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Mediterranean diet better than low fat diet to reduce cardiovascular risks

MD-FM Thursday February 28, 2013




GENERIQUE
Carillon
 
Sarah:
MD FM — Medical News from around the world with Peter Goodwin.
 
P1

PETER:
Hello, and with me is Sarah Maxwell. To begin with: people at high cardiovascular risk who eat a Mediterranean diet — high in olive oil, nuts, fish, fresh fruits and vegetables and low in animal fat and red meat — have fewer cardiovascular events than those on a low-fat diet…

SARAH:
Yes, in a study — published in the New England Journal of Medicine — over 7000 people who were at high cardiovascular risk but were not ill were randomized to one of three diets, either: A Mediterranean diet supplemented with extra-virgin olive oil, the same diet with mixed nuts added, or the placebo group who were advised to reduce dietary fat. The trial had to be stopped in just less than five-years follow-up because there was a 30 per cent reduction in major cardiovascular events for those on the two Mediterranean diets and also a significant reduction in the risk of stroke:

Bob-Martinez: “If you consider the best medication for preventing cardiovascular disease --that is the statin treatment -- it is about 20, 25, 30 percent, depending on how large is the reduction in lipids, so it is very similar to what you can get with statins.”

SARAH:
That was senior study author Miguel Angel Martínez-González, from Pamplona in Spain, who added that, a Mediterranean diet should NOT however replace statins but that eating it — together with — more olive oil and nuts can benefit us all:

Bob-Martinez-2: “The differences were not very large in diet between the three groups so this is the interesting step: to get a small change so people can increase the consumption of virgin olive oil and tree nuts and using them to replace the unhealthy foods.”

SARAH:
Professor Martínez-González, from Spain

P2

PETER:
Coronary artery bypass graft surgery — or CABG — should remain the standard of care for patients with multi-vessel severe coronary artery disease according to results published this week in the Lancet…

SARAH:
The SYNTAX trial randomized 1800 patients with severe coronary artery disease including multi-vessel and left main disease and is described in the Lancet as arguably the most important trial of CABG and PCI ever undertaken — and the results are clear: at 5-year follow-up, CABG significantly reduced major adverse cardiac and cerebrovascular events — including death — compared to PCI:

Bob-Taggart-1: There was a strong survival benefit for around 80% of patients undergoing bypass grafting rather than stents. In around 20% of patients, there were roughly equivalent outcomes between bypass graft and stents, although even in these patients, those who had undergone stents still needed far more repeat interventions.”

SARAH:
That was Professor David Taggart, from Oxford University in the UK, who wrote a comment on the study and emphasized the importance of the heart team. He said the 20% of patients for whom PCI was an acceptable alternative — those with less complex disease: for instance with left main coronary disease or low SYNTAX scores — should be thoroughly discussed by the team including both cardiac surgeons and interventional cardiologists:

Bob-Taggart-2: “I strongly believe that all interventions in patients should be agreed by a heart team --so that’s a team of doctors rather than an individual doctor, because it’s far more likely that patients will get the right treatment option.”

SARAH:
And Professor Taggart gave us his comments on another study “syntax score II” — published in the same issue of The Lancet — that showed, at four-years, that combining clinical factors with the original anatomical syntax score can be a better guide for decision-making between CABG and PCI:

Bob-Taggart-3: “In maybe about 40% of patients it would show you that one treatment was better than the other. But there’s still a lot of patients in the middle ground. In this middle ground, if we apply the overall SYNTAX trial to these patients, they would do far better with bypass grafting.”  

SARAH:
Oxford University’s David Taggart.

VIRGULE MUSICALE

P3

PETER:
For patients with diabetes who have elevated baseline glycated hemoglobin levels or who have already started on either thiazolidine-dione or insulin, are more likely to gain weight from intensive glucose-lowering treatment. This came out of a study reported in Diabetes Care, in which 9000 patients with type-2 diabetes were randomized to either intensive or standard glucose lowering treatment and followed for two years.

VIRGULE MUSICALE
 
P4

PETER:
There are several types of pro-biotics and pre-biotics that could help fight various types of diseases associated with a dys-biosis, according to news  from the 2nd World Summit on Gut Microbiota, held in Madrid last week…
 
SARAH:
The meeting heard that after we’re born the normal colonization of our gut microbiota is an integral part of our internal environmental signaling system that can modulate mammalian development. This finding is a result of recent advances in meta-genomic analysis. And thanks to these permanent microbe-host interactions, the gut microbiome has a central position in health.

PETER:
So what did the conference have to say about what happens to the gut microbiome during a disease?

SARAH:
Well, delegates heard that the overall balance in the composition of this gut microbial community — and the presence or absence of key species —  is important for our health. When it’s disturbed, these micro-organisms can influence the appearance of a number of conditions: including: a digestive-like metabolic syndrome, functional intestinal disease and auto-immune diseases like Crohn’s disease.

PETER:
Sounds fascinating, but what emerged about how we can restore the balance of the gut bacteria?
 
SARAH:
Well: stand-by for this: One method — for the future — could be to perform fecal transplantations. Apparently this is an experimental treatment that’s only used in recurrent Clostridium difficile entero-colitis. But for now — the Madrid conference heard — we have either performing pro-biotic or pre-biotic tools. And their efficacy has been validated by over 1000 clinical studies:
 
Bob-Guarner: “Today we know that probiotics are effective in antibiotic associated diarrhea, some are effective in certain forms of irritable bowel syndrome, some probiotics in mild forms of ulcerative colitis which is an inflammatory bowel disease, and also in allergies: some probiotics can prevent allergies in neonates, i.e. atopic eczema. And prebiotics now have a place in nutrition but also in medicine: for necrotizing enterocolitis in newborn babies, together with antibiotic therapies…”
 
SARAH:
That was Professor Francisco Guarner, from Barcelona in Spain, speaking to our correspondent Jean-Paul Marre at the meeting.

VIRGULE MUSICALE

P5

PETER:
It’s possible to predict the risk of post-traumatic stress disorder in soldiers according to a study published in Clinical Psychological Science…

SARAH:
Yes, for veterans of the Vietnam war, although the severity of combat exposure was a necessary element for PTSD onset, The fact that a soldier had been involved in harming people in civilian life or harming prisoners was even more significant. As well as this: “personal vulnerability” contributed to the odds of developing the disorder:

Bob-Dohrenwend-1: We estimate that 97 percent of those who were at the most severe on exposure, at the largest vulnerability load and were involved in harming prisoners or civilians developed the syndrome”

SARAH:
That was lead study author Bruce Dohrenwend from New York. While the severity of combat exposure was the strongest predictor of PTSD onset, they found that pre-war vulnerability was important in predicting whether the syndrome persisted:

Bob-Dohrenwend-2: “One main message in terms of prevention could be to keep the most vulnerable soldiers out of the most severe combat situations, since the greater the severity of combat the greater the development of the disorder, and the greater its persistence when the veterans are high on both combat exposure and vulnerability. You would think that’s obvious, but the fact of the matter is that, in Vietnam, they were not being kept out of anything --they were disproportionately likely to be in combat.”

SARAH:
Doctor Bruce Dohrenwend, from New York, who said that — like Vietnam — the wars in Afghanistan and in Iraq were defined as “wars amongst the people” where such factors are likely to play a big part.


BREVE 1 -59 mots Sur fond musical
 
PETER:
Finally, in brief:

In patients with chronic idiopathic urticaria — also called chronic spontaneous urticaria — an IgE monoclonal antibody called omalizumab diminished clinical symptoms and signs of the disease in patients who had remained symptomatic despite H1-antihistamines. These results — published online first in the New England Journal of Medicine — come from a phase III study, with 323 patients randomized to receive either three injections of omalizumab at various doses or placebo, and were followed for 16 weeks.

And...
 
BREVE 2

The atomic structure of an important natural antibiotic called dermcidin — produced by human skin when it sweats — has been reported in the Proceedings of the National Academy of Sciences.  This is is a cause for excitement because it’s highly efficient agent at fighting Mycobacterium tuberculosis and Staphylococcus aureus. So these data could contribute to the development of next generation antibiotics that control multi-resistant bacteria.

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!
 
JINGLE FIN     
 

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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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