<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_3241"
                     title="&apos;Brain Exercise&apos; May Worsen Existing Alzheimer&apos;s (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/Neurology/AlzheimersDisease/tb/21998?impressionId=1283456278990"
                     
      &lt;p&gt;Keeping mentally active may help stave off Alzheimer&apos;s disease, but once patients are diagnosed with the condition, &quot;brain exercise&quot; may actually speed up cognitive decline, researchers said  --  adding that that may not be a bad thing.&lt;/p&gt;
&lt;p&gt;Among more than 1,000 older individuals in a large, longitudinal cohort study, scores on a measure of cognitive activity were significantly correlated with the rate of worsening in global cognitive function, according to Robert S. Wilson, PhD, of Rush University in Chicago, and colleagues.&lt;/p&gt;
&lt;p&gt;For each one-point increase in cognitive activity scores in Alzheimer&apos;s disease patients, the rate of cognitive decline increased 42% (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), they reported online in &lt;em&gt;Neurology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;But in patients with no cognitive impairment, each point in cognitive activity scores was associated with a 52% reduction in the rate of cognitive decline (&lt;em&gt;P&lt;/em&gt;=0.003), confirming &lt;a href=&quot;http://www.medpagetoday.com/PrimaryCare/Geriatrics/4735&quot; mce_href=&quot;http://www.medpagetoday.com/PrimaryCare/Geriatrics/4735&quot; target=&quot;_blank&quot;&gt;previous studies&lt;/a&gt; indicating that mental activity reduces the risk of dementia.&lt;/p&gt;
&lt;p&gt;&quot;More frequent cognitive activity was related to slower cognitive decline in those without cognitive impairment and more rapid cognitive decline in Alzheimer&apos;s disease, with no effect in mild cognitive impairment,&quot; Wilson and colleagues wrote.&lt;/p&gt;
&lt;p&gt;They argued that such an effect should not be a total surprise.&lt;/p&gt;
&lt;p&gt;Other researchers have suggested that mental activity maintains cognitive abilities even as the underlying pathologic burden continues to grow with age.&lt;/p&gt;
&lt;p&gt;But, Wilson and colleagues noted, &quot;cognitively active people do develop dementia,&quot; presumably when the pathologic burden becomes overwhelming.&lt;/p&gt;
&lt;p&gt;&quot;If cognitive activity does somehow allow the brain to tolerate more pathologic changes, those with high premorbid cognitive activity are likely to have a higher pathologic burden than those with low premorbid activity at the time of dementia onset and therefore to experience a more rapidly progressive dementia course,&quot; they theorized.&lt;/p&gt;
&lt;p&gt;&quot;In effect, these results suggest that the benefit of delaying the initial appearance of cognitive impairment comes at the cost of more rapid dementia progression.&quot;&lt;/p&gt;
&lt;p&gt;Wilson and colleagues analyzed data from the Chicago Health and Aging Project, an ongoing cohort study that began in 1993. At baseline, participants were 65 or older and were free of cognitive impairment.&lt;/p&gt;
&lt;p&gt;The current analysis focused on 1,157 of the participants with 12 years of follow-up. After six years in the study, participants had been tested for cognitive impairment and categorized as cognitively normal, mildly impaired, or having Alzheimer&apos;s disease. They were then followed for another six years, undergoing periodic mental status evaluations.&lt;/p&gt;
&lt;p&gt;At baseline, participants also rated how often they participated in seven cognitive activities: watching television, listening to the radio, reading newspapers, reading magazines, reading books, playing card or board games, and going to museums.&lt;/p&gt;
&lt;p&gt;Cognitive function was evaluated periodically with four brief assessments including the Mini-Mental State Exam, tests of immediate and delayed word recall, and the Symbol Digit Modalities Test.&lt;/p&gt;
&lt;p&gt;Wilson and colleagues calculated that the interaction of baseline cognitive activity score with changes in cognitive function scores and time was -0.075 in the Alzheimer&apos;s disease patients (SE 0.022), whereas in the participants with no cognitive impairment at follow-up the interaction estimate was 0.029 (SE 0.010).&lt;/p&gt;
&lt;p&gt;&quot;These observational data suggest that interventions designed to enhance cognitive plasticity may prove beneficial in compressing the cognitive morbidity of Alzheimer&apos;s disease,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;In other words, &quot;brain exercise&quot; may shorten the period of time in which patients must live with a diagnosis of Alzheimer&apos;s disease, as they remain mentally healthy deeper into old age and then decline quickly.&lt;/p&gt;
&lt;p&gt;They also noted that, to be effective, cognitive enrichment interventions may need to be initiated before the development of cognitive impairment,&quot; since any degree of cognitive deficit probably means an already substantial pathological burden.&lt;/p&gt;
&lt;p&gt;Wilson and colleagues cited several limitations to their analysis: the possibility of unmeasured differences between the diagnostic subgroups, the lack of detail in the cognitive function tests used, and a relatively small number of follow-up evaluations.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;No commercial funding for the study was reported.&lt;/p&gt;&lt;p&gt;Wilson serves as consulting editor for two other neurology journals and reported several NIH grants. Other authors reported consulting or other relationships with pharmaceutical companies including Pfizer and Eli Lilly.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3234"
                     title="Behavior Trial Shows Dementia Benefits (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/Geriatrics/AlzheimersDisease/tb/21989?impressionId=1283456278990"
                     
      &lt;p&gt;Patients with dementia had significant short-term improvement in functional and quality-of-life outcomes after four months of home-based behavioral intervention, data from a randomized trial showed.&lt;/p&gt;
&lt;p&gt;Compared with a control group, patients assigned to the intervention had significantly better scores related to functional dependence and engagement (&lt;em&gt;P&lt;/em&gt;=0.03 to &lt;em&gt;P&lt;/em&gt;=0.007). Caregivers also had significant improvement in well-being and confidence in performing activities (&lt;em&gt;P&lt;/em&gt;=0.002 for both).&lt;/p&gt;
&lt;p&gt;After four months, significantly more paired patients and caregivers had eliminated at least one caregiver-identified problem (&lt;em&gt;P&lt;/em&gt;=0.01).&lt;/p&gt;
&lt;p&gt;Outcomes at nine months did not differ between the control and intervention groups, although caregivers tended to perceive greater benefits, investigators reported in the Sept. 1 issue of &lt;em&gt;JAMA&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;These findings add to an increasing evidentiary base for nonpharmacologic management of patients with dementia,&quot; Laura N. Gitlin, PhD, of Thomas Jefferson University in Philadelphia, and coauthors wrote in the commentary that followed their results.&lt;/p&gt;
&lt;p&gt;&quot;Improvement in patient function, albeit small, compares favorably with pharmacologic trials, yet with no adverse effects or known risks,&quot; they added.&lt;/p&gt;
&lt;p&gt;Few large randomized trials have evaluated treatments for supporting physical function of patients with dementia. Trials of pharmacologic interventions have shown few, if any, benefits related to patient physical function or caregiver burden, the authors wrote in the introduction to their report.&lt;/p&gt;
&lt;p&gt;Previous studies of nonpharmacologic interventions yielded some promising results, but showed small effect size and focused on outcomes other than functional dependence, they continued.&lt;/p&gt;
&lt;p&gt;To examine the effects of a biobehavioral intervention on functional outcomes and caregiver stressors, Gitlin and coauthors conducted the Care of Persons with Dementia in their Environments (COPE) trial. The intervention focused on modifiable environmental stressors with a goal of decreasing sensorial, physical, and cognitive demands to bring them more in line with patient capabilities.&lt;/p&gt;
&lt;p&gt;The intervention included as many as 10 sessions with occupational therapists and two sessions (one by telephone) with an advance practice nurse. The occupational therapists interviewed caregivers to determine patient routines, habits, and interests and caregiver concerns.&lt;/p&gt;
&lt;p&gt;After reviewing results of cognitive and functional testing, the occupational therapists trained caregivers to modify home environments, activities, and communications to support patient capabilities, to help caregivers identify solutions for concerns, and to reduce stress.&lt;/p&gt;
&lt;p&gt;The control group for the trial received three 20-minute telephone calls to discuss caregiving challenges  --  with trained researchers who were not occupational therapists or nurses  --  and educational materials.&lt;/p&gt;
&lt;p&gt;The primary outcomes for patients were functional dependence, quality of life, frequency of agitated behaviors, and engagement at four months; for caregivers, primary outcomes were well-being, confidence using activities, and perceived benefits at four months.&lt;/p&gt;
&lt;p&gt;Investigators randomized 237 dyads (patients and their caregivers) to the COPE intervention or a control group. Data collection comprised 209 dyads at four months and 173 at nine months.&lt;/p&gt;
&lt;p&gt;After four months, investigators assessed the proportion of participants who had improved or worsened and arrived at a net improvement for each of the principal outcomes, all of which favored the intervention group: &lt;ul&gt; &lt;li&gt;Functional dependence: 48.5% for the intervention group versus 29.3% for the control group, &lt;em&gt;P&lt;/em&gt;=0.02&lt;/li&gt; &lt;li&gt;Daily activities dependence: 61.6% versus 43.7%, &lt;em&gt;P&lt;/em&gt;=0.03&lt;/li&gt; &lt;li&gt;Activity engagement: 12.7% versus -1.9%, NS&lt;/li&gt; &lt;li&gt;Perceived change in well-being: 46.1% versus 19.6%, &lt;em&gt;P&lt;/em&gt;=0.007&lt;/li&gt; &lt;li&gt;Confidence using activities: 31% versus 4.7%, &lt;em&gt;P&lt;/em&gt;=0.005&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;At nine months, the two groups did not differ significantly with respect to the primary outcomes. Significantly, however, caregivers in the intervention group reported a &quot;great deal&quot; of improvement in their lives (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), in their disease understanding (&lt;em&gt;P&lt;/em&gt;=0.001), in their confidence managing behaviors (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), in making their life easier (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), in their ability to care for patients (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), in patients&apos; quality of life (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), and in their ability to keep patients home (&lt;em&gt;P&lt;/em&gt;=0.02).&lt;/p&gt;
&lt;p&gt;The authors noted several limitations of the study: inability to determine the active component of the intervention, generalizability of the results, and a disparity in staff time to provide and explain information to the two groups.&lt;/p&gt;
&lt;p&gt;&quot;Because most patients live at home with functional decline, a nonpharmacologic, biopsychosocial-environmental intervention may positively contribute to disease management,&quot; the authors wrote in conclusion.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors reported that they had no relevant disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3199"
                     title="ESC: Simple Clinical Factors May Provide Clues to Future Ischemic Events (CME/CE)"
                     score="0.012"
                     href="http://www.medpagetoday.com/MeetingCoverage/ESCCongress/tb/21940?impressionId=1283456278990"
                     
      STOCKHOLM  --  Easily assessed clinical factors could help predict which atherothrombosis patients might have an increased risk of an ischemic event, according to results of a large international registry.&lt;br&gt;
&lt;br&gt;In four-year data, culled from among more than 32,000 patients, a composite of cardiovascular death, MI, or stroke during follow-up was predicted by diabetes (HR 1.44, 95% CI 1.36 to 1.53), an ischemic event within the past year (HR 1.71, 95% CI 1.57 to 1.85), and polyvascular disease (HR 1.99, 95% CI 1.78 to 2.24).&lt;br&gt;
&lt;br&gt;The findings were reported by Deepak Bhatt, MD, MPH, of Harvard, at the European Society of Cardiology Congress here and were simultaneously published online in the &lt;em&gt;Journal of the American Medical Association&lt;/em&gt;.&lt;p&gt;&lt;/p&gt;

&lt;p&gt;Cardiovascular risk stratification among patients with established atherosclerosis enables the intensity of preventive treatments to be tailored to individual patient groups,&quot; Bhatt said during his presentation.&lt;/p&gt;

&lt;p&gt;Identifying patients at the highest risk within an at-risk population may allow clinicians to more precisely direct novel preventive therapies  --  or enable researchers to design trials for those patients most likely to benefit from new treatments.&lt;/p&gt;
&lt;p&gt;&quot;New antiplatelet, anticoagulant, anti-atherosclerotic, and anti-inflammatory agents will probably be expensive and may have additional adverse effects,&quot; Bhatt and colleagues wrote. &quot;Thus, the ability to target these therapies to patients at highest ischemic risk will be desirable and likely would be cost-effective.&quot;&lt;/p&gt;
&lt;p&gt;The data analyzed came from patients participating in the REACH (Reduction of Atherothrombosis for Continued Health) Registry, which enrolled patients from 3,647 centers in 29 countries. Participants either had to have established coronary artery disease, cerebrovascular disease, or peripheral artery disease, or at least three risk factors for atherothrombosis.&lt;/p&gt;
&lt;p&gt;At baseline, the international registry covered 45,227 patients, but because of centers dropping out, four-year data were only available for 31,195 patients.&lt;/p&gt;
&lt;p&gt;During the follow-up period, between 2003 and 2008, 5,481 patients had at least one ischemic event, including 2,315 who died from cardiovascular causes, 1,228 who had MIs, 1,898 who had strokes, and 40 who had an MI and a stroke on the same day.&lt;/p&gt;
&lt;p&gt;The highest rate of the composite outcome of cardiovascular death, MI, or stroke occurred in patients who had a prior history of ischemic events at baseline (18.3%), followed by those with stable coronary, cerebrovascular, and peripheral artery disease without a history of ischemic events (12.2%) and those without established atherothrombosis but with multiple risk factors (9.1%) (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for all comparisons).&lt;/p&gt;
&lt;p&gt;Rates ranged from a low of 7.1% among patients who had only had cardiovascular risk factors but who were free from diabetes to 25% among patients with a history of ischemic events and polyvascular disease.&lt;/p&gt;
&lt;p&gt;&quot;This greater than three fold gradient in cumulative risk for cardiovascular death, myocardial infarction, or stroke illustrates that not all atherothrombosis is equal  --  an observation that the broad array of clinicians caring for these types of patients may find clinically relevant,&quot; Bhatt and his colleagues wrote in their paper.&lt;/p&gt;
&lt;p&gt;When cardiovascular hospitalization was added to the composite endpoint, rates ranged from 16.6% among patients who made it into the registry based on risk factors alone to 47.1% among those with a baseline history of ischemic events and polyvascular disease.&lt;/p&gt;
&lt;p&gt;The researchers did not find any evidence that their findings varied by geographical region  --  suggesting broad applicability, they noted.&lt;/p&gt;
&lt;p&gt;They acknowledged some limitations to their data, however, including the incomplete follow-up of the initial cohort because of dropouts and the fact that the endpoints were not adjudicated.&lt;/p&gt;
&lt;p&gt;Bhatt also said selection bias could not be ruled out.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The REACH Registry is sponsored by sanofi-aventis, Bristol-Myers Squibb, and the Waksman Foundation and is endorsed by the World Heart Foundation.&lt;/p&gt;&lt;p&gt;The design and conduct of the study were done by the academic executive committee in collaboration with the sponsors. The collection and management of the data were done by the sponsors under the direction of the academic executive committee. Analysis was done by the sponsors and independently verified by an academic statistician; the latter analyses were presented in the paper. The sponsors were able to review but not approve the study.&lt;/p&gt;&lt;p&gt;Bhatt reported having received institutional research support from AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Heartscape, sanofi-aventis, and The Medicines Company.&lt;/p&gt;&lt;p&gt;His co-authors reported numerous relationships with industry. One of the authors is employed by sanofi-aventis.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3167"
                     title="ESC: Mixed Risks for PPIs Plus Clopidogrel (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/MeetingCoverage/ESCCongress/tb/21896?impressionId=1283456278990"
                     
      &lt;p&gt;STOCKHOLM  --  Concomitant use of a proton pump inhibitor and clopidogrel (Plavix) significantly increased the risk of myocardial infarction but not death, a meta-analysis involving almost 160,000 patients found.&lt;/p&gt;
&lt;p&gt;The meta-analysis showed a 31% increase in the relative risk of MI (95% CI 1.12 to 1.53) among patients who took the two drugs together compared with those who did not, according to Jolanta Siller-Matula, MD, of the Medical University of Vienna in Austria, and colleagues.&lt;/p&gt;
&lt;p&gt;On the other hand, the analysis of 25 studies found that combined use of the two drugs did not significantly increase the risk of dying (RR=1.04, 95% CI 0.93 to 1.16), Siller-Matula and colleagues reported here at the European Society of Cardiology.&lt;/p&gt;
&lt;p&gt;As well, the meta-analysis showed that treatment with a PPI reduced the risk of gastrointestinal (GI) bleeding by 50% in patients receiving clopidogrel alone or with a placebo, Siller-Matula&apos;s team reported.&lt;/p&gt;
&lt;p&gt;&quot;As meta-analyses have the highest evidence level, this study adds important insights into the discussion on safety of PPIs, especially because randomized trials with PPIs, in particular with omeprazole, are not ethically acceptable as omeprazole decreases the concentration of clopidogrel in the blood,&quot; Siller-Matula told &lt;em&gt;MedPage Today&lt;/em&gt; in an e-mail.&lt;/p&gt;
&lt;p&gt;&quot;This meta-analysis has significant implications for many patients. My advice to clinicians is to only prescribe gastric protection when absolutely necessary. If indicated, pantoprazole should be used, as pantoprazole has no negative effect on platelet inhibition by clopidogrel when assessed ex vivo,&quot; she said.&lt;/p&gt;
&lt;p&gt;Data from large clinical registries have suggested that concomitant treatment with clopidogrel and a PPI worsen clinical outcomes in patients with coronary disease. Other studies have shown no increased risk with use of both drugs.&lt;/p&gt;
&lt;p&gt;The only prospective, randomized trial to evaluate the issue ended prematurely when the sponsor declared bankruptcy. Data collected to discontinuation showed &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/TCT/16133&quot; mce_href=&quot;http://www.medpagetoday.com/MeetingCoverage/TCT/16133&quot; target=&quot;_blank&quot; title=&quot;TCT:&amp;#8200;PPIs&amp;#8200;Safe&amp;#8200;for&amp;#8200;Patients&amp;#8200;Taking&amp;#8200;Antiplatelets&quot;&gt;no difference in risk&lt;/a&gt; among patients treated with clopidogrel or placebo.&lt;/p&gt;
&lt;p&gt;&quot;Given the lack of a definitive trial, we performed a meta-analysis to determine whether concomitant use of PPIs plus clopidogrel increases the incidence of combined major cardiovascular events (MACE), MI, death, or gastrointestinal bleeding in patients with cardiovascular disease,&quot; Siller-Matula explained.&lt;/p&gt;
&lt;p&gt;A systematic review identified 25 studies that involved a total of 159,138 patients. The studies included observational studies, randomized trials, and post-hoc analyses of randomized trials.&lt;/p&gt;
&lt;p&gt;The primary outcomes were combined MACE, MI, stent thrombosis, death, and GI bleeding.&lt;/p&gt;
&lt;p&gt;The analysis showed that patients treated with clopidogrel and PPIs had a 29% increased relative risk of MACE (95% CI 1.15 to 1.45) as well as a 31% increased risk of MI compared with patients who did not receive the two drugs together.&lt;/p&gt;
&lt;p&gt;The combination of a PPI and clopidogrel was associated with a nonsignificant 4% increase in mortality risk.&lt;/p&gt;
&lt;p&gt;Concomitant use of the two drugs halved the relative risk of GI bleeding (RR=0.50, 95% CI 0.37 to 0.69), compared with patients treated with clopidogrel alone or with placebo.&lt;/p&gt;
&lt;p&gt;Sensitivity analysis showed that the results remained unchanged irrespective of publication type, study quality or size, or risk of clinical events. Despite the consistency of findings, Siller-Matula concluded that concomitant PPI-clopidogrel therapy &quot;might be associated with an increased risk of cardiovascular events.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Prospective randomized trials are required to investigate whether a cause-and-effect relationship truly exists and to explore whether different PPIs worsen clinical outcome in clopidogrel-treated patients, as the PPI-clopidogrel drug-drug interaction seems not to be a class effect,&quot; she added.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Siller-Matula reported that she and her co-authors had no relevant disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3156"
                     title="BPA Affects Hormones in Men (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/PublicHealthPolicy/EnvironmentalHealth/tb/21882?impressionId=1283456278990"
                     
      Increased exposure to a chemical common to food and drink packaging predicted higher testosterone levels in men, suggesting the chemical bisphenol A (BPA) effects endocrine changes in men, data from a cohort study showed.&lt;br&gt;
&lt;br&gt;In multivariable-adjusted models, higher daily excretion of BPA had a significant association with higher total testosterone concentrations (&lt;em&gt;P&lt;/em&gt;=0.044 to &lt;em&gt;P&lt;/em&gt;=0.004), investigators reported in &lt;em&gt;Environmental Health Perspectives&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;BPA excretion was not associated with other serum parameters in men and had no associations with serum outcomes in women&lt;em&gt;&lt;/em&gt;.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;&quot;These results are important because they provide a first report in a large-scale human population of associations between elevated exposure to BPA and alterations in circulating hormone levels,&quot; Tamara Galloway, PhD, of the University of Exeter in England, and colleagues noted in the discussion of their findings.&lt;/p&gt;
&lt;p&gt;BPA has a history of suspicion regarding its possible effects on the human endocrine system. Exposure occurs primarily through dietary means, although dental sealants, dermal exposure, and inhalation of household dust also may contribute to total daily exposure, the researchers noted.&lt;/p&gt;
&lt;p&gt;Population studies have shown that more than 90% of people have detectable urinary levels of BPA metabolites.&lt;/p&gt;
&lt;p&gt;Studies of the health effects of BPA generally have focused on estrogenic activity, including evidence of estrogen agonism and androgen antagonism. Additionally, BPA has been linked to thyroid dysregulation, altered pancreatic beta-cell function, and obesity.&lt;/p&gt;
&lt;p&gt;On the basis of experimental evidence, Galloway and colleagues hypothesized that higher urinary BPA would be associated with adverse effects in humans. They had previously reported a correlation between BPA exposure and cardiovascular disease and diabetes and replicated the findings in a sample of participants in the National Health and Nutrition Evaluation Survey (&lt;em&gt;Epidemiology &lt;/em&gt; 2008; 19: S379, &lt;em&gt;PLoS One&lt;/em&gt; 2010; 5: e8673).&lt;/p&gt;
&lt;p&gt;Following publication of studies showing a link between BPA and levels of reproductive hormones, the investigators evaluated BPA urinary excretion and sex hormone levels among participants in an ongoing cohort study in Italy. In contrast to previous studies of such associations, Galloway and colleagues based their findings on 24-hour urine collections to determine daily excretion rates for BPA.&lt;/p&gt;
&lt;p&gt;The study involved a random sample of about 715 adults 20 to 74. Each participant provided a 24-hour urine sample, which was evaluated by liquid chromatography mass spectrometry to determine BPA concentrations.&lt;/p&gt;
&lt;p&gt;The principal outcomes were serum concentrations of total testosterone and 17 beta-estradiol.&lt;/p&gt;
&lt;p&gt;The geometric mean urinary BPA concentration was 3.59 ng/mL, and daily excretion averaged 5.63 &amp;#181;g. Higher excretion was associated with male sex, younger age, greater waist circumference (&lt;em&gt;P&lt;/em&gt;=0.013), and weight (&lt;em&gt;P&lt;/em&gt;=0.003).&lt;/p&gt;
&lt;p&gt;In models adjusted for age, sex, and study site, women had significantly lower BPA excretion compared with men (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001). Older age was associated with significantly lower excretion (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;In fully adjusted models, BPA excretion had a significant association with total testosterone (&lt;em&gt;P&lt;/em&gt;=0.004) but not 17 beta-estradiol.&lt;/p&gt;
&lt;p&gt;Further analysis did show a significant association between BPA excretion and sex hormone binding globulin in premenopausal women (&lt;em&gt;P&lt;/em&gt;=0.004).&lt;/p&gt;
&lt;p&gt;The authors acknowledged several limitations of the study, including the need for validation in other independent populations, use of a single 24-hour BPA excretion rate, and the cross-sectional nature of the study.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Co-authors Cathryn Money and Paul McCormack are employees of AstraZeneca.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>