People who drink moderate amounts of coffee each day have a lower risk of death from disease


Image: People who drink moderate amounts of coffee each day have a lower risk of death from disease

Many people drink coffee for an energy boost, but do you know that it can also prolong your life? A study published in the journal Circulation revealed that moderate amounts — or less than five cups — of coffee each day can lower your risk of death from many diseases, such as cardiovascular disease, Type 2 diabetes, and nervous system disorders. It can also lower death risk due to suicide.

The study’s researchers explained this effect could be attributed to coffee’s naturally occurring chemical compounds. These bioactive compounds reduce insulin resistance and systematic inflammation, which might be responsible for the association between coffee and mortality. (Related: Coffee drinkers have a lower mortality rate and lower risk of various cancers.)

The researchers reached this conclusion after analyzing the coffee consumption every four years of participants from three large studies: 74,890 women in the Nurses’ Health Study; 93,054 women in the Nurses’ Health Study 2; and 40,557 men in the Health Professionals Follow-up Study. They did this by using validated food questionnaires. During the follow-up period of up to 30 years, 19,524 women and 12,432 men died from different causes.

They found that people who often consumed coffee tend to smoke cigarettes and drink alcohol. To differentiate the effects of coffee from smoking, they carried out their analysis again among non-smokers. Through this, the protective benefits of coffee on deaths became even more apparent.

With these findings, the researchers suggested that regular intake of coffee could be included as part of a healthy, balanced diet. However, pregnant women and children should consider the potential high intake of caffeine from coffee or other drinks.

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Because the study was not designed to show a direct cause and effect relationship between coffee consumption and dying from illness, the researchers noted that the findings should be interpreted with caution. Still, this study contributes to the claim that moderate consumption of coffee offers health benefits.

The many benefits of coffee

Many studies have shown that drinking a cup of coffee provides health benefits. Here are some of them:

  • Coffee helps prevent diabetes: A study conducted by University of California, Los Angeles (UCLA) researchers showed that drinking coffee helps prevent Type 2 diabetes by increasing levels of the protein sex hormone-binding globulin (SHBG), which regulates hormones that influence the development of Type 2 diabetes. Researchers from Harvard School of Public Health (HSPH) also found that increased coffee intake may lower Type 2 diabetes risk.
  • Coffee protects against Parkinson’s disease: Studies have shown that consuming more coffee and caffeine may significantly lower the risk of Parkinson’s disease. It has also been reported that the caffeine content of coffee may help control movement in people with Parkinson’s disease.
  • Coffee keeps the liver healthy: Coffee has some protective effects on the liver. Studies have shown that regular intake of coffee can protect against liver diseases, such as primary sclerosing cholangitis (PSC) and cirrhosis of the liver, especially alcoholic cirrhosis. Drinking decaffeinated coffee also decreases liver enzyme levels. Research has also shown that coffee may help ward off cancer. A study by Italian researchers revealed that coffee intake cuts the risk of liver cancer by up to 40 percent. Moreover, some of the results indicate that drinking three cups of coffee a day may reduce liver cancer risk by more than 50 percent.
  • Coffee prevents heart disease: A study conducted by Beth Israel Deaconess Medical Center (BIDMC) and HSPC researchers showed that moderate coffee intake, or two European cups, each day prevents heart failure. Drinking four European cups a day can lower heart failure risk by 11 percent.

Hand hygiene protocols lower antibiotic requirement and mortality


https://speciality.medicaldialogues.in/hand-hygiene-protocols-lower-antibiotic-requirement-and-mortality/

Even Well-Controlled Type 1 Diabetes Associated with Increased Mortality Risk


Patients with type 1 diabetes who have good glycemic control still have about twice the mortality risk as the general population, according to a case-control study in the New England Journal of Medicine.

Using Swedish registries, researchers matched 34,000 adults with type 1 diabetes to roughly 170,000 adults without type 1 diabetes (mean age, 36). All patients with diabetes were at elevated risk for all-cause mortality, even those with well-controlled mean glycated hemoglobin levels (5.4% for patients with hemoglobin A1c levels of 6.9% or below vs. 2.9% mortality rate for controls during 8 years’ follow-up). In that same period, mortality increased with increasing levels of glycated hemoglobin (12% for HbA1c of 9.7% or higher).

There were similar trends in cardiovascular and diabetes mortality, which accounted for much of the excess overall mortality risk.

Hip replacement death rate halved


Death rates following hip replacement surgery fell by half in England and Wales between 2003 and 2011, a study in The Lancet has found.

Although death within 90 days of surgery is rare, mortality decreased from 0.56% to 0.29% in an analysis of more than 400,000 patients.

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The researchers said that fitter patients and better physiotherapy could be behind the decrease.

They added that simple treatment options would reduce the risk further.

Researchers from the universities of Bristol, Oxford, East Anglia and Exeter used data from the UK’s joint-replacement database, the National Joint Registry, to look at death rates following this type of surgery.

In their study they found that 1,743 patients died within 90 days of surgery during the eight years.

In 2004, 24,723 patients had hip replacement surgery and 139 of those died within 90 days.

While in 2011, there were 60,727 hip replacement operations carried out and 164 patient deaths.

Quick fix

The reason for the fall in death rates could be down to a number of factors.

The researchers identified the use of a spinal anaesthetic as likely to lead to fewer complications. Specific treatments to stop blood clots after surgery were also linked to a lower risk of death.

We need to concentrate efforts on reducing the risk of death in high risk groups such as those with severe liver disease.”

Prof Ashley BlomUniversity of Bristol

But people are also living longer and patients are recovering more quickly after surgery as a result of better post-operative care. For example, patients are encouraged to get up and start walking around the day after surgery.

The study said: “More recent generations of old people… are generally fitter and less frail than old people at the start of the study.

“Likewise, other aspects of surgery and anaesthesia have improved sufficiently to account for the change in mortality rates.”

The research team noticed that people with certain medical conditions were at a much higher risk of dying following surgery – particularly those with severe liver disease, those who had had a heart attack and those with diabetes and renal disease.

Those patients who died were most likely to be elderly men, they said.

‘Surprising’

But there were also some unexpected findings. Overweight people (with a body mass index of 25-30) appeared to have a lower risk of death after hip surgery than those patients with a “normal” BMI of 20-25.

Ashley Blom, professor of orthopaedic surgery at the University of Bristol, said: “The finding that overweight people have a lower risk of death is surprising, but has been confirmed by other recent studies, and challenges some of our preconceptions.

“We need to concentrate efforts on reducing the risk of death in high risk groups such as those with severe liver disease.”

But he said that the “dramatic” overall fall in death rates was “extremely good news”.

“It is also very exciting that we can further reduce the risk of post-operative death by adopting relatively simple measures,” Prof Blom said.

A spokesperson from Arthritis Research UK, welcomed the findings.

“This is great news for people in the UK who have osteoarthritis and require hip replacement surgery.

“Although not everyone who has arthritis will need hip replacement surgery, for many people, it’s their only hope to reduce the pain, disability and stiffness associated with the disease.

“There are however always risks associated in having major surgery such as hip replacement surgery, so we advise people to discuss these risks with their surgeon before they decide to have a hip replacement.”

Source: BBC

 

Low Diastolic BP Associated with Higher Mortality in Chronic Kidney Disease.


The association of blood pressure with mortality in chronic kidney disease seems to follow a J-shaped curve, especially with regard to diastolic pressure, according to an Annals of Internal Medicine study.
Researchers followed some 650,000 U.S. veterans with non-dialysis–dependent disease over a median of 6 years. After adjustment for such factors as age, diabetes, and cardiovascular disease, patients with blood pressure in the range of 130 to 159 mm Hg systolic and 70 to 89 diastolic had the lowest mortality risk. Even patients with “ideal” systolic blood pressure of less than 130 had increased mortality rates if their diastolic levels were under 70.
The association could be caused, the authors speculate, by lower coronary perfusion with decreased diastolic pressure. Editorialists (and the authors) emphasize the observational nature of the data, with the “attendant limitations,” and note the preponderance of male patients. “Translating these findings into practice is challenging,” they conclude.
Source: Annals of Internal Medicine article

 

Decline in 20-year mortality after myocardial infarction in patients with chronic kidney disease: evolution from the prethrombolysis to the percutaneous coronary intervention era.


Cardiovascular disease is the main cause of death in patients with chronic kidney disease (CKD). Here we measured temporal trends in treatment and mortality after myocardial infarction (MI) depending on kidney function at presentation in 12,087 patients admitted for MI to a coronary care unit from 1985 to 2008. The patients were categorized into those with normal kidney function (estimated glomerular filtration rate over 90ml/min per 1.73m2), and those with CKD as defined by Kidney Foundation practice guidelines, with 8632 patients (71%) at CKD stages 2–5. Use of evidence-based care increased over time in all CKD stages. Mortality rates fell over the entire time period. When comparing data from 2000–2008 to that from 1985–1990, adjusted 30-day mortality fell both in patients with CKD stages 4–5 (adjusted odds 0.33, 95% confidence interval 0.18–0.60) and in those without kidney impairment (adjusted odds 0.21, 95% confidence interval 0.10–0.42). This mortality decrease was sustained during long-term follow-up. There was no significant interaction between kidney function and decade of admission. Overall, median survival was over 20, 15, 8, and 1.8 years for patients with normal kidney function, stage 2, stage 3, and stage 4–5 CKD, respectively. Thus, during the past 25 years, treatment of patients with a MI improved substantially with a concomitant decline in mortality. Although our findings were similar for all stages of kidney function, the prognosis remains poor for patients with stage 4–5 CKD.

Sourcardioe: Nature.

Blood-brain barrier disruption is associated with increased mortality after endovascular therapy.


OBJECTIVE: To evaluate the incidence, baseline characteristics, and clinical prognosis of blood-brain barrier (BBB) disruption after endovascular therapy in acute ischemic stroke patients.

METHODS: A total of 220 patients treated with endovascular therapy between April 2007 and October 2011 were identified from a prospective, clinical, thrombolysis registry. All patients underwent a nonenhanced CT scan immediately after treatment. CT scan or MRI was systematically realized at 24 hours to assess intracranial hemorrhage complications. BBB disruption was defined as a hyperdense lesion on the posttreatment CT scan.
RESULTS: BBB disruption was found in 128 patients (58.2%; 95% confidence interval [CI], 51.4%-64.9%). Cardioembolic etiology, high admission NIH Stroke Scale score, high blood glucose level, internal carotid artery occlusion, and use of combined endovascular therapy (chemical and mechanical revascularization) were independently associated with BBB disruption. Patients with BBB disruption had lower rates of early major neurologic improvement (8.6% vs 31.5%, p < 0.001), favorable outcome (39.8% vs 61.8%, p = 0.002), and higher rates of 90-day mortality (34.4% vs 14.6%, p = 0.001) and hemorrhagic complications (42.2% vs 8.7%, p < 0.001) than those without BBB disruption. By multivariable analysis, patients with BBB disruption remained with a lower rate of early neurologic improvement (adjusted odds ratio [OR], 0.28; 95% CI, 0.11-0.70) and with a higher rate of mortality (adjusted OR, 2.37; 95% CI, 1.06-5.32) and hemorrhagic complications (adjusted OR, 6.38; 95% CI, 2.66-15.28).
CONCLUSION: BBB disruption has a detrimental effect on outcome and is independently associated with mortality after endovascular therapy. BBB disruption assessment may have a role in prognosis staging in these patients.

Source: Neurology

Vegetarian Dietary Patterns and Mortality in Adventist Health Study 2.


Importance  Some evidence suggests vegetarian dietary patterns may be associated with reduced mortality, but the relationship is not well established.

Objective  To evaluate the association between vegetarian dietary patterns and mortality.

Design  Prospective cohort study; mortality analysis by Cox proportional hazards regression, controlling for important demographic and lifestyle confounders.

Setting  Adventist Health Study 2 (AHS-2), a large North American cohort.

Participants  A total of 96 469 Seventh-day Adventist men and women recruited between 2002 and 2007, from which an analytic sample of 73 308 participants remained after exclusions.

Exposures  Diet was assessed at baseline by a quantitative food frequency questionnaire and categorized into 5 dietary patterns: nonvegetarian, semi-vegetarian, pesco-vegetarian, lacto-ovo–vegetarian, and vegan.

Main Outcome and Measure  The relationship between vegetarian dietary patterns and all-cause and cause-specific mortality; deaths through 2009 were identified from the National Death Index.

Results  There were 2570 deaths among 73 308 participants during a mean follow-up time of 5.79 years. The mortality rate was 6.05 (95% CI, 5.82-6.29) deaths per 1000 person-years. The adjusted hazard ratio (HR) for all-cause mortality in all vegetarians combined vs nonvegetarians was 0.88 (95% CI, 0.80-0.97). The adjusted HR for all-cause mortality in vegans was 0.85 (95% CI, 0.73-1.01); in lacto-ovo–vegetarians, 0.91 (95% CI, 0.82-1.00); in pesco-vegetarians, 0.81 (95% CI, 0.69-0.94); and in semi-vegetarians, 0.92 (95% CI, 0.75-1.13) compared with nonvegetarians. Significant associations with vegetarian diets were detected for cardiovascular mortality, noncardiovascular noncancer mortality, renal mortality, and endocrine mortality. Associations in men were larger and more often significant than were those in women.

Conclusions and Relevance  Vegetarian diets are associated with lower all-cause mortality and with some reductions in cause-specific mortality. Results appeared to be more robust in males. These favorable associations should be considered carefully by those offering dietary guidance.

Source: JAMA

 

 

Oxygen Saturation and Outcomes in Preterm Infants.


BACKGROUND

The clinically appropriate range for oxygen saturation in preterm infants is unknown. Previous studies have shown that infants had reduced rates of retinopathy of prematurity when lower targets of oxygen saturation were used.

METHODS

In three international randomized, controlled trials, we evaluated the effects of targeting an oxygen saturation of 85 to 89%, as compared with a range of 91 to 95%, on disability-free survival at 2 years in infants born before 28 weeks’ gestation. Halfway through the trials, the oximeter-calibration algorithm was revised. Recruitment was stopped early when an interim analysis showed an increased rate of death at 36 weeks in the group with a lower oxygen saturation. We analyzed pooled data from patients and now report hospital-discharge outcomes.

RESULTS

A total of 2448 infants were recruited. Among the 1187 infants whose treatment used the revised oximeter-calibration algorithm, the rate of death was significantly higher in the lower-target group than in the higher-target group (23.1% vs. 15.9%; relative risk in the lower-target group, 1.45; 95% confidence interval [CI], 1.15 to 1.84; P=0.002). There was heterogeneity for mortality between the original algorithm and the revised algorithm (P=0.006) but not for other outcomes. In all 2448 infants, those in the lower-target group for oxygen saturation had a reduced rate of retinopathy of prematurity (10.6% vs. 13.5%; relative risk, 0.79; 95% CI, 0.63 to 1.00; P=0.045) and an increased rate of necrotizing enterocolitis (10.4% vs. 8.0%; relative risk, 1.31; 95% CI, 1.02 to 1.68; P=0.04). There were no significant between-group differences in rates of other outcomes or adverse events.

CONCLUSIONS

Targeting an oxygen saturation below 90% with the use of current oximeters in extremely preterm infants was associated with an increased risk of death.

Source: NEJM

 

Azithromycin Does Not Increase Cardiovascular Mortality in the General Population.


The excess cardiovascular mortality previously observed with azithromycin use is attributable to the infection being treated, not the antibiotic, a New England Journal of Medicine study finds.

Using Danish registries, researchers compared 1.1 million episodes of azithromycin use with either 1.1 million episodes of no antibiotic use or 7.4 million episodes of penicillin V use among adults.

The risk for cardiovascular death was roughly three times higher with current azithromycin use than with no antibiotic use. However, cardiovascular death rates did not differ between azithromycin and penicillin. This indicates, the authors write, that “the increased risk … observed in the comparison with no antibiotic use was entirely attributable to the risk of death associated with acute infection” or some other risk factor in patients receiving antibiotics.

The authors add that while previous research showed a link between azithromycin and cardiovascular mortality in a higher-risk (Medicaid) population, the current study “shows that this effect is not present in the general population.”

NEJM commentators still highlight the potential risk for QT prolongation with use of macrolides and emphasize caution in their use for patients with preexisting cardiovascular conditions.

Source: NEJM