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Coronary Heart Disease: Stagnation in Young Adults & Women

Coronary Heart Disease: Stagnation in Young Adults & Women

Recent reports have shown that coronary heart disease (CHD) continues to be a leading cause of death among Americans despite a remarkable decline in cardiovascular deaths related to the disease over the past several decades. CHD mortality rates fell by as much as 52% in men and 49% in women between 1980 and 2002, according to some research. However, other data suggests that these beneficial trends may not have been experienced by all demographic groups. “A 2007 study showed that there was a dramatic slowing in the average annual rate of decline of CHD mortality among adults aged 35 to 54,” explains Viola Vaccarino, MD, PhD. “Younger women appeared to be a particularly vulnerable patient group in this analysis.” Examining Long-Term Trends For a study published in Circulation, Dr. Vaccarino and colleagues examined CHD mortality rates in the United States by age and sex from 1979 to 2011. “It’s important to assess long-term trends in CHD mortality to monitor our progress and see if more work is needed,” says Dr. Vaccarino.  The study group calculated age-specific CHD mortality rates and compared estimated annual percentage changes (EAPC) during three approximate decades of data: 1979–1989, 1990–1999, and 2000–2011. The authors then used regression modeling to assess EAPC trends over time. According to the results, the EAPC from 1979 to 2011 was lower in people younger than 55 years of age than in older groups in the two most recent decades. In contrast, CHD mortality rates declined steeply after 2000 for both women and men who were aged 65 and older. Younger Women at Particular Risk The study also revealed that the...
Women Suffer from Asthma Symptoms More Frequently and More Severely than Men

Women Suffer from Asthma Symptoms More Frequently and More Severely than Men

Women suffer more frequently and more severely from pollen and food allergies and therefore also from asthma. Firstly, female sex hormones increase the risk and symptoms of asthma and allergies and, secondly, hormone preparations such as the contraceptive pill play a role. These factors should be given more consideration than was previously the case. Erika Jensen-Jarolim from MedUni Vienna’s Institute of Pathophysiology and Allergy Research stresses this point on the occasion of International Women’s Day on 8 March. Up until the age of 10, boys are more likely to suffer from allergies and asthma and to have more severe symptoms. But the increased production of the sex hormone estrogen associated with the onset of sexual maturity and puberty means that girls become much more susceptible. Jensen-Jarolim explains: “Oestrogens cause inflammatory cells, such as the mast cells, for example, to react more sensitively to allergens. Conversely, the male hormone testosterone seems to exert a kind of protective function.” Related Articles CME/CE: Characterizing Asthma-COPD Overlap Syndrome Late-Onset Asthma & Cardiovascular Disease Risks Serum Periostin IDs Comorbid Chronic Rhinosinusitis in Asthma Mite-Proof Mattress Covers Could Reduce Severity of Asthma Flares This phenomenon accompanies women through the waves of hormone production in their respective life phases — from their first period to the taking of contraceptives, pregnancy through to hormonal replacement therapy at the menopause. In addition to that, they become more sensitive to environmental pollutants, especially smoking. Nowadays, taking hormones is almost unavoidable because of life and family planning and also to avoid falling hormone levels, which play a significant role in the development of osteoporosis, for example. “Such hormone treatments can...
No Link Found Between HIV Levels and Immune Activation During Antiretroviral Treatment

No Link Found Between HIV Levels and Immune Activation During Antiretroviral Treatment

Despite successful treatment, people receiving antiretroviral drugs continue to have small amounts of human immunodeficiency virus (HIV) in their blood, as well as elevated immune system activation. However, new research published in PLOS Pathogens shows no correlation between these two measurements. Previous research has revealed links between elevated immune system activation and medical complications such as heart disease. Knowing why patients on antiretroviral drugs have elevated immune activation could help address or prevent such complications. However, the mechanism behind this elevated activation is unclear and actively debated. To gain new insight, Rajesh Gandhi of Massachusetts General Hospital, Boston, and colleagues in the AIDS Clinical Trials Group (ACTG) tested whether elevated immune activation drives or is driven by the low levels of HIV still found in patients undergoing treatment. Using blood samples from people who took part in ACTG clinical trials, they measured molecular markers of HIV, immune system activation, and inflammation in 101 people before and during treatment with antiretroviral drugs for a median of 7 years. During treatment, the participants had undetectable levels of virus in the blood on standard commercial tests but HIV could still be detected using sensitive research techniques. Related Articles Direct and indirect effects of enablers on HIV testing, initiation and retention in antiretroviral treatment and AIDS related mortality Antiretroviral Treatment in HIV-1-Positive Mothers Use of plasma human herpesvirus-8 viral load measurement: evaluation of practice in three UK HIV treatment centers The HIV treatment cascade and care continuum: updates, goals, and recommendations for the future Before treatment, the researchers found a correlation between HIV levels, immune activation, and inflammation in the patients. However, this...
Implementing COPD Pulmonary Function Tests at the Point of Care

Implementing COPD Pulmonary Function Tests at the Point of Care

COPD is the third leading cause of death in the United States, with millions diagnosed and an additional 12 million who may remain undiagnosed. Beyond the personal burden for patients and families, the economic burden of COPD is estimated to reach $50 billion by 2020. To date, most patients with COPD are not diagnosed with the disease until they have lost 50% or more of their lung function. Suspicion of COPD is essential to enhancing outcomes of the disease among individuals aged 40 and older with dyspnea, especially for those with progressive dyspnea with exertion or with chronic productive cough and a history of smoking. Spirometry or pulmonary function testing can confirm COPD, assuring an accurate and timely diagnosis, but these tests are not available in many primary care offices. This means that physicians may need to send patients to an outside lab for lung function testing. Patients are often unable or unwilling to go to an outside site for this initial testing. In-office spirometry testing and diffusion capacity (DLCO) assessment could facilitate and confirm a diagnosis of COPD. However, research suggests that these tests continue to be underutilized due to lack of equipment, concerns about cost, lack of knowledge, or a combination of these factors. The Solution To address the growing number of COPD sufferers, it is crucial for primary care physicians and pulmonologists to provide reliable lung function testing so that the disease can be detected earlier. This testing would also enable clinicians to get accurate diagnoses and assist with the development of personalized treatment planning to optimize patient outcomes. The Global Initiative for Obstructive Lung Disease...
Statins May Benefit Cirrhotic Patients with Hepatitis B or C Infections

Statins May Benefit Cirrhotic Patients with Hepatitis B or C Infections

Infection with hepatitis B virus (HBV) or hepatitis C virus (HCV) can lead to cirrhosis as well as liver cancer. A Hepatology study from Taiwan has found that statins may provide benefits to patients with HBV- or HCV-related cirrhosis. When the liver fails to compensate for the functional overload resulting from disease, a situation called decompensation occurs. Decompensation significantly lowers the survival rate among patients with cirrhosis, and very few effective drugs are available. This latest study assessed information on 1350 cirrhotic patients identified from a representative group of Taiwan National Health Insurance beneficiaries from 2000 to 2013. Statin use was linked with a decreased the risk of decompensation in a dose-dependent manner. “The study demonstrates a favorable outcome that should be re-confirmed by future prospective and large-scaled studies,” said senior author Dr. Ching-Liang Lu. “Moreover, future investigations should also explore whether the favorable effect of statin use can also be extended to cirrhosis due to other causes, such as...
Best Nursing Schools in the Country Named by U.S. News

Best Nursing Schools in the Country Named by U.S. News

U.S. News ranked the top nursing schools in the country into two separate categories: Master’s Degree and Doctor of Nursing Practice. Duke University has the distinguished honor of topping both lists, while Johns Hopkins University in Baltimore secured the No. 2 spot on both rankings as well. The rankings are based on reputation, program selectivity and faculty resources, among other indicators. See the full methodology here. The top 10 nursing schools for Master’s Degrees are: Duke University (Durham, N.C.) Johns Hopkins University (Baltimore) University of Pennsylvania (Philadelphia) Emory University (Atlanta) Ohio State University (Columbus) University of Washington (Seattle) Yale University (New Haven, Conn.) Columbia University (New York City) University of Pittsburgh University of Maryland-Baltimore Click here to view the full Master’s list. The top 10 nursing schools for DNPs are: Duke University (Durham, N.C.) Johns Hopkins University (Baltimore) University of Washington (Seattle) Rush University (Chicago) Columbia University (New York City) Ohio State University (Columbus) University of Pittsburgh Case Western Reserve University (Cleveland) Yale University (New Haven, Conn.) University of Maryland-Baltimore Click here to view the full DNP...
Managing Acute Respiratory Tract Infections

Managing Acute Respiratory Tract Infections

Acute respiratory tract infections (ARTIs) are one of the most common reasons for acute outpatient physician office visits and antibiotic prescriptions among adults in the United States. “Inappropriate use of antibiotics for ARTIs is an important contributor to antibiotic resistance, an urgent public health threat, and costs the U.S. economy billions of dollars each year,” says Amir Qaseem, MD, PhD. “Efforts to reduce the inappropriate prescribing of these drugs in the ambulatory setting is a priority.” These efforts are necessary to improve quality of care, lower healthcare costs, and slow and prevent the continued rise in antibiotic resistance. Authors of the new guideline, which was published in Annals of Internal Medicine and is available online at http://annals.org, conducted an extensive literature review of evidence about appropriate antibiotic use for ARTI in adults. “According to CDC, 50% of antibiotic prescriptions may be unnecessary or inappropriate in the outpatient setting,” says Dr. Qaseem, who was one of the authors of the guidelines. “The recommendations in this paper are important to help stopping the unnecessary and inappropriate use of antibiotics for ARTIs.” Four Key Points According to Dr. Qaseem, the guideline from ACP and the CDC provide four key points of advice in an effort to promote high-value care: Clinicians should not perform testing or initiate antibiotic therapy in patients with bronchitis unless pneumonia is suspected. Providers and patients should weigh the benefits and potential for adverse effects when considering symptomatic therapy for these individuals. Clinicians should test patients with symptoms that are suggestive of group A streptococcal pharyngitis using a rapid antigen detection test and/or culture. For example, this testing should...
Study: Pharmacies Should Proactively Offer Naloxone to All Patients Who Meet Evidence-based Criteria

Study: Pharmacies Should Proactively Offer Naloxone to All Patients Who Meet Evidence-based Criteria

Pharmacies should proactively offer naloxone, a drug that blocks or reverses the effects of overdose, to patients taking opioid medications through universal opt-out strategies in an effort to get the life-saving drug into the hands of more people who need it, according to a new study out of Boston Medical Center (BMC). The US Department of Health and Human Services named expanding access to the rescue medication naloxone (known also by the brand name Narcan) one of three main strategies to address the opioid crisis. Research has found educating and providing naloxone to people who are at risk of witnessing or experiencing an overdose leads to a 30-50 percent decrease in opioid death rates. After conducting a series of eight focus groups in two states with over 60 pharmacists, pain patients, current and former drug users, and family members of people who use opioids, researchers found consistent support for an “opt-out” model of offering naloxone in the pharmacy, rather than the current model that has people asking for it at the pharmacy counter–where too few do. The opt-out model universally offers naloxone to those obtaining opioid prescriptions or those with identifiable medication-related risks, such as patients taking high doses of opioids for pain or for opioid use disorder, or those who are co-prescribed opioids and sleep aids or anxiety drugs. It would also target those who pick up such prescriptions for their family members. Related Articles Access to Naloxone Eased in Louisiana, Utah Use of Intranasal Naloxone by Basic Life Support Providers Naloxone Price Hikes Could Affect Rates of Opioid-Related Deaths Most Patients Taking Opioids Open to Receiving Naloxone...
Gastric Acid Suppression Medications Increase Risk for Recurrence of Clostridium Difficile Infection

Gastric Acid Suppression Medications Increase Risk for Recurrence of Clostridium Difficile Infection

Researchers at Mayo Clinic have found patients who use gastric suppression medications are at a higher risk for recurrent Clostridium difficile (C-diff) infection. C-diff is a bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon. The study is published in JAMA Internal Medicine. “In our study, we found that use of gastric acid suppression medications are associated with a statistically significant increased risk of development of recurrent C-diff in patients with a prior episode of C-diff,” says Sahil Khanna, M.B.B.S., a gastroenterologist at Mayo Clinic and senior author of the study. Dr. Khanna says gastric suppression medications studied include proton pump inhibitors, such as omeprazole, and histamine 2 blockers, such as ranitidine, which are commonly prescribed and consumed over-the-counter medications for gastroesophageal reflux disease, peptic ulcer disease or dyspepsia. Related Articles Bezlotoxumab Promising Against Recurrent Clostridium difficile Post-Operative Clostridium difficile Infection Among Veterans Health Administration Patients Asymptomatic C. difficile Ups Risk for Other Hospital Patients Gastric Acid Suppressants May Up Risk of Recurrent C. difficile In a systematic review and meta-analysis of 16 studies with 7,703 patients with C-diff, 1,525 developed recurrent C-diff. The rate of recurrent C-diff in patients with gastric suppression was 22.1%, compared to 17.3% in patients without gastric acid suppression. Click here to read the full...
Reducing Risks for Sudden Unexpected Death in Epilepsy

Reducing Risks for Sudden Unexpected Death in Epilepsy

For physicians who treat epilepsy, keeping patients focused on the positive—the promise of a normal, healthy life if seizures are controlled—may mean that difficult but important conversations about the implications of uncontrolled seizures are not happening. Specifically, research suggests that too few patients are being told about sudden unexpected death in epilepsy (SUDEP), the direst outcome of uncontrolled seizures. In a new Epilepsy Foundation survey of more than 1,000 epilepsy patients and caregivers, only 18% of patients and 27% of caregivers reported that they’ve had a discussion about SUDEP with a healthcare provider. For the approximate 3 million Americans with epilepsy, SUDEP is not uncommon. In fact, studies indicate that SUDEP is the leading epilepsy-related cause of death. An estimated one in 1,000 adults in the United States with epilepsy dies from SUDEP each year, and the risk increases to one in 150 among those with uncontrolled tonic-clonic (grand mal) seizures. Critical Conversations Considering this strong causal link between uncontrolled seizures and SUDEP, it’s critical that physicians convey to their patients the urgency of achieving seizure control and provide strategies to help. This starts with, but is not limited to, adherence to anti-epilepsy treatment regimens. These tragic but preventable deaths will continue as long as physicians and patients are not having conversations about how even a single seizure can put patients at risk for SUDEP. To help drive discussions about SUDEP, the Epilepsy Foundation’s SUDEP Institute recently issued a special expert consensus report called #AimForZero: Striving Toward a Future Free from Sudden Unexpected Death in Epilepsy. The report is the centerpiece of a multi-channel campaign to motivate people with...
Proving a Medical Malpractice Case I – Proving Negligence (Part II)

Proving a Medical Malpractice Case I – Proving Negligence (Part II)

[Editor’s note: this is the second installment of “Proving a Medical Malpractice Case I – Proving Negligence” by our blogger, Dr. Medlaw. You can read the first part here.] The one issue that never matters in a Standard of Care analysis is the individuality of patients because the entire purpose of medical care is to apply one’s overall knowledge and skill and  available resources to what is suitable for the specific patient. This brings us to how an expert establishes the Standard of Care for a lay jury. The guidelines from professional boards and societies will undoubtedly be cited.  The defense will note the likely disclaimer that these are not meant as definitive statements of the Standard of Care and will probably ask the judge to instruct the jury as such but these are still able to be taken as some evidence of  what the Standard of Care constitutes. The expert will also use texts, citations from the literature and references to their own experience to define what they hold to be the Standard of Care.  These presentations are, of course, subject to challenge on cross-examination. The expert’s testimony should also address the more intangible aspect of medicine as well.  Courts expect that medicine, as a discipline grounded in tested science, will have adequately formalized standards for practice but that “regions of art” will also be identifiable as distinct from that. It is the role of the expert to explain how the art in the practice, such as best medical judgment in a given circumstance, impacted on the case in a way that flat statistics cannot. So, now we...
Managing Own Cholesterol Proving Difficult for Most Patients

Managing Own Cholesterol Proving Difficult for Most Patients

People who have high cholesterol may understand they need to manage their condition, but many aren’t sure how to do that, nor do they feel confident they can, according to a new survey from the American Heart Association. The survey was conducted as part of Check.Change.Control.Cholesterol™, the association’s new initiative to help people better understand and manage their overall risk for cardiovascular disease, especially as it relates to cholesterol. Participants included nearly 800 people from across the country with either a history of cardiovascular disease (e.g. heart attack, stroke) or at least one major cardiovascular disease risk factor, (e.g. high blood pressure, high cholesterol or diabetes). High cholesterol is a known risk factor for heart disease and stroke, causing about 2.6 million deaths each year. Yet, nearly half (47 percent) of survey respondents with a known history of or at least one risk factor for heart disease or stroke, had not had their cholesterol checked within the past year. Respondents with high cholesterol reported more recent testing, although 21 percent of them had not had their cholesterol checked in the past year. Among other survey findings: Most people with high cholesterol said they understood the importance of managing their cholesterol, being confused, discouraged and uncertain about their ability to do so. 82% of all respondents identified a link between cholesterol and risk for heart disease and stroke. Overall, people with a history of cardiovascular had lower perceptions of their real medical risk of cardiovascular disease. Patients with a history of cardiovascular disease are at high risk for having another cardiovascular disease event, but among these patients, only 29% recognized...
Ban on Trans Fats in Diet May Reduce Heart Attacks and Stroke

Ban on Trans Fats in Diet May Reduce Heart Attacks and Stroke

People living in areas that restrict trans fats in foods had fewer hospitalizations for heart attack and stroke compared to residents in areas without restrictions, according to a study led by a Yale researcher. This finding suggests the benefit of limiting trans fats could have widespread impact as trans fat restrictions are set to expand nationwide. The study was published April 12 in JAMA Cardiology. Minimal amounts of trans fat intake are linked to greater risk of cardiovascular disease, the leading cause of death worldwide. Related Articles Childhood Adiposity Linked to Later Risk of Fatty Liver Disease Odd Chain Fatty Acids; New Insights of the Relationship Between the Gut Microbiota, Dietary Intake, Biosynthesis and Glucose Intolerance. To study the impact of restricting trans fats, Dr. Eric Brandt and his co-authors compared outcomes for people living in New York counties with and without the restrictions. Using data from the state department of health and census estimates between 2002 and 2013, the researchers focused on hospital admissions for heart attack and stroke. They found that three or more years after the restrictions were implemented, people living in areas with restrictions had significantly fewer hospitalizations for heart attack and stroke based on trends in similarly urban areas without the restrictions. The decline for the combined conditions was 6.2%. Click here to read the complete...
HIV Transmission Risk During Antiretroviral Therapy

HIV Transmission Risk During Antiretroviral Therapy

Research has shown that effective antiretroviral therapy (ART) decreases the risk of sexual transmission of HIV by suppressing blood and genital HIV RNA to undetectable levels by 24 weeks. However, the virus is still detectable in genital secretions during the first few weeks of ART, making residual risk of HIV transmission possible during the time between ART initiation and systemic viral suppression, explains Andrew Mujugira, MD, PhD. In a previous study of genetically linked HIV transmissions, Dr. Mujugira’s colleagues found that only one of 103 such transmissions occurred from an infected partner on ART. “The lone case was a female-to-male transmission that occurred soon after the infected partner started ART,” explains Dr. Mujugira. A  Secondary Analysis For a study published in the Journal of Acquired Immune Deficiency Syndromes, Dr. Mujugira and colleagues sought to determine HIV transmission risk during this period. “We conducted a secondary analysis of data from the Partners PrEP Study,” he says. “This was a randomized trial of antiretroviral pre-exposure prophylaxis (PrEP) for HIV prevention in 4,747 heterosexual HIV serodiscordant couples. The study was conducted at nine clinical trial sites from 2008 to 2012. A total of 1,817 HIV-infected people with HIV-uninfected partners initiated ART during the study.” HIV transmission risk was assessed using multiple biologic and behavioral measures: Time to first viral suppression in blood plasma. Persistence of HIV RNA in endocervical secretions and semen plasma. Frequency of condom-less sex (by self-report). Pregnancy incidence (in couples with HIV-infected and uninfected women). Phylogenetically linked HIV transmission within the couple. Important Findings The study team found that the cumulative probabilities of achieving blood viral suppression—defined as less...
New, Persistent Opioid Use Common After Surgery

New, Persistent Opioid Use Common After Surgery

Among about 36,000 patients, approximately 6 percent continued to use opioids more than three months after their surgery, with rates not differing between major and minor surgical procedures, according to a study published by JAMA Surgery. Millions of Americans undergo surgery each year, and many patients receive their first exposure to opioids following surgery. Despite increased focus on reducing opioid prescribing for long-term pain, little is known regarding the incidence and risk factors for persistent opioid use after surgery. Chad M. Brummett, M.D., of the University of Michigan Medical School, Ann Arbor, and colleagues used nationwide insurance claims data set from 2013 to 2014 to identify U.S. adults (ages 18 to 64 years) without opioid use in the year prior to surgery. Related Articles Recent Decline in Prescription Opioid Use Among U.S. Teens Opioid Users Incur Higher Costs After Elective Abdominal Surgery Initial Rx Can Affect Likelihood of Long-Term Opioid Use Concurrent Benzodiazepine, Opioid Use Up Significantly For patients filling a perioperative opioid prescription, the researchers calculated the incidence of persistent opioid use for more than 90 days among patients who had not used opioids previously, after both minor and major surgical procedures, and assessed data for patient-level predictors of persistent opioid use. A total of 36,177 patients met the inclusion criteria, with 29,068 (80 percent) receiving minor surgical procedures and 7,109 (20 percent) receiving major procedures. The group had an average age of 45 years and was predominately female (66 percent) and white (72 percent). The rates of new persistent opioid use were similar between the two groups, ranging from 5.9 percent to 6.5 percent. By comparison, the...
Physicians Practice: 7 Ways for Doctors to Relax

Physicians Practice: 7 Ways for Doctors to Relax

The author of this article is Eric Sprey, associate editor at Physicians Practice. Consciously choosing to have a positive outlook on life may improve your mood. It can also motivate others around you to become more positive about their jobs. Here are other strategies to relax more as a physician: Mentor. Balance your clinical practice with another professional pursuit, such as teaching or practice administration and/or leadership. This may help you feel more fulfilled. Volunteer. Developing outside interests like volunteering in the community or abroad can be a buffer to stress. Practice mindful meditation. This type of meditation can reduce stress, but the key is to carve out time to put it into action, even if it is just 10 minutes. Exercise. While it may seem a no-brainer, exercise confers multiple benefits, including stress management. Devote 30 minutes a day to some form of exercise to reach your highest level of performance. Become politically active. Engaging with legislative organizations can help you gain more control over laws that impact your practice. Have fun. Physicians need to let their hair down, especially considering the stresses associated with making life and death decisions every day. Network. Tools are available to help physicians derive better professional satisfaction and sustain medical practices. For example, the American Medical Association (AMA) has developed a series of knowledge-based educational modules called the AMA Steps Forward program. For the complete article, click...
40 Percent of General Practitioners Intend to Quit Within 5 Years

40 Percent of General Practitioners Intend to Quit Within 5 Years

Around two in every five GPs in the South West have said they intend to quit within the next five years, exposing the magnitude of the region’s impending healthcare crisis suggesting that the picture for the UK may be particularly challenging. The University of Exeter’s recent largescale survey of GPs across the region also found that seven out of ten GPs intend to change their working patterns in a way that would mean less contact with patients. This included leaving patient care, taking a career break, or reducing their hours. More than 2,000 GPs responded to the survey, in research which involved collaboration with Bristol University. It was funded by the National Institute for Health Research and published today in BMJ Open. The data provides a snapshot of low morale which, if echoed in other regions, could point to a deeper and more imminent crisis than previously anticipated in relation to the worsening shortage of GPs nationwide. Related Articles Strategies ID’d for Integration of Nurse Practitioners Into ICUs One in Five Post-Op Patients Need Unscheduled Help Physician Burnout Eroding Sense of Calling Burnout & Satisfaction: Examining Trends Professor John Campbell, of the University of Exeter Medical School, who led the research, has called for a move away from “sticking plaster solutions” towards robust, joined-up action to avert the crisis nationwide. Professor Campbell, a practising GP, said: “We carried out this survey because of a nationally recognised crisis in the shortage of GPs across the country, and our findings show an even bleaker outlook than expected for GP cover, even in an area which is often considered desirable, and which...
Aspirin, Anticoagulants, & Atrial Fibrillation

Aspirin, Anticoagulants, & Atrial Fibrillation

Previous research shows that aspirin is not as beneficial as oral anticoagulant agents for reducing thromboembolism risk. Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide and is associated with a significant risk for stroke. “Among patients with AF who are at intermediate or high risk for thromboembolism, national guidelines recommend that clinicians use anticoagulation with warfarin or the newer non-vitamin K antagonist oral anticoagulant agents (OACs) to help reduce morbidity and mortality,” explains Jonathan Hsu, MD, MAS. Little is known, however, about the extent to which AF patients at risk for stroke are prescribed only aspirin and the factors that determine this prescribing practice. A Closer Look For a study published in the Journal of the American College of Cardiology, Dr. Hsu and colleagues investigated the prevalence and predictors of treatment with aspirin only versus OAC therapy in AF patients at risk for stroke. The authors used 2008-2012 data from the National Cardiovascular Data Registry’s Practice Innovation and Clinical Excellence (PINNACLE) study. The data from PINNACLE allowed the research team to examine patterns of aspirin and OAC prescriptions among outpatients with AF who are being treated by cardiovascular specialist practices throughout the United States. It also enabled them to look at use of other antiplatelet agents. “Of the more than 210,000 patients with AF in the study who had a high risk for stroke, about 38% to 40% were treated with aspirin only instead of an oral anticoagulant,” says Dr. Hsu. “Coronary atherosclerosis-related comorbidities—including hypertension, dyslipidemia, coronary artery disease, and prior myocardial infarction, among other factors—were associated with more frequent prescriptions of aspirin only. Factors associated with...
High-Dose Vitamin D Supplementation Does Not Prevent Cardiovascular Disease

High-Dose Vitamin D Supplementation Does Not Prevent Cardiovascular Disease

Studies have reported increased incidence of cardiovascular disease (CVD) among individuals with low vitamin D status. To date, randomized clinical trials of vitamin D supplementation have not found an effect, possibly because of using too low a dose of vitamin D. Robert Scragg, M.B.B.S., Ph.D., of the University of Auckland, New Zealand, and colleagues randomly assigned adults (age 50 to 84 years) to receive oral vitamin D3 (n = 2,558; an initial dose of 200,000 IU, followed a month later by monthly doses of 100,000 IU) or placebo (n = 2,552) for a median of 3.3 years. Related Articles Does Vitamin D Decrease Risk of Cancer? Vitamin D, Calcium Supplementation Among Older Women Does Not Significantly Reduce Risk of Cancer Of the 5,108 participants included in the primary analysis, the average age was 66 years; 25 percent were vitamin D deficient. Cardiovascular disease occurred in 303 participants (11.8 percent) in the vitamin D group and 293 participants (11.5 percent) in the placebo group. Similar results were seen for participants with vitamin D deficiency at study entry and for other outcomes such as heart attack, angina, heart failure, hypertension, and stroke....
New CDC Study Finds Flu Vaccine Saves Children’s Lives

New CDC Study Finds Flu Vaccine Saves Children’s Lives

A new CDC study published today in Pediatrics is the first of its kind to show that flu vaccination significantly reduced a child’s risk of dying from influenza. The study, which looked at data from four flu seasons between 2010 and 2014, found that flu vaccination reduced the risk of flu-associated death by half (51 percent) among children with underlying high-risk medical conditions and by nearly two-thirds (65 percent) among healthy children. The study findings underscore the importance of the recommendation by CDC and the American Academy of Pediatrics that all children 6 months and older get an annual flu vaccine. Researchers estimated how effective the vaccine was at preventing flu-related deaths by comparing the vaccination status of the children who died from flu to comparison groups of children.  The comparison groups were obtained from two national surveys and a database of commercial insurance claims. Related Articles CDC: U.S. Flu Vaccination Rates Low So Far This Season CDC Concerned About Falling Flu Vaccination Rates AAP Releases Updated Guidance for Flu Vaccination in Children Flu Vaccination Among Healthcare Professionals “Every year CDC receives reports of children who died from the flu. This study tells us that we can prevent more of these deaths by vaccinating more,” said Brendan Flannery, PhD, lead author and epidemiologist in the Influenza Division. “We looked at four seasons when we know from other studies that the vaccine prevented flu illness, and we found consistent protection against flu deaths in children.” During the study period, 358 laboratory-confirmed, flu-associated child deaths were reported to CDC. Of the reported pediatric deaths with known vaccination status (291), only one in four...
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