• Trans Fat Intake Is Associated with Excess Risks for All-Cause Death and
Adverse CV Outcomes
• People Worldwide Living Longer, but not necessarily in Good Health
• Consumption of Spicy Food Is associated inversely with Risk for Death
• Long Work Hours are Associated with Excess Risk for Coronary Heart Disease
and Stroke
• Statin use common for Primary Prevention among the Very Elderly
• H. Pylori Eradication Treatments Ranked
• Parent-Child Weight Status associated with Parental Pressure to Eat or
Restrict Food
• Follow-Up: Interview on an Obesity Pathway in the Genome
• Risks of Cardiometabolic Comorbidities
• Cases of Human Plague this year in U.S.
• How to keep Your Pregnant Patient from Getting Fired
• Do People understand the New FDA Sunscreen Labels?
• An Artificial Heart made of Bioprosthetic Materials: Plusses and Minuses
• Exercise Program, Supplements show no effect on Cognition in Elders
• Quitting Smoking after Heart Attack linked to Better Mental Health
• Polidocanol reduces Colon Polypectomy Bleeding
MM: The FDA is reacting to a significant amount of data that supports the withdrawal of trans fat from the commercial market as a health risk and hazard. One of the many problems with this approach is the possible effect on the infrastructure of the companies that are producing these products and the downstream loss of jobs for the people providing the trans fats for the food industry. Can these products be re-directed to biodiesel? Will jobs be lost? What will the food industry replace the trans fats with? Will they be more dangerous that the trans fats were? Dr Eisenstein used to say that drug companies and probably food manufacturing & processing never get rid of a product unless they have something more dangerous to replace it with. I can only hope for the welfare of the American population and the international community that this will not be the case.
BMJ 2015 Aug 12; 351:h3978
Trans Fat Intake Is Associated with Excess Risks for All-Cause Death and
Adverse CV Outcomes
The FDA is requiring all trans fat to be eliminated from foods by 2018.
For decades, clinicians have encouraged patients to consume diets low in saturated fat. However, emerging evidence suggests that saturated fat intake is not associated as clearly with health risks as we previously thought. In contrast, trans fat intake is associated unambiguously with elevated cardiovascular (CV) risk, which has prompted the FDA to declare that trans fat is “not generally recognized as safe” for use in human food and to set a 2018 deadline for food companies to eliminate trans fat from their products. In this meta-analysis of dozens of prospective observational studies, researchers assessed associations between saturated or trans fat intake and several health outcomes.
After adjustment for multiple variables, high intake of saturated fat (found in meat, eggs, milk products, salmon, chocolate, and palm oil) was not associated with excess risks for all-cause death, coronary heart disease (CHD)–related mortality, CV-related mortality, total CHD, ischemic stroke, or type 2 diabetes.
After adjustment for confounders, high total trans fat intake was associated with significant excess risks for all-cause death (relative risk, 1.3), CHD-related mortality (RR, 1.3), and total CHD (RR, 1.2).
Intake of industrial trans fat (found in processed foods) was associated with excess risks for CHD-related mortality (RR, 1.2) and total CHD (RR, 1.4), whereas intake of ruminant trans fat (produced in the gut of some grazing animals and comprising a small proportion of fat in dairy products, beef, and lamb) was associated with lower risk for type 2 diabetes (RR, 0.6).
Comment: In this analysis, saturated fat intake was not associated with adverse health outcomes. However, these results should not be interpreted as endorsing a high–saturated fat diet. First, given the observational design, confounding is possible. Second, in certain subgroups (e.g., younger participants [age, <60], U.S. cohorts), researchers noted a significant association between higher saturated fat intake and CHD-related mortality. Third, a recent meta-analysis of randomized trials showed that reducing saturated fat intake from 17% to 9% of total energy intake (and replacing saturated fat with polyunsaturated fat, but not carbohydrates or proteins) significantly lowered risk for CV disease (Cochrane Database Syst Rev 2015; 6:CD011737). These results do support the FDA's decision to require elimination of trans fat from foods.
Citation(s):de Souza RJ et al. Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: Systematic review and meta-analysis of observational studies. BMJ 2015 Aug 12; 351:h3978. (http://dx.doi.org/10.1136/bmj.h3978)
http://www.bmj.com/content/351/bmj.h3978?ijkey=60c7bc4d7973f3026fa26b62f76d8b3
6367ec67e&keytype2=tf_ipsecsha
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MM: It is not just the length of life that matters but the quality (QOL) that is important. How many times have you heard a person say that if they'd known they were going to live so long, they would have taken better care of their bodies. Smoking, drinking, excessive eating. lack of exercise and intellectual stimulation and finally the failure to create lasting and meaningful relationships with a variety of people of varying ages all take a drain on the human body and psyche. These are all necessary components to have a full and fulfilling life. There are other areas that are beneficial such as a satisfying religious connection, a loving partner and giving of yourself to others that have been shown to enrich a person's life and personal sense of well-being. There is not a single activity or action that is right for everyone but there are lots of options.
People Worldwide Living Longer, but Not Necessarily in Good Health
By Kelly Young, Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS
Global life expectancy increased by 6 years to 71.5 years from 1990 to 2013, but time spent living in good health has not quite kept pace, according to a Lancet study.
Using a database of country-level results for major diseases and injuries, researchers calculated disability-adjusted life-years and healthy life expectancy both globally and for each of 190 nations.
Among the results:
- From 1990 to 2013, healthy life expectancy rose by 5.4 years, to 62.3 years.
- In 2013, Japan had the highest healthy life expectancy (73 years), while Lesotho had the lowest (42 years). For U.S. men, healthy life expectancy was 66 years and for women, 69.
- The biggest contributors worldwide to lost years of healthy life were ischemic heart disease, lower respiratory infections, stroke, low back and neck pain, and road injuries.
- Age-standardized disability-adjusted life-years fell by 27% during this period, but this was offset by population growth and aging.
The authors note: "Global health is improving but population increase and ageing are keeping the crude rates of [disability-adjusted life-years] constant, showing that progress in health does not mean fewer demands on health systems."
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2961340-X/abstract
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MM: I am not convinced that the eating of spicy foods alone endows longevity benefits. I think that people who are healthier and feel better in general are more likely to be eating a varied and more interesting diet. Those with GI problems are probably less likely to be eating spicy foods as that may aggravate their GI issues. If it is true that the gut modulates more than two thirds of all immunological and inflammatory functions in the human body then it also makes sense that people with GI issues are to some extent health compromised and it follows that they will suffer from more inflammatory conditions that are self limiting and are more susceptible to various auto-immune and immuno-deficiency conditions compared to those with healthy guts and who, by chance, are more likely to be eating more spicy foods.
BMJ 2015; 351:h3942
Consumption of Spicy Food Is Associated Inversely with Risk for Death
During 7 years, people who ate spicy food at least once weekly were less likely to die of any cause.
Evidence suggests that consuming spices has health benefits. Whether daily consumption of spicy foods affects health outcomes, including mortality, is unclear. In this prospective, population-based study of 199,000 men and 288,000 women (age range, 30–79 at enrollment) in the U.S. and China, researchers assessed the associations between regular consumption of spicy foods and total and cause-specific mortality during a median 7-year follow-up.
A total of 11,800 men and 8400 women died during follow-up. After adjustment for multiple variables, consumption of spicy foods was associated inversely with risk for all-cause death. Compared with participants who ate spicy foods rarely (<1 day weekly), those who ate spicy foods more often were 10% to 14% less likely to die. Similar results were observed for men and women. Finally, consumption of spicy foods was associated inversely with risks for death caused by ischemic heart disease, cancer, and lung disease.
Comment: In this large prospective study, consumption of spicy food was associated inversely with risk for all-cause and specific death during 7 years. People who enjoy spicy foods will welcome these results, which are biologically plausible. Spices have bioactive ingredients that have health benefits (e.g., consumption of red pepper dampens appetite and ingestion of calories). However, given the study's design, causality cannot be established, and residual confounding is possible.
Citation(s):Lv J et al. Consumption of spicy foods and total and cause specific mortality: Population based cohort study. BMJ 2015; 351:h3942.
(http://dx.doi.org/10.1136/bmj.h3942)
Abstract/FREE Full TextForouhi NG.Consumption of hot spicy foods and mortality-is chilli good for your health? BMJ 2015; 351:h4141.
(http://dx.doi.org/10.1136/bmj.h4141)
http://www.bmj.com/content/351/bmj.h4141?ijkey=27c57267d9ad714b63a8c3f
4006c380779594434&keytype2=tf_ipsecsha
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MM: Working more hours may be indicative of greater stress and greater adrenal fatigue that will have an effect on heart and cardiovascular health in general. Having time to enjoy the company of others and decompress has an effect on sleep, body weight and a variety of bodily conditions such as blood pressure and cardiac output. The long hours alone are likely not the culprit. The denial of everything else that provides a greater Quality of Life is more likely the detrimental component.
Lancet 2015 Aug 19
Long Work Hours are Associated with Excess Risk for Coronary Heart Disease
and Stroke
Encouraging or requiring people to work longer hours could have substantial public health implications.
Two meta-analyses of published cohort studies have suggested that long working hours lead to excess risk for coronary heart disease (CHD). To explore this hypothesis further, researchers combined data from 25 prospective cohort studies from Europe, the U.S., and Australia that included data on working hours and incident CHD or stroke. The resulting data sets included more than 600,000 people who were followed for a mean 8.5 years for CHD and more than 500,000 people who were followed for a mean 7.2 years for stroke.
Compared with standard working hours (35–40 hours weekly), and after adjustment for age, sex, and socioeconomic status, long working hours (>55 hours weekly) were associated significantly with higher risk for incident CHD (relative risk, 1.13) and stroke (RR, 1.33). Risk for incident stroke increased linearly as working hours increased; no such dose-response relation was seen for CHD. Excess risk for CHD with longer working hours was more pronounced in patients with low than with high socioeconomic status; no other significant subgroup differences were found.
Comment: Mechanisms for an association between long working hours and incident CHD and stroke are unknown but might include prolonged or repetitive stress, physical inactivity, and excess alcohol consumption. Average working hours vary widely among developed countries and represent modifiable social decisions. Social policies encouraging or requiring people to work longer hours could have substantial public health implications.
Citation(s):Kivimäki M et al. Long working hours and risk of coronary heart disease and stroke: A systematic review and meta-analysis of published and unpublished data for 603 838 individuals. Lancet 2015 Aug 19; [e-pub].
(http://dx.doi.org/10.1016/S0140-6736(15)60295-1)
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MM: There is no doubt in my mind that statins are over-prescribed. One of the problems is that cholesterol has been demonized and is no longer recognized as a very necessary part of life. As we age cholesterol has a changing function from earlier in our lives. It is necessary for the production of Vitamin D, for sex hormone production and a variety of other metabolic functions. As we age the need for high levels of sex hormones may not be overly important for pro-creation but they are necessary for maintaining cognition, energy, and general health. A lack of these hormones may lead to depression, wasting, falling and injuries such as broken hips or other bones. Overall, we need to provide further education for clinicians working with the elderly and make them aware that cholesterol is not the enemy. lack of movement and poor dietary structure is a much greater nemesis.
Statin Use Common for Primary Prevention Among the Very Elderly
By Amy Orciari Herman, Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD
One third of very elderly people without vascular disease reported using statins in 2011–2012 — despite the lack of a clear understanding of the benefits in this population — according to a research letter in JAMA Internal Medicine.
Researchers examined national survey data from over 13,000 community-dwelling elders aged 80 and older from 1999 to 2012. Among those without vascular disease, use of statins rose from 9% in 1999–2000 to 34% in 2011–2012. Statin use among those with vascular disease also increased significantly during this time.
Harlan Krumholz, editor-in-chief of NEJM Journal Watch Cardiology, commented: "This article points to a key vulnerability in the evidence about the risks and benefits of statins for primary prevention for our oldest patients. By our conventional risk equations, all very elderly have high risk. With an expanding elderly population and growing use of statins, it is imperative that we generate knowledge about which elderly patients derive the most benefit."
http://archinte.jamanetwork.com/article.aspx?articleid=2429533
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MM: I find it interesting and aggravating that probiotics accompanying triple antibiotic therapy ranked almost as high as triple antibiotic therapy alone but it has been placed way in the back of the intellectual bus and ignored. The use of combines probiotic/antibiotic triple therapy not only eradicates H. pylori more effectively that the triple therapy alone but prevents and certainly addresses more downstream issues such as dysbiosis and pathogenic overgrowth as a result of the elimination of bacterial microorganism diminished competitive inhibition. The gross elimination of microorganisms increases the risk and likelihood of establishing a GI dysbiosis and consequent co-morbid conditions such as rheumatoid arthritis, Irritable bowel syndrome, allergies, asthma and a host of other immunological ind inflammation associated diseases and conditions.
H. pylori Eradication Treatments Ranked
By Kelly Young, Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH
Concomitant triple therapy has come out on top in a ranking of effective Helicobacter pylori eradication treatments published in the BMJ.
Using a network meta-analysis of 143 randomized trials, researchers compared 14 different regimens. In terms of efficacy in eradicating H. pylori, the highest ranking treatments included:
- concomitant triple therapy (simultaneous proton pump inhibitor plus three antibiotics; 7, 10, or 14 days);
- probiotic-supplemented triple therapy (10 or 14 days);
- levofloxacin-based triple therapy (10 or 14 days);
- hybrid treatment (14 days);
- sequential treatment (10 or 14 days).
Relative efficacy rates are available in the article. The previously recommended 7 days of standard triple treatment (a PPI, clarithromycin, plus either amoxicillin or metronidazole) was the least effective — perhaps because of H. pylori's increasing antibiotic resistance, the authors write.
The only significant reductions in adverse events came from 7 days of triple therapy plus probiotics and levofloxacin-based triple therapy. Longer treatments appeared to increase this risk.
An editorialist notes that "the best treatment will depend on local resistance patterns, but standard triple therapy is an increasingly unlikely candidate."
http://www.bmj.com/content/351/bmj.h4052?etoc=
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MM: Nature vs Nurture certainly comes into play in this study. Combine that with social pressure and any stigma associated with being overweight and it leads to a possible unhealthy relationship with food that is passed from generation to generation. Children who are more active will increase muscle development and will increase metabolic calorie consumption. It is much easier to start building muscle mass at an early age than later in life. With that in mind, perhaps these parents should emphasize types of food and appropriate physical activity rather than strictly the amount of food consumed.
Parent-Child Weight Status Associated with Parental Pressure to Eat or Restrict Food
By Kelly Young, Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH
Parents and children with similar weight status have higher odds of parental pressure to eat more or less food, according to a cross-sectional study in Pediatrics.
Researchers assessed the BMIs of over 2000 Minnesota adolescents and their parents and surveyed the parents about whether they encouraged their child to eat more or tried to restrict access to food.
When both the parent and the child were not overweight, there was a higher level of parental pressure to eat, compared with when one or both were overweight. However, when both the parent and the child were overweight, there was a higher level of parental food restriction, compared with when one or both were not overweight.
The authors conclude that clinical interventions could target parent-child pairs most at risk (i.e., those concordant on weight status) "to help them reduce parent food restriction and pressure-to-eat practices ... and engage in other practices that may be more effective."
http://pediatrics.aappublications.org/content/early/2015/08/18/peds.2015-0326
Follow-Up: Interview on an Obesity Pathway in the Genome
Clinical Conversations interviews the senior author of a paper describing a genetic pathway that controls how efficiently we burn calories.
Published in the New England Journal of Medicine last week, the work offers no immediate cure for obesity, but it does offer a solid pathway to be exploited in that effort.
[Running time: 26 minutes]
http://podcasts.jwatch.org/index.php/podcast-183-an-obesity-switch-in-the-genome-described/2015/08/21/?query=pfw
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MM: It seems that the answer to living a long and healthy life is to focus on an appropriate balance of physical activity, balanced and generally healthy foods that are not consumed to excess and being blessed with good genes that do not lend themselves to western society diseases.
Risks of Cardiometabolic Comorbidities
A long-term cohort follow-up revealed that mortality associated with having diabetes was as bad as having a prior stroke or myocardial infarction.
To provide estimates of morbidity and mortality associated with various combinations of cardiometabolic conditions, investigators analyzed data from 689,300 participants in the Emerging Risk Factors Collaboration in 91 cohorts across 18 countries collected from 1960 through 2007. Analyses were stratified by sex and adjusted for age and then further adjusted for major cardiovascular risk factors, diet, and socioeconomic status.
During extended follow-up, 135,000 deaths occurred (all-cause mortality rate, 7 per 1000 person-years). For individuals with a history of diabetes, stroke, or myocardial infarction (MI), mortality was much higher (about 16 per 1000 patient-years). For a combination of any two of the factors (diabetes, MI, or stroke), mortality was about 32 per 1000 person-years, and if all three were present, mortality was 60 per 1000 person-years. Mortality rates were similar for individuals recruited remotely versus those recruited more recently in a separate cohort from the U.K. Biobank.
The investigators estimate that a history of any two of the conditions reduced life expectancy at age 60 by about 12 years, whereas the combination of all three reduced life expectancy by about 15 years. The association between baseline cardiovascular disease and mortality was stronger for men than for women, whereas the association between baseline diabetes and mortality was stronger for women than for men.
Comment: These data highlight the devastation that cardiometabolic diseases cause and the fact that the overall mortality risk associated with diabetes is the same as the risk conferred by overt cardiovascular disease. Although there is likely significant heterogeneity, with some diabetes patients being at very high risk while others are at much lower risk, the overall risk associated with diabetes is still significantly increased. Furthermore, the increased mortality from a combination of all three conditions suggests a synergistic and multiplicative effect rather than only additive. These analyses also reveal sex differences in disease risk, with diabetes being a stronger risk factor in women and MI or stroke in men.
Citation(s):Di Angelantonio E et al. Association of cardiometabolic multimorbidity with mortality. JAMA 2015 Jul 7; 314:52.
(http://dx.doi.org/10.1001/jama.2015.7008)
http://www.ncbi.nlm.nih.gov/pubmed/26151266?access_
num=26151266&link_type=MED&dopt=Abstract
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MM: The very term "Plague" is frightening. The reason that there is a 500% increase in the number of people with plague may be associated with more people encountering animal hosts of the disease. How this is happening is still a mystery but even though there has been remarkable growth to the numbers, I do not believe that there is a worldwide risk for this disease to spread as there was 1000 years ago in Europe.
Cases of Human Plague This Year in U.S.
By Kelly Young, Edited by David G. Fairchild, MD, MPH
Eleven people have been diagnosed with plague in the U.S. since April. The CDC is urging healthcare providers to consider a diagnosis of plague in patients who have compatible symptoms (e.g., fever and malaise, possibly with abdominal pain, nausea, and vomiting) and who may have had contact with rodents while living or traveling in western states.
From 2001 to 2012, the median annual number of plague cases in humans was three. The CDC is not sure why there are more cases this year.
The following states have reported cases: Arizona, California, Colorado, Georgia, New Mexico, and Oregon. The cases in Georgia and California have been tied to recent travel around Yosemite National Park.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm64e0825a1.htm
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MM: This is an important guidance tool for pregnant women and their physicians. In these challenging economic times it seems that more and more employers are looking for ways to cut overhead and it would be a tragedy for a pregnant mom to fall prey to the financial numbers of a company for no other reason than a perceived decrease in productivity in the future. I have had several female staff members who left on maternity leave and returned to be fully functional and frequently more productive staff members.
Obstet Gynecol 2015 Aug; 126:250
How to Keep Your Pregnant Patient from Getting Fired
Suitably written work-accommodation notes for pregnancy-related health issues may protect pregnant women from losing their employment.
Women sometimes request notes from their clinicians documenting the need for work accommodations during pregnancy — and clinicians who write such notes properly can prevent their patients from losing their employment. The Family and Medical Leave Act (FMLA) mandates 12 weeks of unpaid leave with job protection, but only applies to certain employees (e.g., those who worked more than half time for ≥1 year at a company with >50 employees). If FMLA leave is exhausted during pregnancy, employment may be terminated unless the employee returns to work immediately postpartum. The Americans with Disabilities Act (ADA) does not necessarily protect women who request pregnancy-related work accommodations.
In writing a work note, clinicians should consider whether restriction is medically necessary or simply requested based on a belief that a particular work requirement (e.g., lifting) endangers pregnancy. Other considerations include whether accommodations can be delayed so allowable leave is not depleted before delivery, whether restrictions preclude an essential job function (if so, counsel the patient that job loss might result), and whether modifications can be made gradually as pregnancy progresses. The note should include the name and a brief description of the medical condition in lay and medical terms, revealing the patient's pregnancy only with her consent; any associated limitations; the accommodations needed and a list of potential solutions; and the onset and expected duration of impairment. The authors provide specific examples of how to write effective notes.
Comment: I was unaware that the ADA and FMLA do not protect women with pregnancy-related work restrictions. It's likely that women who need their salaries most are also those at highest risk for job loss in such circumstances. This helpful article provides the means for us to mitigate the threat to pregnant women's livelihoods when work restrictions are medically advisable.
Citation(s):Jackson RA et al. My obstetrician got me fired: How work notes can harm pregnant patients and what to do about it. Obstet Gynecol 2015 Aug; 126:250. (http://dx.doi.org/10.1097/AOG.0000000000000971)
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MM: For a sunscreen to provide both anti-cancer and anti-aging properties it must be BOTH Broad Spectrum and have an SPF at a minimum of 15. If it fails to meet BOTH of these requirements then it does not provide protection to children or adults other then the possible prevention of sunburn.
JAMA Dermatol 2015 Jun 17
Do People Understand the New FDA Sunscreen Labels?
For labeling to be effective, consumers must know what it means.
In 2011, the FDA approved a new sunscreen labeling system that maintained sun protection factor (SPF) as a quantitative index of ultraviolet B (UVB) protection and initiated a new system for rating UVA protection. Do consumers understand the new labels? Investigators surveyed 114 patients aged 18 and older attending an academic medical center dermatology clinic in summer 2014 regarding sunscreen labels.
Most responders did know which label items referred to UVA and to UVB protection. However, more than 40% indicated that their choice of sunscreen was driven primarily by high SPF, sensitive-skin formulation, and water or sweat resistance, and only about one third thought that use of a broad-spectrum sunscreen was important. A surprisingly small percentage understood that high SPF or broad-spectrum sunscreen protects against skin cancer (38%), that a broad-spectrum sunscreen is the most appropriate for preventing photoaging (7%), and that SPF value indicates the protective value against sunburn (23%).
Comment: The new, long-overdue labeling system for sunscreens announced in 2011 was welcomed by physicians. However, to be effective, it must be understood by consumers. This is particularly important for the new UVA and UVB classification. Many people don't understand that UVA and UVB have distinct effects and are responsible for different, but overlapping, UV-light–induced skin changes. Physicians can aid patient education by better explaining these differences and the importance of broad-spectrum sunscreen.
A publicity campaign by the FDA and other national organizations on photoprotection, the classification system used to assess their relative efficacy, and the differences in disease caused by the two forms of ultraviolet light would help people select the most suitable sunscreen.
Citation(s):Kong BY et al. Assessment of consumer knowledge of new sunscreen labels. JAMA Dermatol 2015 Jun 17.
(http://dx.doi.org/10.1001/jamadermatol.2015.1253)
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MM: I always love it when I get a chance to get my geeky nerd side involved. How cool is it to think that we are developing technology to save lives that uses combinations of manufactured materials and parts of farm animals. Is anyone else reading this that thinks it is ultra-cool and interesting?
Lancet 2015 Jul 28
An Artificial Heart Made of Bioprosthetic Materials: Plusses and Minuses
The first two patients had few problems with thromboembolism, but what happens when the device suddenly fails?
The development of a total artificial heart (TAH) has been challenging due to thromboembolism and hemorrhage. As part of a feasibility and safety trial, inventors in France who developed a bioprosthetic TAH (the CARMAT TAH) now report their experience in implanting the device in two male patients with end-stage dilated cardiomyopathy.
The device is made almost entirely with hemocompatible blood-chamber surfaces, including treated bovine pericardial and physiological myocardial tissue; physiologic pulsatile flow, delivered through viscoelastic contractility, allows for physiologic pressure curves. Implantation of the C-TAH requires removal of the ventricles.
The procedures were performed 9 months apart. The first patient (age, 76) presented with tamponade on postsurgical day 22 requiring intervention. Anticoagulation was stopped on day 24. He died suddenly on day 74 due to device failure. Autopsy detected no relevant thrombus formation. The second patient (age, 68) was discharged from the hospital on postsurgical day 150. Four months later, he experienced low cardiac output and was admitted due to sudden device failure. Attempts at implanting a new device were unsuccessful. The authors state that both device failures were due to electronic components.
Comment This is the first report of successful implantation of this device for biventricular failure. Using bioprosthetic material appears to provide thromboembolic protection. As editorialists note, the disadvantage of all TAH systems compared with ventricular assist devices is “the absence of a biologic back-up pump” — the weak, but still existing, heart valve. These devices will become viable alternatives to ventricular assist devices only when the components demonstrate extreme durability.
Citation(s):Carpentier A et al. First clinical use of a bioprosthetic total artificial heart: Report of two cases. Lancet 2015 Jul 28; [e-pub].
(http://dx.doi.org/10.1016/S0140-6736(15)60511-6)
Stepanenko A and Kaufmann F.A novel total artificial heart: Search for haemocompatibility. Lancet 2015 Jul 28; [e-pub].
(http://dx.doi.org/10.1016/S0140-6736(15)60999-0)
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MM: I am surprised at these results. Exercise improves muscle tone and balance and prevents falls that are a risk for the elderly. When a person is debilitated it is not unusual for their cognitive function to deteriorate. The supplements for eye health are not typically associated with improved cognition so I am further confused at any relationship being projected with this particular combination.
Exercise Program, Supplements show no effect on Cognition in Elders
By Amy Orciari Herman, Edited by David G. Fairchild, MD, MPH
Certain lifestyle interventions might not significantly affect cognitive function in older adults, suggest two JAMA trials.
In the first, over 1600 community-dwelling, sedentary elders at high risk for mobility disability were randomized to moderate-intensity exercise (walking, resistance training, and flexibility exercises) or health education. At 24 months, the groups were similar in cognitive function scores and in the incidence of mild cognitive impairment or dementia.
The second study included 3500 elders who underwent cognitive function testing as part of a trial assessing the effects of dietary supplements on progression to late age-related macular degeneration. Participants were randomized to take long-chain polyunsaturated fatty acids, lutein/zeaxanthin, both, or placebo. Over 5 years, the annual change in cognition scores didn't differ significantly with supplement use.
Thomas Schwenk, deputy editor of NEJM Journal Watch General Medicine, notes, "Nutritional supplements are not food, and studies on a wide range of conditions have failed to show any benefit from short-term supplementation of isolated nutrients. These latest results do not contradict the finding that long-term adherence to a Mediterranean or heart-healthy diet is beneficial to cognitive function. The same caveat applies to some extent for physical activity — the specific components of exercise that enhance cognitive function ... are poorly characterized."
http://jama.jamanetwork.com/article.aspx?articleid=2429712
http://jama.jamanetwork.com/article.aspx?articleid=2429713
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MM: Quitting smoking may decrease carotid plaque and possibly improve cerebral blood flow and perfusion. Providing more oxygen and nutrients to the brain cells and removing more metabolic by-products in a more efficient way may be a good way to clean out cognitive and brain metabolic pathways. It certainly makes sense that improved cognition would accompany this.
Quitting Smoking after Heart Attack linked to Better Mental Health
By Kelly Young, Edited by David G. Fairchild, MD, MPH
Quitting smoking after a myocardial infarction is associated with better health outcomes than continued smoking, according to a study in Circulation: Cardiovascular Quality and Outcomes.
Roughly 4000 patients were followed for 1 year after MI. At the time of admission for MI, 37% were current smokers; of these, nearly half quit during follow-up.
After multivariable adjustment, patients who continued to smoke had increased risk for angina as well as worse quality of life and mental health, compared with never-smokers. Meanwhile, recent quitters and former smokers were similar to never-smokers in terms of angina frequency and mental health. Recent quitters also had better mental health than continued smokers.
The authors conclude: "Our findings ... should provide strong support for counseling patients about how smoking cessation not only reduces the risk of MI and death but is also associated with better health status over time. As such, these observations may offer current smokers increased incentive and motivation for quitting."
http://circoutcomes.ahajournals.org/content/early/2015/08/25/
CIRCOUTCOMES.114.001545.full.pdf+html
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Gastrointest Endosc 2015 Aug; 82:350
Polidocanol Reduces Colon Polypectomy Bleeding
Both immediate and delayed bleeding rates were lower with polidocanol 1% than with epinephrine.
The most common complication of endoscopic mucosal resection (EMR) of large colorectal lesions is delayed hemorrhage.In a nonrandomized study, two groups of 306 patients each underwent EMR with submucosal injection of saline containing 1:10,000 epinephrine or 10 mL of polidocanol 1%, which is not currently FDA-approved for this purpose. The median size of lesions was 32 mm, and polyps were transected using ERBE Endocut.
Immediate bleeding occurred less frequently in the polidocanol group than in the epinephrine group (3.9% vs. 10.7%), as did delayed bleeding (1.3% vs. 6.2%). Adverse events included two perforations in the epinephrine group and none in the polidocanol group, and no postpolypectomy syndrome was reported.
Comment: Polidocanol is a sclerosant, but the authors found it effective at concentrations below 2%. The observation that 1% polidocanol has a sealing effect on vessels that impacts immediate bleeding — and, most importantly, delayed bleeding — is an important observation that merits further investigation in a prospective controlled trial.
Citation(s):Facciorusso A et al. Polidocanol injection decreases the bleeding rate after colon polypectomy: A propensity score analysis. Gastrointest Endosc 2015 Aug; 82:350. (http://dx.doi.org/10.1016/j.gie.2015.01.003)
http://www.ncbi.nlm.nih.gov/pubmed/25910664?access_num=
25910664&link_type=MED&dopt=Abstract
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