Visual Representations of Silent Atherosclerosis


Adherence to both pharmacologic treatment and lifestyle modification were better after patients received visual reports.

Primary prevention of cardiovascular (CV) disease often fails because of poor adherence to evidence-based guidelines by both patients and clinicians. Might visual representations of patients’ existing atherosclerosis increase adherence to preventive guidelines?

Researchers randomized 3532 participants (age, >60; or age, >40 with ≥1 conventional CV risk factor) in a Swedish population-based CV prevention program to undergo carotid ultrasound examinations and to either receive or not receive a visual report of the results. Each patient’s report displayed a stylized representation of the ultrasound image and a gauge that compared vascular age with chronological age. Patients who received visual reports also received reinforcing phone calls from a nurse and copies of their reports 6 months later; their clinicians also received copies of their visual reports. Patients who did not receive visual reports received standard guideline-based preventive care.

After 1 year, mean Framingham Risk Score decreased from 12.9 to 12.2 in patients who received visual reports and increased from 12.9 to 13.3 among controls (a statistically significant between-groups difference). A similar pattern was noted for the European Systematic Coronary Risk Evaluation score. The effect of the intervention was greatest among patients with the highest baseline CV risk.

Comment

Secondary outcome data suggested that the visual reports led to improvements in both pharmacologic treatment and lifestyle modification, implicating both provider and patient behaviors. Longer-term follow-up and cost-effectiveness data will be published later. Carotid imaging is relatively inexpensive and accessible, but given the incentives for overtreatment in the U.S., widespread carotid imaging might encourage unnecessary and potentially harmful downstream procedures.

 

Source: Lancet

Vitamin D does not prevent fractures in adults : Lancet


https://speciality.medicaldialogues.in/vitamin-d-does-not-prevent-fractures-in-adults-lancet/

Low-calorie liquid diet may help Low-calorie liquid diet


A reversal of type 2 diabetes (T2D) may be possible with low-calorie liquid diet for up to 5 months, increased physical activity, and cognitive behavioural therapy, preliminary results of the DiRECT* trial has shown.

“This was a clinical trial driven largely by the patients’ will and the response was very positive,” said lead author Professor Michael Lean from the University of Glasgow in Scotland at the recent IDF Congress 2017. “Our findings suggest that even if you have had T2D for 6 years, putting the disease into remission is feasible.”

The open-label randomized DiRECT trial included 250 patients (age 20-65 years) in the UK who had T2D for 6 years and were not on insulin. Half of the patients were treated using normal diabetes treatment, including medications, and weight-loss counselling while the other half were withdrawn of their antidiabetic and antihypertensive drugs and given a low calorie, liquid diet (no more than 825–853 kcal/day for 3 to 5 months), followed by gradual food reintroduction (over 2–8 weeks), and a structured support programme for long-term weight-loss maintenance, including cognitive behaviour therapy and exercise. [Lancet 2017;doi: 10.1016/S0140-6736(17)33102-1]

At 1 year, diabetes remission (HbA1c <6.5 percent after 2 months off antidiabetic medications) for up to 12 months was achieved by almost half of the patients in the intervention group (68 patients, 46 percent) and six (4 percent) in the control group (odds ratio [OR], 19.7; p<0.0001). Mean body weight dropped by 10 kg in the intervention group and 1 kg in the control group (p<0.0001).

Thirty-six patients in the intervention group achieved the primary outcome of >15 kg weight loss and diabetes remission vs zero in the control group (p<0.0001).

Overall, one patient experienced biliary colic and abdominal pain but still continued in the study. Others had constipation, headache, and dizziness but still persisted, said Lean. The trial is set to continue for 2 more years.

“The diagnosis of T2D is a medical emergency that needs action. Hopefully, this is a watershed in the understanding and management of the disease,” said lead author Professor Roy Taylor from the Newcastle University, UK. “Short-duration T2D can be put into remission by primary care staff using a structured programme.”

The researchers said the study is a bit controversial and different from previous studies as it was conducted in a real-life setting, with nurses or dietitians delivering the weight-loss regimen. What is also interesting is that it appeared to be the only study to date with T2D remission as the primary outcome.

“These results are impressive and strongly support the view that T2D is tightly associated with an excessive fat mass in the body,” said Prof Matti Uusitupa from the University of Eastern Finland, Kuopio, in an accompanying editorial. “[T]he time of diabetes diagnosis is the best point to start weight reduction and lifestyle changes because the motivation of the patient is usually high …” [Lancet 2017;doi:10.1016/S0140-6736(17)33100-8]

It is easy to lose weight but difficult to maintain weight loss. The bigger challenge is how to avoid weight rebound in the long term, added Lean. The ongoing DiRECT trial will seek to determine if weight loss and remission are achievable in the long term.

The “Deadly Breast Cancer Gene” is a Myth, Lancet Study Confirms


A powerful new Lancet study reveals that the so-called breast cancer susceptibility genes — BRCA 1 and BRCA 2 — do not, in fact, cause breast cancer. This means Angelina Jolie’s prophylactic mastectomy, for instance, was for naught. 

new Lancet Oncology study, reported widely in the mainstream media, confirms that the so-called “breast cancer genes” (i.e. BRCA1/2) do not have the power to determine breast cancer survival outcomes, as widely believed by the medical profession.

The study, titled “Germline BRCA mutation and outcome in young-onset breast cancer (POSH): a prospective cohort study“, found:

“[There is] no significant difference in overall survival or distant disease-free survival between patients carrying a BRCA1 or BRCA2 mutation and patients without these mutations after a diagnosis of breast cancer.”

The BBC broke down the study’s findings in greater detail, in their online article titled, Breast cancer survival ‘unaffected by faulty gene“:

“The study, published in The Lancet Oncology, found 12% of 2,733 women aged 18 to 40 treated for breast cancer at 127 hospitals across the UK between 2000 and 2008 had a BRCA mutation.

“The women’s medical records were tracked for up to 10 years.

“During this time, 651 of the women died from breast cancer, and those with the BRCA mutation were equally likely to have survived at the two-, five- and 10-year mark as those without the genetic mutation.

“This was not affected by the women’s body mass index or ethnicity.

“About a third of those with the BRCA mutation had a double mastectomy to remove both breasts after being diagnosed with cancer. This surgery did not appear to improve their chances of survival at the 10-year mark.”

The study has powerful implications for the future of breast screening programs and the standard of care for ‘breast cancer’ patients. So powerful is the belief that BRCA genes ’cause’ breast cancer, that millions around the world consider it fact. Celebraties like Angelina Jolie have added fuel to the fire of this dangerous myth, by electing to have her breasts removed ‘prophylactically’ due to her BRCA status and the recommendations of her physicians. I discussed questionable nature of this decision in a previous article, titled “Did Angelina Jolie Make A Mistake By Acting On The ‘Breast Cancer Gene’ Theory?”and elaborated further on the topic in an article titled Pinkwashing Hell: Breast Removal as a Form of ‘Prevention“.

In the excerpt below from the Discussion portion of the new Lancet Oncology paper, researchers not only failed to find a causal link between the BRCA genes and overall breast cancer survival, but noted that some BRCA mutation carriers (diagnosed with triple negative breast cancer) may actually have improved survival relative to non-mutation carriers:

“We found no clear evidence that either BRCA1 or BRCA2 germline mutations significantly affect overall survival with breast cancer after adjusting for known prognostic factors. Decisions about timing of risk-reducing surgery should take into account primary tumour prognosis and patient preference. BRCA mutation carriers presenting with triple-negative breast cancer might have an improved survival during the first few years after diagnosis compared with non-carriers, although immediate bilateral mastectomy did not account for this advantage. Finally, analysis of early outcome data from trials exploring BRCA-deficient tumour treatment in patients with triple-negative breast cancer should be interpreted with caution in view of the possible early survival advantage for BRCA mutation carriers.” 

While this finding may be surprising to those who have been led to believe that the BRCA gene ‘mutation’ status is a death sentence, we have spent the past few years debunking this  misinformation by looking at the non-industry funded evidence itself. Millions of women have already been needlessly traumatized by overdiagnosis and overtreatment of non-cancerous, indolent growths of epithelial origin such as ductal carcinoma in situ (DCIS). The “BRCA gene causes breast cancer” meme is another example of a mythical entity which has brought significant harm to women in the name of ‘saving  lives.’ It has been leveraged by private and governmental interests alike to corral populations into cancer screening programs, whose results have often run contrary to their stated objectives of preventing suffering.

New Dressing for Diabetic Foot Ulcer Healing: Lancet


https://speciality.medicaldialogues.in/new-dressing-for-diabetic-foot-ulcer-healing-lancet/

Drug-Resistant Tuberculosis


Executive Summary

“Practices for the management of individual patients in settings with a high tuberculosis burden are not sufficient to prevent the emergence, amplification, and spread of drug-resistant tuberculosis” is one of the key messages from The Lancet Respiratory Medicine Commission, led by Keertan Dheda from the University of Cape Town, South Africa. The Commission focuses on multidrug-resistant, extensively drug-resistant, and incurable tuberculosis, and highlights the growing burden of disease, its implications for patient management, as well as social and legal aspects. The authors also provide practical solutions for tackling emerging resistant cases—an exponentially increasing concern in high-burden countries.

Read more: http://thelancet.com/commissions/drug-resistant-tuberculosis?dgcid=twitter_social_lancet

source: the Lancet

Coronary atherosclerosis in indigenous South American Tsimane: a cross-sectional cohort study.


Background

Conventional coronary artery disease risk factors might potentially explain at least 90% of the attributable risk of coronary artery disease. To better understand the association between the pre-industrial lifestyle and low prevalence of coronary artery disease risk factors, we examined the Tsimane, a Bolivian population living a subsistence lifestyle of hunting, gathering, fishing, and farming with few cardiovascular risk factors, but high infectious inflammatory burden.

Methods

We did a cross-sectional cohort study including all individuals who self-identified as Tsimane and who were aged 40 years or older. Coronary atherosclerosis was assessed by coronary artery calcium (CAC) scoring done with non-contrast CT in Tsimane adults. We assessed the difference between the Tsimane and 6814 participants from the Multi-Ethnic Study of Atherosclerosis (MESA). CAC scores higher than 100 were considered representative of significant atherosclerotic disease. Tsimane blood lipid and inflammatory biomarkers were obtained at the time of scanning, and in some patients, longitudinally.

Findings

Between July 2, 2014, and Sept 10, 2015, 705 individuals, who had data available for analysis, were included in this study. 596 (85%) of 705 Tsimane had no CAC, 89 (13%) had CAC scores of 1–100, and 20 (3%) had CAC scores higher than 100. For individuals older than age 75 years, 31 (65%) Tsimane presented with a CAC score of 0, and only four (8%) had CAC scores of 100 or more, a five-fold lower prevalence than industrialised populations (p≤0·0001 for all age categories of MESA). Mean LDL and HDL cholesterol concentrations were 2·35 mmol/L (91 mg/dL) and 1·0 mmol/L (39·5 mg/dL), respectively; obesity, hypertension, high blood sugar, and regular cigarette smoking were rare. High-sensitivity C-reactive protein was elevated beyond the clinical cutoff of 3·0 mg/dL in 360 (51%) Tsimane participants.

Interpretation

Despite a high infectious inflammatory burden, the Tsimane, a forager-horticulturalist population of the Bolivian Amazon with few coronary artery disease risk factors, have the lowest reported levels of coronary artery disease of any population recorded to date. These findings suggest that coronary atherosclerosis can be avoided in most people by achieving a lifetime with very low LDL, low blood pressure, low glucose, normal body-mass index, no smoking, and plenty of physical activity. The relative contributions of each are still to be determined.

Source:Lancet

EU-approved ‘safe’ air pollution levels causing early deaths.


Published time: December 09, 2013 14:08
Edited time: December 10, 2013 08:37

General view of the Origny sugar factory in Sainte-Benoite near Saint-Quentin. (AFP Photo / Philippe Huguen)General view of the Origny sugar factory in Sainte-Benoite near Saint-Quentin. (AFP Photo / Philippe Huguen)

Air pollution in the European Union is causing premature deaths even when levels meet quality guidelines, a report has shown. Even in areas where pollution was much lower than the limit, scientists found there is a higher-than-normal risk of death.

The study, published the British Medical Association’s journal The Lancet, found that Europeans who have had prolonged exposure to pollution from industrial activities or road traffic have a higher chance of premature death. The increased risk to a person’s health is linked to tiny particles of soot and dust than can get lodged in the lungs and cause respiratory illnesses.

The study, carried out by Utrecht University in the Netherlands, found the particles measure 2.5 microns or 2.5 millionth of a meter. Exposure for “up to a few months” to particles of 2.5 microns can increase the risk of premature death.

“Although this does not seem to be much, you have to keep in mind that everybody is exposed to some level of air pollution and that it is not a voluntary exposure, in contrast to, for example, smoking,” scientist Rob Beelen, who led the study, told AFP.

The findings of the study echo the results of similar investigations carried out in North America and China.

“Our findings support health impact assessments of fine particles in Europe which were previously based almost entirely on North American studies,” Beelen said.

As part of the study the researchers drew on 22 previously published studies that documented the health of 367,000 people in 13 countries in Western Europe over 14 years. Beelen and his team then traveled to the areas where the participants lived and took traffic pollution readings that they used to calculate how much pollution local residents were exposed to.

 

AFP Photo / Frederick FlorinDuring the investigation, 29,000 of the 367,000 participants recruited in 1990 died. In order to increase accuracy, investigations also took into account such factors as physical exercise, body mass, education and smoking habits. 

European Union guidelines set the maximum exposure to particles of 25 micrograms per cubic meter. Beelen says the results of this study are evidence the EU needs to reset its safety limits to 10 micrograms per cubic meter.

“Despite major improvements in air quality in the past 50 years, the data from Beelen and his colleagues’ report draw attention to the continuing effects of air pollution on health,” Jeremy Langrish and Nicholas Mills, of the University of Edinburgh, told the Medical Press.

In China a red alert was issued for poor air quality was issued Thursday after pollution reached hazardous levels. The coastal city of Qingdao recorded PM2.5 Air Quality Index levels of over 300, while Nanjing saw a reading of 354 on Wednesday, according to local news portal news.longhoo.net.

In light of the dangerous levels of pollution the Chinese government is considering the practice of ‘cloud seeding’ to clear toxic fog in the country. According to a document released by the China Meteorological Administration, from 2015 local meteorological authorities will be permitted to use cloud seeding to disperse pollution.

The World Health Organization has classified outdoor pollution as one of the principal causes of cancer and estimates around 3.2 million people die every year globally as a result of prolonged exposure.

Ibuprofen Kills Thousands Each Year, So What Is The Alternative?


A recent Reuters’ article opened with the following stunning sentence:

Long-term high-dose use of painkillers such as ibuprofen or diclofenac is ‘equally hazardous’ in terms of heart attack risk as use of the drug Vioxx, which was withdrawn due to its potential dangers, researchers said.”  

The 2004 Vioxx recall, as you may remember, was spurred by the nearly 30,000 excess cases of heart attacks and sudden cardiac deaths caused by the drug between 1999-2003. Despite the fact that scientific research had accumulated as early as 2000 linking Vioxx to increased heart attacks and strokes, the drug’s manufacturer Merck, and the FDA, remained silent as the death toll steadily increased.

Ibuprofen Kills Thousands Each Year, So What Is The Alternative?

The Reuters report focused on new research published in Lancet indicating the risk of heart attack increases as much as a third and the risk of heart failure doubles among heavier users of NSAID drugs.

INFLAMED: Our Default Bodily State

Why are so many folks taking NSAID drugs like ibuprofen anyway?

Pain and unhealthy levels of inflammation are fast becoming default bodily states in the industrialized world. While in most cases we can adjust the underlying pro-inflammatory conditions by altering our diet, and reducing stress and environmental chemical exposures, these approaches take time, discipline and energy, and sometimes we just want the pain to stop now. In those often compulsive moments we find ourselves popping an over-the-counter pill to kill the pain.

The problem with this approach is that, if we do it often enough, we may kill ourselves along with the pain…

Ibuprofen really is a perfect example of this. As mentioned above, this petrochemical-derivative has been linked to significantly increased risk of heart attack and increased cardiacand all-cause mortality (when combined with aspirin), with over two dozen serious adverse health effects, including:

  1. Anemia[1]
  2. DNA Damage[2]
  3. Hearing Loss[3]
  4. Hypertension[4]
  5. Influenza Mortality[5]
  6. Miscarriage[6]

Ibuprofen is, in fact, not unique in elevating cardiovascular disease risk and/or mortality. The entire category of non-steroidal anti-inflammatory drugs (NSAIDs) appears to have this under-recognized dark side; cardiovascular disease and cardiac mortality score highest on the list of over 100 unintended adverse health effects associated with their use. See also our analysis of the rarely acknowledged dark side to aspirin: The Evidence Against Aspirin And For Natural Alternatives.

So, what does one do? Pain is pain. Whether it happens to you, or you witness it in another (which can be worse), finding relief is a top priority.

Ibuprofen Kills More Than Pain, So What Is The Alternative?

Research on Natural Alternatives To Ibuprofen

Here is some evidence-based research on alternatives to ibuprofen, sourced from the National Library of Medicine:

  1. Ginger – A 2009 study found that ginger capsules (250 mg, four times daily) were as effective as the drugs mefenamic acid and ibuprofen for relieving pain in women associated with their menstrual cycle (primary dysmenorrhea). [7]
  2. Topical Arnica – A 2007 human study found that topical treatment with arnica was as effective as ibuprofen for hand osteoarthritis, but with lower incidence of side effects.[8]
  3. Combination: Astaxanthin, Ginkgo biloba and Vitamin C – A 2011 animal study found this combination to be equal to or better than ibuprofen for reducing asthma-associated respiratory inflammation.[9]
  4. Chinese Skullcap (baicalin) – A 2003 animal study found that a compound in Chinese skullcap known as baicalin was equipotent to ibuprofen in reducing pain.[10]
  5. Omega-3 fatty acids: A 2006 human study found that omega-3 fatty acids (between 1200-2400 mg daily) were as effective as ibuprofen in reducing arthritis pain, but with the added benefit of having less side effects.[11]
  6. Panax Ginseng – A 2008 animal study found that panax ginseng had analgesic and anti-inflammatory activity similar to ibuprofen, indicating its possible anti-rheumatoid arthritis properties.[12]
  7. St. John’s Wort – A 2004 animal study found that St. John’s wort was twice as effective as ibuprofen as a pain-killer.[13]
  8. Anthrocyanins from Sweet Cherries & Raspberries – A 2001 study cell study found that anthrocyanins extracted from raspberries and sweet cherries were as effective as ibuprofen and naproxen at suppressing the inflammation-associated enzyme known as cyclooxygenase-1 and 2.[14]
  9. Holy Basil – A 2000 study found that holy basil contains compounds with anti-inflammatory activity comparable to ibuprofen, naproxen and aspirin.[15]
  10. Olive Oil (oleocanthal) – a compound found within olive oil known as oleocanthal has been shown to have anti-inflammatory properties similar to ibuprofen.[16]
  11. There are, of course, hundreds of additional substances which have been studied for their pain-killing and/or anti-inflammatory effects, and there are also aromatherapeutic approachesthat do not require the ingestion of anything at all, but there is also a danger here. When we think of taking an alternative pain-killer to ibuprofen, we are still thinking within the palliative, allopathic medical model: suppress the symptom, and go on about our business. It would behoove us to look deeper into what is causing our pain. And when possible, remove the cause(s). And that often requires a dramatic dietary shift away from pro-inflammatory foods, many of which most Westerners still consider absolutely delightful, e.g. wheat, dairy,nighshade vegetables and even wheat-free grains, etc.

    [1] Direct cytotoxicity of non-steroidal anti-inflammatory drugs in acidic media: model study on human erythrocytes with DIDS-inhibited anion exchanger. Pharmazie. 2002 Dec;57(12):848-51. PMID: 12561250

    [2] Genotoxicity of ibuprofen in mouse bone marrow cells in vivo. Drug Chem Toxicol. 2012 Jan 27. Epub 2012 Jan 27. PMID: 22283434

    [3] Analgesic use and the risk of hearing loss in men. Am J Med. 2010 Mar;123(3):231-7. PMID: 20193831

    [4] Effect on blood pressure of lumiracoxib versus ibuprofen in patients with osteoarthritis and controlled hypertension: a randomized trial. J Hypertens. 2008 Aug;26(8):1695-702. PMID: 18622250

    [5] The effect on mortality of antipyretics in the treatment of influenza infection: systematic review and meta-analysis. J R Soc Med. 2010 Oct;103(10):403-11. PMID: 20929891

    [6]  Taking non-aspirin NSAIDs in early pregnancy doubles risk of miscarriage, study shows. BMJ. 2011 ;343:d5769. Epub 2011 Sep 9. PMID: 21908536

    [7] Comparison of effects of ginger, mefenamic acid, and ibuprofen on pain in women with primary dysmenorrhea. J Altern Complement Med. 2009 Feb 13. PMID: 19216660

    [8] Choosing between NSAID and arnica for topical treatment of hand osteoarthritis in a randomised, double-blind study. Rheumatol Int. 2007 Apr;27(6):585-91. Epub 2007 Feb 22. PMID: 17318618

    [9] Summative interaction between astaxanthin, Ginkgo biloba extract (EGb761) and vitamin C in suppression of respiratory inflammation: a comparison with ibuprofen. Phytother Res. 2011 Jan;25(1):128-36. PMID: 20632299

    [10] The antiinflammatory and analgesic effects of baicalin in carrageenan-evoked thermal hyperalgesia. Anesth Analg. 2003 Dec;97(6):1724-9. PMID: 14633550

    [11] Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. Surg Neurol. 2006 Apr;65(4):326-31. PMID:16531187

    [12] Potential analgesic and anti-inflammatory activities of Panax ginseng head butanolic fraction in animals. Food Chem Toxicol. 2008 Dec;46(12):3749-52. Epub 2008 Oct 1. PMID:18930781

    [13] Antinociceptive activity of methanolic extracts of St. John’s Wort (Hypericum perforatum) preparation. Pak J Pharm Sci. 2004 Jul;17(2):13-9. PMID: 16414593

    [14] Cyclooxygenase inhibitory and antioxidant cyanidin glycosides in cherries and berries. Phytomedicine. 2001 Sep;8(5):362-9. PMID: 11695879

    [15] Antioxidant and cyclooxygenase inhibitory phenolic compounds from Ocimum sanctum Linn. Phytomedicine. 2000 Mar;7(1):7-13. PMID: 10782484

    [16] Molecular mechanisms of inflammation. Anti-inflammatory benefits of virgin olive oil and the phenolic compound oleocanthal. Curr Pharm Des. 2011 ;17(8):754-68. PMID:21443487

     

‘Sugar gel’ helps premature babies.


A dose of sugar given as a gel rubbed into the inside of the cheek is a cheap and effective way to protect premature babies against brain damage, say experts.

premature baby

Dangerously low blood sugar affects about one in 10 babies born too early. Untreated, it can cause permanent harm.

Researchers from New Zealand tested the gel therapy in 242 babies under their care and, based on the results, say it should now be a first-line treatment.

Their work is published in The Lancet.

Sugar dose

Dextrose gel treatment costs just over £1 per baby and is simpler to administer than glucose via a drip, say Prof Jane Harding and her team at the University of Auckland.

“Start Quote

This is a cost effective treatment and could reduce admissions to intensive care services which are already working at high capacity levels”

Andy Cole Bliss

Current treatment typically involves extra feeding and repeated blood tests to measure blood sugar levels.

But many babies are admitted to intensive care and given intravenous glucose because their blood sugar remains low – a condition doctors call hypoglycaemia.

The study assessed whether treatment with dextrose gel was more effective than feeding alone at reversing hypoglycaemia.

Neil Marlow, from the Institute for Women’s Health at University College London, said that although dextrose gel had fallen into disuse, these findings suggested it should be resurrected as a treatment.

We now had high-quality evidence that it was of value, he said.

Andy Cole, chief executive of premature baby charity Bliss, said: “This is a very interesting piece of new research and we always welcome anything that has the potential to improve outcomes for babies born premature or sick.

“This is a cost-effective treatment and could reduce admissions to intensive care services, which are already working at high capacity levels.

“While the early results of this research show benefits to babies born with low blood sugars, it is clear there is more research to be done to implement this treatment.”

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