Wednesday, November 26, 2008

Conventional blood pressure test has no prognostic value

Researchers enrolled 556 people aged 65 on average who had high blood pressure despite having been treated with anti-hypertensive drugs and followed up for 4.8 years to determine which form of blood pressure monitoring was a better predictor of risk of cardiovascular disease in people with medication-resistant high blood pressure.

They found that conventional surgery-measured BP did not predict strokes or heart attacks, but readings taken over 24-hour period could. Critics say conventional blood pressure testing by a GP remains essential and is invaluable in detecting and monitoring high blood pressure that often has no symptoms and is difficult to detect.

Source: Salles GF, Cardoso CRL, Muxfeldt ES. Prognostic Influence of Office and Ambulatory Blood Pressures in Resistant Hypertension. Archive of Internal Medicine 2008; 168: 2340-2346
(f/t via Athens)

Incompetent boss increases employees' heart disease risk

Many studies have linked employee health to workplace conditions but a new Swedish study called WOLF, involving more than 3200 men aged 19 to 70 without pre-existing ischemic heart disease who were working in Stockholm, suggested a significant effect of concrete managerial skills on employee heart disease risk .

All the participants were asked to rate the leadership style of their senior managers on competencies, researchers found that the poorer the men rated their boss's leadership ability, the higher the risk of heart disease. The risk increased the longer the men worked in the same stressful environment.

The lead researcher said "Enhancing managers' skills -- regarding providing employees with information, support, power in relation to responsibilities, clarity in expectations, and feedback -- could have important stress-reducing effects on employees and enhance the health at workplaces".

Source: Nyberg A, et al "Managerial leadership and ischaemic heart disease among employees: the Swedish WOLF study" Occupational and Environmental Medicine 2008; DOI: 10.1136/oem.2008.039362. (See BBC link )

Friday, November 21, 2008

Counselling could cut breast cancer

227 women aged between 20 and 85 years who had undergone surgery for breast cancer were enrolled in a study and were randomly assigned into two groups, one group received a psychological intervention, while the other did not.

The psychological intervention aimed to reduce distress, improve quality of life and mood, improve heath related behaviours and to improve the women’s adherence to their cancer treatment and follow-up programme.

After 11 years follow-up and comparison, researchers found that the psychological intervention roughly halved the chances of cancer returning and affected the length of time it took for the disease to reoccur. Critics say the study highlights the importance of appropriate support for women with breast cancer.

Source: Andersen BL, Yang HC, Farrar WB. Psychologic intervention improves survival for breast cancer patients. Cancer 2008; Published Online: 17 Nov 2008

Pepermint oil is effective in treating IBS

A new study of randomised controlled trials comparing fibre, antispasmodics, and peppermint oil with placebo or no treatment in adults with irritable bowel syndrome found that all three were more effective than placebo in the treatment of irritable bowel syndrome (IBS).

However, critics say the treatment effect might have been overestimated by the lack of concealment in the allocation of the treatments. Adverse effects were not reported across studies. The trials have only compared each treatment to placebo, so it cannot be assumed that any one treatment is more effective than the others.

Ford AC, Talley NJ, Spiegel BMR, et al. Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ 2008; 337:a2313 ( f/t via Athens)

Large waist doubled death risk

A large scale study involving about 360,000 participants, conducted by research institutions across Europe has found that those with a large waist had twice the risk of premature death even if they were not overweight.

The study ran for 9.7 years and researchers found that BMI, waist circumference and waist-to-hip ratio were all strongly associated with the risk of death. They said the findings suggested that "general adiposity (fat) and abdominal adiposity are associated with the risk of death and support the use of waist circumference or waist-to-hip ratio in addition to BMI in assessing the risk of death".

The European co-ordinator of the study said people with large waist should exercise every day, avoid alcohol and improve their diet.

Source: "General and Abdominal Adiposity and Risk of Death in Europe" NEJM 359(20):2105-2120 (November 13, 2008) free f/t

Friday, November 14, 2008

JUPITER trial - will you change your practice?

The findings of a large statins trial presented at the Am Heart Association meeting on 9 November 2008 dominated the news and stirred up debates.

The study, called JUPITER trial, funded by AstraZeneca (maker of rosuvastatin, marketed as Crestor, the drug in the trial) is a large international, double-blinded, placebo controlled randomised clinical trial including 17,802 "healthy" men and women with normal LDL cholesterol but elevated CRP (C-reactive protein) assigned to receive either 20mg of daily dose of rosuvastatin or placebo.

The researchers found the rosuvastatin reduced their risk of heart attack ( 54% ), stroke (48% ), in need of angioplasty or bypass surgery (46% ) and death from any cause ( 20% ). The trial leader, Dr Paul Ridker, who receives grant from the drug company, said expanding the use of statin could prevent 250,000 heart attacks, strokes, vascular procedures or death over 5 years. The JUPITER trial was designed a 4-year study but stopped after 1.9 years because of the benefits found.

Opinions on the findings are mixed and many questions raised. Some said that clinical practice on CRP testing and statin therapy would be affected by this important landmark study while some questioned the short follow-up and long-term safety of low LDL levels achieved in this trial. Dr Mark Hlatky wrote in the NEJM's editorial "the evidence should be examined critically" before drug treatment is expanded and "Long-term safety is clearly important in considering committing low-risk subjects without clinical disease to 20 years or more of drug treatment."

NEJM published this article and the accompanying editorial ( free f/t ) on its website on 9 November 2008 and invited doctors to contirbute their thoughts on the JUPITER results.


Source: "Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein" Published at www.nejm.org November 9, 2008 (10.1056/NEJMoa0807646)

Poor sleep links to heart disease

In a study of 1,255 Japanese adults with high blood pressure aged 70.4 in average, researchers recorded each participant's blood pressure changes over 24-hour period and followed them for about 50 months.

During the follow-up, there were 99 cardiovascular disease events, they also found that participants who slept less than 7.5 hours a night had 68% high risk of one of these complications than those who had longer sleep.

They also found that the risk was higher among participants who also had an increase in overnight blood pressure than those who did not have an increase in blood pressure. Researchers concluded that "shorter duration of sleep is a predictor of incident cardiovascular disease in elderly individuals with hypertension, .......Physicians should inquire about sleep duration in the risk assessment of patients with hypertension."

Source: "Short Sleep Duration as an Independent Predictor of Cardiovascular Events in Japanese Patients With Hypertension" Arch Intern Med. 2008;168(20):2225-2231 (f/t via Athens)

Calcium and vitamin D do not prevent breast cancer

Previous studies have reported vitamin D supplements may reduce breast cancer risk but a new study, published online in the Journal of the National Cancer Institute, found that calcium and vitamin-D supplements do not reduce breast cancer incidence in postmenopausal women.

More than 36,000 postmenopaused women were randomly assigned to take 1000 mg of calcium plus 400 IU of vitamin D daily or placebo. Researchers found that the incidence of breast cancer was similar in the supplement ( 528) and placebo ( 546) groups. The authors concluded that " the main findings do not support a causal realtionship between calcium and vitamin D supplement use and reduced breast cancer incidence".

In an accompanying editorial "Breast Cancer Prevention Using Calcium and Vitamin D: A Bright Future?" ( free f/t), the authors say that the study results may have been affected by multiple "important confounders" and that vitamin D and calcium may still have a "bright future" in breast cancer prevention and further studies will be needed.

Source: "Calcium Plus Vitamin D Supplementation and the Risk of Breast Cancer" Journal of the National Cancer Institute. Advance Access published online on November 11, 2008 JNCI, doi:10.1093/jnci/djn360

Folic acid and B vitamins do not affect cancer risk

Folic acid and B vitamins are thought to have an important role in cancer prevention, but a study published in JAMA found that these supplements had no significant effects on overall cancer risk.

More than 5000 women health professionals, aged 42 or older, enrolled in a RCT designed to evaluate the effects of folic acid and B vitamins on cancer risk in women with high risk cardiovascular disease. They were randomly assigned to receive a daily combination of folic acid and B vitamin or a placebo for 7.3 years.

Researchers found that the supplement group had similar risk of developing cancer or death and there was a significant reduced risk of cancer in women aged 65 or older at study entry. The authors said "if the findings is real and substantiated, the results may have public health signficance because the incidence rates of cancer are high in elderly perosns...."

Source: Effect of Combined Folic Acid, Vitamin B6, and Vitamin B12 on Cancer Risk in Women. JAMA, 2008; 300 (17): 2012-2021 ( f/t via Athens)