Deep Sleep Linked to Lower Hypertension Risk in Older Men

August 30, 2011 — In men 65 years and older, increased percentage of time spent in slow-wave sleep appears to be associated with a lower risk for incident hypertension, according to new research findings.

Maple M. Fung, MD, with the San Diego Veterans Affairs Healthcare System, Medicine Service, in San Diego, California, and colleagues reported the findings online August 29 in Hypertension.

According to the researchers, sleep-disordered breathing (SDB), which includes obstructive sleep apnea, sleep deprivation, and/or short sleep duration, is strongly associated with hypertension. "To our knowledge, a comprehensive evaluation of sleep characteristics and incident HTN [hypertension] in an elderly cohort has not been reported."

The current study sought to determine whether incident hypertension is associated with SDB, sleep duration, and sleep architecture in 784 community-dwelling men at least 65 years old (mean age, 75.1 ± 4.9 years). Participants were recruited from the Outcomes of Sleep Disorders in Older Men ancillary study, and they did not have hypertension when sleep patterns were first recorded with polysomnography.

At a mean follow-up of 3.4 years, 243 of the 784 participants met criteria for incident hypertension. After results were adjusted for age, nonwhite race, study site, and body mass index, only percentage duration of slow-wave sleep showed a significant and inverse association with incident hypertension (odds ratio for lowest to highest quartile of slow-wave sleep, 1.83; 95% confidence interval, 1.18 - 2.85).

"In contrast, indices of breathing disturbances, level of hypoxemia, sleep duration, and arousal index were not independently associated with an increased risk of HTN after considering confounders," Dr. Fung and colleagues note.

According to the researchers, slow-wave sleep is the third and final stage of non-REM sleep and is considered to be the most restorative of the rapid eye movement (REM) and non-REM stages of sleep. Slow-wave sleep has also been linked to many health benefits, including enhanced cognitive skills, positive changes in glucose metabolism, and decreased heart rate and blood pressure.

In this study, men classified in the lowest quartile of slow-wave sleep spent less than 4.1% of their total sleep in this restorative phase of sleep, whereas men in the highest quartile spent more than 16.9% of total sleep time in this phase.

"This article adds to the growing body of literature that associates sleep architecture with metabolic and physiological changes that may reflect altered neurohormones and inflammatory markers," they add. "Further studies are necessary to confirm these observations, elucidate the causal pathways, and determine whether modifications in (slow-wave sleep) improve HTN."

The National Heart, Lung, and Blood Institute provides funding for the Osteoporotic Fractures in Men Study sleep ancillary study "Outcomes of Sleep Disorders in Older Men." Dr. Fung has received previous grant support from Forest Laboratories and currently owns stock and is employed by Amgen.

Hypertension. Published online August 29, 2011.

Read More

Moderate Wine Intake Neither Hurts or Helps in Heart Failure

August 29, 2011 (Paris, France) — It's no secret that drinking red wine in modest amounts improves some measures of cardiovascular health, and there's evidence it may actually improve survival in some populations with heart disease. But a post hoc analysis based on a large heart-failure-trial cohort finds no sign that wine drinking had an effect, in either direction, on mortality or HF hospitalizations [1]. Still, imbibing moderately improved some measures of systemic inflammation and, presumably, quality of life--although the latter wasn't measured in the study.

Taking advantage of lab-test results from their large cohort of patients with chronic heart failure living in one of the world's red-wine hubs, investigators from the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico--Heart Failure (GISSI-HF) found that greater wine intake was associated with lower levels of fibrinogen (p<0.0001) and the inflammatory markers pentraxin 3 (p<0.05) and osteoprotegerin (p=0.0002), although no such pattern was observed for high-sensitivity C-reactive protein (hs-CRP) or white-blood-cell count.

Nor, in the GISSI-HF cohort of 1229 patients with such lab data, was wine-intake level related to levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), a marker of HF severity, or blood glucose, reported Dr Roberto Latini (Mario Negri Institute for Pharmacological Research, Milan, Italy) here at the European Society of Cardiology (ESC) 2011 Congress.

Those patients were part of a larger population of 6973 GISSI-HF patients who filled out dietary questionnaires at randomization and showed the lack of association between wine intake and outcomes over a mean follow-up of 3.9 years.

Adjusted* Hazard Ratios (95% CI) for Clinical Outcomes by Wine-Intake Levels vs No Wine Consumption (N=2461) in GISSI-HF

End point	"Sometimes" drink wine, n=1325	1–2 glasses/day, n=2570	>3 glasses/day, n=617
All-cause mortality	0.91 (0.80–1.03)	0.96 (0.86–1.07)	0.91 (0.76–1.09)
Worsening HF	1.05 (0.92–1.19)	1.08 (0.97–1.21)	1.00 (0.84–1.20)

*Adjusted for age, HF severity, medications

Overall, the findings, Latini told heartwire , mean at the very least that patients with heart failure can safely drink wine in moderation. But he cautions that they may not necessarily apply outside Italy. He said perhaps two-thirds of wine drinking by Italians in the GISSI-HF age demographic is of red wine, which is customarily consumed at meals.

"Now among the younger generations, it's like it is in the United States, where they drink a glass of wine before meals or a show," not necessarily with food, he noted. "So possibly, I wouldn't be surprised if the results would be different in another cohort of patients, in northern Europe, for example. It's something that should be validated in different contexts; I wouldn't generalize these results."

The primary GISSI-HF trial was funded the Societa Prodotti Antibiotici, Pfizer, Sigma Tau, and AstraZeneca. Latini had no disclosures; his report stated that the current post hoc analysis "was performed without specific funding from companies, in particular wine-producers' or wine-drinkers' associations."

Read More

Smoking May Increase Bladder Symptoms in Women

August 29, 2011 — Urinary urgency and frequency among women are about 3 times more common among current than never smokers, according to the results of a questionnaire survey in a population-based cohort reported in the September issue of Obstetrics & Gynecology.

"Although smoking increases illness burden for many conditions, the relation between smoking and lower urinary tract symptoms remains unclear," Riikka M. Tähtinen, MD, from the Department of Obstetrics and Gynecology at Kanta-Häme Central Hospital, Hämeenlinna, and Tampere University Hospital, Finland, and colleagues. "Earlier studies have been inconsistent, perhaps as a result of failing to distinguish among [urinary incontinence (UI)] types or by analyzing all urinary symptoms as a single cluster. Because various bladder symptoms probably have different etiologies, combining them may have obscured important associations."

The study goal was to evaluate the association of smoking status and intensity on frequency, nocturia, stress UI (SUI), urgency, and urgency UI.

Using the Finnish Population Register, the investigators randomly identified 3000 women aged 18 to 79 years and mailed them questionnaires including questions on occurrence (never, rarely, often, always) of SUI, urgency, and urgency UI. Urinary frequency was defined as longest voiding interval less than 2 hours, and nocturia as 2 or more voids per night. Information was collected concerning comorbidities, medications, sociodemographic, lifestyle, and reproductive factors, and other potential confounders. Associations were studied using multivariable analyses.

Response rate was 67.0%, with 7.1% of women reporting frequency, 12.6% nocturia, 11.2% SUI, 9.7% urgency, and 3.1% urgency UI. Smoking was associated with urinary urgency, with an odds ratio (OR) of 2.7 (95% confidence interval [CI], 1.7 - 4.2) for current vs never smokers and an OR of 1.8 (95% CI, 1.2 - 2.9) for former vs never smokers. Smoking was also associated with urinary frequency (OR, 3.0 [95% CI, 1.8 - 5.0] for current smokers; OR, 1.7 [95% CI, 1.0 - 3.1] for former smokers). However, smoking was not associated with nocturia or SUI.

After adjustment, prevalence differences between never and current smokers were 6.0% for urgency (95% CI, 3.0% - 9.1%) and 6.0% (95% CI, 3.3% - 8.7%) for frequency. Among current smokers, heavy compared with light smoking was associated with additional risk for urgency (OR, 2.1; 95% CI, 1.1 - 3.9) and frequency (OR, 2.2; 95% CI, 1.2 - 4.3).

Limitations of this study include the lack of data on pack-years of smoking, a possible misclassification bias, the inability to adjust for delivery mode, a response rate of 67%, reliance on self-report, the cross-sectional design precluding conclusions about causality, and a lack of generalizability to other populations.

"Urgency and frequency are approximately three times more common among current than never smokers," the study authors write. "Parallel associations for urgency and frequency with smoking intensity suggest a dose–response relationship.... These results suggest an additional rationale for smoking cessation in women seeking medical attention for bladder symptoms and highlight the diversity between such symptoms."

This study was supported by unrestricted grants from the Competitive Research Funding of the Pirkanmaa Hospital District and Pfizer Inc. Dr. Tähtinen was supported by an unrestricted grant from the Competitive Research Funding of the Kanta-Häme Central Hospital. A second study author was supported by unrestricted grants from the Finnish Medical Society and the Finnish Cultural Foundation. Some of the study authors report various financial relationships with Merck Sharp & Dohme Corp, Pfizer, Ferring, Johnson & Johnson, Amgen, Astellas, GlaxoSmithKline, and/or Orion Pharma.

Obstet Gynecol. 2011;118:643-648. Abstract

Read More

Chocolate Good for the Heart and Brain

August 29, 2011 (Paris, France) — In a city renowned for its love of food, it is only fitting that researchers presented the results of a new study in Paris, France, showing that chocolate is good for the heart and brain. In a presentation at the European Society of Cardiology (ESC) 2011 Congress, British investigators are reporting that individuals who ate the most chocolate had a 37% lower risk of cardiovascular disease and a 29% lower risk of stroke compared with individuals who ate the least amount of chocolate.

In the study, published online August 29, 2011 in BMJ to coincide with the ESC presentation, Dr Adriana Buitrago-Lopez (University of Cambridge, UK) and colleagues state: "Although overconsumption can have harmful effects, the existing studies generally agree on a potential beneficial association of chocolate consumption with a lower risk of cardiometabolic disorders. Our findings confirm this, and we found that higher levels of chocolate consumption might be associated with a one-third reduction in the risk of developing cardiovascular disease."

In this meta-analysis of six cohort studies and one cross-sectional study, overall chocolate consumption was reported, with investigators not differentiating between dark, milk, or white chocolate. Chocolate in any form was included, such as chocolate bars, chocolate drinks, and chocolate snacks, such as confectionary, biscuits, desserts, and nutritional supplements. Chocolate consumption was reported differently in the trials but ranged from never to more than once per day. Most patients included in the trials were white, although one study included Hispanic and African Americans and one study included Asian patients.

Of the seven studies, five trials reported a significant inverse association between chocolate intake and cardiometabolic disorders. For example, individual studies showed reductions in the risk of coronary heart disease (odds ratio 0.43; 95% CI 0.27–0.68), the risk of cardiovascular disease mortality (relative risk [RR] 0.50; 95% CI 0.32–0.78), and the risk of incident diabetes in men (hazard ratio 0.65; 95% CI 0.43–0.97).

Overall, the pooled meta-analysis results showed that high levels of chocolate consumption compared with the lowest levels of chocolate consumption reduced the risk of any cardiovascular disease 37% (RR 0.63; 0.44–0.90) and stroke 29% (RR 0.71; 0.52–0.98). There was no association between chocolate consumption and the risk of heart failure, and no association on the incidence of diabetes in women.

The researchers note that the findings corroborate the results of previous meta-analyses of experimental and observational studies in different populations showing a similar relationship between chocolate and cocoa consumption and cardiometabolic disorders.

"These favorable effects seem mainly mediated by the high content of polyphenols present in cocoa products and are probably accrued through the increasing bioavailability of nitric oxide, which subsequently might lead to improvements in endothelial function, reductions in platelet function, and additional beneficial effects on blood pressure, insulin resistance, and blood lipids," conclude Buitrago-Lopez and colleagues.

Read More

Low DHA Levels Linked to Increased Suicide Risk

August 26, 2011 — Low levels of docosahexaenoic acid (DHA), the major omega-3 fatty acid concentrated in the brain, may increase suicide risk, new research suggests.

A retrospective case-control study of1600 United States military personnel, including 800 who had committed suicide and 800 healthy counterparts, showed that all participants had low omega-3 levels. However, the suicide risk was 62% greatest in those with the lowest levels of DHA.

Our findings add to an extensive body of research that points to a fundamental role for DHA and other omega-3 fatty acids in protecting against mental health problems and suicide risk.

"Our findings add to an extensive body of research that points to a fundamental role for DHA and other omega-3 fatty acids in protecting against mental health problems and suicide risks," co–principal investigator Capt. Joseph R. Hibbeln, MD, acting chief, Section on Nutritional Neurosciences at the National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, said in a statement.

He told Medscape Medical News that the US military "goes to great steps" to ensure they provide the best nutrition to their soldiers, especially in combat and deployment situations. However, these findings on the potential usefulness of omega-3 fatty acids for the brain should be taken into account when designing military diets in the future.

"Omega-3 is already recommended by the American Psychiatric Association as adjunctive therapy for anybody with a psychiatric disorder, especially for those with major depression," said Dr. Hibbeln.

When asked whether he would recommend omega-3 even to those without a diagnosis, Dr. Hibbeln replied, "it certainly wouldn't hurt."

"It's best not to categorize this as 'a drug,' but instead as a fundamental nutrient."

The study was published online August 23 in the Journal of Clinical Psychiatry.

Largest Study of Its Kind

"The recent escalation of U.S. military suicide deaths to record numbers has been a sentinel for impaired force efficacy and has accelerated the search for reversible risk factors," write the investigators.

They note that suicide rates in military personnel have doubled since the start of Operation Enduring Freedom and Operation Iraqi Freedom, and now "rival the battlefield in toll."

Previous research has shown that omega-3 essential highly unsaturated fatty acids (n-3 HUFAs), especially DHA, are needed for optimal neural function.

Nutritional deficiencies in n-3 HUFAs may increase vulnerability to combat deployment stress, manifesting as psychiatric symptoms including adjustment disorders, major depression, impulsive violence, and suicide.

"Nutritional deficiencies in n-3 HUFAs may increase vulnerability to combat deployment stress, manifesting as psychiatric symptoms including adjustment disorders, major depression, impulsive violence, and suicide," the investigators write.

In addition, observational studies conducted in civilian populations have suggested that low DHA levels are linked to increased risk for suicide attempt and may contribute to adverse psychiatric symptoms.

For this study, prospectively collected blood samples from the Armed Forces Health Surveillance Center were evaluated from 800 suicide deaths (95.6% men; mean age, 27.3 years) and 800 randomly selected age- and sex-matched healthy control participants. All were active-duty personnel from the Army, Navy, Air Force, and Marines who served from 2002 to 2008.

"To our knowledge, this is the largest study of biological factors among suicide deaths," the authors write.

The Armed Forces Health Surveillance Center also maintains matched health data, including postdeployment health assessment questionnaires and International Statistical Classification of Diseases, Ninth Revision, mental health and substance abuse diagnosis reports.

Higher Suicide Risks

Results showed that "each standard deviation [SD] of lower DHA was associated with a 14% greater risk for suicide (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.02-1.27; P < .03)," report the investigators.

Men who had serum DHA levels below 1.75% had a significantly greater risk of completing suicide than men with higher levels (adjusted OR, 1.62; 95% CI, 1.12 - 2.34; P < .01.)

There was also a 52% higher suicide risk for all participants who reported having witnessed fellow soldiers wounded, killed, or dead (OR, 1.52; 95% CI, 1.11 - 2.09; P < .01).

In addition, there was an increased risk for suicide associated with more inpatient mental health visits (OR, 1.47;P < .001). However, it was not associated with any substance abuse diagnosis.

Although women had a significantly higher mean DHA percentage compared with men (1.48% vs 1.15%), there was no difference in fatty acids found between the women who did and those who did not complete suicide.

"Nearly all US military personnel had low n-3 HUFA status in comparison to North American, Australian, Mediterranean, and Asian populations," write the researchers.

"Although these data suggest that low serum DHA may be a risk factor for suicide, well-designed intervention trials are needed to evaluate causality," they add.

The treatment committee for the American Psychiatry Association, of which Dr. Hibbeln was a member, issued recommendations in 2006 for 1 g/day of n-3 HUFAs for anyone with a psychiatric disorder, and the US Food and Drug Administration has determined that up to 3 g/day is considered safe.

Omega-3 Intake Matters

"I thought this was an impressive study with a very large sample size," Janice Kiecolt-Glaser, PhD, professor of psychiatry and psychology and S. Robert David Chair of Medicine at the Institute for Behavioral Medicine Research at Ohio State University College of Medicine in Columbus, told Medscape Medical News.

It suggests that the diet of our military, in terms of omega-3 intake, is poor and that it could have implications for mental health. And that's an important and cautionary note for all of us.

"It suggests that the diet of our military, in terms of omega-3 intake, is poor, and that it could have implications for mental health. And that's an important and cautionary note for all of us," said Dr. Kiecolt-Glaser, who was not involved in the study.

As recently reported by Medscape Medical News, Dr. Kiecolt-Glaser led a trial showing that omega-3 supplements may lower both anxiety symptoms and proinflammatory cytokines in healthy young adults.

Dr. Kiecolt-Glaser said she was surprised at how low the omega-3 intake was overall in the current study. "Given this is a population that's already under a lot of strains and at risk for depression, it's something that really needs attention."

She noted that Dr. Hibbeln "has become Mr. Omega-3 for a lot of the psychiatric literature," in terms of depression and omega-3 use.

"He's done cross-national studies in a variety of different cohorts that showed repeatedly that depression is associated with lower levels of omega-3. Then, in randomized controlled trials, we see that omega-3 intake has beneficial effects," she reported.

On the basis of the results of this study, said Dr. Kiecolt-Glaser, it's a "no brainer" to investigate whether making dietary improvements in military personnel makes a difference to mental health outcomes.

"For clinicians who treat civilians, I'd say that omega-3 intake matters, and that it's helpful to keep in mind that there might be dietary issues related to depression as well."

The study was supported by a grant from the Defense Advanced Research Projects Agency and by the Division of Intramural Basic and Clinical Research at the National Institute on Alcohol Abuse and Alcoholism. The study authors and Dr. Kiecolt-Glaser have disclosed no relevant financial relationships.

J Clin Psychiatry. Published online August 23, 2011. Abstract

Read More

A Drink a Day May Keep Alzheimer's Away

August 26, 2011 — Light to moderate drinking seems to reduce the risk for dementia and cognitive decline, according to a new study published in the August issue of Neuropsychiatric Disease and Treatment.

A meta-analysis of 143 studies on the effects of alcohol on the brain showed that moderate drinking, defined as no more than 2 drinks a day for a man and no more than 1 drink a day for a woman, reduced the risk for Alzheimer's disease and other forms of dementia by 23%.

"It doesn't seem to matter if it's beer, wine, or spirits, as long as the drinking was moderate," Edward J. Neafsey, PhD, from the Department of Molecular Pharmacology and Therapeutics at Loyola University Medical Center, Maywood, Illinois, told Medscape Medical News.

Dr. Neafsey and coauthor Michael A. Collins, PhD, became interested in seeing whether alcohol might be protective of human brains after their experiments showed that rat brains exposed to low doses of alcohol for a few days demonstrated resiliency when subsequently treated with a toxin.

"If the rat brain slices were treated for 5 or 6 days with low alcohol and then the toxin was administered, there was hardly any damage, whereas if they didn't get the pretreatment with alcohol, there was significant damage. This led us to ask if there was anything in the human literature that would fit with this protective effect of alcohol," Dr. Neafsey explained.

The researchers reviewed studies dating from 1977 up to the present. The studies fell into 2 categories: those that provided ratios of risk between drinkers and nondrinkers (n = 74) and those that rated cognition in drinkers as "better," "no different," or "worse" than cognition in nondrinkers (n = 69).

Heavy Drinking a Different Story

Light to moderate drinking conferred a similar benefit, but heavy drinking (more than 3 - 5 drinks/day) was associated with a nonsignificantly higher risk for dementia and cognitive impairment.

Most of the studies did not distinguish between the different types of alcohol, but in a few studies, wine appeared to be more beneficial than beer or spirits. "It really seemed to be that alcohol per se was protective, not the type, because the few studies that did make the distinction reported no difference among the effects of the different types of alcohol," Dr. Neafsey said.

The protective effect of moderate drinking held after adjusting for age, education, sex, and smoking.

A number of explanations for the protective effect of moderate alcohol have been proposed. Some dementias are related to cardiovascular system problems, such as atherosclerosis, and alcohol may be protective because it raises the level of high-density lipoprotein (the good) cholesterol and might improve blood flow in the brain.

One theory that Dr. Neafsey and Dr. Collins are working on now holds that alcohol acts as a mild stressor for brain cells and "preconditions" them, making them better able to ward off stress.

"Alcohol doesn't kill the brain cells, but it's a slight stress. When the cells are exposed they increase levels of various protective compounds, so...they are prepared when something more stressful that might kill or damage them comes along. The theory is called 'preconditioning,' where a mild stress given a few days before a severe stress causes a significant protection."

Understanding the mechanism of alcohol's protective effect could lead to a treatment to prevent cognitive impairment and dementias, Dr. Neafsey said.

"Whether it's treatment with a pill or a lifestyle change, if we could understand the mechanism, it would improve our ability to deal with these illnesses," he said.

Novel Approach

Medscape Medical News asked Anton P. Porsteinsson, MD, the William B. and Sheila Konar professor of psychiatry at the University of Rochester School of Medicine, New York, to comment on this study.

"This is a well-done meta analysis. The findings are consistent with other meta analyses that have been done. Am I tremendously surprised at the findings? No, because they are looking at the same pool of studies," Dr. Porsteinsson said.

"The fact that they approach it in slightly different ways and yet find similar outcomes makes me confident that this is what the data are actually signaling to us: that very modest alcohol consumption is protective," he said.

The next step is to figure out how moderate alcohol consumption exerts its protective effect.

"Is it some direct effect of the alcohol on the brain? Are people who consume moderate amounts of alcohol different in some way, in their diet, or their level of exercise? Are low concentrations of alcohol neuroprotective? Is it through some metabolic impact?" Dr. Porsteinsson said.

Also interesting was that alcohol appeared to protect against all types of dementia, he said.

"This makes it less likely to have a direct effect on beta amyloid or tau, but more of a global effect. It is an interesting review. They made it a pleasure to read."

The study was supported by the National Institutes of Health. Dr. Neafsey, Dr. Collins, and Dr. Porsteinsson have disclosed no relevant financial relationships.

Neuropsychiatric Dis Treat. 2011;7:465-484. Abstract

 

Read More

Heart-Healthy Foods Better Than a Low-Saturated-Fat Diet

August 23, 2011 (Toronto, Ontario) — A diet rich in foods with proven heart-healthy benefits is significantly better than a diet low in saturated fat for reducing LDL-cholesterol levels in patients with hyperlipidemia, according to the results of a new study [1]. The "dietary portfolio" of cholesterol-lowering foods reduced LDL-cholesterol levels by 26 mg/dL, nearly as large a reduction as was observed in some of the earliest statin trials, according to researchers.

"The four major components of the dietary portfolio are foods that theFood and Drug Administration has recognized as being able to carry a heart-healthy claim for their ability to lower serum cholesterol levels," said lead investigator Dr David Jenkins (University of Toronto, ON). "These include soy proteins, sticky types of fibers like oats, barley, and psyllium, vegetables, viscous fibers, nuts, and plant sterols. We basically looked for ways in which these components were enriched in foods obtainable from the supermarket and encouraged people with support and help to look after themselves."

Speaking with heartwire, Jenkins said the foods included in the diet have been shown to reduce serum LDL-cholesterol levels by as much as 28% to 35%. Unknown, however, was how effective the dietary portfolio would be in real-world conditions or how effective the diet would be compared with a standard diet low in saturated fat.

Portfolio Diet vs Diet Low in Saturated Fat

Published in the August 24, 2011 issue of the Journal of the American Medical Association, the 24-week, parallel-design study included 351 patients with hyperlipidemia from four academic medical centers in Canada. Patients were randomized to one of two dietary interventions: a standard diet low in saturated fat; and the portfolio diet consisting of plant sterols, soy protein, viscous fibers, and nuts. In addition to the portfolio diet, the patients eating the heart-healthy foods received dietary advice for six months, with intensive-treatment patients receiving seven 40-minute counseling sessions and the routine-treatment portfolio patients receiving two counseling sessions.

The purpose of the different intensities of dietary counseling was to determine whether the routine dietary portfolio, which would be considered manageable by physicians in that it required just two counseling sessions, would be as effective as a more intensive treatment arm requiring multiple office visits.

Intensive therapy with the portfolio diet reduced LDL-cholesterol levels 13.8% from baseline, a reduction of 26 mg/dL (p<0.001). Similarly, patients treated with the portfolio diet who received just two counseling sessions also had significant reductions in LDL cholesterol, which was reduced 13.1% from baseline, or down 24 mg/dL. The reductions in LDL cholesterol were not statistically different in the two dietary-portfolio treatment arms.

Overall, individuals who followed more of a plant-based diet within the dietary portfolio had the lowest reduction in LDL-cholesterol levels, noted Jenkins.

Comparatively, patients in the control arm eating a standard low-saturated-fat diet reduced their LDL cholesterol levels 3%, down 8 mg/dL from baseline. The percentage reduction in LDL cholesterol was significantly greater in both portfolio diets compared with the low-saturated-fat diet (p<0.001).

To Treat or Not to Treat With a Statin

To heartwire , Jenkins noted that patients in the study had an average LDL-cholesterol level of 171 mg/dL at baseline, so they were considered hyperlipidemic but were not taking any medication to lower their cholesterol levels. The next step for the researchers is to test the effectiveness of the heart-healthy portfolio diet in patients with increased cardiovascular risk or those taking medications to lower their LDL-cholesterol levels. The hope is that eating a diet rich in soy proteins, viscous fibers, nuts, and vegetables can incrementally add to the benefit offered by LDL-lowering medications.

"We don't regard this as the end of the line by any means in terms of where we have to go with this diet," said Jenkins. "We have to see what this diet does in combination with statins, how much of an advance we can get, and whether we can actually lower the dose of statin therapy. More important, we need to know if the diet is applied over a long period of time, do we actually see a cardiovascular-outcome benefit, initially in ultrasound and magnetic-resonance imaging of the arteries, and in the longer term, in improvements in cardiovascular events."

Jenkins added that patients in the present analysis are typically patients that cause some problems for doctors, mainly in the sense that "they can be scratching their heads" about whether or not they should be treated with a statin. These results showed that the diet can help pull patients out of a middle-risk category to one that is lower risk. For example, the diet resulted in a 10% reduction in the Framingham risk score, which is sufficient to take a patient from moderate risk to low risk, he said.

Read More

Macrolide Useful in COPD But May Cause Hearing Loss

August 24, 2011 — Azithromycin given daily for 1 year in addition to usual treatment reduces exacerbations and improves quality of life in selected patients with chronic obstructive pulmonary disease (COPD) but causes hearing decrements in a small percentage of patients, according to the results of a randomized controlled trial reported in the August 25 issue of the New England Journal of Medicine.

"Acute exacerbations adversely affect patients with ...COPD," write Richard K. Albert, MD, from Denver Health in Denver, Colorado, and colleagues from the COPD Clinical Research Network. "Macrolide antibiotics benefit patients with a variety of inflammatory airway diseases."

The goal of this study was to examine the association of azithromycin use with frequency of exacerbations in patients with COPD who had an increased risk for exacerbations but no evidence of hearing impairment, resting tachycardia, or risk for corrected QT interval prolongation.

Of 1577 patients screened, 1142 (72%) were randomly assigned to receive, in addition to their usual care, 250 mg of azithromycin daily (n = 570), or daily placebo (n = 572) for 1 year. The 1-year follow-up rate was 89% for patients receiving azithromycin and 90% for those receiving placebo.

In the azithromycin group, the median time to the first exacerbation was 266 days (95% confidence interval [CI], 227 - 313) vs 174 days (95% CI, 143 - 215) in the placebo group (P < .001). There were 1.48 exacerbations per patient-year in the azithromycin group and 1.83 per patient-year in the placebo group (P = .01), with a hazard ratio of 0.73 in the azithromycin group for having an acute COPD exacerbation (95% CI, 0.63 - 0.84; P < .001).

Compared with the placebo group, the azithromycin group had a greater improvement in St. George's Respiratory Questionnaire scores. Mean decrease was 2.8 ± 12.8 vs 0.6 ± 11.4 units (P = .004) on a scale of 0 to 100, with lower scores reflecting better functioning. The azithromycin group also fared better in the percentage of participants with more than the minimal clinically important difference of −4 units (43% vs 36%; P = .03). However, patients in the azithromycin group were more likely to have hearing decrements than those in the placebo group (25% vs 20%; P = .04).

"Among selected subjects with COPD, azithromycin taken daily for 1 year, when added to usual treatment, decreased the frequency of exacerbations and improved quality of life but caused hearing decrements in a small percentage of subjects," the study authors write. "Although this intervention could change microbial resistance patterns, the effect of this change is not known."

Limitations of this study include evaluation of only a single-dose regimen, incomplete collection of sputum samples, and study duration limited to 1 year.

'Do Good, Not Harm'

An accompanying editorial by Nikolaos M. Siafakas, MD, PhD, from the Department of Thoracic Medicine, Medical School at the University of Crete in Crete, Greece, discusses prevention of COPD exacerbations.

"[I]f azithromycin is going to be used in patients who are known to have frequent exacerbations of COPD, then the local antibiotic resistance patterns should be closely monitored," Dr. Siafakas writes. "It also makes sense to ask whether, in such patients, subsequent exacerbations should be treated empirically with a different class of antibiotics. On balance, however, the long-term use of azithromycin to prevent acute exacerbations of COPD would not seem to be at odds with the classical advice of Hippocrates, 'Ωφελέειν ου Βλάπτειν' — 'Do good, not harm.'"

The National Institutes of Health supported this study. The COPD Clinical Research Network is supported by a Cooperative Agreement from the Division of Lung Diseases of the National Heart, Lung, and Blood Institute. Dr. Albert has received consulting fees from Gilead Sciences, fees for expert testimony from the Bruce Fagel Law Firm, and royalties from Elsevier, and being named on a patent pending for a device that provides continuous monitoring of the elevation of the head of the bed (Denver Health and the University of Colorado). The other study authors have disclosed various financial relationships with such commercial entities as Novartis Pharmaceuticals, Forest Pharmaceuticals, Boehringer Ingelheim, Roche, GlaxoSmithKline, Phillips Pharmaceuticals, Theratechnologies, Breathe Technologies, AstraZeneca, and Boston Scientific. A complete description of disclosures is available in the original article.

N Engl J Med. 2011;365:689-698, 753-754.

Read More

Saffron may help prevent liver cancer

Saffron provides a significant chemo preventive effect against liver cancer in animal models. A new study has found that saffron, a commonly used spice, that add flavour and colour to foods, provides a significant chemo preventive effect against liver cancer in animal models. When saffron was administered to rats with Di Ethyl Nitrosamine (DEN), induced liver cancer, an inhibition of cell proliferation and stimulation of apoptosis was observed. Hepatcellular carcinoma (HCC), or liver cancer, is the fifth most common cancer and the third leading cause of cancer mortality in the world. Prior studies have shown that saffron, a naturally derived plant product, possesses antioxidant, anti-cancer, and anti-inflammatory properties. The research team administered saffron to the animals at 75mg/kg, 150 mg/kg, and 300 mg/kg per day two weeks prior to DEN injection and continued the regimen for 22 weeks. Results show saffron significantly reduced the number and the incidence of liver nodules, with animals receiving the highest dose of saffron showing complete inhibition of hepatic nodules. Animals that received pre-treatment with saffron displayed a decrease in the elevation of gamma glutamyl transpeptidase, alanine aminotransferase and alpha-fetoprotein (GGT, ALT, aFP)—proteins, which indicate liver damage. Furthermore, saffron inhibited the elevation of cells positive for Ki-67, cyclo-oxygenase 2, inducible nitric oxide synthase, nuclear factor-kappa Bp-65 and the phosphorylated tumour necrosis factor receptor, all of which have respective roles in the development and progression of cancerous cells. “Our findings suggest that saffron provides an anti-cancer protective effect by promoting cell death (apoptosis), inhibiting proliferation of cancerous cells, and blocking inflammation,” concluded Prof. Amr Amin from United Arab Emirates University. The detailed study appeared in the September issue of Hepatology, a journal published by Wiley Blackwell on behalf of the American Association for the Study of Liver.     زعفران جگر کے کینسر میں مفید زعفران میںپایا جانے والاخاص قسم کا کیمیکل جگر کے کینسر کے خلاف موئثر ہے۔ ایک نئی تحقیق کے مطابق زعفران جو کہ کھانےمیں ذائقہ اور رنگ پیدا کرنے کے لئے عام استعمال کیا جاتا ہے کے اندر جگر کے کینسر سے بچائو کا خاص کیمیکل پا یا جاتا ہے۔ تجربات کے نتائج نے ثابت کیا ہے کہ زعفران جگر کے اندر کینسر کی وجہ سے پیدا ہونے والے غیر معمولی ابھاروں کو خاطر خواہ حد تک کم کرنے میں مدد کرتا ہے اور اس کا زیادہ مقدار میں  استعمال جگر کے کینسر سے مکمل نجات کا ذریعہ بھی بن سکتا ہے۔

Read More

Faisalabad: Dengue prevention discovered

فیصل آباد: زرعی سائنسدانوں نے ڈینگی سے بچاؤ کا طریقہ دریافت کرلیا

زرعی یونیورسٹی فیصل آباد کے سائنسدانوں نے ڈینگی وائرس کے پھیلاؤ سے بچاؤکے لئے کیمیکل فری طریقہ دریافت کر لیا ہے جسے ایک بڑی کامیابی قرار دیا جارہا ہے.

ملک بھر میں ڈینگی کا مرض گذرے چند برس میں وبا کی شکل اختیار کرتا جا رہا ہے۔ مچھروں کی بہتات سے پھیلنے والی اس بیماری کو روکنے کے لئے محکمہ صحت کی جانب سے کئے گئے اقدامات بے سود رہے۔ زرعی یونیورسٹی فیصل آباد کے سائنسدانوں نے مچھروں کو قابو کرنے کا طریقہ ڈھونڈ ہی لیا۔ سائنسدانوں نے مالٹے کے چھلکے سے ایسا رس تیار کیا ہے جو ان مچھروں کی افزائش روک دے گا۔ ماہرین نے ایسے حشرارت کا پتہ بھی لگایا ہے جو ان مچھروں کو کھاتے ہیں۔ سائنسدانوں کی اس کامیاب تحقیق کو عملی جامہ پہنانے کے لئے صوبائی اور وفاقی حکومت کو ارسال کر دیا گیا ہے۔

The Health Ministry has failed to stop the spread of disease caused by Dengue mosquitoes.

Researchers at Faisalabad Agricultural University discovered a chemical free method to stop the spread of Dengue virus.

The Researchers has discovered that the orange rind contains certain elements that prevent the growth of Dengue mosquitoes.

The researchers have also found such insects that eat Dengue mosquitoes.

The researchers have sent their findings to the federal and provincial authorities so that they could be used to quell the spread of disease.

All measures taken by the Health Ministry in last few years has failed to stop the spread of Dengue fever and the count of dengue patients is on the rise.

Read More