Multivitamin Use Does Not Reduce Cardiovascular Risk in Men.

Taking a daily multivitamin does not reduce the risk for major cardiovascular events in men, according to a JAMA study.

As part of the Physicians’ Health Study II, nearly 15,000 men aged 50 and older were randomized to a daily multivitamin or placebo. After a median follow-up of 11 years, the rate of the primary composite outcome — myocardial infarction, stroke, or cardiovascular mortality — did not differ between the two groups. There were slightly fewer MI deaths among multivitamin users, but the authors speculate that this may have been due to chance. The effect did not differ between men with and without baseline cardiovascular disease.

An editorialist writes that multiple trials “clearly confirm that CVD cannot be prevented or treated with vitamins.” She concludes: “The message needs to remain simple and focused: CVD is largely preventable, and this can be achieved by eating healthy foods, exercising regularly, avoiding tobacco products, and, for those with high risk factor levels or previous CVD events, taking proven, safe, and effective medications.”

Source: JAMA

HIV Drug-Resistance Mutations Emerge in Patients with Low-Level Viremia.

Adherence counseling or regimen changes may be warranted for patients on ART whose viral loads are repeatedly >200 copies/mL.

Patients who develop low-level viremia (LLV) while receiving antiretroviral therapy (ART) may be at increased risk for viral rebound, but we do not yet know what to do for such patients (JW AIDS Clin Care Aug 20 2012). In the present study, researchers evaluated whether new drug-resistance mutations develop during LLV, a factor that could influence clinical management.

Drawing from a large, prospective study of HIV-infected patients in California, the investigators identified 47 patients who experienced LLV (defined as a viral load <1000 copies/mL) while receiving ART; 89% were treatment experienced at study entry. Drug-resistance genotyping was performed on 82 samples obtained during periods of LLV between 2001 and 2010. The median viral load in these samples was 267 copies/mL (range, 174–414 copies/mL).

Nearly half of the samples (46%) were found to have new HIV drug-resistance mutations when compared with prior genotypes. Of the 18 patients who had more than one episode of LLV, 8 (44%) accumulated new drug-resistance mutations over a median of 11 months. (Several of these patients were receiving drug combinations that are less potent than current regimens.) Risk factors for the accumulation of resistance included receipt of fewer active drugs and longer time since an episode of LLV. Most LLV episodes (76%) were followed by virologic suppression.

Comment: This small but important study suggests that patients on ART with persistent LLV (viral loads between 200 and 1000 copies/mL) have a substantial risk for developing HIV drug-resistance mutations. Because most patients in this study were treatment experienced, some of the mutations may represent archived resistance; moreover, many of the patients who developed new mutations were on outdated regimens. Nevertheless, this study suggests that patients with persistent viral loads of approximately 200 copies/mL or greater should have intensified adherence counseling or a change in regimen. It is less clear what we should do, if anything, in patients with lower levels of detectable viremia — an issue that is coming up more frequently as the detection threshold for viral-load assays continues to go down.

Soure: Journal Watch HIV/AIDS Clinical Care

Low-Intensity Aerobic Activity Improves Gait Instability in Parkinson Disease .

A low-intensity treadmill regimen improves gait instability and cardiovascular fitness in patients with Parkinson disease, according to a study in the Archives of Neurology.

Roughly 70 patients with Parkinson’s and gait instability were randomized to one of three physical activity interventions to be performed three times a week for 3 months: higher-intensity treadmill exercise, lower-intensity treadmill exercise, or stretching and resistance training. All patients underwent a screening exercise test for cardiopulmonary safety.

The primary outcome — distance on a 6-minute walk test — improved in all groups, but only the 12% improvement in the lower-intensity treadmill group achieved statistical significance. Cardiovascular fitness improved significantly in the two treadmill groups, while muscle strength improved in the stretching-resistance group.

The authors write: “The fact that the lower-intensity treadmill exercise is the most feasible exercise for most patients with PD has important implications for clinical practice.”

Source: Archives of Neurology


Sulfonylurea Drugs Associated with Increased Cardiovascular Risk vs. Metformin .

An observational study of patients beginning diabetes treatment finds that sulfonylureas carry a roughly 20% greater risk for major cardiovascular events than metformin. The work appears in the Annals of Internal Medicine.

Researchers used federal data from the Veterans Health Administration to ascertain outcomes in 250,000 veterans (almost all of whom were men) starting monotherapy for diabetes with a sulfonylurea (either glyburide or glipizide) or metformin. The primary outcome — a composite of hospitalization for acute MI or for stroke, or death — was more common among sulfonylurea users by 2.2 events per 1000 person-years of observation after adjustment for multiple factors, such as blood pressure and BMI.

An editorialist considers the findings “credible and important,” but ultimately “hypothesis-generating” in the absence of a randomized trial.

Source: Annals of Internal Medicine

Chelation Therapy Shows Unexpected, Albeit Limited, Success in CVD .

Patients may ask about reports on the success of chelation therapy to remove calcium from patients with cardiovascular disease. Skeptics are — well, skeptical. The study was presented on Sunday at the American Heart Association meeting.

According to a New York Times account, some 1700 patients with previous myocardial infarction were randomized to about a year’s worth of chelation therapy or placebo. During nearly 5 years’ follow-up, 26% of those on active therapy experienced a cardiovascular event, as opposed to 30% of those on placebo.

One critic called the work “fatally flawed,” according to the Times, and said that wide adoption of the procedure would be “a public health catastrophe.”

Source: New York Times

10 High Protein Breakfast Ideas That Don’t Involve Eggs.

Tofu Breakfast Tacos:

A collection of tofu scramble recipes would be a fairly disappointing way to take this gallery, but this variation looked to delicious not to include. The important part is all the spices used; from there, add whatever vegetables, salsas, or other condiments you want.


Blueberry Quinoa Parfait:

Parfaits usually consist of way more sugar than protein, but the quinoa, pecans and yogurt in this one actually pack a substantial amount, and blueberries add plenty of sweetness without added, processed sugars.


Ful Mudammas Breakfast Burrito:

The first time I had ful mudammas, I’ll admit: they were topped with an egg. But the Middle Eastern bean dish is delicious either way, and pack plenty of protein without any dairy or meat. Try them in this vegan breakfast burrito for a modern take.


Tempeh Bacon-Topped, Roasted Plum and Baby Spinach Salad:

Is it just me, or does tempeh bacon sometimes taste better than real bacon? In any case, the soybeans are a good source of protein without much fat; stick it on a salad like this one for a super-healthy breakfast, or eat it alongside whatever else you have going on for a protein boost. It’s good; trust me.


Chia Porridge with Seeds, Nuts and Berries:

Chia seeds don’t just grow animal-shaped plants; they also provide a great source of vegetarian fuel and protein. Try them in this breakfast porridge for a delicious, dairy-free, egg-free way to get some morning protein



Almond Butter and Bacon Sandwich:

I kind of can’t believe I’m recommending this, but desperate times call for desperate measures. Plus, almond butter and bacon might just be really delicious together, and they definitely pack a good amount of protein.


Almond Butter Breakfast Bars:

This is a great way to get some protein on the go, and it also happens to be vegan (and egg-free!). Skip the sugar and add some extra almond butter to keep it high-protein.



Avocado Toast with Bacon:

Avocado toast is one of my absolute favorite breakfasts, but it still packs a lot more fat and carbs than protein. Top it with bacon (or tempeh bacon) for a boost, and try using sprouted grain bread to get a dose of fiber and avoid simple carbs. It’s delicious, and incredibly easy to make.


Chia Seed Breakfast Bowl:

This chia-based breakfast packs even more protein thanks to yogurt (use dairy-free if you like), and it’s also simpler to make. Top with nuts or mix in almond butter if you want even more protein.


Mini Crustless Tofu Quiches:

Skipping the crust and adding vegetables to these tofu quiches gives you a nice break from eggs, without the extra carbs that are so hard to avoid in other breakfasts.


Mini Crustless Tofu Quiches:

Skipping the crust and adding vegetables to these tofu quiches gives you a nice break from eggs, without the extra carbs that are so hard to avoid in other breakfasts.