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Quitting smoking by age 40 can reduce excess risks of death by 90 per cent

MD-FM Thursday January 31, 2013





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

PETER:
Hello, and with me is Sarah Maxell. To begin with, for smokers of any age, it’s never too late to kick the habit…

SARAH:
Yes, whatever your age, you can lower your excess risk of death if you quit smoking — that holds even for long-term smokers, according to a study published in the New England Journal of Medicine. Smokers have even lower life expectancies than was previously thought, and the full benefits of quitting — for instance at age 40 — brings the excess risk of death down by as much as 90%! Senior study author Richard Peto, from Oxford University:

Bob-Peto: “Smokers, on average, are losing about at least 10 years of life expectancy but stopping smoking really works, even if you’ve been smoking for quite a lot of years. If fact it still works if you stop at 50 or stop at 60 –You’ve still got a very big risk left, but you’d avoid quite a lot of risk. And it’s really worth physicians knowing this, obviously particularly for doctors who treat heart attacks it’s worth knowing: that even after a smoker has had a heart attack, if they stop, their prognosis over the next 5 years is a lot better. But just of the general population: stopping works, even if you’ve been smoking for several years.”

SARAH:
That was Professor Sir Richard Peto, from the UK, who said smoking is still the most important cause of death in Western Europe.

P2

PETER:
And — female smokers are at greater risk than was known up until now from smoking-related illnesses such as: lung cancer, chronic bronchitis, and cardiovascular diseases. That’s from another study in the same issue of the New England Journal of Medicine that showed women have caught up with men in terms of their chances of developing ailments associated with smoking.

VIRGULE MUSICALE

P3

PETER:
For people who are obese, having a gastric band can halve their excess weight and that weight loss can be maintained over time. That’s the finding of a 15-year study, reported in Annals of Surgery…

SARAH:
Yes, progress and weight changes were followed in over 3000 patients who’d had a gastric band in a longitudinal cohort study from Australia. Researchers also did a meta-analysis of all bariatric procedures with 10 or more years follow up, and lead investigator Paul O’Brien told MDFM how gastric banding and gastric bypass compared:

Bob-O’Brien: “By three years, the bypass is a little bit better, it’s certainly better at year one, it’s very rapid weight loss –people lose a lot of weight after the bypass in the first year but whatever they lose in the first year is all they are going to lose, they never lose much beyond that. Whereas the band takes three years to really get going, we have a gentle progression of weight loss. By five years, there is no difference, and that lack of difference carries through now in this particular study out beyond ten years.”

SARAH:
That was Professor Paul O’Brien, from Monash University in Melbourne. Some external experts were disappointed that only a few patients were actually followed-up for 15 years and questioned some of the team’s methods...

Bob-Himpens: “What is true though is that the enthusiasm that everybody has for the gastric bypass becomes far less as time evolves. There’s a definite weight regain with the gastric bypass we do not witness with the band. However I must say that with the band, in our study, about 50% of patients no longer had a band beyond 10 years because of complications.”

SARAH:
Doctor Jacques Himpens, from Brussels, who last year published a long-term study in Obesity Surgery.


VIRGULE MUSICALE
 
P4

PETER:
In the UK, one in six cases of adult onset asthma appear to be caused by exposure to asthmagens in the workplace. That’s from a large, long-term study — published in Thorax — looking at people from various professional backgrounds…

SARAH:
Yes, jobs were coded using an Asthma Specific Job Exposure Matrix and 18 occupations were associated with an increased risk of adult onset asthma. Some, were jobs already known to be linked with asthma such as, hairdressers and farmers, and there were quite a few cleaning-related jobs too. But they also identified new jobs such as doorkeepers, where the association with asthma is still rather puzzling…
 
PETER:
Hmm, and these were all people born in the late 50’s weren’t they, but how similar was the sort of exposure they all had?
 
SARAH:
Well, there were differences. lead study author, Rebecca Ghosh:
 
Bob-Ghosh-1: “When we used the job exposure matrix, this is the strongest associations we saw again: with the flour and enzymes, which are baking jobs, cleaning products, and also people exposed to metal fumes, and textile production.”
 
SARAH:
Doctor Rebecca Gosh, from Imperial College, in London, who added that her study doesn’t provide evidence of a cause-and-effect relationship between these different occupations and asthma — only an association:
 
Bob-Gosh-2: “We cannot say for definite what these people were exposed to and we cannot say that these jobs definitely cause asthma, so… This study is adding to the body of knowledge about occupations that may cause asthma so what it’s doing is just adding to the existing knowledge and anything that can be done to help identify people with occupational asthma and potential exposure that’s sort of the goal of this work
 
SARAH:
That was Rebecca Ghosh, in London.
 
VIRGULE MUSICALE

P5

PETER:
For people with an acute anterior cruciate ligament tear, early surgery may not always be the way to go...

SARAH:
That’s right. In young, active adults early reconstruction plus rehabilitation wasn’t any better than initial rehabilitation with the option of later knee reconstruction. That’s from five-year results — published in the British Medical Journal — of a randomized trial showing that half the people who had the delayed approach, didn’t even need reconstruction at all!

PETER:
Oh dear! But it can be hard to justify refraining from early surgery can’t it?

SARAH:
Maybe. But the findings were that there were no statistical differences in outcomes such as: pain symptoms, knee related quality of life, physical activity level and radiographic osteoarthritis, whether a patients’ knee had been surgically reconstructed early or late, or if they had been treated with rehabilitation alone:
 
Bob-frobell-1: “Now you have to bear in mind that this is an early time frame for osteoarthritis –5 years is a short period of time. But we still see some OA and there is no difference in what we can detect, but longer term follow up is of course needed and we are planning a 10 year follow up starting this year actually with the first patients.”
 
SARAH:
That was lead author Richard Frobell, from Lund University Hospital in Sweden, who had this message for patients and doctors:
 
Bob-Frobell-2: “The main message from our results would be that both patients and treating physicians should consider rehabilitation as a first treatment option in these patients. Maybe you don’t need to operate on everyone with ACL injury. Maybe you could start off with rehabilitation and then wait and only operate on those in need.”
 
SARAH:
Professor Richard Frobell, from Sweden.


BREVE 1 Sur fond musical
 
PETER:
Finally, in brief:

Older women with heart disease are three times more likely to develop mild cognitive impairment, according to a study published Online First in JAMA Neurology. The link was specifically limited to the non-amnestic subtype of impairment — that is: involving cognitive domains other than memory. Men with heart disease also had an increased risk of mild cognitive impairment, but the association didn’t achieve statistical significance.

And...
 
BREVE 2

Five-years of folic acid supplementation does not increase or decrease the incidence of cancer, according to a meta-analysis published in The Lancet. It reviewed 13 trials that compared folic acid supplementation with placebo in a total of nearly 50,000 people and there was no significant impact on the incidence of cancers such as; prostate, lung or breast with short-term supplementation.

And with St Valentine’s Day fast approaching the European Society of Cardiology today announced that marriage — at any age — lowers your risk of having a heart attack. All the more reason to find a spouse if you don’t have one!

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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