RESEARCH SUGGESTS LINK BETWEEN CHOCOLATE CONSUMPTION, REDUCED STROKE RISK

Reuters (10/11, Joelving) reports that, according to research published in the Journal of the American College of Cardiology, chocolate consumption may be linked to a reduced risk of stroke.

HealthDay (10/11, Gordon) reports, "The study included more than 33,000 Swedish women between the ages of 49 and 83. None of the women had any history of stroke, heart disease, cancer or diabetes when the study began in 1997."

MedPage Today (10/11, Phend) reports, "Overall stroke risk dropped 14% with each 50 g (1.8 oz) of chocolate a woman ate each week after accounting for other factors." The investigators found that "cerebral infarction risk similarly fell 12% for those eating the equivalent of about 1.2 chocolate bars or 100 chocolate chips (adjusted relative risk 0.88, 95% confidence interval 0.77 to 0.96)." Meanwhile, "hemorrhagic stroke risk dropped 27% per 50 g of weekly consumption (adjusted RR 0.73, 95% CI 0.54 to 0.99)." WebMD (10/11, Doheny) also covered the

POSTED BY STEVEN ALMANY, MD

HOLIDAY SCHEDULE 2011

Please make sure to get all your prescriptions filled at least one week prior to the holiday to ensure you have them in time.

Christmas:
CLOSED- Monday December 26

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SERUM TESTOSTERONE LEVELS MAY BE LINKED TO RISK OF CV EVENTS IN ELDERLY MEN

HeartWire (10/4, Nainggolan) reports that "elderly men in the highest quartile of serum testosterone levels have around a 30% lower risk of cardiovascular events over five years compared with men in the lower three quartiles," according to a study published in the Journal of the American College of Cardiology. Investigators found that "the association remains even after adjustment for traditional cardiovascular risk factors and excluding those with CVD at baseline."

POSTED BY STEVEN ALMANY, MD

HOLIDAY SCHEDULE 2011

Please make sure to get all your prescriptions filled at least one week prior to the holiday to ensure you have them in time.

Thanksgiving:
CLOSED- Thursday November 24
CLOSED- Friday November 25

Christmas:
CLOSED- Monday December 26

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DIETARY CHANGES MAY LOWER CHOLESTEROL BETTER THAN STATINS

On its website, ABC News /Good Morning America (10/24, Main) reports that dietary changes may "do a better job" than taking statins to lower cholesterol. In a study published in the Journal of the American Medical Association, researchers "followed 345 people with high cholesterol who were placed on one of two vegetarian, low-cholesterol diets for six months." Those in the "low-saturated-fat diet...were told simply to eat low-fat dairy and get more fruits and vegetables into their meals." The second group incorporated "specific cholesterol-lowering foods into their meals," such as "soy proteins, nuts, oats, peas, and beans. That group saw a drop in cholesterol three times higher than the group on the regular low-saturated-fat diet, and both diets proved to be at least as successful as early trials of statins."

POSTED BY STEVEN ALMANY, MD

WOMEN WITH HPV MAY HAVE INCREASED HEART ATTACK, STROKE RISK

The New York Times (10/25, D5, Grady, Subscription Publication) reports, "Women infected with the human papillomavirus, or HPV, are two to three times as likely as uninfected women to have had a heart attack or stroke, according to a report" published in the Journal of the American College of Cardiology. After "researchers analyzed the data and adjusted for heart risks like smoking, blood pressure and weight, they found that women with HPV were 2.3 times as likely as those without the virus to have heart disease." However, investigators "said that if the link is real, heart disease, like cancer, would be likely to develop only in people with lingering HPV infection."

The Wall Street Journal (10/25, Hobson) "Health Blog" notes that HPV also suppresses the action of retinoblastoma protein, another tumor suppressor that has been linked to atherosclerosis.

An accompanying editorial observed, "This finding re-emphasizes the potential roles that a variety of chronic infectious agents may play in the pathogenesis of atherosclerosis," Forbes (10/25, Husten) reports.

MedPage Today (10/25, Neale) reports, "Although HPV status was not related to various metabolic risks, it was strongly associated with cardiovascular disease after adjustment for demographics, health and sex behaviors, medical comorbidities, and cardiovascular risk factors and management." However, "the cross-sectional design of the study precludes any conclusions about a cause-and-effect relationship between HPV infection and cardiovascular disease."

POSTED BY STEVEN ALMANY, MD

HOLIDAY SCHEDULE 2011

Please make sure to get all your prescriptions filled at least one week prior to the holiday to ensure you have them in time.

Thanksgiving:
CLOSED- Thursday November 24
CLOSED- Friday November 25

Christmas:
CLOSED- Monday December 26

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VITAMIN E AND THE RISK OF PROSTATE CANCER: THE SELENIUM AND VITAMIN E CANCER PREVENTION TRIAL (SELECT)

Date Posted: October 31, 2011

Authors:
Klein EA, Thompson IM Jr, Tangen CM, et al.

Citation:
JAMA 2011;306:1549-1556.

Study Question:
What is the long-term effect of vitamin E and selenium on risk of prostate cancer in relatively healthy men?

Methods:
A total of 35,533 men from 427 study sites in the United States, Canada, and Puerto Rico were randomized between August 22, 2001, and June 24, 2004, in the SELECT study (Selenium and Vitamin E Cancer Prevention Trial). Eligibility criteria included a prostate-specific antigen (PSA) of 4.0 ng/ml or less, a digital rectal examination not suspicious for prostate cancer, and age 50 years or older for black men and 55 years or older for all others. The primary analysis included 34,887 men who were randomly assigned to one of four treatment groups: 8,752 to receive selenium; 8,737 vitamin E; 8,702 both agents; and 8,696 placebo. With a median follow-up of 5.5 years, there was no benefit from either antioxidant or combination, but there was a signal for increased prostate cancer. This analysis reflects the final data collected by the study sites on their participants, with extension through July 5, 2011.

Results:
This report includes 54,464 additional person-years of follow-up (median 7 years) and 521 additional cases of prostate cancer since the primary report. Compared with the placebo (referent group) in which 529 men developed prostate cancer, 620 men in the vitamin E group developed prostate cancer (hazard ratio [HR], 1.17; 99% confidence interval [CI], 1.004-1.36; p = 0.008); as did 575 in the selenium group (HR, 1.09; 99% CI, 0.93-1.27; p = 0.18), and 555 in the selenium plus vitamin E group (HR, 1.05; 99% CI, 0.89-1.22; p = 0.46). Compared with placebo, the absolute increase in risk of prostate cancer per 1,000 person-years was 1.6 for vitamin E, 0.8 for selenium, and 0.4 for the combination.

Conclusions:
The authors concluded that dietary supplementation with vitamin E significantly increased the risk of prostate cancer among healthy men.
Perspective:
The antioxidant supplement story continues to evolve with no evidence of benefit for cancer or cardiovascular disease risk reduction from beta carotene, folate, vitamin E, selenium, or vitamin C, and increased risk of lung cancer with high-dose beta carotene and risk of polyps with high-dose folate. Yet so many patients take large doses, some of which is prescribed by well-intended physicians including specialists in aging/dementia, ophthalmology, and urology. The authors concluded with the following message for providers and the public: ‘The lack of benefit from dietary supplementation with vitamin E or other agents with respect to preventing common health conditions and cancers or improving overall survival, and their potential harm, underscore the need for consumers to be skeptical of health claims for unregulated over-the-counter products in the absence of strong evidence of benefit demonstrated in clinical trials.’ Clearly, long-term implications of taking nutraceuticals and dietary supplements are not known and very hard to assess.

Author(s):
Melvyn Rubenfire, M.D., F.A.C.C. (Disclosure)

POSTED BY DAVID CRAGG, MD

MICHIGAN HEART GROUP'S PHYSICIAN LIAISON IS HERE TO HELP YOU

Michigan Heart Group has a Physician Liaison on staff to assist with questions, concerns or problems you, your staff or your patients may have with our office.

Stacie Batur is available Monday through Thursday at (248) 267-5050 (x6509). She is often between two buildings or visiting referring physician offices. If you get her voice mail, please leave a message and she will call you back shortly. If you need to speak to her immediately you can reach her on her cell phone at (248) 765-4466.

HOLIDAY SCHEDULE 2011

Please make sure to get all your prescriptions filled at least one week prior to the holiday to ensure you have them in time.

Thanksgiving:
CLOSED- Thursday November 24
CLOSED- Friday November 25

Christmas:
CLOSED- Monday December 26

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CLOSED- Monday January 2

OMEGA-3 FATTY ACIDS AND CARDIOVASCULAR DISEASE: EFFECTS ON RISK FACTORS, MOLECULAR PATHWAYS, AND CLINICAL EVENTS

Date Posted:
October 31, 2011

Authors:
Mozaffarian D, Wu JH.

Citation:
J Am Coll Cardiol 2011;58:2047-2067.

Perspective:
The following are 10 points to remember about this state-of-the-art paper:

1. Fish are a major food source of long-chain n-3 polyunsaturated fatty acids (PUFAs) including eicosapentaenoic acid (EPA) (20:5n-3) and docosahexaenoic acid (DHA) (22:6n-3). Alpha-linolenic acid (ALA) (18:3n-3) is an n-3 fatty acid found in plants, including some seeds, nuts, and nut oils. ALA cannot be synthesized in humans. Thus, tissue and circulating levels of EPA and DHA are predominantly determined by their direct dietary consumption.

2. Environmental concerns regarding fish consumption include potential contaminants such as mercury. However, the mercury content of most fish is low, with a few selected species containing higher levels. Availability of sustainable, environmentally sound commercial fishing must also be addressed to preserve this food source into the future.

3. N-3 PUFA has multiple physiological effects that may translate into reduced cardiovascular disease risk. Plasma triglycerides are lowered with n-3 PUFAs by decreased hepatic production of very low-density lipoprotein and enhanced clearance. Lower resting heart rate and blood pressure have also been observed with n-3 PUFA intake, which may occur through improved left ventricular diastolic filling or augmented vagal tone. In short-term trials, n-3 PUFA consumption increases biomarkers of nitric oxide production, mitigates peripheral vasoconstrictive responses to norepinephrine and angiotensin II, improves arterial wall compliance, and enhances vasodilatory responses. Such effects, separately or in sum, could account for lowering of systemic vascular resistance and blood pressure.

4. High doses of n-3 PUFA are considered to have antithrombotic effects; however, n-3 PUFA has not been shown to consistently affect platelet aggregation or levels of coagulation factors. No excess in clinical bleeding outcomes have been observed in randomized trials. Improved flow-mediated arterial dilation has been observed with n-3 PUFAs, along with lower circulating markers of endothelial dysfunction.

5. Some observational studies have noted a higher incidence of type 2 diabetes with n-3 PUFA or fish consumption. However, among controlled trials, no association has been noted between n-3 PUFAs and biomarkers of glucose-insulin homeostasis.

6. It remains unclear if n-3 PUFAs have anti-inflammatory effects. In several trials, n-3 PUFA supplementation reduced plasma and urine levels of arachidonic acid (AA)-derived eicosanoids such as leukotriene E4. Findings for other circulating biomarkers of inflammation, such as interleukin-1-beta and tumor necrosis factor-alpha, are mixed.

7. N-3 PUFA affects a myriad molecular pathways, including alteration of physical and chemical properties of cellular membranes, direct interaction with and modulation of membrane channels and proteins, regulation of gene expression via nuclear receptors and transcription factors, changes in eicosanoid profiles, and conversion of n-3 PUFA to bioactive metabolites.

8. In prospective observational studies and adequately powered randomized clinical trials, the benefits of n-3 PUFA seem most consistent for coronary heart disease mortality and sudden cardiac death. Potential effects on other cardiovascular outcomes are less well established, including conflicting evidence from observational studies and/or randomized trials for effects on nonfatal myocardial infarction, ischemic stroke, atrial fibrillation, recurrent ventricular arrhythmias, and heart failure.

9. Research gaps include the relative importance of different physiological and molecular mechanisms, precise dose responses of physiological and clinical effects, whether fish oil provides all the benefits of fish consumption, and clinical effects of plant-derived n-3 PUFA.

10. Overall, current data provide strong concordant evidence that n-3 PUFAs are bioactive compounds that reduce risk of cardiac death. National and international guidelines have converged on consistent recommendations for the general population to consume at least 250 mg/day of long-chain n-3 PUFAs or at least two servings/week of oily fish.

Author(s):
Elizabeth A. Jackson, M.D., F.A.C.C. (Disclosure)
Topic(s):
Prevention/Vascular, General Cardiology

POSTED BY DAVID CRAGG, MD

LOW VITAMIN D LEVELS MAY BE LINKED TO RISK FACTORS FOR CARDIOVASCULAR DISEASE

USA Today (10/4, Marcus) reports, "Low vitamin D levels are common and are linked to a number of risk factors for cardiovascular disease," according to research published in the Journal of the American College of Cardiology. Investigators looked at data from "more than 75 previous studies, most of which were observational." The study's lead author said, "There's evidence low vitamin D levels affect blood pressure, insulin resistance, coronary artery disease.".

POSTED BY STEVEN ALMANY, MD