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High Potency Statins May Increase The Risks Of Type 2 Diabetes

MD-FM Thursday May 30th, 2013





MD-FM, Medical News from around the world with Peter Goodwin.



Hello, and with me is Sarah Maxwell. To begin with, treatment with high potency statins may increase the risk of developing type-2 diabetes, according to a study published in the British Medical Journal…



Yes, it showed that, high potency statins, such as: atorvastatin, rosuvastatin and simvastatin, were associated with a 10 to 22% increased risk of developing diabetes, compared to the lower potency, pravastatin, the “reference drug” in the study. The absolute risk however was low. And the team noticed a possible dose-response relationship with rosuvastatin, but not with atorvastatin or simvastatin

Mumdani-1: One of the caveats is that with rosuvastatin we noted a bit of a dose response effect, where higher doses may be associated with diabetes, but the lower doses may not be. But those results should be interpreted with caution, for studies that are even bigger than ours to look at more carefully



That was senior study author, Muhammad Mamdani, from Toronto, whose team analyzed long-term data on half a million people. He said that other low potency statins, such as lovastatin and fluvastatin, showed no increased risk of diabetes. But that doesn’t mean patients should all be switched:


Mumdani-2: I think the physician has to really do this on a case by case basis. Patients who have a very high LDL, I think these patients should stay on the higher potency statins, just because the benefits outweight the risks of statin therapies, however for most patients, depending on what their LDL levels are, I imagine that they would do just fine on pravastatin, because I believe it also confers a lower risk of diabetes



Dr. Muhammad Mamdani from Canada.



For patients with depression, most non-pharmacologic psychotherapeutic interventions available today are effective; and they appear to have pretty comparable, moderate to large effects. That’s according to a first-of-its-kind meta-analysis looking at 15,000 patients, reported in PLoS Medicine



Yes, it compared seven types of psychotherapies with each other and with a control group of patients — either on a waiting list or continuing usual care. All therapies were better at reducing symptoms compared to controls and, interestingly, the interventions were more or less as effective as each other, regardless of patient characteristics. For instance, younger and older patients, or mothers with postpartum depression, and those with different severity of depression: the patients varied across the entire spectrum. Dr. Alexander Tsai, who did not take part in this study, said these findings could help guide decision-making in practice:


Tsai: Right now in practice, I would say that for the most part, practitioners don’t have a whole lot of guidance in terms of systematically determining who would be a good candidate for different types of psychotherapies. When I see a patient, I don’t have a lot of guidance in terms of whether he would benefit from interpersonal psychotherapy or cognitive behavioral psychotherapy or other types of psychotherapies, I have some inclinations based on theory and based on clinical experience, but not based on the evidence. And I would say that this study suggests that most, or at least the seven types of psychotherapies that were investigated are probably equivalent


That was Alexander Tsai, from Cambridge, Massachusetts.


New genetic factors strongly predisposing you to the risk of developing schizophrenia have been uncovered, in a study, reported in JAMA Psychiatry, that looked at five large families, each with several affected relatives. Rare variants were discovered in genes associated with the networking of particular signal receptors, the so-called “NMDA” receptors, on nerve cells distributed throughout the brain.







The first-ever vaccine against enterovirus-71 has proven effective for protecting young children against the diseases associated with it. That’s the finding of a randomized study, led from China looking at over 10,000 children from six to 35 month of age.



Yes, and 14 months after vaccination, it was well tolerated and provided 90% protection against clinical EV-71-associated hand, foot and mouth disease, and 80% protection against other EV-71- associated complications, namely neurological ones.



This is good news for South East Asia where this virus had been spreading recently; and EV-71 outbreaks can cause meningitis, encephalitis and seizures, right?



Well, exactly however, the vaccine might not be as effective in all Asian Pacific regions, since EV-71 comes in different strains, according to Nigel Crawford, who wrote an editorial about the study in The Lancet:


Crawford: It’s quite a complex virus in terms of its different types: A, B and C. And epidemics come regularly through different parts of Asia but the strain in China has been quite stable, it’s a C4 genotype. And this vaccine produces antibodies and gives protection against C4 but we don’t know what it means for the other genotypes that are seen around the different regions. So it’s possible this vaccine will work really well in China or other countries that happen to have C4 but we don’t know what that means for other types or if the genotype changes



That was Dr. Nigel Crawford, from the University of Melbourne in Australia, who said another question still remains: Will this immune protection be sustained up to the age of five years? And does it work in newborns, who can be severely affected by the virus?



Contrary to previous study findings, calcium supplements, up to 1000 mg daily, may not only benefit bone health, but also life expectancy in women. That’s according to an epidemiological study, published in the Journal of Clinical Endocrinology & Metabolism



Yes, researchers followed over 9000 randomly selected men and women from the community over 10 years, and found that overall mortality risks were lower, by 20% on average, among women taking regular calcium supplements. However, they didn’t find a similar association in men. Lead study author, David Goltzman:


Goltzman-1: We did not find any positive or negative results in men and there’s at least two reasons for this, they are not mutually exclusive: one is that we just didn’t have the statistical power because our numbers of men were less than 50% than numbers of women, and the other is that there may of course be biological differences



That was Dr. David Goltzman, in Montreal, Canada. His team also looked at the effects of vitamin-D intake on mortality, but didn’t find any association there. These data are reassuring, following previous reports suggesting that calcium supplements, although important for bone health, might be associated with increased cardiovascular events:


Goltzman-2: We feel reasonably comfortable with our findings, and we’re not saying that people should be consuming 4 g of calcium with impunity but we’re saying that, within the recommendations for bone health, moderate amounts of consumption is safe



Dr. David Goltzman, from McGill University in Canada.

BREVE 1 Sur fond musical



Finally, in brief:


There’s an increased incidence of cancer in patients who received CT scan irradiations when they were children or adolescents, between 1985 and 2005. That’s from a study, reported in the British Medical Journal, showing the overall cancer incidence was about 25% greater than for people not exposed. There was a dose-response relation and while radiation doses from contemporary CT scans are likely to be lower, the authors say, the cancer risk isn’t ruled out yet.

And …..




For people with uncontrolled hypertension, self-monitoring using tele-monitoring, and supervision by primary care clinicians, is an effective way to achieve important reductions in blood pressure, according to a study published in the British Medical Journal. However, it was also associated with an increase in the use of National Health Service resources: so the long-term cost-effectiveness of the intervention will have to be evaluated.




And finally: the first publication on clinical symptoms of 111 cases of infection with the new avian influenza A, H7N9, virus, is available online on the New England Journal of Medicine’s website.


That's all from MDFM for now. Sarah Maxwell and I will be back with more next week, so until then from me Peter Goodwin, goodbye!


Previous editions


Best of Science in Nutrition 2013: Yogurt for a healthier diet (EB & IUNS 2013)

Best of Science in Nutrition 2013: Yogurt for a healthier diet (EB & IUNS 2013)
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