Tuesday, June 30, 2009
statins
Global Efforts to Lower 'Bad' Cholesterol Working
MONDAY, June 22 -- People in the United States and around the world who are trying to lower their "bad" cholesterol have been succeeding more often in the past decade, new research suggests.
The look at almost 10,000 patients from nine countries found that, overall, 73 percent had reached their target level of low-density lipoprotein (LDL) -- nearly double the number since the survey was first conducted in 1996-1997. Three-quarters of those surveyed were on a statin drug to lower cholesterol (for an average duration of about two years), while others either used different medications or made only lifestyle changes, such as improved exercise and nutrition regimens, to try to bring down their LDL levels, the researchers found.
In the United States, patients of all levels of risk for coronary heart disease showed improvement from their initial 38 percent success rate in 1996-1997. Of those considered at low risk, 86 percent met their target LDL level; 74 percent of moderate-risk patients reached their goal; and 67 percent in the high-risk category hit their mark, according to the findings, published in the current issue of Circulation.
LDL is known as "bad" cholesterol because it is associated with increased cardiovascular risk. A person's risk category was based on factors such as having existing coronary artery disease, being obese, diabetic, a smoker and having other known links to heart disease. LDL targets were based on these risk categories, ranging from less than 160 milligrams per deciliter for those at low risk to less than 70 milligrams per deciliter for those considered very high risk, according to a news release from the American Heart Association.
The only real disappointment internationally was in the category of those considered at very high risk, where only 30 percent met their target, the study authors noted.
"Although there is room for improvement, particularly in very high-risk patients, these results indicate that lipid-lowering therapy is being applied much more successfully than it was a decade ago," study author Dr. David D. Waters, a professor emeritus of medicine at the University of California, San Francisco, said in the news release.
The rates of achieving the LDL goals ranged from 47 percent in Spain to 84 percent in South Korea, a variation the researchers were at a loss to explain. The other countries in the study, besides the United States, were Brazil, Canada, France, Mexico, the Netherlands and Taiwan.
The study was funded by Pfizer, Inc., maker of the statin drug, Lipitor.
Saturday, June 27, 2009
colonoscopy colon kanker
Summary and Comment
CT Colonography for Colorectal Cancer Screening
Concerns remain about the procedure replacing colonoscopy as a colorectal cancer screening tool.
Computed tomography (CT) colonography is a less-invasive and better-tolerated alternative to colonoscopy as a colorectal cancer (CRC) screening tool in average-risk individuals. However, we know less about its accuracy in detecting advanced colorectal neoplasia in individuals at excess risk for CRC.
Now, researchers have assessed the accuracy of CT colonography in this setting, using unblinded colonoscopy as the reference standard. The European multicenter cross-sectional study involved 937 participants who underwent same-day CT colonography and colonoscopy. All participants had excess risk for CRC, defined by the study as having first-degree relatives with diagnoses of advanced colorectal neoplasia (the family-history group; age range, 40–65), having undergone endoscopic removal of colorectal adenomas (the postpolypectomy group; age range, 18–70), or having positive results on fecal occult blood tests (FOBT; the FOBT-positive group; age range, 59–69). The primary and secondary endpoints were sensitivity, specificity, and positive predictive value (PPV) and negative predictive value (NPV) of CT colonography for advanced neoplasia 
6 mm and 10 mm, respectively.
A per-patient analysis showed that CT colonography’s sensitivity and specificity for all patients with advanced neoplasia 6 mm were 85.3% and 87.8%, respectively, and its PPV and NPV were 61.9% and 96.3%. For all patients with advanced neoplasia 10 mm, CT colonography’s sensitivity and specificity were 90.8% and 84.5%, respectively, and its PPV and NPV were 48.8% and 98.3%. Of the three patient subgroups, CT colonography’s specificity and NPV were lowest in the FOBT-positive group (76.4% and 84.9%, respectively). Prevalence of neoplasia 6 mm was 7.5% in the family-history group, 11.1% in the postpolypectomy group, and 50.2% in the FOBT-positive group.
Comment: I find these results disappointing for several reasons. First, they are barely as good as those of the American College of Radiology Imaging Network trial, despite a population prone to neoplasia. Second, a high-prevalence population is bound to elicit higher sensitivity. Third, the idea of performing CT colonography in a population such as the FOBT-positive group is untenable from a cost-effectiveness or efficacy standpoint. Also, both the authors and an editorialist suggest that the lesser performance of CT colonography is a reasonable trade for a test that would improve patient acceptance of CRC screening. This suggestion would be reasonable, except that no evidence exists to show that CT colonography would improve acceptance. This study, despite receiving some attention in the lay press, does not advance our understanding of the best role for CT colonography, which I believe is screening patients with a low preprocedure probability of advanced neoplasia.
Published in Journal Watch Gastroenterology June 26, 2009
Friday, June 26, 2009
Omega-3 statins
From Southern Medical Journal
Addressing Lipid Treatment Targets Beyond Cholesterol: A Role for Prescription Omega-3 Fatty Acid Therapy
Published: 06/15/2009
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Abstract and Introduction
Abstract
Decreasing very high triglyceride (TG) levels (≥500 mg/dL) is recommended to prevent pancreatitis. Decreasing low-density lipoprotein cholesterol (LDL-C) is the primary lipid treatment target to reduce the risk of atherosclerotic coronary heart disease. A secondary lipid treatment target for patients at LDL-C goal, but with persistent TG elevations, includes achievement of non-high density lipoprotein cholesterol goals (non-HDL-C). Statins are the mainstay of therapy to lower LDL-C, but statin monotherapy may not achieve all lipid treatment goals. Thus, in patients with multiple lipid abnormalities, combination lipid-altering therapy is often necessary. Drugs such as niacin and fibrates provide lipid benefits beyond LDL-C when used in combination with a statin. Prescription omega-3-fatty acids combined with statin therapy also provide improvements in lipid parameters beyond cholesterol alone.
Introduction
In 2004, more than 15 million Americans were diagnosed with atherosclerotic coronary heart disease (CHD).[1] Death occurs in an estimated 38% of people experiencing a CHD-related event.[1] Thus, CHD poses an enormous healthcare and economic burden. In the United States alone, the 2007 estimated direct and indirect costs of CHD were more than $150 billion.[1] Modifiable risk factors for CHD include cigarette smoking, dyslipidemia, hypertension, diabetes mellitus, abdominal obesity, limited physical activity, limited daily fruit and vegetable consumption, excessive alcohol intake, and psychosocial factors.[2]
Tuesday, June 23, 2009
dementia B12 Folium zuur
Journal of Neurology, Neurosurgery, and Psychiatry 2008;79:864-868
RESEARCH PAPERS
Changes in folate, vitamin B12 and homocysteine associated with incident dementia
1 Department of Psychiatry and Centre for Aging and Geriatrics, Chonnam National University Medical School, Kwangju, Republic of Korea
2 Section of Epidemiology, Institute of Psychiatry, London, UK
3 Clinical Trial Centre, Chonnam National University Hospital, Kwangju, Republic of Korea
Correspondence to:
Professor Jin-Sang Yoon, Department of Psychiatry, Chonnam National University Medical School, 5 Hak-dong, Dong-ku, Kwangju, 501-757, Republic of Korea; jsyoon@chonnam.ac.kr
Objectives: Prospective findings have not been consistent for folate, vitamin B12 and homocysteine concentrations as predictors of dementia. This study aimed to investigate both baseline concentrations of folate, vitamin B12 and homocysteine and changes in these concentrations as predictors/correlates of incident dementia.
Methods: Of 625 elderly patients without dementia at baseline, 518 (83%) were followed over a 2.4 year period and were clinically assessed for incident dementia and Alzheimer’s disease (AD). Serum concentrations of folate, vitamin B12 and homocysteine were measured at the baseline and follow-up assessments. Covariates included age, sex, education, disability, depression, alcohol consumption, physical activity, vascular risk factors, serum creatinine concentration, vitamin intake and weight change.
Results: Only baseline lower folate concentrations predicted incident dementia. The onset of dementia was significantly associated with an exaggerated decline in folate, a weaker increase in vitamin B12 concentrations and an exaggerated increase in homocysteine concentrations over the follow-up period. These associations were reduced following adjustment for weight change over the same period.
Conclusions: Incident dementia is more strongly associated with changes in folate, vitamin B12 and homocysteine than with previous concentrations. These changes may be linked to other somatic manifestations of early dementia, such as weight loss.
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- (2009). Could B12 and Folate Deficiencies Cause Brain Atrophy and Dementia?. JWatch Neurology 2009: 1-1
[Full Text] - Smith, A D., Refsum, H. (2009). Vitamin B-12 and cognition in the elderly. Am. J. Clin. Nutr. 89: 707S-711S
[Abstract] [Full Text]
B12 folium zuur en dementia
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© 2008 American Academy of Neurology
Vitamin B12 status and rate of brain volume loss in community-dwelling elderly
From OPTIMA (A.V., H.R., C.J., K.M.B., C.d.J., M.M.B., A.D.S.), Department of Physiology, Anatomy and Genetics, University of Oxford, UK; Institute of Basic Medical Sciences (A.V., H.R.), Department of Nutrition, University of Oslo, Norway; Oxford University Centre for Functional MRI of the Brain (S.M.S.), UK; and Department of Geriatric Medicine (M.M.B.), The Canberra Hospital and Australian National University Medical School, Australia.
Address correspondence and reprint requests to Anna Vogiatzoglou, Department of Physiology, Anatomy and Genetics, University of Oxford, Le Gros Clark Building, South Parks Rd., Oxford OX1 3QX, UK anna.vogiatzoglou@dpag.ox.ac.uk
Objectives: To investigate the relationship between markers of vitamin B12 status and brain volume loss per year over a 5-year period in an elderly population.
Methods: A prospective study of 107 community-dwelling volunteers aged 61 to 87 years without cognitive impairment at enrollment. Volunteers were assessed yearly by clinical examination, MRI scans, and cognitive tests. Blood was collected at baseline for measurement of plasma vitamin B12, transcobalamin (TC), holotranscobalamin (holoTC), methylmalonic acid (MMA), total homocysteine (tHcy), and serum folate.
Results: The decrease in brain volume was greater among those with lower vitamin B12 and holoTC levels and higher plasma tHcy and MMA levels at baseline. Linear regression analysis showed that associations with vitamin B12 and holoTC remained significant after adjustment for age, sex, creatinine, education, initial brain volume, cognitive test scores, systolic blood pressure, ApoE 
4 status, tHcy, and folate. Using the upper (for the vitamins) or lower tertile (for the metabolites) as reference in logistic regression analysis and adjusting for the above covariates, vitamin B12 in the bottom tertile (<308> with increased rate of brain volume loss (odds ratio 6.17, 95% CI 1.25–30.47). The association was similar for low levels of holoTC (<54> and for low TC saturation. High levels of MMA or tHcy or low levels of folate were not associated with brain volume loss.
Conclusion: Low vitamin B12 status should be further investigated as a modifiable cause of brain atrophy and of likely subsequent cognitive impairment in the elderly.
Abbreviations: AD = Alzheimer disease; CAMCOG = Cambridge Mental Disorders of the Elderly Examination; CV = coefficient of variation; holoTC = holotranscobalamin; MMA = methylmalonic acid; NS = not significant; OPTIMA = Oxford Project to Investigate Memory and Aging; OR = odds ratio; PBVL = percentage of brain volume loss; SIENA = structural image evaluation using normalization of atrophy; TC = transcobalamin; tHcy = total homocysteine.
Supplemental data at www.neurology.org
Supported by Alzheimer’s Research Trust (UK), the Medical Research Council, the Charles Wolfson Charitable Trust, the Norwegian Foundation for Health and Rehabilitation through the Norwegian Health Association, Axis-Shield plc, and the Johan Throne Holst Foundation for Nutrition Research.
Disclosure: The authors report no disclosures.
Received December 12, 2007. Accepted in final form June 4, 2008.
This article has been cited by other articles:
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Could B12 and Folate Deficiencies Cause Brain Atrophy and Dementia? Journal Watch Neurology, April 14, 2009; 2009(414): 1 - 1. [Full Text] | |
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A. Vogiatzoglou, A D. Smith, E. Nurk, P. Berstad, C. A Drevon, P. M Ueland, S. E Vollset, G. S Tell, and H. Refsum Dietary sources of vitamin B-12 and their association with plasma vitamin B-12 concentrations in the general population: the Hordaland Homocysteine Study Am. J. Clinical Nutrition, April 1, 2009; 89(4): 1078 - 1087. [Abstract] [Full Text] [PDF] | |
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L. Feng, J. Li, K.-B. Yap, E.-H. Kua, and T.-P. Ng Vitamin B-12, apolipoprotein E genotype, and cognitive performance in community-living older adults: evidence of a gene-micronutrient interaction Am. J. Clinical Nutrition, April 1, 2009; 89(4): 1263 - 1268. [Abstract] [Full Text] [PDF] | |
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A D. Smith and H. Refsum Vitamin B-12 and cognition in the elderly Am. J. Clinical Nutrition, February 1, 2009; 89(2): 707S - 711S. [Abstract] [Full Text] [PDF] | |
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