Statins Linked to Reduced Prevalence of Atrial Fibrillation in Patients With ACS

Information from Industry Assess clinically focused product information on Medscape. Click Here for Product Infosites -- Information from Industry.

NEW YORK (Reuters Health) Sept 13 - Patients presenting with symptoms of acute coronary syndrome (ACS) are less likely to develop new-onset atrial fibrillation (AF) if they are being treated with a statin, study results suggest.

Dr. Maliha Zahid at the University of Pittsburgh and associates examined the medical records of patients with suspected ACS admitted to the Veterans Administration Hospital in Pittsburgh between 2001 and 2006. Their study cohort included 1,526 patients, of whom 138 had new onset of AF; 601 were on statins.

Patients on statins were significantly less likely to have new-onset AF (adjusted odds ratio 0.57, p <>

Their analyses also showed that renal failure and age over 65 years were significantly associated with increased risk of developing AF (OR 1.89 and 1.58, respectively). Factors that significantly reduced AF onset included chest pain (OR 0.35), non-Caucasian race (OR 0.61), diabetes (OR 0.67) and ACE inhibitor use (OR 0.63).

The investigators suggest that the reduced risk associated with diabetes "is potentially related to the fact that patients with diabetes receive more aggressive medical care and superior blood pressure control, specifically with ACE inhibitors and angiotensin II receptor blockers, which decrease the incidence of AF."

In regards to the decreased risk of AF related to chest pain, they believe that clinicians are more likely to suspect ACS in the presence of chest pain, and therefore start treatment earlier.

Am J Cardiol 2007;100:404-405.

• Printer-Friendly Medscape psyhiatry 18-9-2007
• Email This
• Discuss This

Abstract and Introduction

Abstract

Behaviors related to HIV infection vary by race, with African American and Latino men who have sex with men (MSM) more likely to report sex with women than are European-American MSM. The epidemic among African Americans, in particular, is growing rapidly among both men and women. Some have hypothesized that bisexually active men may be contributing to the epidemic among women. However, little is known about risk patterns among men of different races who are already infected. In this study of 456 HIV-seropositive MSM we found that, like HIV-negative MSM, African American MSM who are HIV-positive were less likely than European American men to identify as gay, more likely to report sex with women, and less comfortable discussing their MSM behavior with close friends and acquaintances. African American participants also exhibited higher levels of internalized homophobia, as well as lower self-efficacy for disclosing their HIV status to sex partners. Implications for interventions for this population are discussed.

Introduction

Dr. Giovannucci has disclosed no relevant financial relationships.

Arch Intern Med. 2007;167:1709-1710, 1730-1737.

Clinical Context

According to the authors of the current study, vitamin D deficiency can affect a wide variety of conditions including bone health, cancer, cardiovascular disease, some infectious diseases, and diabetes, and evidence from animal, clinical, and epidemiologic studies supports a protective effect of vitamin D on these functions, while failing to demonstrate beneficial effects of other micronutrients such as vitamin E and carotene. For example, according to the authors, a meta-analysis of trials using β-carotene, vitamins A and E, ascorbic acid, and selenium found an increased risk for all-cause mortality with an RR of 1.06. The authors hypothesized that by increasing vitamin D intake, we may be correcting a deficiency caused by a lack of natural sources of vitamin D especially from sunlight, and this may explain its greater beneficial effects. Deficiencies in vitamin D are known to be associated with increased risk for falls and fractures among other risks.

This is a quantitative meta-analysis of 18 randomized clinical trials examining the all-cause mortality associated with vitamin D supplementation with either ergocalciferol (vitamin D₂) or cholecalciferol (vitamin D₃) on any health condition.

Genetic Test for Warfarin Sensitivity Cleared for Marketing

The FDA has cleared for marketing a genetic test to gauge a patient's sensitivity to the anticoagulant warfarin (Coumadin).

The Verigene warfarin metabolism test, manufactured by Nanosphere, detects variants of two genes, CYP2C9 and VKORC1, which can contribute to changes in warfarin metabolism. The agency says that about one-third of patients on warfarin "metabolize it quite differently than expected and experience a higher risk of bleeding."

According to the FDA, "The Nanosphere test is not intended to be a stand-alone tool to determine optimum drug dosage, but should be used along with clinical evaluation and other tools, including INR, to determine the best treatment for patients."

Published online before print September 10, 2007
(Circulation 2007, doi:10.1161/CIRCULATIONAHA.107.690768)

Background—Weight gain is used by disease-management programs as a marker of heart failure decompensation, but little information is available to quantify the relationship between weight change in patients with heart failure and the risk for imminent hospitalization. Methods and Results—We conducted a nested case-control study among patients with heart failure referred to a home monitoring system by managed care organizations. We matched 134 case patients with heart failure hospitalization to 134 control patients without heart failure hospitalization on the basis of age, sex, duration of home monitoring, heart failure severity, and baseline body weight. Compared with control patients, case patients experienced gradual weight gain beginning 30 days before hospitalization; changes in daily weight between case and control patients were statistically significant (P<0.001).> hospitalization, when weight patterns in case and control patients began to diverge more substantially, mean increases of more than 2 and up to 5 pounds, more than 5 and up to 10 pounds, and more than 10 pounds (relative to time of enrollment in the monitoring system) were associated with matched adjusted odds ratios for heart failure hospitalization of 2.77 (95% confidence interval 1.13 to 6.80), 4.46 (95% confidence interval 1.45 to 13.75), and 7.65 (95% confidence interval 2.22 to 26.39), respectively, compared with mean increases of 2 pounds or less. Conclusions—Increases in body weight are associated with hospitalization for heart failure and begin at least 1 week before admission. Daily information about patients’ body weight identifies a high-risk period during which interventions to avert decompensated heart failure that necessitates hospitalization may be beneficial.

Submitted on January 16, 2007
Accepted on July 19, 2007

P

But mutations in the genes account for less than 10 percent of all cases of breast cancer. And only 1 in about 400 women has the mutation. (The risk of a mutation is about 10 times as high for women who are Ashkenazi Jews, but they can be tested for three specific mutations, for a cost of $460.)

BMJ 2007;335:355-356 (25 August), doi:10.1136/bmj.39266.497396.BE

Editorials

Diagnosing atrial fibrillation in general practice

The combination of a clinical history, clinical signs, and an ECG will pick up most cases

The first 150 words of the full text of this article appear below.

In this week's BMJ, Mant and colleagues and Fitzmaurice and colleagues present the results of the SAFE (screening for atrial fibrillation in the elderly) study. They assess how accurately general practitioners, practice nurses, and an interpretive computer program can diagnose atrial fibrillation on an electrocardiogram (ECG), and they report on the effectiveness of screening patients aged 65 and over for atrial fibrillation in British general practice.^{1 2} The prevalence of atrial fibrillation rises with age from 1.5% in people in their 60s to more than 10% in those over 90. People with atrial fibrillation have double the mortality and a four to fivefold higher risk of stroke than those without fibrillation. About a quarter of all strokes in elderly people are caused by atrial fibrillation. Strokes caused by atrial fibrillation are often severe and lead to high mortality and a low quality of life.³

Even if normal rhythm cannot be . . . [Full text of this article]

Department of General Practice, Division Clinical Methods and Public Health, Academic Medical Centre, Amsterdam, 1100 DD Netherland

Summary and Comment

Warfarin Is Better Than Aspirin for Stroke Prevention in Older Patients with AF

And warfarin does not increase risk for intracranial bleeding.

Citation(s):

Mant J et al. Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): A randomised controlled trial. Lancet 2007 Aug 11; 370:493-503.

Medline abstract (Free) Garcia D and Hylek E. Stroke prevention in elderly patients with atrial fibrillation. Lancet 2007 Aug 11; 370:460-1. Medline abstract (Free)

Issue: Changing Sexual Orientation HOME | CLOSE

Sub-Issue: Ex-Gays

Q:?

PRO (YES) The Archives of Sexual Behavior (Vol. 32, No. 5, pp. 403-417) published a 2003 study in which psychiatrist Robert L. Spitzer, M.D. wrote: "This study tested the hypothesis that some individuals whose sexual orientation is predominantly homosexual can, with some form of reparative therapy, become predominantly heterosexual... The majority of participants gave reports of change from a predominantly or exclusively homosexual orientation before therapy to a predominantly or exclusively heterosexual orientation in the past year. Reports of complete change were uncommon... Thus, there is evidence that change in sexual orientation following some form of reparative therapy does occur in some gay men and lesbians." 2003 Archives of Sexual Behavior The Catholic Medical Association stated in its 2005 online publication, "Homosexuality and Hope": "Reviews of treatment for unwanted same-sex attractions show that it is as successful as treatment for similar psychological problems: about 30% experience a freedom from symptoms and another 30% experience improvement.... Those who claim that change of sexual orientation is impossible usually define change as total and permanent freedom from all homosexual behavior, fantasy, or attraction in a person who had previously been homosexual in behavior and attraction... For a Catholic with same sex attraction, the goal of therapy should be freedom to live chastely according to one's state in life. Some of those who have struggled with same-sex attractions believe that they are called to a celibate life. They should not be made to feel that they have failed to achieve freedom because they do not experience desires for the other sex. Others wish to marry and have children. There is every reason to hope that many will be able, in time, to achieve this goal. They should not, however, be encouraged to rush into marriage since there is ample evidence that marriage is not a cure for same-sex attractions. With the power of grace, the sacraments, support from the community, and an experienced therapist, a determined individual should be able to achieve the inner freedom promised by Christ." 2005 Catholic Medical Association Psychological Reports, in a 2000 study by Joseph Nicolosi, Ph.D. et al. (Vol. 86, No. 3, Pt. 2, pp. 1071-1088) stated: "We present the results of a survey of 882 dissatisfied homosexual people whom we queried about their beliefs regarding conversion therapy and the possibility of change in sexual orientation. ... Of the 882 participants, 726 of them reported that they had received conversion therapy from a professional therapist or a pastoral counselor. ... Before treatment or change, only 2.2% of the participants perceived themselves as exclusively or almost entirely heterosexual, whereas after treatment or change, 34.3% perceived themselves as exclusively or almost entirely heterosexual. ... As a group, the participants reported large and statistically significant reductions in the frequency of their homosexual thoughts and fantasies that they attributed to conversion therapy or self-help. They also reported large improvements in their psychological, interpersonal, and spiritual well-being. 2000 Psychological Reports

CON (NO) U.S. Surgeon General David Satcher, M.D., Ph.D. wrote in his 2001 "The Surgeon General's Call To Action To Promote Sexual Health and Responsible Sexual Behavior": "Sexual orientation is usually determined by adolescence, if not earlier, and there is no valid scientific evidence that sexual orientation can be changed." 7/9/01 Office of the Surgeon General The American Psychological Association, on its website section; "Answers to Your Questions About Sexual Orientation and Homosexuality," accessed on 12/7/04, stated: "The reality is that homosexuality is not an illness. It does not require treatment and is not changeable." 12/7/04 American Psychological Association The American Journal of Psychiatry published a 2000 article by the APA (American Psychiatric Association) Commission on Psychotherapy by Psychiatrists (Vol. 157, No. 10, pp. 1719-1721), which stated: "...anecdotal reports of 'cures' are counterbalanced by anecdotal claims of psychological harm. In the last four decades, 'reparative' therapists have not produced any rigorous scientific research to substantiate their claims of cure. 'Reparative' therapy literature also tends to overstate the treatment's accomplishments while neglecting any potential risks to patients." 2000 American Journal of Psychiatry The Human Rights Campaign, in their 1999 publication "Mission Impossible: Why Reparative Therapy and Ex-Gay Ministries Fail," stated: "The psychological, medical and psychiatric establishments agree that sexual orientation cannot be changed, and that so-called 'reparative therapy' aimed at altering gay peoples' orientations does not work and may, in fact, be harmful... The purveyors of 'reparative therapy' are well outside mainstream research and thinking in the psycho-therapeutic world." 1999 Human Rights Campaign

HOME | CLOSE

Issue: Background HOME | CLOSE

Sub-Issue: Homosexuality in Animals

Q: Is it relevant to look at the animal kingdom to determine if human same-sex behavior is "natural"?

General Reference (not clearly pro or con) Tina Adler, freelance science writer, in a January 4, 1997 article in Science News titled "Animals' Fancies: Why Members of Some Species Prefer Their Own Sex," stated: "Research into the benefits and origins of homosexuality in animals is important to the furthering understanding of animal behavior. However, people can't help wondering what the findings say about, well, people. Growing numbers of human studies are now linking homosexuality to unique biological traits. While some researchers examine what benefits animals may derive from same-sex sexual activities, others are trying to pinpoint straightforward biological causes of the behavior." 1/4/97 Tina Adler

PRO (YES) Robin Dunbar, Professor of Evolutionary Psychology at the University of Liverpool, England, stated in the July 23, 2004 National Geographic article "Homosexual Activity Among Animals Stirs Debate" by James Owen: "The bottom line is that anything that happens in other primates, and particularly apes, is likely to have strong evolutionary continuity with what happens in humans." 7/23/04 Robin Dunbar Paul Vasey, Associate Professor at the University of Lethbridge, and Volker Sommer, Professor at University College London, explain in the introduction to their book Homosexual Behaviour in Animals: An Evolutionary Perspective published in September 2006: "Because we are committed to a broad comparative perspective on the topic of homosexual activity, this volume also includes a chapter on the human ‘animal’. It is our conviction that evolutionary treatises should not be ‘homocentric’ in that they either focus on humans, while excluding a comparison with other animals, or that they focus on animals, while excluding our species, Homo sapiens. Such boundaries, when maintained for reasons of orthodoxy and dogmatism, are meaningless and counterproductive to scientific understanding – a point which we will reiterate below. Of course, humans are unique and the behaviour of humans does, therefore, require unique explanations – but so does the behaviour of bottlenose dolphins and bisons." 09/2006 Paul Vasey Volker Sommer Bruce Bagemihl, Ph.D., stated in his book Biological Exuberance, Animal Homosexuality and Natural Diversity, (St. Martin's Press, 1999): "[H]omosexuality in any given context (or species) can be seen as the intersection at various points on a number of... axis, thereby allowing comparisons to be made across multiple factors... [T]he plurality of homosexualities in both animals and people suggests a blurring of the seemingly opposite categories of nature and culture, or biology and society...such diversity may in fact be part of our biological endowment, an inherent capacity for 'sexual plasticity' that is shared with many other species. On the other hand, it is equally meaningful to speak of the 'culture' of homosexuality in animals, since the extent and range of variation that is found (between individuals or populations or species) exceeds that provided by genetic programming and begins to enter the realm of individual habits, learned behaviors, and even community-wide 'traditions.'" 1999 Bruce Bagemihl

CON (NO) Erik Holland, author of The Nature of Homosexuality (Lincoln, NE, iUniverse Inc.), stated in his 2004 book: "The best evidence so far suggests that same-sex sexual behavior is uncommon in the animal kingdom. Depending on the species, same-sex sexual behavior could possibly be related to dominant-subordinate relationships, regulations of social tension, alliance formation, seeking a partner to help take care of one's offspring, undermining the conceptive-reproductive success of non-relatives, or could simply just be non-adaptive behavior that exists for the sole purpose of satisfying sexual desires in those experiencing same-sex attraction." 2004 Erik Holland Luiz Sergio Solimeo, a member of the American Society for the Defense of Tradition, Family and Property, wrote in the article "The Animal Homosexuality Myth," which appeared on the National Association for Research & Therapy of Homosexuality's website which was accessed on Febrauary 13, 2007: "If seemingly 'homosexual' acts among animals are in accordance with animal nature, then parental killing of offspring and intra-species devouring are also in accordance with animal nature. Bringing man into the equation complicates things further. Are we to conclude that filicide and cannibalism are according to human nature?... The animal kingdom is no place for man to seek a blueprint for human morality...The fact that man has a body and sensitive life in common with animals does not mean he is strictly an animal. Nor does it mean that he is a half-animal. Man's rationality pervades the wholeness of his nature so that his sensations, instincts and impulses are not purely animal but have that seal of rationality which characterizes them as human. Thus, man is characterized not by what he has in common with animals, but by what differentiates him from them. This differentiation is fundamental, not accidental. Man is a rational animal. Man's rationality is what makes human nature unique and fundamentally distinct from animal nature." 2/13/2007 Luiz Sergio Solimeo The National Association for Research and Therapy of Homosexuality (NARTH) stated in a 1995 letter to the New York Review of Books written by NARTH President Dr. Charles Socarides: "Firstly, the term homosexuality should be limited to the human species, for in animals the investigator can ascertain only motor behavior. As soon as he interprets the animal's motivation he is applying human psychodynamics -- a risky, if not foolhardy scientific approach. Secondly, assumptions as to the origin of human homosexuality cannot be based on the study of genes, hypothalamus, anterior commissure, or the lower brain structures, or species such as the drosophila fly, or even lower primates; because in man the enormous evolutionary development of the cerebral cortex has made motivation -- both conscious and unconscious -- of overwhelming central significance in sexual patterning and sexual-object choice. Below the level of chimpanzee, sexual arousal patterns are completely automatic and reflexive." 1995 NARTH

HOME | CLOSE

Issue: Background HOME | CLOSE

Sub-Issue: Homosexuality in Animals

Q: What are some examples of same-sex behavior in animals?

General Reference (not clearly pro or con) Bruce Bagemihl, Ph.D., in his 1999 book Biological Exuberance: Animal Homosexuality and Natural Diversity, wrote: "On every continent, animals of the same sex seek each other out and have probably been doing so for millions of years. They court each other, using intricate and beautiful mating dances that are the result of eons of evolution. Males caress and kiss each other, showing tenderness and affection toward one another rather than just hostility and aggression. Females form long-lasting pair-bonds — or maybe just meet briefly for sex, rolling in passionate embraces or mounting one another. Animals of the same sex build nests and homes together, and many homosexual pairs raise young without members of the opposite sex. Other animals regularly have partners of both sexes, and some even live in communal groups where sexual activity is common among all members, male and female. Many creatures are "transgendered," crossing or combining characteristics of both males and females in their appearance or behavior. Amid this incredible variety of different patterns, one thing is certain: the animal kingdom is most definitely not just heterosexual. Homosexual behavior occurs in more than 450 different kinds of animals worldwide, and is found in every major geographic region and every major animal group. It should come as no surprise, then, that animal homosexuality is not a single, uniform phenomenon. Whether one is discussing the forms it takes, its frequency, or its relationship to heterosexual activity, same-sex behavior in animals exhibits every conceivable variation." 1999 Bruce Bagemihl Paul Vasey, Ph.D., Associate Professor of Psychology and Neuroscience at the University of Lethbridge in Alberta, Canada, published the article "Sexual Partner Preference in Female Japanese Macaques" in Archives of Sexual Behavior (2002, Vol. 31, No. 1, pp. 51-62): "Multiple lines of evidence indicate that female homosexual behavior in Japanese macaques is a sexual behavior, not a sociosexual one. Additional evidence indicates that female Japanese macaques do not engage in homosexual behavior simply because acceptable male mates are unavailable or unmotivated to copulate. Patterns of sexual partner choice by female Japanese macaques that are the focus of intersexual competition indicate that females of this species choose same-sex sexual partners even when they are simultaneously presented with a motivated, opposite-sex alternative." 2002 Paul Vasey The Observer, a U.K. newspaper, published an article on 2/8/04 written by their science editor, Robin McKie, about "gay" penguins: "As gays go, Roy and Silo are not unusual. They cohabit, are affectionate in public and have been inseparable for years. Only their species marks them out. The New York pair are chinstrap penguins. Every day at Manhattan's Central Park Zoo the two males entwine necks, vocalise to each other and have, er, sex. When offered female companionship, they decline. Roy and Silo have even displayed urges to procreate, and once tried to hatch a rock. Finally their keeper, Rob Gramzay, gave them a fertile egg from another brood. Tango, their chick, was born later. The pair raised it lovingly. 'They did a great job,' admits Gramzay. According to a study of the penguins released this weekend in the New York Times, Milou and Squawk - another pair of Central Park's male chinstraps - have started hanging out together, billing and bowing. At the New York Aquarium on Coney Island, Wendell and Cass - male blackfoot penguins - are a devoted couple." 2/8/04 Observer Charles E. Roselli, Ph.D., et al., wrote in an article titled "The Volume of a Sexually Dimorphic Nucleus in the Ovine Medial Preoptic Area/Anterior Hypothalamus Varies with Sexual Partner Preference" in Endocrinology (2004, Vol. 145, No. 2, pp. 478-483): "Approximately 8% of rams exhibit sexual preferences for male partners (male-oriented rams) in contrast to most rams, which prefer female partners (female-oriented rams). We identified a cell group within the medial preoptic area/anterior hypothalmus of age-matched adult sheep that was significantly larger in adult rams than in ewes (females). This cell group was labeled the ovine sexually dimorphic nucleus (oSDN). In addition to a sex difference, we found that the volume of the oSDN was two times greater in female-oriented rams than in male-oriented rams... Because the medial preoptic area/anterior hypothalamus is known to control the expression of male sexual behaviors, these results suggest that naturally occurring variations in sexual partner preferences may be related to differences in brain anatomy and capacity for estrogen synthesis." 2004 Charles Roselli

HOME | CLOSE