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Saturday, 31 August 2013

Moderate physical activity does not increase risk of knee osteoarthritis

Adults age 45 and older who engaged in moderate physical activity up to two and a half hours a week did not increase their risk of developing knee osteoarthritis over a 6-year follow-up period, a new study finds.
Study participants who engaged in the highest levels of physical activity – up to 5 hours a week – did have a slightly higher risk of knee osteoarthritis, but the difference was not statistically significant.
Those findings taken together are good news, said Joanne Jordan, MD, MPH, senior study author and director of the Thurston Arthritis Research Center in the University of North Carolina School of Medicine.
"This study shows that engaging in physical activity at these levels is not going to put you at a greater risk of knee osteoarthritis," she said. "Furthermore, we found this held true no matter what a person's race, sex or body weight is. There was absolutely no association between these factors and a person's risk."
The corresponding author of the study, published online August 27 by the journal Arthritis Care & Research, is Kamil Barbour, PhD, of the Centers for Disease Control and Prevention (CDC) in Atlanta.
"Moderate physical activities are those that produce some increase in heart rate or breathing, like rapid walking," Barbour said. "Meeting physical activity recommendations through these simple activities are a great way to reduce your risk of heart disease, stroke, high blood pressure, diabetes, and other diseases."
The results are based on an analysis of data collected from 1999 to 2010 as part of UNC's long-running Johnston County Osteoarthritis Project, a prospective, population-based study of knee, hip, hand and spine osteoarthritis and disability in African Americans and Caucasians, aged 45 years and older. This project is funded by the CDC and the National Institute of Arthritis, Musculoskeletal, and Skin Diseases (NIAMS).
This new analysis included data from 1,522 study participants and tested whether or not there was an association between meeting Department of Health and Human Services (HHS) guidelines for 150 minutes of physical activity per week and the development of knee osteoarthritis, as confirmed both by X-rays and the presence of knee pain or other symptoms.
The study's findings support HHS recommendations and concludes that activities such as walking, conditioning exercises and household activities such as gardening or yard work that amount to moderate weekly levels of physical activity should continue to be encouraged.
Source:Arthritis Care & Research

Coordination Between Brain Regions may Help Reduce Forgetfulness in People

American scientists may have found a way to reduce forgetfulness in people, a new study reveals.The study was conducted at New York University by Lila Davachi, an associate professor in NYU's Department of Psychology and Center for Neural Science, and Kaia Vilberg, now a postdoctoral researcher at the University of Texas' Center for Vital Longevity and School of Behavioral and Brain Sciences in Dallas. 
Davachi said that when memories are supported by greater coordination between different parts of the brain, it's a sign that they are going to last longer. 
It is commonly understood that the key to memory consolidation-the cementing of an experience or information in our brain-is signaling from the brain's hippocampus across different cortical areas. Moreover, it has been hypothesized, but never proven, that the greater the distribution of signaling, the stronger the memory takes hold in our brain. 
To determine if there was scientific support for this theory, they examined how memories are formed at their earliest stages through a series of experiments over a three-day period. 
On day one of the study, they aimed to encode, or create, new memories among the study's subjects. Here, they showed participants a series of images-objects and outdoor scenes, both of which were paired with words. 
On day two, the subjects returned to the lab and completed another round of encoding tasks using new sets of visuals and words. 
After a short break, participants were placed in an MRI machine-in order to monitor neural activity-and viewed the same visual-word pairings they saw on days one and two as well as a new round of visuals paired with words. They then completed a memory test of approximately half of the visual-word pairings they'd seen thus far. On day three, they returned to the lab for a memory test on the remaining visuals. 
By testing over multiple days, the researchers were able to isolate memories that declined or were preserved over time and, with it, better understand the neurological factors that contribute to memory preservation. 
Their results showed that memories that were not forgotten were associated with greater coordination between the hippocampus and left perirhinal cortex (LPRC)-two parts of the brain previously linked with memory formation. 
Their findings have been published in the journal Neuron.


Presence of Protein in Urine Among Diabetics may Provide Early Signal of Cognitive Decline

A new study published in the Clinical Journal of the American Society of Nephrology reveals that identifying the presence of a protein in urine could provide an early sign of future cognitive decline in type 2 diabetes patients who have a normal kidney function.Individuals with diabetes have an increased risk of experiencing cognitive impairment, especially impairment due to vascular causes. Joshua Barzilay, MD (Kaiser Permanente of Georgia/Emory School of Medicine), Lenore Launer, PhD (National Institute on Aging) and their colleagues evaluated whether albuminuria-a kidney complication that is common in people with diabetes and is characterized by protein excretion in the urine-predicts cognitive decline in older adults with diabetes. The researchers studied 2977 diabetics with an average age of 62 years. Patients were recruited between August 2003 and December 2005 and were followed until June 2009. Participants underwent three neuropsychological tests: at the start of the study and again at 20 and 40 months. Tests included information processing speed, verbal memory, and executive function. 
People with persistent albuminuria over four to five years had greater percent declines on information processing speed than participants without albuminuria. Persistent and progressive albuminuria were linked with a greater than 5% decline in information processing speed scores but not with verbal memory or executive function performance.
"Our finding was a subtle change in cognition; however, were this decline to continue over 10 to 15 years it could translate into noticeable cognitive decline by the age of 75 to 80 years, when cognitive impairment generally becomes clinically evident," said Dr. Barzilay. "Given how common albuminuria and diabetes are in the older population, these findings have a great deal of importance from a population point of view. Moreover, albuminuria is also common among older people with hypertension without diabetes." 
Study co-authors include James Lovato, MS, Anne Murray, MD, MS, Jeff Williamson, MD, Faramaz Ismail-Beigi, MD, PhD, Diane Karl, MD, and Vasilios Papademetriou, MD. 
Disclosures: The authors reported no financial disclosures. The work was funded by the National Institutes of Health and the National Institute on Aging. 
The article, entitled "Albuminuria and Cognitive Decline in People With Diabetes and Normal Renal Function," will appear online at on August 29, 2013, doi: 10.2215/CJN.11321112. 

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies. 
Founded in 1966, and with more than 14,000 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients. 


New amendments to trial rules prompt more cos to suspend enrollment of subjects in India

Even as a comprehensive amendment to the Drugs and Cosmetics Act is awaited with a separate chapter on the rules to streamline the clinical trials sector, the industry is reportedly facing increased heat due to the new guidelines and requirements already imposed by the Central Drugs Standard Control Organisation (CDSCO).
Apart from mounting criticism on the new guidelines and resultant slow-down in the approvals, many have reportedly suspended enrollment of participants too. Union Health Ministry has confirmed that the National Institutes of Health (NIH) under the US Government raised concerns about how these new requirements will be implemented, particularly the specific provision related to compensation.
“NIH has suspended enrollment of participants in 35 interventional trials in India,” Union Health Minister Ghulam Nabi Azad informed the Parliament recently. But he went on to claim that it would not affect the country’s health programmes and domestic pharma industry.
It was being pointed out that many foreign private companies have also stopped trials in India after the new guidelines, especially on the compensation part, were issued and claimed that such provisions could lead to unreasonable claims by subject-patients.
There were already wide-spread concerns about the new guidelines which reportedly affected the approval process of trials in the country. Indian Society for Clinical Research (ISCR), an association of clinical trials professionals, had pointed out this recently.
In order to strengthen the regulatory provisions and the monitoring mechanism of clinical trials in the country, Drugs and Cosmetics Rules, 1945 have been amended through three notifications this year. One amendment laid down procedures to analyse the reports of Serious Adverse Events occurring during clinical trials and procedures for payment of compensation in case of trial related injury or death as per prescribed timelines. Another one was made on various conditions for conduct of clinical trials, authority for conducting clinical trial inspections and actions in case of non-compliance. Government also made mandatory the registration of ethics committees, through another amendment.
Following concerns by the industry, the DTAB has already suggested some changes to the guidelines to relax the norms on compensation in the case of injury or death during the clinical trials. The timeline for reporting the serious adverse events also will be modified in line with the international practices. This was done in accordance with the recommendations by a technical committee set up by the Ministry of Health and in the wake of apprehensions raised by different stakeholders.

Success Rates of IVF High Among Women Under 35 Years of Age

A new study conducted by researchers at University of NSW reveals that In-vitro fertilization (IVF) is more successful among women below 35 years of age, with the procedure leading to the successful birth of a baby in 50 percent of cases, though it may drop dramatically after five tries.The study, which is the first in the world to track national success rates for IVF, is based on 2011 statistics from 35 centers in Australia and New Zealand. 
According to the study's lead author UNSW Professor Elizabeth Sullivan, although fertility treatment can be useful, it is always best to conceive spontaneously if possible. 
It was found that the overall chance for all age groups of delivering a baby is 21 per cent after one cycle of treatment, increasing to 40 per cent by the fifth cycle, but when women aged 35 and older are removed from the statistics, the success rate jumps to more than 50 per cent after five attempts. 
Prof Sullivan says although older women have a very low success rate using their own eggs, they usually manage as well as younger women using donor eggs. 
The study is to be presented at a Fertility Society of Australia scientific meeting.


Whole Fruits Protect Against Type 2 Diabetes

 Whole Fruits Protect Against Type 2 DiabetesEating fresh fruits like blueberries, grapes, apples, pears has been linked to a reduced risk of type 2 diabetes, but drinking fruit juices boosts the risk, says study.British, US and Singaporean researchers pored over data from three big health investigations that took place in the United States, spanning a quarter of a century in all. 
More than 187,000 nurses and other professional caregivers were enrolled. 
Their health was monitored over the following years, and they regularly answered questionnaires on their eating habits, weight, smoking, physical activity and other pointers to lifestyle. 
Around 6.5 percent of the volunteers developed diabetes during the studies. 
People who ate at least two servings each week of certain whole fruits, especially blueberries, grapes and apples, reduced their risk of type 2 diabetes by as much as 23 percent compared to those who ate less than one serving per month. 
"Our findings provide novel evidence suggesting certain fruits may be especially beneficial for lower diabetes risk," said Qi Sun, an assistant professor of nutrition at the Harvard School of Public Health. 
On the other hand, those who consumed one or more servings of fruit juice each day saw their risk of the disease increase by as much as 21 percent. 
Swapping three servings of juice per week for whole fruits resulted in a seven-percent reduction in risk, although there was no such difference with strawberries and cantaloupe melon. 
The paper, published on Friday by the British Medical Journal (BMJ), says further work is needed to to explore this "significant" difference. 
It speculates that, even if the nutritional values of whole fruit and fruit juice are similar, the difference lies with the fact that one food is a semi-solid and the other a liquid. 
"Fluids pass through the stomach to the intestine more rapidly than solids even if nutritional content is similar," says the paper. 
"For example, fruit juices lead to more rapid and larger changes in serum [blood] levels of glucose and insulin than whole fruits." 
The study also points to evidence that some kinds of fruit have a beneficial effect for health. 
Berries and grapes, for instance, have compounds called anthocyanins which have been found to lower the risk of heart attacks. 
But, say the authors, how or even whether this also applies to diabetes risks is for now unclear. 
The investigation looked at data from the Nurses' Health Study, which ran from 1984-2008; the Nurses' Health Study II (1991-2009); and the Health Professionals Follow-Up Study (1986-2008). 
Ten kinds of fruit were used in the questionnaire: grapes or raisins; peach, plums or apricots; prunes; bananas; cantaloupe melon; apples or pears; oranges; grapefruit; strawberries; and blueberries. 
The fruit juices identified in the questionnaire were apple, orange, grapefruit and "other."


Broccoli Could Possibly Benefit Osteoarthritis Patients

A study has indicated that a compound called sulforaphane, which is also found in broccoli, could possibly have some benefits in osteoarthritis.
Osteoarthritis is a condition where the cartilage of a joint undergoes degeneration and damage resulting in painful joints and limitation of motion. Weight-bearing joints are usually involved. Joint-replacement surgeries are commonly used for advanced osteoarthritis. 
A preliminary study was conducted by researchers in the laboratory on cartilage cells obtained from osteoarthritis patients, as well as cartilage tissue obtained from cows. The researchers found that sulforaphane reduces the amount of enzymes produced by the cartilage cells that bring about cartilage destruction and result in osteoarthritis. Thus, sulforaphane appears to have beneficial effect in osteoarthritis. This effect was observed both in the human cartilage cells and the cow cartilage tissue. The researchers also conducted an experiment on mice with artificially-induced arthritis. The mice that were feed sulforaphane showed lesser osteoarthritic changes as compared to those who were fed a diet without the supplement. 
Broccoli and other cruciferous vegetables contain sulforaphane and could possibly bring about similar benefits. However, a number of questions still remain unanswered. For example, it is not known if the amount of sulforaphane in broccoli will be enough to bring about any obvious benefits. Thus, this is indeed a very early proposition. 
The benefits of sulforaphane in arthritis have yet to be demonstrated in human studies. A new study is planned where the effects of broccoli containing high levels of sulforaphane will be administered for two weeks to osteoarthritis patients who are awaiting joint surgery. Sulforaphane supplements are also available, though their safety following long-term use has not yet been established. 

Health Benefits of Broccoli 

Thus, though a compound present in broccoli appears to be effective in osteoarthritis, the benefits of broccoli in osteoarthritis have not been established. However, this should not discourage people from including broccoli in their regular diet. Broccoli has a number of other health benefits. It is rich in calcium, vitamins A and C, and folate. It is also a good source of soluble and insoluble fiber
In the meanwhile, you could still take part in active exercises and maintain your weight; these are time-tested methods to prevent osteoarthritis! 


Low-Fat or Low-Calorie Diet Improves Hepatitis C

A diet plan that includes a low-fat diet or a low-calorie diet along with adequate exercise or physical activity could benefit overweight patients with hepatitis C infection, reveals recent study.
Obesity has been associated with insulin resistance, which can give rise to diabetes. In addition, it could also worsen the liver damage in hepatitis CA study conducted in Romania assessed the effect of diet control in overweight patients with hepatitis C. Some patients were assigned a specific low-calorie diet (NGLCD), whereas others received a low-fat diet. Their adherence to the diet was estimated based on a food journal submitted by the patients. The patients also participated in a lifestyle management program, which included 30 minutes of moderate intensity physical activity for 3-7 days a week. 
The normoglucidic low-calorie diet provided 50-60% calories from carbohydrates per day, 25-35% from fat and 15% from proteins. The simple sugars were restricted to less than 5% of the caloric intake. In the low-fat diet, the fat intake was limited to 20% of total daily calorie intake. The carbohydrate, protein and fiber intake were more as compared to the low-calorie diet. The patients were evaluated at the baseline and at 6 and 12 months after introduction of the dietary and lifestyle changes. 
Data was obtained from a total of 110 subjects. The weight loss was more in the low-calorie group at the end of 6 months, but was similar in both groups at the end of 1 year. There was a reduction in fasting plasma glucose levels and an improvement in insulin resistance at the end of 1 year, which were similar in both the groups. 
Liver function tests and lipid profiles showed an improvement in both the groups. Improvements in the liver structure were also observed. 
The number of people who dropped out from the low-fat diet was significantly higher than those taking the low-calorie diet, which could indicate that the former was not as pleasant as the latter. The diets did not have any adverse effects on the function of the kidneys. 
An important benefit highlighted in the study was the reduction in metabolic syndrome brought about by the two diets. The presence of metabolic syndrome increases the chances of future heart disease. 
The study thus found that both the diets when accompanied by physical activity are beneficial in patients with hepatitis C infection. They help to improve the glucose control and lipid levels. They also improve the health of the liver in terms of structure and function. Thus, they should be advised along with antiviral medication in the treatment of hepatitis C patients. It is necessary that these diets should be adopted over a long term to experience the benefits. 


Effects of lifestyle changes including specific dietary intervention and physical activity in the management of patients with chronic hepatitis C - a randomized trial; 

Singapore scientists unravel cancers linked to herbal remedies

A team of scientists from the National Cancer Centre Singapore, Duke-NUS Graduate Medical School Singapore, and Taiwan's Chang Gung Memorial Hospital, LinKou, have made a breakthrough in understanding the cancer-promoting action of Aristolochic Acid (AA), a natural product of Aristolochia plants traditionally used in some Asian herbal remedies for weight loss and slimming. Using advanced DNA sequencing technologies, the team, led by Professors Teh Bin Tean, See-Tong Pang, Patrick Tan and Steve Rozen discovered that AA is the most potent carcinogen identified to date, causing more DNA mutations than cigarette smoke or ultraviolent light. The team also discovered that besides its previously known contribution to kidney failure and a form of kidney cancer, AA may also contribute to liver cancer. The team identified a "genetic fingerprint" of AA exposure that may pave the way to new approaches to detect AA presence in humans and the environment. The group is also affiliated with the Cancer Science Institute in Singapore, and the Genome Institute of Singapore.
AA is a natural compound found in Aristolochia plants commonly used in traditional herbal preparations for various health problems such as weight-loss, menstrual symptoms and rheumatism. It was officially banned in Europe and North America since 2001 and in Asia since 2003. However, its long-term impact is still being felt as patients with associated kidney failure and cancer are still being diagnosed, especially in Taiwan. In addition, certain AA-containing products are still permitted under supervision and products containing AA are still easily available worldwide, including over the internet.
The potent cancer-promoting activity of AA strongly warrants efforts to restrict the use of AA containing products, including health supplements. "We would like to call for greater public awareness on the adverse health effects of AA. It is therefore important to know the contents of herbal products before one consumes them." said Prof Pang. Reassuringly, in Singapore there is no cause for worry as under the Poisons Act since 1 January 2004, products and herbs sold and supplied in Singapore are not allowed to contain AA and the toxic constituents of Aristolochia herbs.
The Singapore-Taiwan study also reports that carcinogens can leave tell-tale "genetic fingerprints" of their exposure in the DNA of cancer cells, and provides a valuable demonstration of how such fingerprints can be used to identify other cancers not previously associated with that carcinogen. Dr Poon Song Ling, the lead author of the study, said: "AA's contributions to kidney failure and cancer have been documented, but AA's possible role in other cancer types was unknown. In this study, we found that the AA-related DNA fingerprint could be used to screen for the potential involvement of AA in other cancers, such as liver cancer." Such findings could lead to a new wave of DNA-based detection systems for monitoring carcinogen exposures in humans and the environment.
This breakthrough came after 1.5 years of intensive research and was published online on 7 August 2013, 2.00pm, U.S. Eastern Time in Science Translational Medicine, a publication that focuses on practical medical advances that result from all stages of translational medicine. The research was supported by grants from the Singapore National Medical Research Council, the Singapore Millennium Foundation, the Lee Foundation, the National Cancer Centre Research Fund, The Verdant Foundation, the Duke-NUS Graduate Medical School Singapore, the Cancer Science Institute of Singapore, the Chang Gung Memorial Hospital, LinKou, the Taiwan National Science Council, and the Wellcome Trust.
Source:Science Translational Medicine

2 alternative treatments may help relieve postoperative nausea

Aromatherapy and IV dextrose show encouraging results, studies report

San Francisco, CA. (August 22, 2013) – Two simple, non-drug treatments—aromatherapy and intravenous administration of a simple sugar solution—may offer effective new approaches to relieving nausea and vomiting after surgery, report a pair of studies in the September issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS).
"Aromatherapy is promising as an inexpensive, noninvasive treatment for postoperative nausea that can be administered and controlled by patients as needed," according to a research report by Dr Ronald Hunt of Carolinas Medical Center University, Charlotte, NC, and colleagues. The second study suggests that intravenous dextrose solution is also useful in managing the common problem of postoperative nausea and vomiting (PONV).
Aromatherapy Reduces Nausea after Surgery
In the aromatherapy study, 301 patients reporting nausea after surgery were randomly assigned to receive one of four types of aromatherapy. Two groups received true aromatherapy, with essential oil of ginger or a blend of aromatherapy oils (ginger, spearmint, peppermint, and cardamom) placed on a gauze pad.
The other two groups received gauze pads with non-aromatherapy solutions: either rubbing alcohol or, as an odorless placebo, saline solution. Rates of subsequent nausea and vomiting and need for anti-nausea (antiemetic) medications were compared between groups.
Patients receiving the two aromatherapy treatments had lower nausea scores, compared to those receiving the placebo saline solution. In contrast, rubbing alcohol had no significant effect on nausea, compared to saline solution. Patients receiving aromatherapy were also less likely to require antiemetic drugs.
The aromatherapy blend was somewhat more effective than ginger only. About 80 percent of patients receiving the blend had improvement in nausea, compared to about 70 percent with ginger only (versus 40 to 50 percent with saline solution or rubbing alcohol).
Promising Results with IV Dextrose Solution
In the second study, Dr Susan Dabu-Bondoc and colleagues of Yale School of Medicine evaluated intravenous administration of a five percent solution of dextrose—a simple sugar—for prevention or treatment of PONV. Immediately after surgery, 62 patients were randomly assigned to receive the dextrose solution or standard IV fluid.
Postoperative nausea scores were not significantly different between groups. However, patients receiving intravenous dextrose needed less antiemetic medications than those receiving standard IV fluids. Patients in the IV dextrose group were also ready for discharge from the recovery room a little earlier.
Postoperative nausea and vomiting is a common complication, occurring in up to one-third of untreated surgical patients. It's a problem that's not only unpleasant for patients and associated with increased costs for antiemetic medications, but is also linked to prolonged hospitalization and an increased risk of readmission. Effective, non-drug approaches to preventing and managing PONV are needed.
The new results suggest that aromatherapy is a simple and effective treatment for patients developing nausea after surgery. "[A]romatherapy as a fast-acting agent either alone or combined with antiemetic medications merits additional research in the treatment of nausea," Dr Hunt and coauthors conclude.
Given immediately after surgery, IV dextrose doesn't reduce postoperative nausea scores. However, it may be effective in reducing the need for antiemetic drugs and shortening time in the recovery room. Dr Dabu-Bondoc and colleagues write, "This form of PONV therapy has a low side effect profile, is easily accessible, and is inexpensive."
Source: Anesthesia & Analgesia

Diabetic stroke risk after AMI drops in 10 year period

The findings were presented at the ESC Congress today by Ms Stina Jakobsson from Sweden. They reveal that reperfusion therapy and secondary prevention drugs produced the decline and brought stroke risk after AMI closer to that of non-diabetics.
Ms Jakobsson said: "Ischemic stroke following an acute myocardial infarction is a fairly uncommon but devastating event with high mortality. It has long been recognized that patients with diabetes mellitus are at a particularly high risk of complications after an AMI but until now, the risk of ischemic stroke after an AMI in patients with diabetes has been uncertain."
The study included 173,233 patients registered as having their first AMI during 1998-2008 in the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA). RIKS-HIA contains data on all patients admitted to Sweden's 74 coronary care units.
During 1998-2008, of the 33,503 (19%) patients in the register who had a previous diagnosis of diabetes, 5.5% had an ischemic stroke within one year after the AMI. This compared to a stroke rate of 3.5% in patients on the register who did not have diabetes and 0.3% in the Swedish general population (who were not on the register and had no history of AMI). Ms Jakobsson said: "We believe that an important mechanism behind the increased risk for ischemic stroke after an AMI, especially in diabetic patients, may be increased inflammation and platelet reactivity seen with an AMI."
Ischemic stroke rate decreased over time (see figure 1). During 1998-2000, 7.1% of diabetic patients had an ischemic stroke within one year after their first AMI, compared to 4.7% during 2007-2008. A smaller decline was observed in non-diabetic patients, from 4.2% in 1998-2000 to 3.7% in 2007-2008.
In the diabetics, prior reperfusion therapy with coronary angioplasty, coronary angioplasty during the AMI hospital stay, and prescription of the secondary preventive medications acetylsalicylic acid, P2Y12-inhibitors and statins when leaving hospital were independently associated with the reduced stroke risk over time.
Higher age, prior ischemic stroke, a specific type of myocardial infarction (ST-elevation MI) and atrial fibrillation during the hospitalization were found to be risk factors for an ischemic stroke within one year after AMI in patients with diabetes.
The study found that despite the greater improvements in stroke risk seen in diabetic patients, they were treated to a lesser extent than non-diabetic patients with reperfusion therapies during their initial hospital stay. They also left hospital with less standard medication for secondary prevention after an AMI. During the entire study period, the prescription of secondary preventive medication increased in both diabetic and non-diabetic patients.

Ms Jakobsson said: "The decreased ischemic stroke rate in both patient groups over time may be explained by a reduction in established risk factors for stroke and increased use of secondary preventive treatments after AMI. The larger reduction in stroke risk seen in diabetic patients may indicate that they gained more from the greater use of secondary preventive medication. But secondary preventive treatments are still underutilized in diabetic patients and there is room for increased use."
Source:ESC Congress 2013

Smokers who survive to 70 still lose 4 years of life

Dr Emberson said: "Despite recent declines in the numbers of people smoking and tar yields of cigarettes, smoking remains the leading preventable cause of death in Europe."
He added: "Previous studies had demonstrated that prolonged cigarette smoking from early adult life was associated with about 10 years loss of life expectancy, with about one quarter of smokers killed by their habit before the age of 70. Stopping at ages 60, 50, 40 or 30 years gained back about 3, 6, 9 or the full 10 years. However, the hazards of continuing to smoke and the benefits of stopping in older people had not been widely studied."
In the current study, scientists tracked the health of 7,000 older men (mean age 77 years, range 66 to 97) from 1997 to 2012 who took part in the Whitehall study of London civil servants. Hazard ratios (HRs) for overall mortality and various causes of death in relation to smoking habits were calculated after adjustment for age, last known employment grade and previous diagnoses of vascular disease or cancer.
During the 15-year study 5,000 of the 7,000 men died. Deaths in current smokers were about 50% higher than in never smokers (HR=1.50), due chiefly to vascular disease (HR=1.34), cancer (HR=1.74) and respiratory disease (HR=2.39).
Deaths in former smokers were 15% higher than in never smokers (HR=1.15), due chiefly to cancer (HR=1.24) and respiratory disease (HR=1.58). Compared with never smokers, men who had quit smoking within the previous 25 years (median 14 years) had a 28% higher mortality rate (HR=1.28) while men who quit >25 years ago (median 35 years) had no significant excess risk (HR=1.05).
Dr Emberson said: "Our results clearly show that active smoking continues to increase the risk of death in old age. Risk in former smokers decreases as the time since quitting gets longer and, if one survives long enough, eventually reaches levels of never smokers."
Average life expectancy from age 70 was about 18 years in men who had never regularly smoked, 16 years for men who gave up smoking before age 70 but only about 14 years in men still smoking at age 70. Two-thirds of never smokers (65%), but only half of current smokers (48%), survived from age 70 to age 85.
Dr Emberson said: "This study shows that even if you were to ignore all the deaths caused by smoking before the age of 70, older smokers still do considerably worse than older non-smokers, losing a considerable amount of subsequent lifespan."
Dr Robert Clarke (UK), coordinator of the study, concluded: "We have shown that even if a smoker is fortunate enough to survive to age 70 they still lose, on average, about 4 years of subsequent lifespan compared with men who do not smoke. Quitting is beneficial at any age and it really is never too late to stop."
Source:ESC Congress 2013

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