AHA Guidelines for CVD Prevention in Women Focus on Lifetime Risk Factors

The American Heart Association's (AHA) updated prevention guidelines for women outline a bold prescription for prevention of CVD that urges women to start early, with adoption of a healthy lifestyle, and sets new target goals for risk-assessment.
The guidelines, appearing online in the February 19 Rapid Access issue of Circulation, were presented by lead author, Lori Mosca, MD, of the New York-Presbyterian Hospital in New York at an AHA media briefing.
The focus is on prevention, with the goal to widen the window of opportunity for women to fight their number 1 killer. "We want to prevent the risk factors," she stressed.
There are now 3 categories ("high risk," "at risk," and "optimal risk") instead of the 4 ("high," "intermediate," "lower," and "optimal") in the Framingham global risk model.

http://www.medscape.com/viewarticle/552777?sssdmh=dm1.251045&src=nldne

Some Antioxidant Supplements May Increase Mortality, Meta-Analysis Finds

Beta carotene, vitamin A, and vitamin E supplements were associated with increased mortality in a large meta-analysis and systematic review reported in today's JAMA.
Researchers examined randomized, controlled trials of antioxidants used for primary or secondary disease prevention. When the researchers focused in on the trials that used high-quality methodology -- 47 studies comprising about 180,000 patients -- they found recipients of supplements had increased mortality compared with controls (relative risk, 1.05). Used singly or in combination with other supplements, beta carotene, vitamin A, and vitamin E increased mortality in high-quality trials. Vitamin C did not have a significant effect on mortality.
The authors conclude: "Our results extend previous reviews and guidelines, suggesting that antioxidant supplements may not be beneficial."

http://www.medpagetoday.com/PrimaryCare/DietNutrition/dh/5152

Caffeine May Prevent Heart Disease Death In Elderly

Habitual intake of caffeinated beverages provides protection against heart disease mortality in the elderly, say researchers at SUNY Downstate Medical Center and Brooklyn College. Using data from the first federal National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, the researchers found that survey participants 65 or more years old with higher caffeinated beverage intake exhibited lower relative risk of coronary vascular disease and heart mortality than did participants with lower caffeinated beverage intake. John Kassotis, MD, associate professor of medicine at SUNY Downstate, said, "The protection against death from heart disease in the elderly afforded by caffeine is likely due to caffeine's enhancement of blood pressure." The protective effect also was found to be dose-responsive: the higher the caffeine intake the stronger the protection. The protective effect was found only in participants who were not severely hypertensive. No significant protective effect was in patients below the age of 65.

http://www.medicalnewstoday.com/medicalnews.php?newsid=63719&nfid=crss

Older antipsychotic drugs may be at least as risky as newer ones for seniors

Older antipsychotic drugs may be at least as risky for elderly dementia patients as newer medications, a study says.
The authors of the study suggest until further evidence is available, doctors should proceed with caution when prescribing either type of antipsychotic drug to elderly patients.
The work, by researchers from Harvard Medical School and the University of British Columbia, backs up a previous study the same group published last year in the New England Journal of Medicine. The new study was published in this week's Canadian Medical Association Journal.
In mid-2005, health regulators in Canada and the United States warned that second generation antipsychotic drugs - called atypical antipsychotics - seemed to raise the risk of death when taken by seniors suffering from dementia. Studies had shown that elderly patients newly prescribed these drugs had a 1.6 greater death rate than patients taking a placebo.
Drugs included in these studies were risperidone (Risperdal), quetiapine (Seroquel) and olanzapine (Zyprexa). A fourth in this class, clozapine (Clozaril), was not studied. But because it is in the same family, Health Canada included it in its warning about the potential risks of atypical antipsychotics.

http://www.topix.net/content/cp/3233266442421641731403027975071041850630

Simple, Inexpensive Solution To Common Cause Of Injury For Seniors

New research suggests that reducing the number of falls suffered by seniors in nursing homes may be helped by taking a vitamin, along with other measures known to decrease falls. According to a study in Journal of the American Geriatrics Society, seniors taking a high daily dose of vitamin D experienced 72 percent fewer falls compared to those taking a placebo. Approximately 50 percent of nursing home residents fall every year, and those who are injured become even more prone to future falls. According to study authors Kerry Broe and Douglas Kiel, "lowering the risk of falls with a simple vitamin D supplement could improve the quality of life for nursing home residents by reducing the incidence of falls." "Past studies have shown that vitamin D could help prevent falls in seniors, and may be due to a possible strengthening effect the vitamin has on the musculoskeletal system. Until now, we didn't know what dosage amount would be effective," say Broe and Kiel. The dose that was most effective, 800 International Units per day, is higher than the dose typically prescribed to seniors. Taking this dose of vitamin D should be done only through the approval of a patient's doctor and certain conditions, such as high blood calcium levels, need to be considered by a physician.

http://www.medicalnewstoday.com/medicalnews.php?newsid=63637&nfid=crss

Uric Acid Levels Tied To Impaired Thinking In The Elderly

Even mildly elevated levels of uric acid in the elderly are associated with slower thinking and memory problems, according to a report by researchers at Yale and Johns Hopkins Schools of Medicine in Neuropsychology. The researchers found that elderly individuals with uric acid levels at the high end of the normal range had the lowest scores on tests measuring mental processing speed, verbal memory and working memory. The study included among 96 persons between the ages of 60 and 92. "These findings suggest that high normal concentrations of serum uric acid should be added to the growing list of cardiovascular and metabolic biomarkers of mild cognitive impairment among elderly adults," said Godfrey Pearlson, M.D., psychiatry professor at Yale and co-author of the study.

http://www.medicalnewstoday.com/medicalnews.php?newsid=63633&nfid=crss

High Cholesterol Linked With Stroke Even in Healthy Women

A new report from the Women's Health Study confirms that high levels of total cholesterol, low-density lipoprotein–cholesterol (LDL-C), and other lipid levels are significantly associated with an increased risk for ischemic stroke, even in women who are otherwise healthy.
"We did not look at people with high risk for cardiovascular disease or with existing cardiovascular disease, but among women who were apparently healthy," lead author Tobias Kurth, MD, ScD, of Brigham and Women's Hospital, Harvard Medical School in Boston, Massachusetts, told Medscape. "That means even when you're fine, you should really watch your cholesterol, and by approaching low cholesterol levels, you may prevent risk for ischemic stroke."
Their report appears in the February 20 issue of Neurology.

http://www.medscape.com/viewarticle/552551?sssdmh=dm1.249679&src=nldne

Clinical Cases in Medicine

More and more teachers and students realize that case-based lessons are very valuable in teaching "real-life" medicine. Launching an online case-based curriculum of clinical medicine, ClinicalCases.org do this work!

After a few weeks of clinical practice, most medical students and residents realize that there is a significant difference between what they read in the textbooks and what they see in the hospital wards and clinics every day. Somehow, the patients are different from their disease description in the books. As one experienced physician put it succinctly: "his CHF did not read the book." How to bridge this gap between theory and practice? Our answer was to create a case-based curriculum of clinical medicine. It is an attempt to reveal what the real medicine looks like and to prepare the mind of the life-long learners that all health workers should be.


http://clinicalcases.blogspot.com/

Pharmacokinetic and pharmacodynamic properties of tramadol IR and SR in elderly patients: a prospective, age-group-controlled study.

Tramadol is widely prescribed, even to the eldest patients. Although age-related differences in pharmacologic responsiveness are to be expected, the pharmacodynamic and pharmacokinetic (PK) properties of tramadol have not been systematically compared between patients of various ages

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=17296459

Retinopathy May Predict Cardiovascular Mortality in Type 2 Diabetes

Proliferative retinopathy in male and female patients with type 2 diabetes may predict coronary heart disease (CHD), but in women, background retinopathy predicted all-cause, cardiovascular disease, and CHD mortality, according to the results of a study reported in the February issue of Diabetes Care.

http://www.medscape.com/viewarticle/552321?rss

Pulse Pressure Important Risk Factor for the Development of New-Onset AF

New prospective data from the community-based, observational Framingham cohort study has shown that pulse pressure is a predictor of new-onset atrial fibrillation (AF), even after adjusting for other clinical variables, such as left atrial size and left ventricular mass, known to be associated with the arrhythmia.

http://www.medscape.com/viewarticle/552468?rss

Rosiglitazone (Avandia) Linked to Fractures in Women

The FDA informed physicians today of a report by GlaxoSmithKline of an increased number of arm, hand, and foot fractures among women taking rosiglitazone (Avandia) for newly diagnosed type 2 diabetes.
The FDA and drug company advised clinicians to carefully consider fracture risk before initiating rosiglitazone therapy.
http://www.medpagetoday.com/Endocrinology/Diabetes/dh/5098