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OCs increase risk of stroke and MI

  
  
  
  
  
As published in the New England Journal of Medicine, researchers from the University of Copenhagen have shown that oral contraceptives increase the risk of thrombotic stroke and myocardial infarction.  The study involved 1,626,158 women, 15-49 years of age, who were followed for 15 y (14,251,063 person-years).  The women had no history of cardiovascular disease or cancer.  There were 3311 and 1725 incident cases of thrombotic stroke and myocardial infarction, respectively.  The RRs of thrombotic stroke and myocardial infarction in oral contraceptives containing 20 ug and 30-40 ug of ethinyl estradiol were 0.9-1.7 and 1.3-2.3, respectively.

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Vorapaxor effective in the secondary prevention of anti-thrombotic events, but not completely safe

  
  
  
  
  
As published in the New England Journal of Medicine, vorapaxor, an anti-platelet agent that inhibits PAR-1, reduces the risk of cardiovascular death and ischemia in patients with stable atherosclerosis.  The study involved 26,449 patients with histories of myocardial infarction, ischemic stroke, and peripheral artery disease.  The patients received vorapaxor (2.5 mg qd) or placebo for a median of 30 months.  At 3 years of follow-up, there were 1028 (9.3%) and 1176 (10.5%) cardiovascular deaths, myocardial infarctions, and ischemic strokes in the vorapaxor and placebo groups (HR=0.87), respectively.  Moderate-to-severe bleeding and intracranial hemorrhage occurred in 4.2% and 2.5%, and 1.0% and 0.5% of the patients in the vorapaxor and placebo groups, respectively.

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What's new in diabetes?

  
  
  
  
  

Diabetes affects 25.8 million, or 8.3% of the population, in the US

  • Of those, 18.8 million are diagnosed; 7 million are undiagnosed
  • Among US residents ≥ 65 years, 10.9 million, or 26.9% , had diabetes in 2010
  • About 215,000 people <20 years had diabetes (type 1 or type 2) in the US in 2010
  • Each year, more than 13,000 young people are diagnosed with type 1 diabetes

New therapies

A 2010 report showed a record 235 medicines in development to treat diabetes, and this number continues to rise.

Since 2010, 7 new drugs have been FDA approved for the treatment of type 2 diabetes mellitus:

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Top Read Internal Medicine Articles in 2011

  
  
  
  
  

Top Read Internal Medicine Articles in 2011

1. High–Dose Vitamin D: Helpful or Harmful
Current Rheumatology Reports

2. Initial hypertension treatment: one combination fits most
Journal of the American Society of Hypertension

3. Vitamin D supplementation for prevention of mortality in adults
Cochrane Reviews

4. Vitamin D Therapy and Cardiovascular Health
Current Hypertension Reports

5. Vitamin D and the Prevention of Hypertension and Cardiovascular Diseases: A Review of the Current Evidence
American Journal of Hypertension

6. Effect of Atenolol vs Metoprolol Succinate on Vascular Function in Patients With Hypertension
Clinical Cardiology     Full Text   

7. Statin usage and all–cause and disease–specific mortality in a nationwide study
Pharmacoepidemiology and Drug Safety

8. Should β Blockers No Longer Be Considered First–line Therapy for the Treatment of Essential Hypertension Without Comorbidities?
Current Cardiology Reports

9. Vitamin D and cardiometabolic health: a review of the evidence
Nutrition Research Reviews

10. Statins and their influence on brain cholesterol
Journal of Clinical Lipidology

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Comparative Long Term Effects of Nebivolol and Carvedilol in Hypertensive Heart Failure Patients

  
  
  
  
  

Comparative Long Term Effects of Nebivolol and Carvedilol in Hypertensive Heart Failure Patients

Journal of Cardiac Failure, 08/31/2011  Clinical Article


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Marazzi G et al. – In the long term, nebivolol and carvedilol appear to be similarly effective in the treatment of hypertensive patients with chronic heart failure (CHF).

Methods
  • A total of 160 hypertensive CHF patients, with LVEF <40% and in New York Heart Association (NYHA) functional class I, II, or III, were randomly assigned to receive nebivolol or carvedilol for 24 months.
  • At baseline and at the end of treatment, all patients underwent clinical evaluation, echocardiography, and 6–minute walking test.
  • The target doses were 10 mg/d for nebivolol and 50 mg/d for carvedilol.
Results
  • Compared with baseline values, LVEF increased by a similar extent in the carvedilol (C) and nebivolol (N) groups (C from 36.1% (SD 1.5%) to 40.9% (SD 1.9%), P < .001; N from 34.1% (SD 1.8%) to 38.5% (SF 2.2%), P < .001).
  • Heart rate and NYHA functional class decreased significantly in ...read more
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Acute gout management during hospitalization: a need for a protocol

  
  
  
  
  

Acute gout management during hospitalization: a need for a protocol

Internal Medicine Journal, 08/15/2011  Clinical Article

Gnanenthiran SR et al. – Acute gout episodes in hospital are variably investigated and treated with frequent suboptimal management. The authors recommend establishment of a hospital–wide protocol to support decision–making regarding investigations, treatment and follow up.

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Methods
  • Case–file review of all episodes of acute gout occurring in a large tertiary hospital over a 20–month period.
Results
  • Of 134 acute gout episodes identified, the large majority (118) occurred in patients not admitted under the rheumatology unit.
  • Baseline anti–gout medications were frequently ceased on admission and in 9% of episodes, no pharmacotherapy was prescribed.
  • Delays in initiation of treatment occurred in up to 29% of patients.
  • Acute management included anti–inflammatory monotherapy, or combinations of colchicine, non–steroidal anti–inflammatory drugs (NSAIDs) and corticosteroids.
  • Of patients prescribed colchicine, 26% received >1.5 mg/day and a strong correlation was found between colchicine dose and the occurrence of diarrhoea.
  • NSAIDs were prescribed in 29% of patients with pre–existing renal impairment.
  • Overall, 25% of patients received inappropriate pharmacological management.
  • In patients not under the direct care of the rheumatology unit, in–hospital rheumatology consultation was sought by the treating unit in 34% of episodes.
  • Consultation was sought more frequently in patients with multiple joint involvement, but there were no other obvious differences in ...read more
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Update on the management of inflammatory bowel disease: specific role of adalimumab

  
  
  
  
  

Update on the management of inflammatory bowel disease: specific role of adalimumab Full Text

 

Clinical and Experimental Gastroenterology, 07/18/2011  Clinical Article

Guidi L et al. – Results of the first randomized, controlled trial on adalimumab for ulcerative colitis (UC) showed that adalimumab at 160/80 mg induction dose was safe and effective for inducing remission and clinical response after 8 weeks in patients with moderately-to-severely active UC failing treatment with corticosteroids and/or immunosuppressants.

Methods
  • Adalimumab is the first fully human monoclonal immunoglobulin directed against tumor necrosis factor(TNF)-α, which binds with high affinity and specificity to membrane and soluble TNF.
  • Adalimumab administered subcutaneously has demonstrated efficacy in the treatment of rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and severe chronic psoriasis.
  • Studies have shown that adalimumab is effective for inducing and maintaining remission of moderate-to-severe active Crohn’s disease (CD) patients at an induction dose of 160/80 mg (week 0 and 2) and at a maintenance dose of 40 mg every other week.
  • Efficacy of adalimumab as a second-line therapy has also been documented for patients with loss of response or intolerance to infliximab.
  • Adalimumab is also ...read more
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Vitamin D supplementation for prevention of mortality in adults Cochrane Reviews, 07/11/2011 Bjelakovic G et al. – Vitamin D in the form of vitamin D3 seems to decrease mortality in predominantly elderly women who are mainly in institutions and dependent

  
  
  
  
  

Vitamin D supplementation for prevention of mortality in adults 

Cochrane Reviews, 07/11/2011

Bjelakovic G et al. – Vitamin D in the form of vitamin D3 seems to decrease mortality in predominantly elderly women who are mainly in institutions and dependent care. Vitamin D2, alfacalcidol, and calcitriol had no statistically significant effect on mortality. Vitamin D3 combined with calcium significantly increased nephrolithiasis. Both alfacalcidol and calcitriol significantly increased hypercalcaemia.

Methods
  • The authors searched The Cochrane Library, MEDLINE, EMBASE, LILACS, the Science Citation Index Expanded, and Conference Proceedings Citation Index–Science (to January 2011).
  • They scanned bibliographies of relevant publications and asked experts and pharmaceutical companies for additional trials.
  • They included randomised trials that compared vitamin D at any dose, duration, and route of administration versus placebo or no intervention.
  • Vitamin D could have been administered as supplemental vitamin D (vitamin D3 (cholecalciferol) or vitamin D2 (ergocalciferol)) or an active form of vitamin D (1α–hydroxyvitamin D (alfacalcidol) or 1,25–dihydroxyvitamin D (calcitriol)).
  • Six authors extracted data independently.
  • Random–effects and fixed–effect model meta–analyses were conducted.
  • For dichotomous outcomes, they calculated the risk ratios (RR).
  • To account for trials with zero events, meta–analyses of dichotomous data were repeated using risk differences (RD) and empirical continuity corrections.
  • Risk of bias was considered in order to minimise risk of systematic errors.
  • Trial sequential analyses were conducted to minimise the risk of random errors.
Results
  • Fifty randomised trials with 94,148 participants provided data for the mortality analyses.
  • Most trials included ...read more
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Does Long-Term Aspirin Use Have Any Effect On Helicobacter pylori Eradication

  
  
  
  
  

 Does Long-Term Aspirin Use Have Any Effect On Helicobacter pylori Eradication

The American Journal of the Medical Sciences, 06/24/2011

Gokturk HS et al. – The data suggest that H pylori eradication rate with standard triple eradication regimen is significantly higher among long–term aspirin users than in controls.

Methods
  • The study population consisted of 77 aspirin using patients with dyspeptic symptoms and 79 age– and sex–matched dyspeptic patients without aspirin use as a control group.
  • Both the study group and control patients were given lansoprazole (30 mg twice a day), clarithromycin (500 mg twice a day) and amoxicillin (1 g twice a day) (LCA) for 14 days as the eradication regimen.
  • Patients on the study group were allowed to take aspirin during the eradication regimen (LCAAsp).
  • Eradication was defined as the absence of H pylori as assessed with the 13C–urea breath test and H pylori stool antigen test 8 weeks after the end of the antimicrobial therapy.
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Resveratrol induces apoptosis in pancreatic cancer cells

  
  
  
  
  

Chinese Medical Journal, 06/07/2011  Clinical Article 

Full Text

Jia–hua Z et al. – Resveratrol provides a promising anti–tumor stratagy to fight against pancreatic cancer.

Methods
  • Several pancreatic cancer cell lines were screened by resveratrol, and its toxicity was tested by normal pancreatic cells.
  • Western blotting was then performed to analyze the molecular mechanism of resveratrol induced apoptosis of pancreatic cancer cell lines.
Results
  • In the screened pancreatic cancer cell lines, capan–2 and colo357 showed high sensitivity to resveratrol induced apoptosis.
  • Resveratrol exhibited insignificant toxicity to normal pancreatic ...read more

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