Too much added sugars may increase heart disease risk

A new JAMA study found that consuming a higher amount of added sugars in processed foods may increase cardiovascular disease risk factors.

The study analysed the US government nutritional data and blood lipid levels in more than 6000 adults and found that the highest consumption of added sugars was 46 teaspoons per day and the lowest was about 3 teaspoons daily. It also found that high consumption of added sugars was significantly correlated to lower levels of good cholesterol (high-density lipoprotein cholesterol, HDL-C) and higher levels of triglycerides, which are important risk factors for cardiovascular disease.

The authors said that this is the first study that examined the the association between added sugars consumption and lipid measures and found that total consumption of sugars in the US has substantially increased. People should cut down their added sugars consumption and further studies on the effect of reducing added sugars and other carbohydrates on lipid profiles are needed.

Source: J. A. Welsh, A. Sharma, J. L. Abramson, V. Vaccarino, C. Gillespie, M. B. Vos. "Caloric Sweetener Consumption and Dyslipidemia Among US Adults". JAMA 2010; 303 (15): 1490 (Full text via Athens)

Should aspirin be used for migraine relief?

A new Cochrane systematic review found that high dose aspirin can reduce migraine headache within 2 hours.


The review compared the use of aspirin to placebo or other migraine drugs including 13 studies and 4222 patients with migraine attacks. The amount of aspirin used in these studies varied between 900 - 1000 mg. Patients were randomly assigned to either a single dose of aspirin or a placebo or an active drug.

Researchers found that 24% of aspirin users were pain-free within 2 hours comapred to 11% of placebo users, aspirin also reduced the symptoms of nausea and vomiting, but aspirin plus antiemetic reduced these symptoms significantly compared with placebo. They concluded that 1000 mg of aspirin is effective for migraine relief, similar to the effect with sumatriptan.


Critics say that it is important to note that the over-the-counter standard aspirin is only 75mg and evidence has shown that regular use of aspirin may increase stomach problem or bleeding, taking high dose aspirin may increase these side effects. Also the effectiveness of aspirin may not apply to everyone as only a quarter of patients in these studies were pain-free after 2 hours.


Source : Kirthi V, Derry S, Moore RA, McQuay HJ. "Aspirin with or without an antiemetic for acute migraine headaches in adults (Review)". The Cochrane Library 2010, Issue 4

Do multivitamin tablets increase breast cancer risk?

Multivitamin supplements are widely used, but a large study involving 35,000 Swedish women aged 49 to 83 found that those who regularly took multivitamins had a higher risk of breast cancer than women who did not.


Based on self-reported questionnaire data, the researchers analysed the women's use of multivitamins as well as details about their health and lifestyle, followed up for 9.5 years until December 2007 to assess the cancer risk. They found that women who took multivitamins were 19% more likely to develop breast cancer than non-users. They also found that women who had taken these supplements for 3 years or more and those who took 7 or more pills a week were at increased risk of breast cancer than non-users, however the increase was very small.

The researchers concluded that "multivitamin use is associated with an increased risk of breast cancer" but they noted that other studies have had conflicting results. The authors said that this study carries an important public health message and recommend women to eat healthy diet instead of using supplements.

Critics say that this study was based on self-reported data that could affect the results. Further research is needed, it is not possible to say which of the supplements may contribute to breast cancer risk.

Source: "Multivitamin use and breast cancer incidence in a prospective cohort of Swedish women". American Journal of Clinical Nutrition, March 24 2010 (full text via Athens)

Brisk walking can reduce stroke risk in women

A large study published in Stroke found that women who walked two or more hours a week or walked briskly lowered the risk of stroke by more than a third.


The researchers followed nearly 40000 women aged over 44 for about 12 years to investigate the link between the levels of physical actitivity and the risk of having a stroke. The participants reported periodically on their physical activities via a questionnaire. 579 women had a stroke during the follow-up years.


The researchers said they have found a borderline significant link between the time spent on physical activities and stroke risk but they did not find a link between vigorous activity and reduced stroke risk. The lead author said the study was observational and physical activity was self-reported, further study is needed on more hemorrhagic strokes and with more ethnically diverse women.

Source: "Physical Activity and Risk of Stroke in Women". Stroke, published online April 2010 DOI

High GI food may increase women's heart risk

According to a study published in the Archives of Internal Medicine, consuming carbohydrates with high glycemic index (GI) such as white bread, sweets and sugary cereals appears to be associated with the risk of coronary heart disease in women but not men. However, not all carbohydrates have the same effect on blood glucose levels.

Italian researchers studied 47,749 adult men and women who completed dietary questinnaires. They found that women who consumed the most carbohydrates overall had approximately twice the risk of heart disease as those consumed the least. Women whose diet had the highest glycemic load had 2.24 times the risk of heart disease than those with the lowest glycemic load.

The researchers concluded "we tentatively suggest that the adverse effects of a high GI diet in women are medicated by sex-related differences in lipoprotein and glocuse metabolism" and that further studies are needed to verify the link between high-glucose foods and cardiovascular disease in men.

Source: "Dietary Glycemic Load and Index and Risk of Coronary Heart Disease in a Large Italian Cohort: The EPICOR Study". Arch Intern Med, 2010; 170 (7): 640-647

Maternal deaths drop worldwide

The Lancet published an article online on 12 April that has found significant decline in maternal deaths worldwide. This finding however is very different from a new UN study claiming that the number of women dying in childbirth remains high at 500,000 a year.

The Lancet study is based on the data collected from 181 countries between 1980 and 2008 provided by the Univeristy of Washington and found that maternal deaths have fallen from about 500,000(1980) to about 343,000 (2008). Many experts are surprised by the finding as they have assumed little progress made in this area.

According to the journal editor, The Lancet was pressured by some advocate groups to delay the publication of the new finding fearing loss of funding, but he said that the new data shows improvements and should encourage politicians to spend more on women's health.

Source: "Maternal mortality for 181 countries, 1980—2008: a systematic analysis of progress towards Millennium Development Goal 5". The Lancet, Early Online Publication, 12 April 2010

Should patients be given a voice in drug-safety reporting?

An oncologist, Ethan Basch, wrote in the March 11 issue of NEJM, that current clinician-based approach to adverse symptom reporting is based on clinicians’ impressions of patients’ symptoms, not on patients’ direct symptom reports. He said that evidence has shown that clinicians responsible for collecting and reporting adverse symptoms in clinical trials systematically downgrade the severity of patients’ symptoms and often miss the side effects, as a result vital information about drug safety is missing .

He argued that doctors, researchers and regulators should pay more attention to patients’ symptom reports while taking a drug because it could help identify symptoms earlier during a course of treatment and reduce preventable harm.

He said that technologies are now available for collecting information directly from patients and patients should be given the tools to self-report adverse symptoms in clinical trials such as online reporting between clinic visits, this can capture a lot of baseline symptoms before the drug is approved including those symptoms that researchers did not anticipate.

He concluded that “patient self-reporting would enhance the capture of subjective elements of safety information and patients are entitled to know the impressions of their peers”, such information would also help clinicians to evaluate the drugs.

Source: "The Missing Voice of Patients in Drug-Safety Reporting". NEJM 362(10):865-869 (full text via Athens)

Statins raise small diabetes risk

Statins have been used as cholesterol-lowering drugs to prevent heart attacks and strokes although trials of statins have produced conflicting results.

A new report based on a meta-analysis of 13 randomised controlled trials of statins between 1994 and 2009 involving 91,000 patients showed that there was a clear link between statin treatment and a small but significant increased risk of diabetes - 9% increase over 4 years in those using the drug than those without the treatment. The researchers said that the risk is very low and outweighed by the benefits of this drug and concluded that patients with moderate or high cardiovascular risk should not stop taking this drug.

Critics say this is a well-conducted review, when all the results were combined into a meta-analysis, the diabetes risk was relatively small, however various unidentified cofounding factors may have affected the observed results. The study was published in The Lancet online.

Source: "Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials". The Lancet, Early Online Publication, 17 February 2010

Can aspirin reduce breast cancer recurrence?

According to a new study published online in the Journal of Clinical Oncology, there was an association between frequent use of aspirin and lower risk of dying from cancer.

Researchers used survey data from US Nurses' Health Study to examine the effect of aspirin on breast cancer recurrence and survival including over 4000 nurses between 1980 and 2006. They found that women who took aspirin after finishing breast cancer treatment were half as likely to die from the disease compared with those who did not use aspirin regularly. However, the researchers pointed out that the participants were all nurses, the results may not be applied to the general population and they called for a randomised controlled trial to establish whether aspirin really caused the reduced risks they had found.

Previous studies on aspirin's anticancer effects have come to mixed conclusions, experts warned that patients should not start taking aspirin as there are risks associated with taking aspirin including bleeding and gastrointestinal complications.

Source: Holmes MD, Chen WY, Li L, et al. "Aspirin Intake and Survival After Breast Cancer". Journal of Clinical Oncology 2010 ( f/t via Athens)

Gastric banding achieved more weight loss in obese teens

According to a study published in the February 10 issue of JAMA, gastric banding achieved significant weight loss than lifestyle intervention in severely obese adolescents.


Australian researchers conducted a randomised controlled trial to compare the outcomes of gastric banding with a lifestyle program on adolescent obesity including 50 people aged between 14 and 18 with a BMI >35. The study, carried out between 2005 and 2008, was followed up for 2 years.


The researchers found that more than 50% weight loss was achieved by 84% in the gastric banding group compared with just 12% in the lifestyle group. The average weight loss was about 34 kg in the gastric banding group and only 3 kg in the lifestyle group. The differences between the 2 groups were significant for all weight measures at 24 months with 24 in the gastric banding group and 18 in the lifestyle group completed the study.


The authors concluded that "Among obese adolescent participants, use of gastric banding compared with lifestyle intervention resulted in a greater percentage achieving a loss of 50% of excess weight" and "There were associated benefits to health and quality of life".


Critics say there are limitations to the study including recruitment bias, small number of participants and short follow-up period. An accompanying editorial "Surgical Treatment of Obesity in Adolescence" notes that this study provides important evidence about the bebefits and risks of bariatric surgery.


Source:"Laparoscopic Adjustable Gastric Banding in Severely Obese Adolescents : A Randomized Trial" JAMA. 2010;303(6):519-526 (f/t via Athens)

Serotonin deficit may cause SIDS

A new study published in JAMA found that the brainstems of babies who have died from Sudden Infant Death Syndrome (SIDS) had lower level of serotonin than those babies who died from other causes. SIDS is still the leading cause of death in infants.

Previous studies had found that serotonin levels have been linked to SIDS, but this study sheds light on the defect in the infants' brain that might account for SIDS.

The researchers found that in 35 of the 41 SIDS babies, serotonin levels were 26 % lower than in those who died of other causes and levels of an enzyme that stimulates serotonin production were 22 % lower. Serotonin receptor was 50 % lower in SIDS babies.

Experts say that this is an important advance in the understanding of what's wrong with the brainstem of SIDS babies but there is still a long way to go to finding a detection test and then a treatment. The authors emphasized avoiding known risk factors such as bed sharing, soft bedding and smoking.

Source: "Brainstem Serotonergic Deficiency in Sudden Infant Death Syndrome" JAMA 2010;303(5):430-437. ( f/t via Athens)

The Lancet retracted the MMR and autism paper

The Lancet issued a press release on Tuesday 2 February 2010 following the GMC's decision on the paper by Wakefield et al in 1998 stating that several elements of the paper are incorrect. "In particular, the claims in the original papaer that children were consecutively referred and that investigations were approved by the local ethics committee have been proven to be false. Therefore we fully retract this paper from the published record."


The study, published in The Lancet, claimed 8 of the 12 children showed signs of autism within days of receiving the MMR vaccine. The lead author, Andrew Wakefield, suggested that there might be a link between the vacciantion and autism. Although it was a very small study with only 12 children, the findings had caused a massive drop in the uptake of the MMR vaccine and sparked panic over the MMR vaccine around the world.


In the same issue of The Lancet, a commentary " Vaccine adverse events: causal or incidental?" written by 2 American vaccine specialists was also published. They pointed out that Wakefield's paper lacked epidemiological evidence to support the causal association with MMR vaccine and warned that such claim would cause confusion and fear among the media and the public. Unfortunately their message was not picked up by the media and the general public had little access to research articles.


The GMC found that Wakefield had no ethical approval nor relevant qualifications to carry out the tests on children. He also failed to declare that he had received money from a law firm representing the parents to carry out the research. Questions were raised on how Wakefield's research was scrutinised by the Royal Free and UCL Medical School where he worked at the time. A subsequent investigation by The Royal Free Hospital in 2004 reported that Wakefield's work on children was "appropriate". However, The Lancet issued a partial retraction of the interpretation from 10 of the 12 authors except Wakefield and one other author. See "The lessons of MMR" The Lancet, 363, 6 March 2004, pp 747–749 ( full text via Athens)

Some critics say the Lancet retraction is a bit too late while others say that the retraction will not change the situation as the MMR-autism debate continues.

See also: "The Lancet retracts controversial MMR research paper". Independent ,2 February 2010

Concerns raised on high prescription errors in children

A study, carried out in 2005 by the Univeristy of London involving a children's hospital, 3 general teaching hospital and 1 non-teaching hospital in London, looked at prescription errors given to children in hospital. The study was published in Archives of Disease in Childhood.


During the study, pharmacists found 391 prescription errors and 429 administration errors in the 3000 prescriptions they exmined over a 2-week period. Errors included incomplete prescriptions, wrong dose, how the drugs should be prepared or how they should given to the patients. One mistake was picked up by the nurse, on 5 occasions, the researchers intervened to prevent the patient suffering the harm.

The researchers believe that their findings show a general picture across Britain and still stand today. The author said prescribing for children is very difficult because most drugs are formualted for adults, doctors have to calculate the dose for children. Much more needs to be done to improve prescribing to children.


They call for better education for doctors on prescription skills and electronic prescribing to be introduced in hospitals. See also post on GMC study on prescription errors in hospitals.

Source: "Minimising medication errors in children”Archives of Disease in Childhood 2009 ;94:161-164

Too much TV viewing shortens lives

Nearly 9,000 Australian adults, divided into 3 groups, were tracked for roughly six and a half years by researchers: those who watched TV less than 2 hours per day, between 2 and 4 hours, and more than 4 hours.

Researchers found that those who watched TV more than 4 hrs had a 46% higher risk of death from all causes and an 80% higher risk of cardiovascular death, each hour watching the TV per day increased the risk of death from cardiovascular disease by 18% and the risk of cancer death by 9%. The study was published online in Circualtion.

Researchers found a strong connection between TV hours and death from cardiovascular disease not only in overweight and obese people, but also among those who had a healthy weight. The lead author said "sitting for long periods has unhealthy influence on blood sugar and blood fats".


Source: Television Viewing Time and Mortality. The Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Circulation. Published online before print January 11, 2010

Higher antibiotic doses to bigger people

Two doctors said in The Lancet Viewpoint, although drug treatments are tailored for individual patients, most dosing regimens, do not take patient's body size into consideration.

They argued that with increasing level of obesity worldwide, the standard dose of antibiotics for all adults is outdated because it may not be strong enough to clear the infection in taller and larger adults and resistance may be developed. Likewise, smaller patients may get too much drug, and suffer greater side-effects as a result.

They said that a patient's bodyweight should be taken into account when calculating their dose of antibiotics to achieve effectivenesss and safety.

Critics say that this review is based on authors' views and experience and is a valuable discussion. Changes to current prescribing would be costly and complicated, therfore further research and follow-up of previous study data would be needed.

Source:
"Adjustment of dosing of antimicrobial agents for bodyweight in adults". The Lancet, 375(9710):248-251

Editorial: "Prescribing medicines: size matters". The Lancet 2010; 375(9710): 172

Breast cancer screening controversy

The US Preventive Services Task Force (USPSTF) has issued new guidelines calling for women to change from annual screening at age 40 to biennial mammograms at 50.

The new guidelines aimed at reducing unnecessary treatment but have caused public uproar and confusion. Radiologists say the USPSTF recommendations were "unfounded" and put forward their own guidelines in the January issue of the Journal of the American College of Radiology.

However, the USPSTF continues to recommend biennial mammograms and says that individuals should take into account one's values regarding specific benefits and harms when deciding when to start the screening.

Source: "Screening for breast cancer: U. S. Preventive Services Task Force recommendation statement" Ann Intern Med 2009; 151: 716-26.

Blood pressure drugs could reduce the risk of dementia

American researchers investigated the incidence of dementia in 800,000 people aged 65 or over with cardiovascular disease, mostly male. The patients were divided into 3 groups according to the type of blood pressure drugs they were taking : ARBs, lisinopril or other cardiovascular drugs.

The researchers found that ARBs were associated with reduced risk of developing dementia when compared with the other 2 types of drugs. ARBs had additional effects when combined with another type of high BP drug. Those with existing dementia who took both drugs were less likely to die early or be admitted to a nursing home. The study concluded that ARBs could reduce the risk of developing Alzheimer's disease or dementia.

Citics say that there are limitations which may have affected the results: the subjects were not randomly assigned a treatment, each group of people might have different diseases such as diabetes or cardiovascular disease and the follow-up period was too short for a condition such as dementia. Further work is needed to include both male and female.

Source: N-C Li, Lee A, Whitmer RA, et al. "Use of angiotensin receptor blockers and risk of dementia in a predominantly male population: prospective cohort analysis". BMJ 2010; 340: b5465

Choose C-sections only when there is a medical reason

According to a survey by the World Health Organization(WHO) published online in The Lancet, women who had caesarean sections without a medical reason were 10 times more likely to be admitted to intensive care, required blood transfusions or encountered complications.


The WHO study reviewed nearly 110,000 births in 9 Asian countries in 2007-08 and found that about 27% of the births were done by C-sections, 2/3 of the hospitals surveyed make more money if C-sections were carried out. The authors warned that C-sections should be opted for only when there is a medical indication to improve the outcome.

In the UK, nearly a quarter of births are carried out by C-sections despite the evidence against it.

Source: "Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007—08" The Lancet, Early Online Publication, 12 January 2010 ( f/t via Athens)

Why so few heart attack survivors take advantage of rehab?

A new reserach published in Circualtion has found, as in many other studies, that cardiac rehab improves the survival rate of heart attack survivors.

The study tracked more than 30,000 Medicare patients aged over 65 for 4 years and found that
those who completed 36 sessions of rehab had a risk reduction of 47% in death and 31% in heart attack than those who had fewer sessions. However only 18% attended all 36 sessions and drop-out rate was high.

Other studies have shown that patients who attended even a few sessions improved their survival rate significantly, but most heart attack survivors did not go to rehab and those who went did not stick to it. Why don't patients take advantage of it?

Some cardiologists say that successful rehab required strong self-discipline and perserverance as well as respect in the medical community supported by adequate resources. A study published in 2007 in Circualtion found that cardiac rehab was provided to about 14% of patients hospitalised for heart attacks and 31% who had bypass surgery.

Source: Bradley G. Hammill “Relationship Between Cardiac Rehabilitation and Long-Term Risks of Death and Myocardial Infarction Among Elderly Medicare Beneficiaries” Circulation. 2010;121:63-70 ( f/t via Athens)

Mozart's music may help premature babies gain weight

A group of Israeli doctors from the Tel Aviv University medical centre carried out a small study involving 20 healthy premature babies to look at the effects of music on short-term metabolic efficiency. The study was published in Pediatrics.

The babies were randomly assigned to either exposure to Mozart's music for 30 minutes or no music, then alternative treatment was given the next day. The researchers measured the babies' resting energy expenditure (REE) during the exposure period and comapred the way the babies responded to the music with their metabolism during music-free period. The study did not measure the changes in weight.

The study found that exposure to Mozart's music for 30 minutes reduced the babies' REE, although the mechanism was unclear, it appeared that the music has relaxed the babies and this effect might increase the babies' weight gain. However the researchers were cautious about the clincal implications of their findings and said that more research is needed.

Other research has found the "Mozart effect" has improved the IQ in college students, lowered heart rates, stress level etc, later studies challenged these findings.

Source: Lubetzky R, Mimouni FB, Dollberg S et al. Effect of Music by Mozart on Energy Expenditure in Growing Preterm Infants. Pediatrics Vol. 125 No. 1 January 2010