HHAL MEDICAL NEWS MAY2008

How Often Do We Need to Check Cholesterol Levels?

Adherent patients with well-controlled cholesterol levels could be monitored every 3 to 5 years.

To examine variations in cholesterol concentrations, investigators used data from the Long-term Intervention with Pravastatin in Ischaemic Disease (LIPID) study of 9014 patients (mean age, 62 years; 83% men) with coronary heart disease who were randomized to receive pravastatin (40 mg) or placebo. Lipid concentrations were measured by a single laboratory at randomization, at 6 and 12 months, and then annually until 5 years. The average pretreatment cholesterol level was 5.65 mmol/L.

Standard deviations for within-person short-term variability of a single measurement (based on measures taken 4 weeks before randomization) were 0.38 and 0.42 mmol/L for the placebo and pravastatin groups, respectively (average variation, 7%). Both the placebo and pravastatin groups had small increases in within-person variability over time. The mean cholesterol increase in the pravastatin group from 6 months to 5 years was 0.14 mmol/L (average variation, 0.7% per year). Mean LDL levels had similar variances over time (variances of difference from baseline to years 1, 3, and 5 were 0.32, 0.42, and 0.45 mmol/L, respectively, in the placebo group and 0.49, 0.53, and 0.56 mmol/L in the pravastatin group).

Comment: This study reaffirms that adherent patients with well-controlled cholesterol levels can be monitored every 3 to 5 years. A clinical point frequently forgotten is that cholesterol levels can and will vary by 7%. Therefore, treatment decisions should not be made based on a single measure. These findings do not apply to triglyceride levels, which are more variable.

— Joel M. Gore, MD

Published in Journal Watch Cardiology May 21, 2008

Citation(s):

Glasziou PP et al. for the Lipid Study Investigators. Monitoring cholesterol levels: Measurement error or true change? Ann Intern Med 2008 May 6; 148:656.

Medline abstract (Free)

http://us.f812.mail.yahoo.com/ym/ShowLetter?MsgId=8191_6168606_32937_1794_5573_0_22348_19915_3297098245&Idx=0&YY=15519&y5beta=yes&y5beta=yes&inc=25&order=down&sort=date&pos=0&view=a&head=b&box=HHAL%20NEWS%20508

Guidelines Urge Home BP Monitoring for Patients with Hypertension

Patients with hypertension should be encouraged to take regular readings with home blood pressure monitors — just as those with diabetes check their blood glucose — according to a new scientific statement released online by the American Heart Association, the American Society of Hypertension, and the Preventive Cardiovascular Nurses Association.

The article includes an algorithm for using home BP measurements to aid in clinical decision-making. To that end, patients with elevated BP at the office should take home measurements at least 12 times over a week. The preferred devices attach to the upper (usually nondominant) arm, have cuffs that inflate automatically, use oscillometric detection, and store results in memory.

Patients should bring their home monitors to the office to ensure they are using the proper technique and to calibrate their devices.

Hypertension article (Free PDF)

Associated Press story (Free)

Early Intensive Insulin Therapy More Effective Than Oral Agents in Type 2 Diabetes

Patients with newly diagnosed type 2 diabetes respond better to intensive treatment with insulin than with oral medications, according to an industry-funded Lancet study.

Some 400 newly diagnosed adults between the ages of 25 and 70 (mean, 51) were randomized to short-term intensive therapy with either insulin (continuous subcutaneous infusion or multiple daily injections) or oral hypoglycemic agents. Treatment was stopped when patients had maintained normal glucose levels for 2 weeks.

Glycemic control was achieved by significantly more insulin than oral-drug recipients (96% vs. 84%), and the time to glycemic control was significantly shorter with insulin (5 vs. 9 days). At 1 year, roughly half of insulin patients required no medication, compared with about a quarter of oral-medication patients.

The authors speculate that early intensive glycemic control may "rescue injured beta cells, avoiding irreversible loss of beta-cell secretory function and beta-cell mass that leads to the worsening of diabetes."

Lancet article (Free abstract; full text requires subscription)

The dangers of olfactory loss

Summary

Objective > To assess the risk of home accidents related to severe hyposmia.

Methods > A questionnaire, completed by 57 hyposmic patients and 49 control subjects with a normal sense of smell, asked about four

specific types of olfactory-related home accidents: undetected fires, undetected gas leaks, consumption of spoiled food, and incidents of food

burning. Level of olfactory function was determined by olfactory testing (Biolfa®).

Results > Olfactory testing revealed that 60% of the patients were anosmic and 40% had severe hyposmia. They reported cooking-related

accidents most often (63%), followed by eating spoiled food (51%), inability to detect a gas leak (47%) and inability to smell a fire (26%).

All these accidents were significantly more frequent than in the control population (p < 10-4).

Discussion and conclusion > This paper, the first in the European literature and the second in the international literature, shows that patients

with severely impaired olfaction are more likely to experience related accidents than those with normal olfactory function

'Metabolic Syndrome' Offers No Benefit in Risk Assessment

Diagnosing "metabolic syndrome" has no apparent clinical value, reports a Lancet study released early online.

To study whether the syndrome can predict risk for cardiovascular diseases and diabetes, researchers used two study populations comprising some 7500 elderly individuals (aged 60 to 82 years) without diabetes at baseline. Members of the first population either had preexisting cardiovascular disease or were at heightened risk for it. The second group, drawn from the general population, was used to corroborate the results of the first study.

In both studies, metabolic syndrome was associated strongly with risk for diabetes, but the association between metabolic syndrome and cardiovascular disease was negligible. In addition, increased fasting glucose alone was strongly associated with diabetes — to the extent that the authors say a separate diagnosis of metabolic syndrome is "not necessary."

A commentator from the American Diabetes Association agrees, calling the work "another nail in the coffin of the metabolic syndrome."

Lancet article)

Metabolic Syndrome Linked with Cholesterol Levels

Syndrome more likely in those with high levels of low-density lipoprotein

There is an association between levels of oxidized low-density lipoprotein (LDL) and presence of the metabolic syndrome and its components, according to research published in the May 21 issue of the Journal of the American Medical Association.

Paul Holvoet, Ph.D., of the Katholieke Universiteit Leuven in Belgium, and colleagues conducted a study of 1,889 participants aged 18 to 30 at baseline who were examined again after 15 and 20 years.

The researchers found that there were 243 subjects (12.9 percent) who did not have metabolic syndrome at the 15-year mark and who did have it at the 20-year mark. Those in the highest quintile for oxidized LDL were 3.5 times more likely to have the metabolic syndrome than those in the lowest quintile. The odds for those in the second, third and fourth quintile were 2.1, 2.4 and 2.8, respectively, the report indicates.

"As yet, it is not possible to conclude whether oxidized LDL is a marker related to mechanistic underlying factors on the pathway to the development of metabolic syndrome, or whether it is by itself a functional intermediary in this pathway," the authors write. "However, the strong association of oxidized LDL with the incidence of metabolic syndrome is consistent with a causal role."

Abstract

http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=518212&contextCategoryId=40130

Are Low Vitamin D Levels Associated with Nonspecific Pain?

The results of two studies argue against any simple relation between diffuse pain and vitamin D deficiency

http://general-medicine.jwatch.org/cgi/content/full/2008/520/1?q=etoc_jwgenmed

Smoking Cessation Lowers Risk for Premature Death

All-cause mortality returns to baseline 20 years after smokers quit.

JAMA 2008 May 7; 299:2037