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Phthalates Associated with Preterm Birth 

MD-FM Thursday 21 November 2013

  

Sarah:

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

 

SEGMENT 1: Phthalate exposure associated with increased odds of preterm birth.

 

PETER:

Hello, and with me is Sarah Maxwell. To begin with, for women who are pregnant, exposure to phthalates, man-made chemicals used in some plastics for instance, appears to increase the chances of a premature birth, according to a large case control study reported in JAMA Pediatrics

 

SARAH:

Yes, phthalates are already linked to a variety of negative health effects, yet they’re practically ubiquitous nowadays: They’re used in a range of commercial and industrial goods, processed foods, water, pharmaceuticals and personal care products. In this study, phthalate urine-levels were measured in 130 pregnant women who went on to have a preterm birth and in 350 controls…

 

MEEKER:

“There are a number of things that can lead to a preterm birth. We looked at just those that were considered spontaneous, so this is spontaneous preterm delivery or premature rupture of the membranes and, when we are just looking at those two subtypes, their association became much stronger, ranging from about 2 to 5 times the odds of preterm birth for the highly exposed women compared to the low exposed women”

 

SARAH:

That was senior study author John Meeker, from the University of Michigan in Ann Arbor. Dr Shanna Swan wrote an editorial on the study and said, people can try to reduce their exposure by staying away from contaminated food as much as possible:

 

SWAN:

“We can buy unprocessed food, so food that is not likely to have been put into containers or come through tubing or in any way been processed and we can buy foods that are pesticide free, because phthalates are also in pesticides, and we can buy local food because transportation often involves some exposure, depending on the containers that are used to transport the food. So the nice recommendation to eat local unprocessed organic food helps in many ways and one of them is to reduce phthalate exposure.”

 

SARAH:

Shanna Swan, from Mount Sinai hospital, in New York.

 

SEGMENT 2: Valve repair and replacement both reduce mortality in patients with severe ischemic mitral regurgitation. 

 

PETER:

News now from the American Heart Association’s meeting in Dallas this week: For patients with severe ischemic mitral regurgitation both valve repair AND valve replacement led to surprisingly low mortality rates at one month after surgery ….

 

SARAH:

That’s according to a study comparing these two approaches, published in the New England Journal of Medicine, and it’s the largest randomized trial to date looking at this patient population. Senior study author Dr. Irving Kron:

 

KRON:

“Traditionally we have thought that treating this disease runs a mortality as high as 10 per cent, one in ten do not survive. But we found in fact that the mortality for the repair group was 1.8 per cent and for the replacement group was about 4 per cent, both better than we would have predicted.”

 

SARAH:

That was Irving Kron, from the University of Virginia in Charlottesville, who said it should be reasonable to expect these good results:

 

KRON:

“We had very strict guidelines, the repair had to be done a certain way and the replacement had to be done a certain way, so there was no variability to the surgical approach. So I think there should be a standard approach to the treatment, and that these kind of results should be the expectation.”

 

SARAH:

At one year follow up survival and left ventricular reverse remodelling rates were also comparable for both approaches. Replacement gave a more durable correction of mitral regurgitation but this didn’t emerge as a difference in clinical outcomes.

 

PETER:

And that confirms previous findings doesn’t it, so what should we be making of this then, which approach is better?

 

SARAH:

Dr. Kron said it’s just still too early to say:

 

KRON:

“I think we have to follow them longer but, more importantly, we have to figure out: can we predict which patients who have a repair will go on to have leakage later? We have the data, now we have to put it together. So we should be able to say, in the future, which patients will do better with a replacement and which patient will do better with a repair.”

 

SARAH:

Dr. Irving Kron, from Virginia, taking to us at the AHA meeting in Dallas.

 

SEGMENT 3: American Heart Association cholesterol recommendations under criticism.

PETER:

The American Heart Association’s cholesterol treatment recommendations, published only last week, are already under fierce criticism. According to findings reported in The Lancet, the guidelines’ risk assessment tool, used for initiating statin therapy in primary prevention, overestimated the risk of developing cardiovascular disease by as much as 150 percent in some cases. Researchers warned that this could result in millions of people being given statins unnecessarily to prevent heart attacks and strokes they’re not at risk of. And following a lively debate at the AHA meeting,   .

 

SEGMENT 4: Long-term use of oral contraceptives may raise risk of glaucoma.

 

PETER:

Long-term use of oral contraceptive is associated with an increased risk of developing glaucoma. That’s according to a study presented at the American Academy of Ophthalmology meeting, held in New Orleans this week

 

SARAH:

In an analysis looking at over 3,400 women aged 40 years or more, there were twice as many self-reported cases of glaucoma in those who had taken the pill for more than three years. Lead study author Dr. Shan Lin said the way in which oestrogen is released in the body might play a role:

 

LIN:

“It’s actually thought that estrogens have beneficial effects on retinal ganglion cells, which are the cells that get damaged in glaucoma. However, it’s probably related to the cyclical nature by which estrogen is produced in women’s bodies and so, when you use oral contraceptives, it actually flattens out that cyclical nature of release of estrogen and it’s really felt that is the cause of perhaps damage to these cells and perhaps glaucoma later on.”

 

SARAH:

That was Shan Lin from the University of California in San Francisco. He said there was a strong message for practitioners both in ophthalmology and obstetrics and gynecology:

 

LIN:

“We need to get this information out to ophthalmologist so that as they get patients who might be at risk for glaucoma, that they ask for oral contraceptive use as potentially another risk factor. Just as I ask about whether you’ve had a family history, I look at whether their ethnicity is related to African-American ethnicity. So this can be another factor that you put into your equation in terms of how closely you’re going to follow this patient for glaucoma. From the Ob-Gyn standpoint, it’s important to realize this, so that you may consider sending this person for a screening for glaucoma.”

 

SARAH:

Dr Shan Lin, talking to MDFM from New Orleans.

 

SEGMENT 5: Perioperative β-blockers beneficial only in some patients with ischemic heart disease. 

 

PETER:

In a new study: for some patients with ischemic heart disease, the use of β-blockers during non-cardiac surgery lowered the risks of major cardiac events and all-cause mortality at one month…

 

SARAH:

Yes, but that was only in those who’d had heart failure or a recent myocardial infarction. For everybody else, β-blocker therapy was actually associated with an increased risk of MACE. This is the finding of a study, reported in JAMA Internal Medicine, that analyzed data from over 28,000 patients with ischemic heart disease.

 

PETER:

Yes, we’ve heard criticism recently, haven’t we?  Many clinicians feel the current guidelines (especially the European ones) encouraging β-blockers peri-operatively for all patients with ischemic heart disease, rely on data that’s been discredited... 

 

SARAH:

Yes, and in fact the European Society of Cardiology is revising these aggressive guidelines right now, with a new version expected early in 2014. Lead study author Charlotte Andersson, from the Heart Centre in Copenhagen, said more trials are also needed:

 

ANDERSSON:

“I should say that this is an observational study, so we should be a little bit careful about drawing any definite conclusion about this but, as I see it, this data encourages, really, a randomized clinical trial, either investigating the effects, again, of beta-blockers, but maybe in a little higher risk population than has previously been investigated. Or that we actually could consider whether or not it would be reasonable to make a randomized clinical trial where we actually remove beta-blockers prior to surgery in a subgroup of patients with stable conditions.”


SARAH:

Professor Charlotte Andersson, talking to us at the American Heart Association meeting in Dallas. 

 

IN BRIEF 1: Use of antihypertensive medication does not change outcomes in stroke patients.

 

PETER:

Finally, in brief: Using anti-hypertensive medication to lower blood pressure in the 48 hours following an acute ischemic stroke, did not improve or worsen outcomes at hospital discharge or at 14 days. These are the findings of a large randomized study, published in JAMA, and presented at the AHA meeting. The primary outcome (a combination of death and major disability) did not differ between patients put on anti-hypertensive treatment and controls. And…

 

IN BRIEF 2: Global eradication of poliomyelitis would benefit all countries.

 

PETER:

Poliomyelitis-free countries remain at risk of outbreaks according to a report, published in the New England Journal of Medicine. Back in the year 2000, China was certified as a ‘poliomyelitis-free region’, but this was followed by the 2011 outbreak of imported wild-type poliovirus. The authors stress that global eradication of poliomyelitis would benefit all countries, even those that are currently free of the virus.

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!

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