Current Topics

JULY 11, 2007

The Resting Heart Rate-Mortality Connection
The higher the resting heart rate in persons with prehypertension, the greater the risk of mortality and coronary heart disease (CHD), according to an analysis of data from the Atherosclerosis Risk in Communities study. Some 3275 adults aged 45 to 64 years were followed for a mean of 10.1 years. The unadjusted risks for all-cause mortality and CHD were 50% and 49% greater, respectively, among persons with prehypertension and elevated resting heart rates compared with those with lower resting heart rates. After controlling for known risk factors, elevated resting heart rate also correlated with an increased risk of CHD in women, but not in men.

King DE, et al. Long-term prognostic value of resting heart rate in subjects with prehypertension. Am J Hypertens. 2006;19:796-800.

DMARD Use Increases Susceptibility to TB
Patients with rheumatoid arthritis (RA) who use disease-modifying antirheumatic drugs (DMARDs) are at increased risk of becoming infected with tuberculosis (TB). The finding emerged from an analysis of 112,300 patients with RA who were in the PharMetrics Patient-Centric database. The rate of TB in the entire cohort was 2.19 cases per 1000 person-years. The adjusted rate ratio of TB was 1.5 among those who used biologic DMARDs and 1.2 among those who used traditional DMARDs. The risk of TB among DMARD users was higher among those who were not currently taking corticosteroids.

Brassard P, et al. Antirheumatic drugs and the risk of tuberculosis. Clin Infect Dis. 2006;43:717-722.

Low-Dose Statin Therapy Decreases CHD Risk
Low-dose statin therapy significantly reduces risk for coronary heart disease (CHD), based on a study of 3966 patients with hypercholesterolemia and no history of CHD or stroke. They were randomized to dietary intervention with or without 10 to 20 mg pravastatin (Pravachol) daily. At an average of 5.3 years' follow-up, mean total cholesterol levels decreased by 2.1% and 11.5%, and mean low-density lipoprotein cholesterol concentration decreased by 3.2% and 18.0%, with diet alone compared with diet plus pravastatin, respectively. In addition, the pravastatin group had a 33% lower risk of a first CHD event. The incidences of malignant neoplasms and serious adverse events were similar in both groups.

Nakamura H, et al. Primary prevention of cardiovascular disease with pravastatin in Japan (MEGA study): a prospective randomised controlled trial. Lancet. 2006;368:1155-1163.

NSAIDs Associated with HF Hospitalization
People who use nonsteroidal antiinflammatory drugs (NSAIDs) are more likely to be hospitalized for heart failure (HF), according to a case-control study of 1396 patients with a first hospital admission for nonfatal HF and a matched group of controls. Current use of NSAIDs was associated with a relative risk of 1.3 for a first hospital admission for HF after controlling for major confounding factors. Previous clinical diagnosis of HF was the primary independent risk factor for a first HF hospitalization (relative risk, 7.3). The relative risk was 8.6 in current users of NSAIDs with previous HF.

Huerta C, et al. Non-steroidal anti-inflammatory drugs and risk of first hospital admission for heart failure in the general population. Heart. 2006;92:1610-1615.

RA Increases Risk of Osteoporotic Fracture
A study of 30,262 patients with rheumatoid arthritis (RA) and matched controls has indicated that RA increases risk for osteoporotic fractures. A total of 2460 patients had a fracture during 7.6 years of follow-up. Compared with the controls, RA patients were twice as likely to have a hip fracture and 1.4 times as likely to have a spine fracture. Predictors of a significantly increased risk of fracture at the hip included more than 10 years of RA, low body mass index (BMI), and oral glucocorticoid use. Analysis revealed that the 5-year risk of hip fracture was 5.7% for a 65-year-old woman with longstanding RA who frequently used oral glucocorticoids and had a low BMI and a history of fracture.

van Staa TP, et al. Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis. Arthritis Rheum. 2006;54:3104-3112.

Chronic Fatigue Syndrome Common After Acute Infection
A significant minority of 253 patients were found to have a relatively uniform postinfective fatigue syndrome at ≥6 months after being infected with Epstein-Barr virus, Coxiella burnetii, or Ross River virus. In this 12-month study, prolonged illness was evident in 29 of the patients at 6 months, 28 of whom met the diagnostic criteria for chronic fatigue syndrome. The syndrome was predicted more by the severity of the acute infection than by other factors.

Hickie I, et al. Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens. BMJ. 2006;333:575-578.

Electromagnetic Shield Lessens Phantom Limb Pain
An electromagnetically shielding stump stocking (ESS) interwoven with metal was found to be effective in the treatment of phantom limb pain in a study that randomized 30 leg amputees to the ESS or to a placebo stocking. At 6 weeks' follow-up, daily maximum pain level decreased significantly in both groups (P <.001 for both), but significantly more so in the ESS group. The ESS also decreased pain significantly more often than did the placebo device. Improvements in general well-being were significantly greater in the ESS group.

Kern U, et al. Management of phantom pain with a textile, electromagnetically-acting stump liner. J Pain Symptom Manage. 2006;32:352-360.

Drug Therapy for Removing Kidney Stones
Calcium channel blockers and alpha-blockers can increase the chances of passing a urinary stone by 65%. These rarely used treatment options were examined in a meta-analysis of 9 randomized controlled trials that included a total of 693 patients (mean age, 34.4-46.5 years; mean stone size, 3.9-7.8 mm), all of whom were treated on an outpatient basis. Medical therapy was more effective than control treatment, regardless of stone size. While a definitive controlled trial is needed, the benign side-effect profile and wide therapeutic window of calcium channel blockers and alpha-blockers make them an attractive alternative to the more popular surgical procedures.

Hollingsworth JM, et al. Medical therapy to facilitate urinary stone passage. Lancet. 2006;368:1171-1179.

High Sugar Intake Linked to Pancreatic Cancer
High intake of sugar increases the risk of pancreatic cancer, according to a population-based cohort study of 77,797 Swedish men and women who had no history of cancer or diabetes when the study began. During a mean follow-up of 7.2 years, 131 new cases of pancreatic cancer were diagnosed. Compared with the lowest consumption categories, the multivariate hazard ratios for pancreatic cancer in the highest categories were 1.69 (P = .06 for trend) for sugar, 1.93 (P = .02 for trend) for soft drinks, and 1.51 (P = .05 for trend) for sweetened fruit soups or stewed fruit.

Larsson SC, et al. Consumption of sugar and sugar-sweetened foods and the risk of pancreatic cancer in a prospective study. Am J Clin Nutr. 2006;84:1171-1176.

Red Meat Linked to Breast Cancer Risk in Premenopausal Women
Eating red meat increases the risk of estrogen and progesterone-receptor positive (ER+/PR+) breast cancer in young women, based on data from 90,659 premenopausal women (ages, 40-49) enrolled in the Nurses' Health Study who completed food frequency questionnaires. At 12 years of follow-up, 1021 cases of invasive breast cancer were documented. Higher red meat intake was strongly associated with increased risk of ER+/PR+ breast cancer. Compared with eating ≤3 servings of red meat weekly, the multivariate relative risk for ER+/PR+ breast cancer was 1.14 with >3 to ≤5 servings weekly, 1.42 with >5 weekly to ≤1 servings daily, 1.20 with 1 to 1.5 servings daily, and 1.97 with >1.5 servings daily (P = .001 for trend). There was no association between red meat intake and risk of ER-/PR-negative breast cancer.

Cho E, et al. Red meat intake and risk of breast cancer among premenopausal women. Arch Intern Med. 2006;166:2253-2259.

Low-Carb Diets Reduce CHD Risk in Women
Women who consume diets low in carbohydrates and high in vegetable sources of fat and protein are at reduced risk of coronary heart disease (CHD), according to data obtained from 82,802 women enrolled in the Nurses' Health Study. All participants completed food frequency questionnaires, which were used to calculate a carbohydrate diet score based on the percentage of energy as carbohydrate, fat, and protein. During 20 years of follow-up, 1994 new cases of CHD were documented. The multivariate relative risk of CHD was 6% lower among those in the lowest compared with highest deciles of carbohydrate intake (P = .52 for trend), based on the percentage of energy from carbohydrate, animal protein, and animal fat. In contrast, the relative risk of CHD was 30% lower among those in the lowest compared with highest deciles of carbohydrate intake (P = .002 for trend), based on the percentage of energy from carbohydrate, vegetable protein, and vegetable fat. Compared with the lowest decile of glycemic load, the highest decile had a 90% greater relative risk of CHD (P = .003 for trend).

Halton TL, et al. Low-carbohydrate-diet score and the risk of coronary heart disease in women. N Engl J Med. 2006;355:1991-2002.

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