Is chocolate good for the heart?

Previous studies have shown that chocolate can reduce blood presure, a strong risk factor for heart failure. Harvard reserachers carried out a large prospective cohort study, including more than 39,000 Swedish women, investigating if chocolate intake is linked to the risk of heart failure.


The data were obtained from a questionnaire on health and lifestyle including details about diet and chocolate intake. After 9 years follow up, the researchers found that women who ate 1 - 2 servings a week or 1 -3 servings a month had lower risk of hear failure than those who ate 3 or more servings a week. They suggest that flavenoids in chocolate may have a beneficial effect on cardiovascular risk factor.


Critics said that the study relied on participants self-reporting of their chocolate intake, it is also unclear how much chocolate was consumed in one "serving". Although this was a large study, it is felt that the evidence was not strong enough to tell if chocolate reduces the risk of heart failure. Furthermore, flavenoids in chocolate can be found in fruit and vegetables.


Source: Mostofsky E, Levitan EB, Wolk A, et al. Chocolate Intake and Incidence of Heart Failure: A Population-Based, Prospective Study of Middle-Aged and Elderly Women. Circulation: Heart failure 2010; Published online before print August 16 ( f/t via Athens)

Diabetes drug linked to higher heart attack risk

Avandia and competitor drug, Actos, are commonly used diabetes drugs. Avandia has been found having harmful effects since 2007 while Actos seems safer apparently.

2 studies published last week reported serious health warnings. One study, published in June 28 issue of JAMA, reviewed the data of 227,000 patients takng either Avandia or Actos, found that Avandia increased the risk of heart attack, stroke or death by 17%.

The second study, published in the Archive of Internal Medicine, analysed 56 clinical trials involving 35,000 patients confirmed these findings. The reserachers questioned why Avandia is still available on the market and why physicians would prescribe it to diabetics when there are other drugs without these side effects. They called for Avandia to be withdrawn from the market.

However, some doctors said that the evidence is inconclusive.

Source:
1). David Juurlink. "Rosiglitazone and the Case for Safety Over Certainty". JAMA. 2010;304(4):(doi:10.1001/jama.2010.954). free f/t

2). Steven Nissen; Kathy Wolski. "An Updated Meta-analysis of Risk for Myocardial Infarction and Cardiovascular Mortality". Arch Intern Med. 2010;170(14), free f/t

Does statin use reduce prostate cancer recurrence?

Statins is a common treatment to lower cholesterol but a study, published online in June 28 in Cancer, found that men taking statins before their prostate surgery were less likely to show signs of the cancer recurring.

The study reviewed the data of 1319 men who had prostatectomy and took statins when they had their operation and showed that they had a 30% lower risk of PSA recurrence compared to those not taking statins. The greater the dose of statins taken, the less likely the cancer was to reappear.

The researchers said if other studies support their findings, a RCT of statins is warranted. However, critics say that the statin users differed significantly from non-users at presentation, eg they were older and had higher BMI that might affect the association between the statin use and risk for biochemical recurrence, also previous studies had mixed findings.

Another study, published in the Journal of Clinical Oncology, with 691 men underwent radiotherapy, showed a significant association between statin use and decreased biochemical recurrence.

Source:
1). Hamilton RJ, Banez LL, Aronson WJ et al. "Results from the Shared Equal Access Regional Cancer Hospital (SEARCH) Database". Cancer, [Early online publication] June 28 2010

2). "Statin Use and Risk of Prostate Cancer Recurrence in Men Treated With Radiation Therapy". Journal of Clinical Oncology, Vol 28, No 16 (June 1), 2010: pp. 2653-2659
Early Release 10.1200/JCO.2009.27.3003 on April 26 2010

Do B vitamins reduce lung cancer risk?

Smoking is the major risk factor for lung cancer, according to a new study published in JAMA, higher levels of vitamin B6 and methionine in the blood was associated with lower risk of lung cancer.

This was a large scale IARC study with 520,000 volunteers across Europe, part of the EPIC cohort. Blood samples were taken from both the case group and the control group and the amount of B6 and methionine measured.

The researchers found that there was a lower risk of lung cancer with a higher level of B6 and methionine whether they were smokers or non-smokers. Overall, people with above average levels of B6 and methionine had 50% reduction in the risk of developing lung cancer than those with below average levels.

Critics say that the blood samples were taken on only one occasion and a cohort study cannot prove a cause and effect for a reduced risk of lung cancer for B6. Furthermore, B6 and methionine are found in meat and potatoes, but it was unknown whether eating more of this food would make a difference to the risk of developing lung cancer because a lower level of these substances in the blood may be due to poor absorption.

Source: Johansson M, Relton C, Magne Ueland P, et al. "Serum B Vitamin Levels and Risk of Lung Cancer". JAMA 2010; 303: 2377-2385

Racial gaps in lung cancer surgery

A new study published in JAMA found that black patients newly diagnosed with lung cancer were less inclined to have surgery than whites because they did not connect well with their doctors.

Researchers analysed data from 386 lung cancer patients in Carolina and found that only 55% of black patients had surgery compared to 66% of white patients. They found that many black patients misunderstood their prognosis or did not feel comfortable enough to discuss with their doctors treatment options and outcomes. Black patients were also less likely to have other sources of support.

The authors said that there are many barriers to improving the disparities but doctors and hospitals can work on the negative perceptions of patient-physician communications and spend more time with patients about their treatment options.

Source: "Factors Associated With Decisions to Undergo Surgery Among Patients With Newly Diagnosed Early-Stage Lung Cancer". JAMA, 2010; 303 (23): 2368-2376

Are HRT patches safer than pills?

A large study including 75,000 women suggests that low-dose HRT patches may be safer than tablets in terms of stroke risk, but the risk increases significantly with high dose patches.

The findings are based on a nested case-control study drawing data from the General Practice Research Database in the UK. Researchers compare a group of women who have stroke ( case group) to a group who do not ( control group) and found that women using low-dose HRT patches had no increased risk of stroke compared with those who had not used HRT patches, however, using high-dose patches had an increased risk of 89% compared with non-use.

Researchers concluded that low-dose HRT patches may be a safer alternative to oral HRT, although these results alone cannot prove causation, "this study should encourage further research on the importance of the route of administration to define the role of transdermal oestrogens in the therapeutic arsenal for the treatment of menopausal symptoms."

Critics say that this study could affect prescribing practice but it only looked at stroke risk while HRT is assocaited with other risks such as breast cancer, venous thromboembolism and heart disease. The study was published in the BMJ.

Source: Renoux C, Dell’Aniello S, Garbe E and Suissa S. Transdermal and oral hormone replacement therapy and the risk of stroke: a nested case-control study. BMJ 2010;340:c2519, (Published June 3 2010) full text via Athens

Brush your teeth twice a day could lower cardiovascular risk

According to a new research by University College London, published in the BMJ, people who brushed their twice a day had a lower risk of heart disease compared with those with less frequent toothbrushing.


The researchers analysed data from more than 11,000 adults who took part in the Scottish Health Survey between 1995 and 2003. Each survey was linked to hospital admissions and deaths, followed up until 2007. They found that people who rarely brushed their teeth had a 70% greater risk of cardiovascular disease than those who brushed their teeth twice a day. However they said that the study did not prove a cause and effect association between oral health and cardiovascular disease.


Previous studies have established a link between gum disease and cardiovascular risk, but the researchers said this is the first study to show an association between self-reported toothbrushing and incident cardiovascular disease and suggest "a possible role of poor oral hygiene in the risk of cardiovascular disease via systemic inflammation." They noted that further studies are needed to confirm whether the observed association is causal or merely a risk marker.


Source: Toothbrushing, inflammation, and risk of cardiovascular disease: results from Scottish Health Survey. BMJ 2010;340:c2451

Statins side effects quantified

A new study, published in the BMJ, to quantify the unintended effects of statins according to type, dose, and duration of use found that statin use was associated with increased risks of serious liver dysfunction, acute renal failure, moderate or serious myopathy ( muscle weakness) and cataracts.

Researchers examined the medical records of over 2 million patients who registered at GP practices in England and Wales, the patients were monitored over a period of 6 years. They found that Simvastatin was the most prescribed statin and the side effects are already known. Eestimates of the absolute risks were also provided : for 10,000 people, there would be 17 extra cases of kidney failure, 252 cataracts, 65 liver problems and 32 myopathy. The adverse effects were similar across the statin types for each outcome except liver dysfunction where fluvastatin was associated with the highest risks.

The accompanying editorial says that the benefits of statins seem to outweigh the risks. It is suggested that patients should not change their medication.

Source: Hippisley-Cox J, and C Coupland. Unintended effects of statins in men and women in England and Wales: population based cohort study using the QResearch database. BMJ 2010;340:c2197 ( f/t via Athens)

Processed meat increased heart disease risk

A new systematic review and meta-analysis of 20 studies involving more than 1.2 millions people from 10 countries found that processed meat such as bacon, salami, sausages, hot dogs and processed deli, was linked to increased risk of heart disease and diabetes, but red meat was not.

Participants were followed up to 18 years and found that those who ate 50 gram a day of processed red meat had 42% higher risk of heart disease and 19% higher risk of type 2 diabetes than those who did not eat processed red meat.

Researchers said that the processed meat contain much higher salt and preservatives ( rather than fats) than unprocessed meat and this could explain the difference. They found the same even when lifestyle factors were taken into account and suggested that these types of meats should be studied separately in future research.

Source: "Red and Processed Meat Consumption and Risk of Incident Coronary Heart Disease, Stroke, and Diabetes Mellitus. A Systematic Review and Meta-Analysis". Circulation. 2010 Published online before print May 17, 2010 ( f/t via Athens)

Medical journals on Twitter

Twitter started as social networking or microblogging that combines blogging and instant messaging. Users can create a short message of up to 140 characters ( called “tweets”), send and receive updates from any computer or mobile devices with Internet access.

Tweets are instantly available to the “followers”, so it is a quick way of communicating with a group of people. Twitter has become a major distributor of timely information, particularly in the area of breaking news. The 1st reports of the crash of a US jetliner into the Hudson River in January 2009 were sent by witnesses on Twitter.

Many medical journals and organisations have started to use Twitter to disseminate information quickly to large groups of people.

For example - "Are probiotic drinks good for children? Looking at research we agree they may have small benefit for some illnesses " - was a tweet by NHS Choices

BMJ, The Lancet, NEJM, JAMA and many others also use Twitter to provide Table of Contents (TOC) service with links to the most current articles.

If you use Twitter to share medical information and opinion, beware of the issues of confidentiality.

Eating nuts may reduce cholesterol

Previous studies have shown that nut consumption reduces the risk of coronary heart disease, a new systematic review published in the May 10 issue of Archives of Internal Medicine found that diets rich in nuts were associated with reduced total cholesterol and bad cholesterol.


Researchers pooled data from 25 trials conducted in 7 countries that compared a control group to an experimental group assigned to consume nuts. An average of 67 grams of nuts per day were consumed over 3 to 8 weeks, they found that total cholesterol was reduced by 5.1% and bad cholesterol by 7.4%, but there was a lesser effect on reducing the cholesterol levels of people with higher BMIs.


Critics noted that the overall population of the studies was relatively small, the study results might have been affected by the different diets used in different studies. The experimental diet lasted only 3 to 8 weeks long, so it is not clear what effect it would have over the longer term. It is also unclear whether the reductions in cholesterol and LDL-cholesterol would be enough to lower the risk of coronary heart disease. Although nuts may reduce cholesterol, they are high in saturated fats and should be eaten in moderation.


Source: "Nut Consumption and Blood Lipid Levels - A Pooled Analysis of 25 Intervention Trials". Arch Intern Med. 2010;170(9):821-827. ( f/t via Athens)

Working overtime is bad for your heart

According to a study of 6000 British civil servants published online in the European Heart Journal, people who regularly work overtime have higher risk of developing coronary heart disease than those who do not.

The study involved over 6000 men and women aged between 39 and 61 who did not have heart disease and worked full time at the start of the study. Researchers found those who worked 3 to 4 hours of overtime a day had 60% higher risk of developing heart disease, overtime work was also associated with lower HDL cholesterol ( good cholesterol).

Experts said the study highlights the importance of work-life balance but note that the link was only found in association with 3-4 hours oertime a day. The lead researcher said more research is needed.

Source: Overtime work and incident coronary heart disease: the Whitehall II prospective cohort study. Eur Heart J (2010). First published online: May 11, 2010 ( f/t via Athens)

Vitamin A does not reduce maternal mortality

A new study, (Obaapa VitaA) in Ghana showed that vitamin A supplementation to women of child-bearing age in poor nations does not reduce maternal death rates. The Ghana findings contradicted previous results from a trial in Nepal which showed a 44% decrease in maternal death among women given vitamin A.

The researchers conducted a randomised and double-blind trial in 7 districts in the Brong Ahafo Region of Ghana. Participants were randomly assigned to vitamin A supplement or placebo capsule orally every week. They found that there was no statistically significant difference between the intervention and the control groups.

The author, Professor B Kirkwood at The London School of Hygiene and Tropical Medicine concluded that "the results of this trial in Ghana vindicate the decision not to change safe motherhood policy immediately after the Nepal trial."

Source: Betty R Kirkwood et al. Effect of vitamin A supplementation in women of reproductive age on maternal survival in Ghana (ObaapaVitA): a cluster-randomised, placebo-controlled trial. The Lancet, 2010; 375(9726):1640-1649 ( f/t via Athens)

Virgin olive oil changes gene activity

Previous studies have shown a Mediterranean diet is associated with lower risks of all major diseases, but a small size study published in the open access journal BMC Genomics shed new light on how virgin olive oil influences certain genes that promote inflammation and can lead to heart disease.

Spanish researchers gave 20 volunteers with metabolic syndrome 2 breakfasts containing virgin olive oil with either high or low levels of phenols randomly on 2 separate days with a week apart. Both researchers and participants did not know who had received which breakfast. The researchers then measured the changes in the gene expression after the breakfasts and found that 39 genes are involved in the inflammation process (that has a role in the build-up of fatty deposits in the blood vessels ) and 35 of them were less active after eating the high-phenol virgin olive oil.

The researchers concluded that the study could partly explain why the risk in cardiovascular disease is reduced in Mediterranean countries where the diet is rich in virgin oliver oil.

Critics say that this study helps our understanding of the effect of olive oil on gene activity but it is difficult to confirm that the changes in gene activity is responsible for the reduction in risk of cardiovascular disease. The small size of the study, all participants with metabolic syndrome, gene expression after one meal and the lack of follow up for long-term outcomes are just some of the limitations that may affect the results of the study.

Source : Antonio Camargo, Juan Ruano, Juan M Fernandez, Laurence D Parnell, Anabel Jimenez, Monica Santos-Gonzalez, Carmen Marin, Pablo Perez-Martinez, Marino Uceda, Jose Lopez-Miranda and Francisco Perez-Jimenez. "Gene expression changes in mononuclear cells from patients with metabolic syndrome after acute intake of phenol-rich virgin olive oil". BMC Genomics, 2010

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