(Reuters) - Women who want to use hormone replacement therapy may be less likely to have a stroke if they use low-dose patches instead of pills, Canadian researchers reported on Thursday.
Their study of British women showed that those who used estrogen patches to control symptoms of menopause did not have any higher risk of stroke than women who did not use HRT.
The study, published in the British Medical Journal, adds to a very slowly growing body of evidence that could rehabilitate the use of HRT, which plummeted in 2002 after the publication of the Women's Health Initiative study, which found an increased risk of ovarian cancer, breast cancer, strokes and other health problems from hormone therapy.
Sales of U.S. market leader Wyeth's combined estrogen-progestin therapy Prempro have fallen by about 50 percent since 2001 to around $1 billion a year. Wyeth is now owned by Pfizer.
But many experts who studied HRT said there was some evidence that if women took a lower dose and if they took HRT by means other than a pill, the risks might not be as high.
Samy Suissa of McGill University in Montreal and colleagues used Britain's national medical database to pick out 15,700 women over 50 who had strokes and nearly 60,000 who had not.
Women who had used low-dose transdermal patches to get their HRT had almost precisely the same risk of stroke -- very slightly less, in fact -- than women who used no HRT.
"I think that these are promising findings," said Dr. JoAnn Manson of Brigham and Women's Hospital and Harvard Medical School in Boston, who helped lead the Women's Health Initiative and who was not involved in Suissa's study.
Suissa's team found that 7.7 percent of stroke patients had been given a prescription for some form of HRT within the previous year of their stroke. And 6.9 percent of women who did not have a stroke got some form of HRT.
"The risk of stroke was not increased with use of low estrogen dose patches compared with no use, whereas the risk was increased with high dose patches," Suissa's team wrote.
HRT pills raised the risk of stroke by 25 percent to 30 percent, regardless of the formulation. High-dose patches raised the risk by 88 percent.
Delivering low doses of hormones through the skin bypasses the liver and may reduce the whole-body effects, Suissa's team said in their report, available at: here
Menopause can cause serious symptoms, including debilitating hot flashes, sleep disturbances and a lack of energy. Women also become more susceptible to heart disease, osteoporosis and some cancers after menopause.
Experts in HRT and menopause say women should be able to choose to use hormones to treat these symptoms but should take the lowest dose possible for the shortest possible time. Before 2002 HRT was regularly prescribed to prevent heart disease and osteoporosis but the experts now recommend against this.
Manson said the ongoing Women's Health Initiative study will look at different doses of hormones. Her team found two years ago that low-dose HRT pills did not raise the risk of stroke and said more study is needed to be sure.
"If there was an option that didn't raise the risk of stroke, that would be a tremendou breakthrough," Manson said in a telephone interview.
Makers of HRT patches include Novogyne, a joint venture of Novartis Pharmaceuticals Corp and Noven Pharmaceuticals Inc, which was acquired last year by Japan's Hisamitsu Pharmaceutical Co Inc and Janssen-Cilag, part of Johnson & Johnson.
Source : http://www.reuters.com/article/idUSTRE6526DW20100603
regards, taniafdi ^_^
6/15/10
Toothbrushing Less Than Twice a Day Linked to Increased CV Risk
News Author: Sue Hughes
June 7, 2010 — Individuals who do not brush their teeth twice a day have an increased risk of heart disease, a new study shows [1].
The study was published online May 27, 2010 in BMJ; corresponding author is Prof Richard Watt (University College London, UK).
The researchers note that while it has been established that inflammation in the body (including mouth and gums) plays an important role in the buildup of atherosclerosis, this is the first study to investigate whether the number of times individuals brush their teeth has any bearing on the risk of developing heart disease.
They analyzed data from more than 11 000 adults who took part in the Scottish Health Survey, in which individuals were asked about lifestyle behaviors such as smoking, physical activity, and oral health routines. Questions asked included how often they visited the dentist and how often they brushed their teeth (twice a day, once a day, or less than once a day). Information was also collated on medical history and family history of heart disease and blood pressure. Blood samples were taken from a subgroup of participants and tested for C-reactive protein (CRP) and fibrinogen levels. The data gathered from the interviews were linked to hospital admissions and deaths.
Results showed generally good oral hygiene practices, with 62% of participants saying they visited the dentist every six months and 71% reporting that they brushed their teeth twice a day. After adjustment for established risk factors, it was found that participants who reported less frequent toothbrushing had an increased risk of heart disease compared with people who brushed their teeth twice a day. Participants who had poor oral hygiene also had increased levels of CRP and fibrinogen.
Hazard Ratio for Cardiovascular Events (Fatal and Nonfatal) Relative to How Often Teeth Are Brushed Each Day
*Adjusted for age, sex, socioeconomic group, smoking, physical activity, visits to dentist, body-mass index, family history of cardiovascular disease, hypertension, and diabetes
The researchers say: "To the best of our knowledge, this is the first study to show an association between a single-item self-reported measure of toothbrushing and incident cardiovascular disease in a large representative sample of adults without overt cardiovascular disease."
They add: "Our study suggests a possible role of poor oral hygiene in the risk of cardiovascular disease via systemic inflammation. Raised inflammatory and homoeostatic responses as well as lipid metabolism disturbance caused by periodontal infection might be possible pathways underlying the observed association between periodontal disease and the increased risk for cardiovascular disease."
But they note that further studies are needed to confirm whether the observed association between oral health behavior and cardiovascular disease is in fact causal or merely a risk marker.
References
regards, taniafdi ^_^
June 7, 2010 — Individuals who do not brush their teeth twice a day have an increased risk of heart disease, a new study shows [1].
The study was published online May 27, 2010 in BMJ; corresponding author is Prof Richard Watt (University College London, UK).
The researchers note that while it has been established that inflammation in the body (including mouth and gums) plays an important role in the buildup of atherosclerosis, this is the first study to investigate whether the number of times individuals brush their teeth has any bearing on the risk of developing heart disease.
They analyzed data from more than 11 000 adults who took part in the Scottish Health Survey, in which individuals were asked about lifestyle behaviors such as smoking, physical activity, and oral health routines. Questions asked included how often they visited the dentist and how often they brushed their teeth (twice a day, once a day, or less than once a day). Information was also collated on medical history and family history of heart disease and blood pressure. Blood samples were taken from a subgroup of participants and tested for C-reactive protein (CRP) and fibrinogen levels. The data gathered from the interviews were linked to hospital admissions and deaths.
Results showed generally good oral hygiene practices, with 62% of participants saying they visited the dentist every six months and 71% reporting that they brushed their teeth twice a day. After adjustment for established risk factors, it was found that participants who reported less frequent toothbrushing had an increased risk of heart disease compared with people who brushed their teeth twice a day. Participants who had poor oral hygiene also had increased levels of CRP and fibrinogen.
Hazard Ratio for Cardiovascular Events (Fatal and Nonfatal) Relative to How Often Teeth Are Brushed Each Day
| Frequency of toothbrushing | HR* (95% CI) |
| Twice a day | 1.0 |
| Once a day | 1.3 (1.0–1.5) |
| Less than once a day | 1.7 (1.3–2.3) |
| p for trend | 0.001 |
The researchers say: "To the best of our knowledge, this is the first study to show an association between a single-item self-reported measure of toothbrushing and incident cardiovascular disease in a large representative sample of adults without overt cardiovascular disease."
They add: "Our study suggests a possible role of poor oral hygiene in the risk of cardiovascular disease via systemic inflammation. Raised inflammatory and homoeostatic responses as well as lipid metabolism disturbance caused by periodontal infection might be possible pathways underlying the observed association between periodontal disease and the increased risk for cardiovascular disease."
But they note that further studies are needed to confirm whether the observed association between oral health behavior and cardiovascular disease is in fact causal or merely a risk marker.
References
- de Oliveira C, Watt R, and Hamer M. Toothbrushing, inflammation, and risk of cardiovascular disease: Results from Scottish Health Survey. BMJ 2010; DOI:10.1136/bmj.c2451. Available at: http://www.bmj.com.
regards, taniafdi ^_^
Thiazolidinediones and Sulfonylureas Most Effective in Lowering HbA1C
June 2, 2010 — Oral antidiabetic drugs (OADs) decrease glycosylated hemoglobin (A1C) levels by approximately 0.5% to 1.25%. The maximal effect is achieved by 3 to 6 months, and thiazolidinediones and sulfonylureas show the greatest efficacy, according to the findings of a systematic review and meta-analysis.
Diana Sherifali, PhD, from the Department of Medicine, McMaster University, Hamilton, Ontario, Canada, and colleagues reported their findings in Diabetes Care, published online ahead of print on May 18.
"Summaries of previous studies of ...OADs suggest that they reduce A1C levels by 0.5-1.5%," the researchers write. "However, this estimated drop in A1C was based on summaries of studies with varying designs, which may lead to over or under estimates of the true effect of OADs."
The current study used predetermined methodologic criteria to determine the effect of OADs on A1C levels more accurately.
Dr. Sherifali and colleagues searched several databases on the medical literature for randomized, placebo-controlled studies published between 1980 and May 2008. A total of 61 trials were selected by 2 independent evaluators. The studies included 26,367 study participants, with approximately 15,000 randomly assigned to treatment and the remainder randomly assigned to placebo.
OAD drug classes included were the alpha-glucosidase inhibitors, biguanides, dipeptidyl peptidase-4 inhibitors, meglitinides, sulfonylureas, and thiazolidinediones. Overall, OADs lowered A1C levels by 0.5% to 1.25%, whereas thiazolidinediones and sulfonylureas lowered A1C levels, to a slightly greater extent, by approximately 1.0% to 1.25%.
In addition, a higher baseline A1C level was associated with a greater decline in A1C levels with 6 months of OAD treatment; by contrast, the length of disease duration had no effect on response to OADs.
The authors concluded that the benefit of initiating an OAD agent is most apparent within the first 4 to 6 months, with A1C levels unlikely to decrease more than 1.5% on average.
According to the researchers, further carefully conducted OAD trials are needed to account for combinations of OAD drug use and its impact on A1C levels, the effectiveness of long-term OAD use, and the potential for adverse events.
Study Limitations
Independent commentator Philip Home, DM, DPhil, MA, professor of diabetes medicine at Newcastle University, told Medscape Diabetes & Endocrinology that limitations of the study were that comparative trials were excluded and that the time course of efficacy is known to be different for sulfonylureas vs other oral medications, which makes comparing efficacy difficult in a study such as this.
"Professionals need to be aware of the limited efficacy of all oral agents, to monitor response early and at frequent intervals, and to add further agents without waiting for their patients to suffer the consequences of continued glucose control above target levels," Dr. Home told Medscape Diabetes & Endocrinology.
The study was sponsored by an unrestricted grant from Merck Frosst. Dr. Sherifali has received support through the Heart and Stroke Foundation of Ontario. Coauthor Kara Nerenberg, MD, MSc, has received support through the Canadian Institutes of Health Research. Coauthor Hertzel C. Gerstein, MD, MSc, has received honoraria for providing advice or speaking. These companies include sanofi-aventis, Bristol-Myers Squibb, AstraZeneca, Bayer, GlaxoSmithKline, Lilly, Novo Nordisk, Biovail, Servier, and Roche.
Dr. Home is on the Medscape Diabetes & Endocrinology editorial board and has disclosed various financial relationships with AstraZeneca Pharmaceuticals LP; Bristol-Myers Squibb Co; Boehringer-Ingelheim Pharmaceuticals, Inc; GlaxoSmithKline; MannKind Corp; Merck & Co, Inc; Novo Nordisk; Novartis Pharmaceuticals Corp; Roche; sanofi-aventis; Tolerx, Inc; XOMA (US) LLC; and Lilly.
Diabetes Care. Published online May 18, 2010.
News Author: Emma Hitt, PhD
Source : http://cme.medscape.com/viewarticle/722806?src=cmemp&uac=97984HK
regards, taniafdi ^_^
Diana Sherifali, PhD, from the Department of Medicine, McMaster University, Hamilton, Ontario, Canada, and colleagues reported their findings in Diabetes Care, published online ahead of print on May 18.
"Summaries of previous studies of ...OADs suggest that they reduce A1C levels by 0.5-1.5%," the researchers write. "However, this estimated drop in A1C was based on summaries of studies with varying designs, which may lead to over or under estimates of the true effect of OADs."
The current study used predetermined methodologic criteria to determine the effect of OADs on A1C levels more accurately.
Dr. Sherifali and colleagues searched several databases on the medical literature for randomized, placebo-controlled studies published between 1980 and May 2008. A total of 61 trials were selected by 2 independent evaluators. The studies included 26,367 study participants, with approximately 15,000 randomly assigned to treatment and the remainder randomly assigned to placebo.
OAD drug classes included were the alpha-glucosidase inhibitors, biguanides, dipeptidyl peptidase-4 inhibitors, meglitinides, sulfonylureas, and thiazolidinediones. Overall, OADs lowered A1C levels by 0.5% to 1.25%, whereas thiazolidinediones and sulfonylureas lowered A1C levels, to a slightly greater extent, by approximately 1.0% to 1.25%.
In addition, a higher baseline A1C level was associated with a greater decline in A1C levels with 6 months of OAD treatment; by contrast, the length of disease duration had no effect on response to OADs.
The authors concluded that the benefit of initiating an OAD agent is most apparent within the first 4 to 6 months, with A1C levels unlikely to decrease more than 1.5% on average.
According to the researchers, further carefully conducted OAD trials are needed to account for combinations of OAD drug use and its impact on A1C levels, the effectiveness of long-term OAD use, and the potential for adverse events.
Study Limitations
Independent commentator Philip Home, DM, DPhil, MA, professor of diabetes medicine at Newcastle University, told Medscape Diabetes & Endocrinology that limitations of the study were that comparative trials were excluded and that the time course of efficacy is known to be different for sulfonylureas vs other oral medications, which makes comparing efficacy difficult in a study such as this.
"Professionals need to be aware of the limited efficacy of all oral agents, to monitor response early and at frequent intervals, and to add further agents without waiting for their patients to suffer the consequences of continued glucose control above target levels," Dr. Home told Medscape Diabetes & Endocrinology.
The study was sponsored by an unrestricted grant from Merck Frosst. Dr. Sherifali has received support through the Heart and Stroke Foundation of Ontario. Coauthor Kara Nerenberg, MD, MSc, has received support through the Canadian Institutes of Health Research. Coauthor Hertzel C. Gerstein, MD, MSc, has received honoraria for providing advice or speaking. These companies include sanofi-aventis, Bristol-Myers Squibb, AstraZeneca, Bayer, GlaxoSmithKline, Lilly, Novo Nordisk, Biovail, Servier, and Roche.
Dr. Home is on the Medscape Diabetes & Endocrinology editorial board and has disclosed various financial relationships with AstraZeneca Pharmaceuticals LP; Bristol-Myers Squibb Co; Boehringer-Ingelheim Pharmaceuticals, Inc; GlaxoSmithKline; MannKind Corp; Merck & Co, Inc; Novo Nordisk; Novartis Pharmaceuticals Corp; Roche; sanofi-aventis; Tolerx, Inc; XOMA (US) LLC; and Lilly.
Diabetes Care. Published online May 18, 2010.
News Author: Emma Hitt, PhD
Source : http://cme.medscape.com/viewarticle/722806?src=cmemp&uac=97984HK
regards, taniafdi ^_^
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6/15/10
Hormone patch may be safer for women
(Reuters) - Women who want to use hormone replacement therapy may be less likely to have a stroke if they use low-dose patches instead of pills, Canadian researchers reported on Thursday.
Their study of British women showed that those who used estrogen patches to control symptoms of menopause did not have any higher risk of stroke than women who did not use HRT.
The study, published in the British Medical Journal, adds to a very slowly growing body of evidence that could rehabilitate the use of HRT, which plummeted in 2002 after the publication of the Women's Health Initiative study, which found an increased risk of ovarian cancer, breast cancer, strokes and other health problems from hormone therapy.
Sales of U.S. market leader Wyeth's combined estrogen-progestin therapy Prempro have fallen by about 50 percent since 2001 to around $1 billion a year. Wyeth is now owned by Pfizer.
But many experts who studied HRT said there was some evidence that if women took a lower dose and if they took HRT by means other than a pill, the risks might not be as high.
Samy Suissa of McGill University in Montreal and colleagues used Britain's national medical database to pick out 15,700 women over 50 who had strokes and nearly 60,000 who had not.
Women who had used low-dose transdermal patches to get their HRT had almost precisely the same risk of stroke -- very slightly less, in fact -- than women who used no HRT.
"I think that these are promising findings," said Dr. JoAnn Manson of Brigham and Women's Hospital and Harvard Medical School in Boston, who helped lead the Women's Health Initiative and who was not involved in Suissa's study.
Suissa's team found that 7.7 percent of stroke patients had been given a prescription for some form of HRT within the previous year of their stroke. And 6.9 percent of women who did not have a stroke got some form of HRT.
"The risk of stroke was not increased with use of low estrogen dose patches compared with no use, whereas the risk was increased with high dose patches," Suissa's team wrote.
HRT pills raised the risk of stroke by 25 percent to 30 percent, regardless of the formulation. High-dose patches raised the risk by 88 percent.
Delivering low doses of hormones through the skin bypasses the liver and may reduce the whole-body effects, Suissa's team said in their report, available at: here
Menopause can cause serious symptoms, including debilitating hot flashes, sleep disturbances and a lack of energy. Women also become more susceptible to heart disease, osteoporosis and some cancers after menopause.
Experts in HRT and menopause say women should be able to choose to use hormones to treat these symptoms but should take the lowest dose possible for the shortest possible time. Before 2002 HRT was regularly prescribed to prevent heart disease and osteoporosis but the experts now recommend against this.
Manson said the ongoing Women's Health Initiative study will look at different doses of hormones. Her team found two years ago that low-dose HRT pills did not raise the risk of stroke and said more study is needed to be sure.
"If there was an option that didn't raise the risk of stroke, that would be a tremendou breakthrough," Manson said in a telephone interview.
Makers of HRT patches include Novogyne, a joint venture of Novartis Pharmaceuticals Corp and Noven Pharmaceuticals Inc, which was acquired last year by Japan's Hisamitsu Pharmaceutical Co Inc and Janssen-Cilag, part of Johnson & Johnson.
Source : http://www.reuters.com/article/idUSTRE6526DW20100603
regards, taniafdi ^_^
Their study of British women showed that those who used estrogen patches to control symptoms of menopause did not have any higher risk of stroke than women who did not use HRT.
The study, published in the British Medical Journal, adds to a very slowly growing body of evidence that could rehabilitate the use of HRT, which plummeted in 2002 after the publication of the Women's Health Initiative study, which found an increased risk of ovarian cancer, breast cancer, strokes and other health problems from hormone therapy.
Sales of U.S. market leader Wyeth's combined estrogen-progestin therapy Prempro have fallen by about 50 percent since 2001 to around $1 billion a year. Wyeth is now owned by Pfizer.
But many experts who studied HRT said there was some evidence that if women took a lower dose and if they took HRT by means other than a pill, the risks might not be as high.
Samy Suissa of McGill University in Montreal and colleagues used Britain's national medical database to pick out 15,700 women over 50 who had strokes and nearly 60,000 who had not.
Women who had used low-dose transdermal patches to get their HRT had almost precisely the same risk of stroke -- very slightly less, in fact -- than women who used no HRT.
"I think that these are promising findings," said Dr. JoAnn Manson of Brigham and Women's Hospital and Harvard Medical School in Boston, who helped lead the Women's Health Initiative and who was not involved in Suissa's study.
Suissa's team found that 7.7 percent of stroke patients had been given a prescription for some form of HRT within the previous year of their stroke. And 6.9 percent of women who did not have a stroke got some form of HRT.
"The risk of stroke was not increased with use of low estrogen dose patches compared with no use, whereas the risk was increased with high dose patches," Suissa's team wrote.
HRT pills raised the risk of stroke by 25 percent to 30 percent, regardless of the formulation. High-dose patches raised the risk by 88 percent.
Delivering low doses of hormones through the skin bypasses the liver and may reduce the whole-body effects, Suissa's team said in their report, available at: here
Menopause can cause serious symptoms, including debilitating hot flashes, sleep disturbances and a lack of energy. Women also become more susceptible to heart disease, osteoporosis and some cancers after menopause.
Experts in HRT and menopause say women should be able to choose to use hormones to treat these symptoms but should take the lowest dose possible for the shortest possible time. Before 2002 HRT was regularly prescribed to prevent heart disease and osteoporosis but the experts now recommend against this.
Manson said the ongoing Women's Health Initiative study will look at different doses of hormones. Her team found two years ago that low-dose HRT pills did not raise the risk of stroke and said more study is needed to be sure.
"If there was an option that didn't raise the risk of stroke, that would be a tremendou breakthrough," Manson said in a telephone interview.
Makers of HRT patches include Novogyne, a joint venture of Novartis Pharmaceuticals Corp and Noven Pharmaceuticals Inc, which was acquired last year by Japan's Hisamitsu Pharmaceutical Co Inc and Janssen-Cilag, part of Johnson & Johnson.
Source : http://www.reuters.com/article/idUSTRE6526DW20100603
regards, taniafdi ^_^
Toothbrushing Less Than Twice a Day Linked to Increased CV Risk
News Author: Sue Hughes
June 7, 2010 — Individuals who do not brush their teeth twice a day have an increased risk of heart disease, a new study shows [1].
The study was published online May 27, 2010 in BMJ; corresponding author is Prof Richard Watt (University College London, UK).
The researchers note that while it has been established that inflammation in the body (including mouth and gums) plays an important role in the buildup of atherosclerosis, this is the first study to investigate whether the number of times individuals brush their teeth has any bearing on the risk of developing heart disease.
They analyzed data from more than 11 000 adults who took part in the Scottish Health Survey, in which individuals were asked about lifestyle behaviors such as smoking, physical activity, and oral health routines. Questions asked included how often they visited the dentist and how often they brushed their teeth (twice a day, once a day, or less than once a day). Information was also collated on medical history and family history of heart disease and blood pressure. Blood samples were taken from a subgroup of participants and tested for C-reactive protein (CRP) and fibrinogen levels. The data gathered from the interviews were linked to hospital admissions and deaths.
Results showed generally good oral hygiene practices, with 62% of participants saying they visited the dentist every six months and 71% reporting that they brushed their teeth twice a day. After adjustment for established risk factors, it was found that participants who reported less frequent toothbrushing had an increased risk of heart disease compared with people who brushed their teeth twice a day. Participants who had poor oral hygiene also had increased levels of CRP and fibrinogen.
Hazard Ratio for Cardiovascular Events (Fatal and Nonfatal) Relative to How Often Teeth Are Brushed Each Day
*Adjusted for age, sex, socioeconomic group, smoking, physical activity, visits to dentist, body-mass index, family history of cardiovascular disease, hypertension, and diabetes
The researchers say: "To the best of our knowledge, this is the first study to show an association between a single-item self-reported measure of toothbrushing and incident cardiovascular disease in a large representative sample of adults without overt cardiovascular disease."
They add: "Our study suggests a possible role of poor oral hygiene in the risk of cardiovascular disease via systemic inflammation. Raised inflammatory and homoeostatic responses as well as lipid metabolism disturbance caused by periodontal infection might be possible pathways underlying the observed association between periodontal disease and the increased risk for cardiovascular disease."
But they note that further studies are needed to confirm whether the observed association between oral health behavior and cardiovascular disease is in fact causal or merely a risk marker.
References
regards, taniafdi ^_^
June 7, 2010 — Individuals who do not brush their teeth twice a day have an increased risk of heart disease, a new study shows [1].
The study was published online May 27, 2010 in BMJ; corresponding author is Prof Richard Watt (University College London, UK).
The researchers note that while it has been established that inflammation in the body (including mouth and gums) plays an important role in the buildup of atherosclerosis, this is the first study to investigate whether the number of times individuals brush their teeth has any bearing on the risk of developing heart disease.
They analyzed data from more than 11 000 adults who took part in the Scottish Health Survey, in which individuals were asked about lifestyle behaviors such as smoking, physical activity, and oral health routines. Questions asked included how often they visited the dentist and how often they brushed their teeth (twice a day, once a day, or less than once a day). Information was also collated on medical history and family history of heart disease and blood pressure. Blood samples were taken from a subgroup of participants and tested for C-reactive protein (CRP) and fibrinogen levels. The data gathered from the interviews were linked to hospital admissions and deaths.
Results showed generally good oral hygiene practices, with 62% of participants saying they visited the dentist every six months and 71% reporting that they brushed their teeth twice a day. After adjustment for established risk factors, it was found that participants who reported less frequent toothbrushing had an increased risk of heart disease compared with people who brushed their teeth twice a day. Participants who had poor oral hygiene also had increased levels of CRP and fibrinogen.
Hazard Ratio for Cardiovascular Events (Fatal and Nonfatal) Relative to How Often Teeth Are Brushed Each Day
| Frequency of toothbrushing | HR* (95% CI) |
| Twice a day | 1.0 |
| Once a day | 1.3 (1.0–1.5) |
| Less than once a day | 1.7 (1.3–2.3) |
| p for trend | 0.001 |
The researchers say: "To the best of our knowledge, this is the first study to show an association between a single-item self-reported measure of toothbrushing and incident cardiovascular disease in a large representative sample of adults without overt cardiovascular disease."
They add: "Our study suggests a possible role of poor oral hygiene in the risk of cardiovascular disease via systemic inflammation. Raised inflammatory and homoeostatic responses as well as lipid metabolism disturbance caused by periodontal infection might be possible pathways underlying the observed association between periodontal disease and the increased risk for cardiovascular disease."
But they note that further studies are needed to confirm whether the observed association between oral health behavior and cardiovascular disease is in fact causal or merely a risk marker.
References
- de Oliveira C, Watt R, and Hamer M. Toothbrushing, inflammation, and risk of cardiovascular disease: Results from Scottish Health Survey. BMJ 2010; DOI:10.1136/bmj.c2451. Available at: http://www.bmj.com.
regards, taniafdi ^_^
Thiazolidinediones and Sulfonylureas Most Effective in Lowering HbA1C
June 2, 2010 — Oral antidiabetic drugs (OADs) decrease glycosylated hemoglobin (A1C) levels by approximately 0.5% to 1.25%. The maximal effect is achieved by 3 to 6 months, and thiazolidinediones and sulfonylureas show the greatest efficacy, according to the findings of a systematic review and meta-analysis.
Diana Sherifali, PhD, from the Department of Medicine, McMaster University, Hamilton, Ontario, Canada, and colleagues reported their findings in Diabetes Care, published online ahead of print on May 18.
"Summaries of previous studies of ...OADs suggest that they reduce A1C levels by 0.5-1.5%," the researchers write. "However, this estimated drop in A1C was based on summaries of studies with varying designs, which may lead to over or under estimates of the true effect of OADs."
The current study used predetermined methodologic criteria to determine the effect of OADs on A1C levels more accurately.
Dr. Sherifali and colleagues searched several databases on the medical literature for randomized, placebo-controlled studies published between 1980 and May 2008. A total of 61 trials were selected by 2 independent evaluators. The studies included 26,367 study participants, with approximately 15,000 randomly assigned to treatment and the remainder randomly assigned to placebo.
OAD drug classes included were the alpha-glucosidase inhibitors, biguanides, dipeptidyl peptidase-4 inhibitors, meglitinides, sulfonylureas, and thiazolidinediones. Overall, OADs lowered A1C levels by 0.5% to 1.25%, whereas thiazolidinediones and sulfonylureas lowered A1C levels, to a slightly greater extent, by approximately 1.0% to 1.25%.
In addition, a higher baseline A1C level was associated with a greater decline in A1C levels with 6 months of OAD treatment; by contrast, the length of disease duration had no effect on response to OADs.
The authors concluded that the benefit of initiating an OAD agent is most apparent within the first 4 to 6 months, with A1C levels unlikely to decrease more than 1.5% on average.
According to the researchers, further carefully conducted OAD trials are needed to account for combinations of OAD drug use and its impact on A1C levels, the effectiveness of long-term OAD use, and the potential for adverse events.
Study Limitations
Independent commentator Philip Home, DM, DPhil, MA, professor of diabetes medicine at Newcastle University, told Medscape Diabetes & Endocrinology that limitations of the study were that comparative trials were excluded and that the time course of efficacy is known to be different for sulfonylureas vs other oral medications, which makes comparing efficacy difficult in a study such as this.
"Professionals need to be aware of the limited efficacy of all oral agents, to monitor response early and at frequent intervals, and to add further agents without waiting for their patients to suffer the consequences of continued glucose control above target levels," Dr. Home told Medscape Diabetes & Endocrinology.
The study was sponsored by an unrestricted grant from Merck Frosst. Dr. Sherifali has received support through the Heart and Stroke Foundation of Ontario. Coauthor Kara Nerenberg, MD, MSc, has received support through the Canadian Institutes of Health Research. Coauthor Hertzel C. Gerstein, MD, MSc, has received honoraria for providing advice or speaking. These companies include sanofi-aventis, Bristol-Myers Squibb, AstraZeneca, Bayer, GlaxoSmithKline, Lilly, Novo Nordisk, Biovail, Servier, and Roche.
Dr. Home is on the Medscape Diabetes & Endocrinology editorial board and has disclosed various financial relationships with AstraZeneca Pharmaceuticals LP; Bristol-Myers Squibb Co; Boehringer-Ingelheim Pharmaceuticals, Inc; GlaxoSmithKline; MannKind Corp; Merck & Co, Inc; Novo Nordisk; Novartis Pharmaceuticals Corp; Roche; sanofi-aventis; Tolerx, Inc; XOMA (US) LLC; and Lilly.
Diabetes Care. Published online May 18, 2010.
News Author: Emma Hitt, PhD
Source : http://cme.medscape.com/viewarticle/722806?src=cmemp&uac=97984HK
regards, taniafdi ^_^
Diana Sherifali, PhD, from the Department of Medicine, McMaster University, Hamilton, Ontario, Canada, and colleagues reported their findings in Diabetes Care, published online ahead of print on May 18.
"Summaries of previous studies of ...OADs suggest that they reduce A1C levels by 0.5-1.5%," the researchers write. "However, this estimated drop in A1C was based on summaries of studies with varying designs, which may lead to over or under estimates of the true effect of OADs."
The current study used predetermined methodologic criteria to determine the effect of OADs on A1C levels more accurately.
Dr. Sherifali and colleagues searched several databases on the medical literature for randomized, placebo-controlled studies published between 1980 and May 2008. A total of 61 trials were selected by 2 independent evaluators. The studies included 26,367 study participants, with approximately 15,000 randomly assigned to treatment and the remainder randomly assigned to placebo.
OAD drug classes included were the alpha-glucosidase inhibitors, biguanides, dipeptidyl peptidase-4 inhibitors, meglitinides, sulfonylureas, and thiazolidinediones. Overall, OADs lowered A1C levels by 0.5% to 1.25%, whereas thiazolidinediones and sulfonylureas lowered A1C levels, to a slightly greater extent, by approximately 1.0% to 1.25%.
In addition, a higher baseline A1C level was associated with a greater decline in A1C levels with 6 months of OAD treatment; by contrast, the length of disease duration had no effect on response to OADs.
The authors concluded that the benefit of initiating an OAD agent is most apparent within the first 4 to 6 months, with A1C levels unlikely to decrease more than 1.5% on average.
According to the researchers, further carefully conducted OAD trials are needed to account for combinations of OAD drug use and its impact on A1C levels, the effectiveness of long-term OAD use, and the potential for adverse events.
Study Limitations
Independent commentator Philip Home, DM, DPhil, MA, professor of diabetes medicine at Newcastle University, told Medscape Diabetes & Endocrinology that limitations of the study were that comparative trials were excluded and that the time course of efficacy is known to be different for sulfonylureas vs other oral medications, which makes comparing efficacy difficult in a study such as this.
"Professionals need to be aware of the limited efficacy of all oral agents, to monitor response early and at frequent intervals, and to add further agents without waiting for their patients to suffer the consequences of continued glucose control above target levels," Dr. Home told Medscape Diabetes & Endocrinology.
The study was sponsored by an unrestricted grant from Merck Frosst. Dr. Sherifali has received support through the Heart and Stroke Foundation of Ontario. Coauthor Kara Nerenberg, MD, MSc, has received support through the Canadian Institutes of Health Research. Coauthor Hertzel C. Gerstein, MD, MSc, has received honoraria for providing advice or speaking. These companies include sanofi-aventis, Bristol-Myers Squibb, AstraZeneca, Bayer, GlaxoSmithKline, Lilly, Novo Nordisk, Biovail, Servier, and Roche.
Dr. Home is on the Medscape Diabetes & Endocrinology editorial board and has disclosed various financial relationships with AstraZeneca Pharmaceuticals LP; Bristol-Myers Squibb Co; Boehringer-Ingelheim Pharmaceuticals, Inc; GlaxoSmithKline; MannKind Corp; Merck & Co, Inc; Novo Nordisk; Novartis Pharmaceuticals Corp; Roche; sanofi-aventis; Tolerx, Inc; XOMA (US) LLC; and Lilly.
Diabetes Care. Published online May 18, 2010.
News Author: Emma Hitt, PhD
Source : http://cme.medscape.com/viewarticle/722806?src=cmemp&uac=97984HK
regards, taniafdi ^_^
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