms didn't suggest a real difference, they cautioned in the June 25 issue of the Archives of Internal Medicine.

"These differences are likely secondary to the small proportion of women included in the trials and a worse cardiovascular health status in these same women," they wrote.

Rather than change prescribing of statins to women after a coronary event, the group encouraged awareness of the disparity and public policies to address it.

"Focusing on a lack of statistical significance in the findings for women is misleading," Fiona Taylor, PhD, and Shah Ebrahim, DM, both of a Cochrane review group at the London School of Hygiene and Tropical Medicine, argued in an accompanying commentary.

They pointed to the effect size of statins as being materially similar between genders, criticizing "over-interpretation of imprecisely estimated effects" among other failings of the current meta-analysis.

A prior, larger meta-analysis of mixed primary and secondary prevention trials did show a significant all-cause mortality reduction with statins for both sexes.

Gutierrez's analysis included 11 randomized, double-blind, placebo-controlled secondary prevention trials with at total of 43,193 patients. Open-label and observational studies did not qualify.

The overall effect sizes for cardiovascular event risk reduction came in virtually the same with statin therapy versus placebo between the genders:

• For women, the relative risk was 0.81 (95% CI 0.74 to 0.89)
• For men, the relative risk was 0.82 (95% CI 0.78 to 0.85)

Risk also came in lower with statins than with placebo for both women and men with regard to myocardial infarction (overall RR 0.73, 95% CI 0.65 to 0.81) and cardiac interventions (overall RR 0.76, 95% CI 0.71 to 0.82).

The all-cause mortality risk reduction with statins didn't reach statistical significance in women (RR 0.92, 95% CI 0.76 to 1.13), unlike in men (RR, 0.79, 95% CI 0.72 to 0.87).

The same was true for stroke prevention, with a relative risk of 0.92 for women taking a statin (95% CI 0.76 to 1.10) versus 0.81 for men on a statin (95% CI 0.72 to 0.92).

However, the interaction of sex and treatment didn't reach significance for either all-cause mortality (P=0.78) or stroke (P=0.99), which Taylor and Ebrahim called more important.

"If a statistical test is wanted, the appropriate P-value is for the sex interaction for the outcome by sex," they wrote. "We suggest that statins work just as well in women as in men."

Adverse events were reported to be no different between men and women in two of the studies; one study suggested more breast cancer with statin than placebo and the remainder did not break out risks separately for the sexes.

The biggest limitation of the meta-analysis was that women represented only 20% of the population in the trials studied overall, which likely underpowered the results for them, the researchers noted.

In an editor's note, Rita F. Redberg, MD, MSc, of the University of California San Francisco, agreed that there's a real need for more women in the clinical trials to settle such issues.

"Are the benefits of statins less in women and risks greater than men, or are there just not enough women in the clinical trials to demonstrate benefit in women," she asked. "Unless we increase inclusion of women in clinical trials and report sex-specific data, there will never be sufficient data to achieve optimal care of all of our patients."

Gutierrez J, et al "Statin therapy in the prevention of recurrent cardiovascular events: A sex-based meta-analysis"Arch Intern Med 2012; 172: 909-919.

Tomado de: Medpagetoday.com

APRENDIZAJE BASADO EN PROBLEMAS

Masculino de 42 años, asintomático , hipertension arterial identificada en su reciente revisión anual (1 año). Ingesta de atenolol con clortalidona (50mg/25mg). Ambos padres diabeticos tipo 2. No fuma. IMC de 32.3. TA actual de 130/80 mmHg.
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Honey: A Sweet Alternative for Treating Cough in Children

Honey is more effective than a placebo in controlling nighttime cough in children with upper respiratory infections (URI), according to the results from a new randomized placebo-controlled, double-blind trial. The results were published online August 6 in Pediatrics.

The World Health Organization recommends honey as a nighttime treatment for coughing in young children with URIs. However, prior studies either tested only a single type of honey or were not blinded.

In the current study, children with URIs and nocturnal cough were given either 1 of 3 different honey products or a placebo 30 minutes before bedtime, based on a double-blind randomization plan. The primary outcome evaluated was a subjective change in cough frequency, based on parent surveys. Secondary outcomes measured included a change in cough severity, the effect of the cough on sleep for both the child and the parent, and the combined score on the pre- and postintervention surveys.

Herman Avner Cohen, MD, from the Pediatric Ambulatory Community Clinic, Petach Tikva, Israel, and colleagues compared symptom scores for each treatment group before and after the intervention and found that patients in all 3 honey groups demonstrated significant improvement compared with patients treated with placebo. There were no significant differences among the different types of honey.

"The results of this study demonstrate that each of the 3 types of honey (eucalyptus, citrus, and labiatae) was more effective than the placebo for the treatment of all of the outcomes related to nocturnal cough, child sleep, and parental sleep," the authors write.

The researchers enrolled 300 children with URIs, aged 1 to 5 years, who were seen at 1 of 6 general pediatric community clinics between January 2009 and December 2009. Patients were eligible if they had a nocturnal cough attributed to the URI. Children were excluded if they had symptoms of asthma, pneumonia, laryngotracheobronchitis, sinusitis, and/or allergic rhinitis. Patients who used any cough or cold medication or honey in the previous 24 hours were also excluded.

Parents were asked to evaluate the children the day of presentation, when no medication had been given, and then again the day after a single dose of 10 g of eucalyptus honey, citrus honey, labiatae honey, or placebo (silan date extract) had been administered before bedtime. Pre- and postintervention subjective assessments were obtained using a 5-item Likert-scale questionnaire regarding the child's cough and sleep difficulty. Only those children whose parents rated severity as at least a 3 (on a 7-point scale) for at least 2 of the 3 questions related to nocturnal cough and sleep quality on the preintervention questionnaire were included.

Of the 300 patients enrolled, 270 (89.7%) completed the single-night study. The median age of these children was 29 months (range, 12 - 71 months). There was no significant age difference among the treatment groups. Symptom severity was also similar among all 4 treatment groups.

Adverse events were reported for 5 patients and included stomachache, nausea, and vomiting and were not significantly different between the groups.

The authors acknowledge the limitations of the study, including the subjective nature of the survey and the fact that the intervention period was limited to a single dose. In addition, they note that some of the improvement measured may be attributed to the natural progression of URIs, which may improve with supportive care and time.

"On the basis of our findings, honey can be offered as an alternate treatment to children >1 year of age," note Dr. Cohen and colleagues.

"Honey may be a preferable treatment of cough and sleep difficulties associated with childhood URI," they conclude.

Funding for this study was provided by a research grant from the Israel Ambulatory Pediatric Association, Materna Infant Nutrition Research Institute, and the Honey Board of Israel. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online August 6, 2012.

Tomado de: Medscape.com

HCV/HIV coinfection increases mortality risk from any cause

Deaths from all causes and those specifically liver-related were more common among patients coinfected with HIV and HCV than the general population and among patients with HIV alone in a recent study.

Researchers evaluated data from 5,914 HIV-positive patients enrolled in two multicenter cohort studies in Spain between 1997 and 2008. Standardized mortality ratios (SMR) and excess mortality rates were compared between HCV-negative and HCV-positive patients within the cohort as well as the general population.

During the study, 231 patients died, with 10.4% of those deaths related to the liver. The all-cause mortality rate was 1.22 deaths per 100 person-years (1.07-1.39) for the entire cohort, 0.61 per 100 person-years (0.47-0.78) for HCV-negative patients and 1.96 per 100 person-years (1.68-2.28) among HCV-positive patients (95% CI for all). The excess mortality rate within the cohort was 1.0 deaths per 100 person-years (0.8-1.1), 0.35 (0.26-0.49) among HCV-negative patients and 1.79 (1.53-2.10) among HCV-positive patients (95% CI for all).

The SMR for death from any cause was 5.6 (95% CI, 4.9-6.4) for the entire cohort, compared with 2.4 (95% CI, 1.9-3.1) among HCV-negative participants and 11.5 (95% CI, 9.9-13.4) for HCV-positive patients. SMRs were consistently higher within the cohort than in the general population. Patients with both HCV and AIDS had an SMR of 20.8 (95% CI, 16.5-26.1), compared with 4.8 (95% CI, 3.5-6.7) among AIDS patients without HCV coinfection.

Patients with HCV also were more prone to death from liver failure, with an SMR of 1.8 (0.6-5.7) for liver-related mortality among HCV-negative participants compared with 22.4 (14.6-34.3) among HCV-positive participants, and an SMR of 9.4 (6.3-13.9) for the entire cohort (95% CI for all). Excess mortality rates because of liver-related causes were 0.23 per 100 person-years (0.15-0.36) among HCV-positive patients, compared with 0.01 per 100 person-years (0.00-0.07) among HCV-negative patients and 0.11 per 100 person-years (0.07-0.17) for the entire cohort (95% CI for all).

“Coinfection with HCV seems to play a very important role in all-cause and liver-related excess mortality,” the researchers wrote. “Rapid changes in the epidemiology of HCV coinfection and major advances in the treatment of these infections are likely to shape future patterns of excess mortality in the coming years.”

Hernando V. J Hepatol. 2012;doi:10.1016/j.jhep.2012.06.010.

Tomado de:Healio.com