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08-07-2012 | Article

Medical news in review: July 1-7, 2012

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

Vitamin D and calcium reduce deaths among elderly

The results of a meta-analysis of individual patient data (IPD) show that vitamin D supplementation with calcium reduces mortality rates in the elderly.

Overall, the findings showed that with or without calcium, vitamin D was associated with a 7% reduction in mortality over a 3-year period; however, the association only became significant when the supplement was combined with calcium, giving a 9% reduction in the risk.

"Accordingly, calcium with vitamin D supplementation to elderly participants is overall not harmful to survival, and may have beneficial effects on general health," say Lars Rejnmark (Aarhus University, Denmark) and colleagues in the Journal of Clinical Endocrinology and Metabolism.

Using data from eight studies, Rejnmark and co-workers conducted IPD-level analysis on 27,345 individuals randomly assigned to receive vitamin D with calcium, 7771 individuals assigned to vitamin D alone, and 35,412 who received placebo or no vitamin D.

The cohort was aged a mean 70 years, and 87% was female, of whom 34% received hormone replacement therapy (HRT); however, HRT use did not significantly affect mortality rates, observes the research team.

During the 36-month follow-up period studied, 3832 (5.4%) participants died, and 1139 (1.6%) sustained an osteoporotic fracture at the hip or spine, report the researchers.

After adjustment for factors including age, gender, fractures, and HRT use, the risk for death among all study participants was 7% less in those assigned to take vitamin D alongside or without calcium compared with their peers who were assigned to placebo/no vitamin D.

When Rejnmark and co-authors included only the studies with a group assigned to vitamin D plus calcium supplementation, the risk for death was significantly reduced among these participants compared with their counterparts who received placebo or no vitamin D (hazard ratio=0.91). This equated to an absolute risk reduction of 0.66%, and the need to treat 151 individuals for 3 years to prevent one death.

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COPD patients get a raw deal after AMI

Patients with chronic obstructive pulmonary disease (COPD) receive less aggressive treatment after hospitalization for acute myocardial infarction (AMI) than those without the lung condition, US study results show.

Mihaela Stefan, from Baystate Medical Center in Springfield, Massachusetts, and colleagues say that COPD patients also had a higher risk for death during hospitalization and at 30 days after discharge.

The authors comment: "Although the use of therapies recommended per current guidelines increased in all patients hospitalized with AMI during the 10 years under study, and the gap in care quality between patients with and without COPD closed substantially, differences in treatment persist, and the outcomes of patients with AMI and underlying COPD did not improve."

The study consisted of 6290 patients with a mean age of 71 years who were admitted to hospital with AMI, and was conducted between 1997 and 2007. In all, 1080 patients had COPD and 5210 did not.

As reported in Chest, COPD patients were older than non-COPD patients, and were more likely to have a history of other cardiovascular conditions, including angina, heart failure (HF), hypertension, stroke, and diabetes. Patients with COPD were 56% less likely to be treated with beta blockers than those without COPD, 30% less likely to be treated with lipid-lowering medication, and 44% less likely to have undergone cardiac catheterization. They were also less likely to have undergone percutaneous coronary intervention and coronary artery bypass graft surgery during their index hospitalization, and more likely to have been prescribed calcium channel blockers.

Among the cohort, inpatient death was more common among COPD patients than non-COPD patients, at respective rates of 13.5% and 10.1%. The same trend was seen during the 30-day period after discharge, with respective death rates of 18.7% and 13.2%.

Adjustment for multiple confounding factors, such as smoking and medication use, revealed that the presence of COPD raised the risk for inpatient death and 30-day postdischarge death in AMI patients by 25.0% and 31.0%, respectively.

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Sexting a surrogate for risky behavior

Teenage "sexting," where adolescents send nude pictures of themselves or sexually explicit text messages by cell phone, is on the increase and is a marker of risky sexual behavior, research suggests.

As reported in the Archives of Pediatric and Adolescent Medicine, Jeff Temple (University of Texas Medical Branch, Galveston, USA) and colleagues evaluated the prevalence of sexting and its association with sexual behavior in 948 high school students from Texas between the age of 14 and 19 years (mean 15.8 years).

Overall, 28% of the students reported having ever sent a naked picture of themselves through text or email and 31% reported having asked for a sext.

Over half (57%) had been asked to send a sext and most were concerned by the request.

Boys and girls who took part in sexting were significantly more likely to have dated, had sex, or participated in risky sexual behavior than those who had never sexted.

More specifically, all those who had sexted had begun dating compared with 89.8% of those who had not, similarly 77.4% of those who had sexted had had sex compared with only 42.0% of those who had not.

Risky sexual behavior, such as having more than one sexual partner over the previous year, was also more common in those who had sexted than those who had not, at 55.8% versus 34.6%, as was drinking alcohol or taking drugs before sex, at 39.8% versus 26.5%.

(click here to read the full article)

Colorectal adenoma-obesity link

A meta-analysis has shown that increasing adiposity shows a direct relationship with the development of adenomas in the colon - helping to shed light on the link between obesity and colorectal cancer (CRC).

Individuals with a body mass index (BMI) of 25 kg/m2 or more had a 24% greater risk for colorectal adenomas than those with a BMI below 25 kg/m2.

Furthermore, comparison of BMI categories showed a clear dose-response relationship between increasing obesity and adenoma risk. The odds ratio (OR) for patients with a BMI between 25 and 30 kg/m2 was 1.21, while for those with a BMI greater than 30 kg/m2, the OR was 1.33. However, obesity had no significant influence on the relative risk for adenoma progression, report Thanos Athanasiou (Imperial College London, UK) and colleagues.

The meta-analysis pooled data from 23 studies, including 105,190 participants, of whom 42,179 had a BMI of 25 kg/m2 or above, denoting overweight or obesity.

As well as finding associations with obesity, the results also indicated that active smoking might also increase colorectal adenoma prevalence. The researchers also found a significant association between female gender (but not male gender) and colorectal adenoma formation according to BMI. Premenopausal women had a higher risk for adenomas compared with postmenopausal women, suggesting a potential role of endogenous estrogens in colorectal adenoma formation.

The review, published in the American Journal of Gastroenterology, adds to growing epidemiologic and meta-analysis evidence of a link between obesity and CRC. "Further identification of the tumorigenic effects of adiposity in cancer progression may lead to novel interventions in cancer management," the authors hope.

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Postoperative delirium effects linger

Patients may take a long time to recover from the cognitive impact of cardiac surgery if they develop postoperative delirium, research shows.

This was particularly marked among patients with delirium lasting more than 3 days, report Jane Saczynski (University of Massachusetts Medical School, Worcester, USA) and team in The New England Journal of Medicine.

Postoperative delirium was common in the current study, affecting 46% of 225 patients (average age 73 years). The researchers used the Confusion Assessment Method to diagnose delirium, which they say is "the most widely adopted, validated approach in the literature."

Patients with postoperative delirium had significantly poorer preoperative cognition than patients without, with Mini-Mental State Examination (MMSE) scores of 25.8 versus 26.9 (absolute difference of 1.1 points), adjusted for variables including age and history of stroke.

They also had a much larger decline in cognition at 2 days after surgery, with MMSE scores falling by 7.7 points compared with 2.1 points in patients without delirium. The fall was largest in patients whose delirium lasted longer than 3 days.

Patients with delirium made faster recoveries between postoperative days 3 and 5 than did those without, but the 3.3-point absolute difference in MMSE scores was still significant and larger than at baseline.

This difference was still present 30 days after surgery, and patients whose delirium lasted longer than 3 days made particularly slow recoveries over this period.

Over the next 5 months, patients with postoperative delirium made larger cognitive gains than the other patients, and the 2.0-point difference in MMSE scores at 6 months was not significant. However, significantly more patients with than without delirium had not regained their preoperative level of cognitive function at this point, at 40% versus 24%.

One year after surgery, 31% and 20% of patients with and without postoperative delirium had regained their previous level of cognitive function. The difference was not significant.

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Booster for shingles shots

Administration of the live attenuated herpes zoster (HZ) vaccine is not associated with an increased risk for shingles shortly after vaccination in patients receiving biologic treatments for immune-mediated diseases, researchers report in JAMA.

And contrary to recommendations suggesting that the HZ vaccine is contraindicated in these patients, Jeffrey Curtis (University of Alabama, Birmingham, USA) and colleagues also found that receipt of the vaccine was associated with a significantly reduced longer-term risk for shingles (also known as HZ) in patients with an immune-mediated disease.

The researchers examined the association between HZ vaccination and HZ incidence within and beyond 42 days of vaccination in 463,541 Medicare beneficiaries aged 60 years and older with rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, or inflammatory bowel disease.

During a median follow-up period of 2 years, 18,683 (4%) patients received the HZ vaccine.

The overall crude HZ incidence rate was 7.8 cases per 1000 person-years within 42 days after vaccination.

However, there were no cases of varicella or HZ among 633 patients exposed to biologics, including 551 patients exposed to antitumor necrosis factor biologics, during this high-risk postvaccination period.

A further 138 HZ cases were recorded during the period of more than 42 days after vaccination, for an incidence rate of 6.7 cases per 1000 person-years. The rate among unvaccinated patients was 11.6 cases per 1000 person-years.

After controlling for demographics, type of immune-mediated disease, healthcare utilization, and exposure to biologic and nonbiologic disease-modifying antirheumatic drugs and oral glucocorticoids, HZ vaccination was associated with a 39% reduced risk for HZ after 42 days, compared with no vaccination."

(click here to read the full article)

By Neil Osterweil