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 They called for Avandia to be withdrawn from the market.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

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

Lancet study confirms Vioxx risk

Vioxx, a pain killer, was withdrawn from the market in 2004 after the APPROVe trial showed that it doubled the risk of heart attacks.


In a new study published in The Lancet, researchers contacted 84% of the people who took part in the original trial and confirmed the findings of previous study. They also found that a year after stopping the treatment, participants still had increased risk of heart attack, stroke or death comapred with those in the placebo group. The researchers raised the concern that long term use of of all non-aspirin NSAIDs may have a similar effect and suggested doctors to weigh up the benefits of these drugs in individual patients.


The drugmaker, Merck, issued a statement :"....this post-hoc analysis using limited data from a prematurely terminated study needs to be interpreted very cautiously......".



Source: Baron JA, Sandler RS, Bresalier RS et al. Cardiovascular events associated with rofecoxib: final analysis of the APPROVe trial. The Lancet 2008; Oct 14 [Early online publication]

Flavanol-containing cocoa improves diabetics blood flow

A small study funded by Mars Inc. (who also provided the cocoa drinks used in the study) found that three mugs of specially formulated cocoa (containing high levels of flavanols, a type of antioxidant ) a day for a month improved blood flow through the arteries by 30% in diabetics.

They used FMD ( flow-mediated dilation) in the brachial artery (artery in the upper arm) to measure cardiovascular risk - lower FMD has been linked to a greater risk of cardiovascular enents. Researchers concluded that "diets rich in flavanols reverse vascular dysfunction in diabetes" and that cocoa could be used as a treatment to reduce the risk of cardiovascular disease.

Critics warn diabetics should not start eating chocolate to try to reduce their cardiovascular risk because of the high levels of fat and sugar involved, they should eat more fruit and vegetables that also have high levels of the antioxidants.

Source: "Sustained Benefits in Vascular Function Through Flavanol-Containing Cocoa in Medicated Diabetic Patients - A Double-Masked, Randomized, Controlled Trial" J American College of Cardiology, 2008; 51:2141-2149

Moderate drinking in middle age can lower heart risk

Multiple news source reported a study that found middle-aged non-drinkers who began moderate drinking resulted in subsequent lower cardiovascular risk.

Researchers followed 7697 adults aged 45-64 who were non-drinkers and participating in the "Atherosclerosis Risk in Communities" study over a 10-year period. After 4 years, researchers found that new moderate drinkers had 38% less cardiovascular risk than non-drinkers. They also found the wine-only drinkers had the lowest cardiovascular events and drinkers of other types also had advantage over non-drinkers but not significant statistically.

The authors said that the resulted cardiovascular benefit must be weighed with caution against the hazards of alcohol drinking. They suggested that for some individuals, limited alcohol may be included in their diet.

Source: "Adopting Moderate Alcohol Consumption in Middle Age: Subsequent Cardiovascular Events" The American Journal of Medicine 121( 3): 201-206