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08-10-2012 | Article

Global medical news in review: September 30-October 6, 2012

medwireNews: A roundup of select stories of interest to US physicians from the MerckMedicus Medical News wire.

Genes predict post-radiation erectile dysfunction

Scientists have identified a group of genetic markers that can predict the risk for erectile dysfunction (ED) after radiotherapy for prostate cancer.

Barry Rosenstein (Mount Sinai School of Medicine, New York) and colleagues say that the 12 single nucleotide polymorphisms (SNPs) each gave an odds ratio for ED of between 1.6 and 5.6 in a cohort of 132 men with ED after brachytherapy and/or external beam radiotherapy, and 103 men without ED.

The risk for ED increased significantly with the number of the SNPs carried - by a factor of 2.2 for each additional allele - after adjusting for patient ancestry and clinical factors.

When the pooled SNP profile was applied during treatment planning, alongside other risk factors such as age and treatment type, the researchers were able to predict the likelihood of ED after radiotherapy with 84% sensitivity and 75% specificity in a validation cohort of 230 men, of whom 128 developed ED, they report in the International Journal of Radiation Oncology Biology Physics.

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Some older patients uncertain about discharge instructions

While the majority of older patients treated and released from emergency departments (EDs) understand their discharge information, half do not understand how long their condition could last, and a third do not understand medication warnings, show study results.

Understanding discharge information has a direct effect on how patients rate their quality of care, add the study authors in BMJ Quality and Safety.

Susan Hastings (Veterans Affairs Medical Center [VAMD], Durham, North Carolina) and colleagues interviewed 305 individuals aged 65 years and above (or a proxy, in 56 cases) within 48 hours of them being discharged from the VAMC ED between October 2008 and March 2010, to evaluate their perception of ED discharge information and quality of care. In all, 61% of visits resulted in prescription of at least one new medication, note the researchers.

While 79% of patients and proxies reported understanding the cause of the problem leading to the ED visit, 43% did not understand at least one element of the discharge information.

Also, 30% of patients and proxies did not understand the potential side effects of new medications, and 29% did not understand their warning signs. However, if patients' conditions worsened, the majority (90%) knew who to contact, with 77% specifying the ED.

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Statins may stave off glaucoma

Cholesterol-lowering medications in the statin class could significantly reduce the risk for developing open-angle glaucoma (OAG), report Joshua Stein (University of Michigan, Ann Arbor) and co-investigators in Ophthalmology.

Of the 524,109 beneficiaries aged a mean 68 years with hyperlipidemia recorded in the i3 InVision Data Mart database (2001-2009), 316,182 (60.3%) had at least one statin prescription. A total of 10,266 (4.3%) were diagnosed with OAG, a further 6934 (14.0%) were suspected of having glaucoma, and 47,511 (17.0%) with OAG were prescribed at least one glaucoma medication during the data period.

After adjustment for variables including age, gender, race, and comorbidities including diabetes, hypertension, obesity, and sleep apnea, patients taking statins intermittently for 1 year and those taking statins continuously for 2 years were a significant 4% and 8% less likely to develop OAG, respectively, than their counterparts who had never taken statins.

Furthermore, the hazard ratio for progressing from suspected glaucoma to an OAG diagnosis decreased by a significant 0.4% for every additional month of statin use versus none, and this risk reduced by a respective 5.0% and 9.0% in those who took the drugs for a year over a 2-year period or for 2 years consecutively.

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Prostate cancer screening improves surgery outcomes

Men who undergo radical prostatectomy (RP) for a tumor that was detected by screening show better long-term outcomes than their peers who undergo the surgery after a chance diagnosis, study results show.

The improved outcomes in the screening group appeared to be largely as a result of them having a significantly lower tumor volume.

Stacy Loeb (University Medical Center, Rotterdam, the Netherlands) and colleagues examined data from the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer (ERSPC), for which 42,376 men were randomly assigned to annual screening for 6 years or treatment as usual that included opportunistic screening.

In all, 1151 men in the screening arm and 210 in the control arm were diagnosed with prostate cancer, respectively. After RP, men from the screening arm showed better outcomes than their peers in the control arm, with significantly higher rates of 10-year progression-free survival (88 vs 72%), metastasis-free survival (98 vs 86%), and cancer-specific survival (98 vs 88%).

In multivariable models adjusted for age, prostate-specific antigen level, clinical stage, and biopsy Gleason score, the screening group had a significantly lower risk for biochemical recurrence and metastasis compared with the control arm (hazard ratio=0.43 and 0.18, respectively).

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CAD or no, beta-blockers do not reduce cardiovascular event risk

Beta-blocker therapy does not reduce the risk for cardiovascular (CV) events in patients with or without coronary artery disease (CAD), report Sripal Bangalore (New York University School of Medicine, New York) and co-authors.

The analysis of patients from the Reduction of Atherothrombosis for Continued Health (REACH) registry revealed that the rate of the primary outcome - a composite of CV death, nonfatal myocardial infarction (MI), and nonfatal stroke - did not differ significantly between individuals with prior MI who used beta blockers and those who did not.

As reported in JAMA, there was also no difference between beta-blocker users and nonusers among CAD patients with or without a history of MI.

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DPP4 inhibitors lower cardiovascular risk in Type 2 diabetes

Patients with Type 2 diabetes who are treated with dipeptidyl peptidase-4 inhibitors (DPP4i) have a significantly reduced risk for cardiovascular events, particularly MI, compared with their peers who take placebo or other drugs, show results of a meta-analysis in Diabetes, Obesity and Metabolism.

The findings corroborate previous studies, and additional data suggest that DPP4i do more than simply modify risk factors through glycemic control and may have additional actions of cardiovascular protection.

Edoardo Mannucci (University Hospital Careggi, Florence, Italy) and colleagues reviewed 70 trials including a total of 41,959 patients with Type 2 diabetes who were assigned to one of two arms: DPP4i treatment, or placebo or other drugs.

After an average follow up of 44.1 weeks across the studies, patients treated with DPP4i were found to have better outcomes than their peers, including a reduced incidence of major cardiovascular events (MACE), MI, stroke, and mortality, with Mantel-Haenzel odds ratios of 0.71, 0.64, 0.77, and 0.60, respectively.

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By Neil Osterweil, medwireNews reporter