Friday, November 29, 2013
USA Today (11/19, Hellmich, 5.82M) reports that according to a study presented a Tuesday’s AHA meeting, “taking the aspirin before bed may reduce the chance of having a heart attack or stroke in the morning.” Study author Tobias Bonten of the Leiden University Medical Center in the Netherlands explained, “Platelet activity is highest in the morning, and that is also the time that most heart attacks and strokes occur, so if you reduce platelet activity during the morning hours, you might reduce heart attacks and stroke at that time.”
The New York Times (11/19, 9.61M) reports in its “Well” blog that Bonten said, “I think in most Western countries, people take aspirin in the morning. It’s already one of our most effective medications. But maybe we can improve it a little bit more by switching the time.”
Friday, November 15, 2013
Among all pregnancies reported to the Australian and New Zealand Dialysis and Transplantation Registry from 2001 to 2011, women who conceived before starting dialysis had a better live birth rate than women who conceived after starting dialysis (91% vs. 63%), but their infants were of similar birth weight and gestational age. In both groups, babies were likely to be premature and of low birthweight. According to the CJASN study, more than 40% of pregnancies reached beyond 34 weeks, extreme prematurity occurred in 11.4% of pregnancies, and almost all babies who were born survived beyond 28 days after birth.
Thursday, November 14, 2013
Wednesday, November 13, 2013
New guidelines that could lead to higher statin use among US adults were discussed on all three of last night’s national news broadcasts, where they received a total of eight minutes of coverage. The guidelines also garnered extensive coverage in print, with stories featured on the front pages of at least four major US papers, and online. Many sources portray the guidelines as a major shift in the treatment of high cholesterol. Some of the sources also characterize the guidelines as “controversial.”
NBC Nightly News reported that “the first new guidelines in a decade about how” statins “should be prescribed” have been released, and they “could result in many more Americans taking these” medications.
On ABC World News, ABC’s Dr. Richard Besser said that the “new guidelines...dramatically expand” the use of statins “to one third of adults.”
The CBS Evening News called the new guidelines “controversial,” and reported that they “put less emphasis on cholesterol numbers and more on other risk factors in determining who should take medication.”
In a second segment on NBC Nightly News, Dr. Tanya Benninson, Chief Medical Officer at NBC Universal, discussed the guidelines.
In a front-page story, the New York Times (11/13, A1, Kolata, Subscription Publication, 9.61M) reports, “The new guidelines, formulated by the American Heart Association and the American College of Cardiology and based on a four-year review of the evidence, simplify the current complex, five-step process for evaluating who needs to take” the drugs.
USA Today (11/13, Szabo, 5.82M) reports, “The guidelines identify four high-risk groups who could benefit from statins: people with pre-existing heart disease, such as those who have had a heart attack; people ages 40 to 75 who have diabetes; patients ages 40 to 75 with at least a 7.5% risk of developing cardiovascular disease over the next decade, according to a formula described in the guidelines; and patients with the sort of super-high cholesterol that sometimes runs in families, as evidenced by an LDL of 190 milligrams per deciliter or higher.”
The Washington Post (11/13, A1, Dennis, Bernstein, 4.28M) reports on its front page that Kim Williams, vice president of the American College of Cardiology said, “Lower [LDL] is better, and no one’s arguing that, but once you have a reason to treat someone, they should be treated fully.”
In a nearly 1,200-word article on its front page, the Los Angeles Times (11/13, Healy, 3.07M) reports that the new “guidelines will align physician practices with a welter of new research showing what works – and what doesn’t – in preventing heart attacks and strokes, said Dr. Steven Nissen, an influential Cleveland Clinic cardiologist who was not involved in drafting the new” guidelines.
Bloomberg News (11/13, Cortez, 1.91M) reports that the aim “is to identify people most likely to benefit from treatment and stop trying to hit arbitrary targets that haven’t been proven to improve health, said Neil Stone...chairman of the panel that wrote the cholesterol guidelines.” However, it could “be difficult for some doctors and patients to adjust.”
In fact, the Wall Street Journal (11/13, A2, Winslow, Subscription Publication, 5.91M) points out that both those in favor of and against the new guidelines are concerned that they will lead to confusion among physicians and patients.
Additionally, the Boston Globe (11/13, A1, Kotz, 1.75M) reports on its front page that some physicians are concerned that nearly “one-third of American adults could now qualify for lifelong statin use, even if they do not have high cholesterol levels or any signs of heart disease.”
The AP (11/13, Marchione) points out that the “National Heart, Lung and Blood Institute appointed expert panels to write the new guidelines in 2008, but in June said it would leave drafting them to the” AHA and ACC. In addition to the statin guidelines, “new guidelines on lifestyle and obesity” were released yesterday, “and ones on blood pressure are coming soon.”
The New York Daily News (11/13, Miller, 3.94M) points out that “the new guidelines were published online” yesterday “and will appear in upcoming issues of the Journal of the American College of Cardiology and the AHA journal Circulation.”
The Los Angeles Times (11/13, Healy, 3.07M) “Science Now” blog reports that this “new game plan for statins represents a stark shift from approaches embraced by cardiologists and primary care physicians for most of the past decade.”
Similarly, CNN (11/13, Sloane, 14.53M) reports on its website that the new guidelines are “being called a tectonic shift in the way doctors will treat high cholesterol.” Also covering the story are Reuters (11/13, Berkrot), the CBS News(11/13, Jaslow, 3.87M) website, the NPR (11/13, Knox, 465K) “Shots” blog, AFP (11/13), The Oregonian (11/13, Muldoon, 751K), the Time (11/13, Park, 13.4M) website, Forbes (11/13, Herper, 6.03M), HealthDay (11/13, 5K),Medscape (11/13, O'Riordan, 164K), and the Baltimore Sun (11/13, Cohn, 812K) “Picture of Health” blog.
On its website, Time (11/12, Sifferlin, 13.4M) reports that the “U.S. Preventive Services Task Force [USPSTF] says that for most vitamins and minerals, there is not enough evidence to determine whether the pills can lower risk of heart disease or cancer.” With regard “to beta-carotene (found in carrots and tomatoes) and vitamin E, there is no evidence that they can protect against either heart disease or cancer; in fact, beta-carotene use contributed to an increased risk of lung cancer in smokers.”
CQ (11/12, Young, Subscription Publication, 967) reports that the USPSTF “said that ‘eating a diet rich in fruits, vegetables, whole grains, fat-free and low-fat dairy products, and seafood may play a role in the prevention of cancer or cardiovascular disease,’ even though no benefit has been shown for vitamins supplements in this connection.”
Reuters (11/12, Seaman) quotes Dr. Michael LeFevre, co-vice chair of the USPSTF, as saying, “At this point in time the science is not sufficient for us to estimate how much benefit or harm there is from taking vitamin or multivitamin supplements to prevent cancer or heart disease.”
MedPage Today (11/12, Neale, 122K) reports that “the guidance” released as a draft recommendation, “applies to primary prevention in healthy adults without nutrient deficiencies, with the exception of women who are pregnant or may become pregnant, a group that ‘should take a daily supplement containing folic acid to help prevent neural tube defects.’” The article points out that “the new proposed guidance is consistent with that from other organizations, including the National Institutes of Health and the Academy of Nutrition and Dietetics, which also found insufficient evidence to recommend the use of multivitamins” as a way to “prevent chronic disease.” HealthDay (11/12, 5K) also covers the story.
News that the FDA plans to eliminate artificial trans fats, which are found in crackers, cookies and many other baked goods, and are said to be responsible for thousands of heart attacks and deaths, was widely covered across the US media Thursday. The move earned praise from many health experts. However, results of a Pew poll and comments from some consumer groups suggest that many oppose the ban, with some seeing it as meddling too much in the food supply. ABC World News reported in its broadcast that the Food and Drug Administration issued a warning that “No amount of trans fat, no matter how small is safe.” The FDA estimates that 7,000 lives would be saved each year if trans fats and other partly hydrogenated oils were banned.
In its broadcast, NBC Nightly News characterizes the FDA move as a “bold” step, noting that while trans fat, also called as partially hydrogenated oil, makes the food taste better, it can make good cholesterol go bad and “bad cholesterol worse,” and “can make heart trouble for all.”
CBS Evening News interviewed FDA Commissioner Margaret Hamburg, who pointedly says: “This action will save lives. The CDC estimates that if we can reduce the levels of trans fat currently in the American diet,” the US could prevent heart attacks and save lives.
The Washington Post (11/8, Dennis, 4.28M) says the move by the FDA is the “most aggressive efforts to limit Americans’ consumption of a specific food ingredient” aimed “at ending the era of trans fats altogether.” The Post provides specific numbers of heart attacks and deaths it can prevent, noting that the ban could prevent 20,000 heart attacks and 7,000 deaths due to heart disease every year. The Post says that though products containing trans fats have “increasingly disappeared from grocery stores and restaurant menus” over the past few years, they “still linger in an array of processed foods, including pancake mix, packaged cookies and ready-made frosting.”
The move to eliminate trans fat was hailed as “lifesaving” by health experts, says USA Today (11/7, Weise, 5.82M). The paper quotes FDA commissioner Margaret Hamburg as saying, “There really is no safe level of consumption of trans fat.” Dean , a professor of medicine at the University of California-San Francisco, says these fats “increase the shelf life of foods but decrease the shelf life of humans.” Thomas , director of the Centers for Disease Control and Prevention says “5,000 Americans a year die of heart disease because artificial trans fat is in the food supply and another 15,000 will get heart disease.”
On its website, CBS News (11/8, 3.87M) quotes Dr. David , a cardiologist with the Cleveland Clinic, who says that “trans fatty acids are added to processed foods as an inexpensive way to improve taste and texture and lengthen shelf life, but there are other ways of achieving these results that do not directly promote the development of heart disease.”
In a front-page article, the Wall Street Journal (11/8, A1, Burton, Jargon, Subscription Publication, 5.91M) says an important moment in the history of trans fat was in middle of the last decade when the FDA mandated that food makers disclose trans fat in food products. The move led food makers to start using oils instead of trans fat, in a bid to stop noting the substance on the “Nutrition Facts” label, reports the Journal.
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n a study of 379 patients aged 75 years and older who initiated dialysis, 75% started treatments in the hospital because of an acute illness or surgery, and loss of independent living frequently occurred following such hospitalizations. Of 254 patients who came from home, 28% died in the hospital or were discharged to hospice, and only 37% could return home. Thirty-nine percent of patients died within 6 months of starting treatment; most of these initiated treatment in the ICU, while patients who started dialysis as outpatients had reasonably good survival. The findings were presented at ASN Kidney Week 2013.
Research published in JAMA linking testosterone therapy to higher heart risks was covered on one of last night’s national news broadcasts, as well as on several major websites, although it received little coverage in major print media.
The CBS Evening News reported that new research suggests that testosterone replacement therapy may be linked to heart risks in certain individuals.
The Wall Street Journal (11/6, Beck, Subscription Publication, 5.91M) reports that for the study, investigators looked at data on more than 8,700 men with low testosterone who underwent coronary angiography at some time between 2005 and 2011 in the US Veterans Affairs health system.
The Los Angeles Times (11/6, Healy, 3.07M) “Science Now” blog reports that patients “taking testosterone were 30% more likely to suffer an adverse event – a stroke, a heart attack or death.”
Forbes (11/6, 6.03M) contributor Larry Husten writes that “after adjusting for differences between the groups there was a significant 29% increase in risk associated with testosterone (CI 1.05-1.58, p = 0.02).” The researchers found that “the effect size was the same in the groups of people who had coronary artery disease and those who did not.”
AFP (11/6) reports that “the increased risk of catastrophic events was especially notable, said researcher Anne Cappola of the University of Pennsylvania, because ‘the men who were taking testosterone in this study were slightly healthier to begin with.’”
The CNN (11/6, 14.53M) “The Chart” blog reports, however, that some physicians “who looked at the study questioned the methods, saying many of these men already had heart issues.”
Bloomberg News (11/6, Ostrow, 1.91M) points out that previous research on “testosterone supplements...in elderly males, funded by the U.S. National Institute on Aging and run at Boston Medical Center, was” halted after “an audit found it caused more heart attacks and high blood pressure.” Also covering the story are Reuters (11/6, Pittman), the AP (11/6, Tanner), the NBC News (11/6, Alexander, 6.79M) website, HealthDay (11/6, Dotinga, 5K),MedPage Today (11/6, Raeburn, 122K), and Medscape (11/6, O'Riordan, 164K).
The prevalence of uncontrolled and resistant hypertension increased with advanced diabetic nephropathy in aDiabetes Care study of 3678 patients with type 1 diabetes. In patients with normal urinary albumin excretion, 14.1% were on antihypertensive treatment and 74.6% had uncontrolled blood pressure despite treatment. The corresponding figures were 60.5 and 71.2% for microalbuminuric, 90.3% and 80.0% for macroalbuminuric, 88.6% and 88.1% for dialysis, and 91.2% and 90.4% for kidney transplanted patients. The prevalence of resistant hypertension was 1.2% in the normoalbuminuric, 4.7% in the microalbuminuric, 28.1% in the macroalbuminuric, 36.6% in the dialysis, and 26.3% in the kidney transplant groups.
In a recent trial, patients with hyperuricemia who took urate lowering therapy and achieved a serum uric acid of less than 6 mg/dL—consistent with the 2012 American College of Rheumatology Guidelines for Management of Gout—experienced a 37% reduction in progression of renal disease. The majority of patients who took urate-lowering therapy during the course of the study were taking allopurinol. The findings, presented at the American College of Rheumatology Annual Meeting, suggest that treating to the guidelines is an effective way of preventing and controlling kidney disease in people with hyperuricemia.
On its website, NBC News (10/25, Aleccia, 6.79M) reports that, according to an analysis published Oct. 24 in the Clinical Journal of the American Society of Nephrology, “paying living kidney donors $10,000 to give up their organs would save money over the current system based solely on altruism – even if it only boosts donations by a conservative five percent.” For the study, researchers from the University of Calgary “compared cost data from a cohort of kidney patients identified in 2004 and followed them for three years.” Investigators calculated that “paying living kidney donors $10,000 apiece would save about $340 per patient, compared with the ongoing costs of dialysis, and would also provide a modest boost of .11 in quality-adjusted life years.”
The Time (10/25, Alter, 13.4M) “Healthland” blog points out that “if the money actually results in a 10% or 20% increase, the savings per patient could reach thousands of dollars,” for the reason that “most patients wait 2-3 years for a kidney, and the cost of dialysis during the wait is usually higher than $10,000.” The analysis did not “address ethical concerns or the potential for abuse,” however.