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    <recommendedItem id="20100101_19_352"
                     title="ICAO: Future Chronic Disease Risk Goes Beyond BMI (CME/CE)"
                     score="0.011"
                     href="http://www.medpagetoday.com/Endocrinology/Diabetes/tb/18233?impressionId=1265783828709"
                     
      When it comes to predicting chronic disease, body mass index doesn&apos;t tell the whole story, according to a population-based study that found elevated risk with obesity and other metabolic risk factors independently.&lt;br&gt;
&lt;br&gt;Metabolically-healthy obese people tended toward being at least twice as likely to develop multiple metabolic risk factors and diabetes as healthy, normal weight individuals over the subsequent 3.5 years of a study led by Sarah Appleton, a postgraduate student at the University of Adelaide, Australia.&lt;br&gt;
&lt;br&gt;However, normal weight individuals with metabolic risk factors  --  a group the researchers called &quot;metabolically obese&quot;  --  were at greater risk, she told attendees at the International Congress on Abdominal Obesity in Hong Kong, a conference sponsored by the International Chair on Cardiometabolic Risk.&lt;br&gt;
&lt;br&gt;Overall, just 4.1% of the 3,743 adults in the population-based, North West Adelaide Health Study were in the normal body mass index range at baseline but had at least two of the following metabolic risk factors:&lt;ul&gt; &lt;li&gt;Triglyceride levels of 1.7 mmol/L or greater&lt;/li&gt; &lt;li&gt;HDL cholesterol under 1.0mmol/L for men or 1.3 mmol/L for women&lt;/li&gt; &lt;li&gt;Blood pressure of 130/85 mm Hg or higher&lt;/li&gt; &lt;li&gt;A fasting plasma glucose of at least 5.6mmol/L or self-reported diabetes&lt;/li&gt; &lt;li&gt;Treatment for any of these disorders &lt;/li&gt; &lt;/ul&gt;
&lt;p&gt;Although free of cardiovascular disease when they entered the study through a random population sample of the northwest region of Adelaide, after a mean of 3.5 years of follow-up, this group was 2.48 times at risk of incident cardiovascular disease or stroke events (95% CI 1.1 to 5.4).&lt;/p&gt;
&lt;p&gt;Compared with metabolically-healthy, normal weight individuals, those with metabolic risk factors tended to be&lt;strong&gt; &lt;/strong&gt;3.27 times as likely to develop diabetes (&lt;em&gt;P&lt;/em&gt;=0.07).&lt;/p&gt;
&lt;p&gt;Identifying these individuals for prevention efforts may require less emphasis on BMI and increased surveillance of central obesity in primary care, the researchers told the congress.&lt;/p&gt;
&lt;p&gt;&quot;The problem with BMI is it doesn&apos;t tell you where the fat is,&quot; Appleton added in an interview. &quot;Visceral fat is really bad for you.&quot;&lt;/p&gt;
&lt;p&gt;Obese individuals without multiple metabolic risk factors at baseline comprised a larger group (12.1%).&lt;/p&gt;
&lt;p&gt;They were more likely to be middle age, live in a disadvantaged neighborhood, have smoked at some point, and get less exercise than their metabolically similar, but slimmer peers.&lt;/p&gt;
&lt;p&gt;Over the subsequent 3.5 years, they were 2.82 times more likely to develop more than one metabolic risk factor than metabolically-healthy, normal weight individuals (95% CI 2.0 to 4.0).&lt;/p&gt;
&lt;p&gt;The metabolically-normal obese also tended to be 2.36 times more likely to develop diabetes (95% CI 0.8 to 7.1). On the other hand, their risk of cardiovascular disease wasn&apos;t elevated, &quot;which likely related to the younger age of that group,&quot; Appleton told &lt;em&gt;MedPage Today&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Notably, abdominal obesity as determined by a waist circumference of 80 cm and over for men or 95 cm and greater for women was 6.1 times more likely among metabolically healthy individuals if their BMI was in the obese versus normal range.&lt;/p&gt;
&lt;p&gt;But those who were in the normal BMI range were 2.2-fold more likely to be overweight or obese according to waist circumference if they had metabolic risk factors, which was statistically significant as well and likely contributed to the health risks they faced over the short-term future, Appleton said.&lt;/p&gt;
&lt;p&gt;Maintenance of metabolic health in the obese population was more likely for younger individuals (OR 2.83 for age 40 or younger, 95% CI 1.1 to 7.6) and those who were at least moderately physically active (OR 2.04, 95% CI 1.01 to 4.1).&lt;/p&gt;
&lt;p&gt;Appleton noted that these findings generally fit with data from the U.S. National Health Assessment Survey and Examination.&lt;/p&gt;
&lt;p&gt;Regardless of whether patients have abdominal obesity, BMI obesity, or other metabolic risk factors, the solution is likely similar  --  improved diet and exercise, she said.&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 study was supported by the University of Adelaide and the South Australian Department of Health.&lt;/p&gt;&lt;p&gt;Appleton reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_207"
                     title="ISET: Women Fare Better in Small Leg Vessel Procedures (CME/CE)"
                     score="-0.001"
                     href="http://www.medpagetoday.com/Cardiology/PeripheralArteryDisease/tb/18051?impressionId=1265783828709"
                     
      &lt;p&gt;HOLLYWOOD, Fla.  --  Contrary to expectations, women who undergo last-ditch, minimally-invasive procedures to open small blood vessels in the leg  --  and forestall amputation  --  generally have better outcomes than men, researchers reported here.&lt;/p&gt;
&lt;p&gt;Overall, 87.5% of women who underwent the infragenicular endoscopic angioplasty avoided amputation for at least two years, compared with 82.9% of the men who were similarly treated (&lt;em&gt;P&lt;/em&gt;=0.041), according to Tejas Shah, MD, of Mount Sinai Medical Center in New York City.&lt;/p&gt;
&lt;p&gt;&quot;This study is the first to compare the outcomes of men and women being treated for blocked lower-leg arteries with endovascular therapy,&quot; Shah said at the International Symposium on Endovascular Therapy (ISET). &quot;The results suggest endovascular therapy should be strongly considered in women with blocked arteries below the knee.&quot;&lt;/p&gt;
&lt;p&gt;In many endovascular procedures, women tend to do worse then men, generally because they tend to have smaller blood vessels. But in this study, involving the smallest leg blood vessels, the opposite occurred. &quot;We really don&apos;t have any good reason why there should be this gender difference,&quot; Shah said.&lt;/p&gt;
&lt;p&gt;&quot;What made this difference significant,&quot; Shah told &lt;em&gt;MedPage Today&lt;/em&gt;, &quot;was that the women in the study, overall, were at significantly greater risk of amputation than the male patients.&quot; He said that about 22.3% of men underwent treatment for claudication, compared with 12.3% of the women, but 77.7% of men were being treated for limb-threatening conditions compared with 87.7% of women.&lt;/p&gt;
&lt;p&gt;The retrospective study involved review of angioplasties, stenting, and atherectomies performed on 152 men and 125 women at Mount Sinai between July 1999 and November 2009.&lt;/p&gt;
&lt;p&gt;When adjusted for comorbidities, women treated for tibial lesions with concurrent proximal disease had higher 24-month primary patency rates compared with men.&lt;/p&gt;
&lt;p&gt;Some 46% of treated leg arteries in women remained open, compared with 30% (&lt;em&gt;P&lt;/em&gt;=0.016) in men. Shah said that a subanalysis of isolated tibial lesions indicated that 50% of women achieved 24-month primary patency rates, compared with 28.8% of men (&lt;em&gt;P&lt;/em&gt; =0.002).&lt;/p&gt;
&lt;p&gt;On the downside, women experienced higher rates of blood clots forming at the access site of the treatment (9% versus 0.6%, &lt;em&gt;P&lt;/em&gt;&amp;lt;.0001). Clotting, typically treated with blood thinners, may require a longer stay in the hospital (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001).&lt;/p&gt;
&lt;p&gt;&quot;In both men and women it is hard to keep these smaller leg blood vessels open,&quot; said Constantino Pe&amp;#241;a, MD, medical director of vascular imaging at Baptist Cardiac &amp;amp; Vascular Institute, Miami.&lt;/p&gt;
&lt;p&gt;&quot;It might be possible that women do better because of their hormone status. But we need to do prospective clinical trials to see if we can determine what factor is involved in making the procedure work better for women.&quot;&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;Shah listed no relevant disclosures.  Pe&amp;#241;a reported financial relationships with Bard and Medtronic.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_1845"
                     title="ADA: Weight-Loss Drugs May Have Benefit in Diabetes"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/ADA/tb/14634?impressionId=1265783828709"
                     
      NEW ORLEANS, June 10 -- Three investigational diet drugs may hold promise for preventing and treating diabetes, researchers said here.
              &lt;br&gt;&lt;br&gt;All three showed improvements in risk factors besides obesity, including blood glucose, blood pressure, and triglycerides, according to three presentations here at the American Diabetes Association meeting.
              &lt;br&gt;&lt;br&gt;&quot;Instead of sulfonylureas and thiazolidinediones, the next generation of diabetes medications will likely be weight-loss drugs,&quot; Louis Aronne, M.D., of Weill-Cornell and New York Presbyterian, who presented data as a lead investigator on a trial for Qnexa, a combination of phentermine and topiramate.
              &lt;p&gt; 
              &lt;p&gt;Dr. Aronne said there is &quot;no real winner&quot; among the three, with lorcaserin  (combining benzazepine and hydrochloride) and contrave (combining bupropion and naltrexone) also showing similar improvements in overall health.
              &lt;p&gt; 
              &lt;p&gt;But each reported somewhat different cardiometabolic benefits at oral and poster sessions here.
              &lt;p&gt; 
              &lt;p&gt;Patients taking lorcaserin had significantly lower levels of fasting plasma glucose and a greater decrease in fasting insulin and insulin resistance as measured by HOMA-IR than those on placebo (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001).
              &lt;p&gt; 
              &lt;p&gt;They also had significant reductions in blood pressure, total cholesterol, and triglycerides compared with controls, according to Christen M. Anderson, M.D., Ph.D., vice president of clinical development for drugmaker Arena Pharmaceuticals.
              &lt;p&gt; 
              &lt;p&gt;Dr. Anderson presented the findings from year two of the BLOOM (Behavioral modification and Lorcaserin for Overweight and Obesity Management) trial as one of its investigators at a late-breaking poster session.
              &lt;p&gt; 
              &lt;p&gt;&quot;We had dramatic improvements in insulin resistance and in biomarkers of cardiovascular disease,&quot; Dr. Anderson said.
              &lt;p&gt; 
              &lt;p&gt;In terms of weight loss, 47.5% of patients on the drug lost at least 5% of their body weight, compared with and 20.3% of those on placebo, and 22.6% lost at least 10% of their body weight compared with 7.7% of placebo patients (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001).
              &lt;p&gt; 
              &lt;p&gt;After two years, patients on the drug maintained a significantly greater amount of weight loss compared with those who had switched to placebo after one year, Dr. Anderson said.
              &lt;p&gt; 
              &lt;p&gt;&quot;We are looking at long-term treatment,&quot; she said. &quot;That&apos;s the implication here.&quot;
              &lt;p&gt; 
              &lt;p&gt;Dr. Anderson stressed that there was no excess valvular insufficiency during two years of use. That was a problem with the combination diet drug phentermine and fenfluramine (Phen-Fen), which was pulled from the market because of cardiovascular complications.
              &lt;p&gt; 
              &lt;p&gt;Also, there was no association with an increased risk of depression or suicidal ideation, she added.
              &lt;p&gt; 
              &lt;p&gt;Qnexa showed significant reductions in hemoglobin A1c levels in both diabetic and prediabetic populations, according to two studies.
              &lt;p&gt; 
              &lt;p&gt;Among diabetic patients, those on the drug had a 1.6% reduction in HbA1c from baseline, compared with 1.1% for patients on placebo (&lt;em&gt;P&lt;/em&gt;=0.038), according to W. Timothy Garvey, M.D., of the University of Alabama at Birmingham.
              &lt;p&gt; 
              &lt;p&gt;Dr. Garvey presented the findings from a 56-week trial of 130 diabetic patients at an oral session here.
              &lt;p&gt; 
              &lt;p&gt;The patients also experienced significant reductions in blood pressure and triglycerides, as well as better reductions in fasting plasma glucose -- from 176 mg/dL to 133 mg/dL in treatment patients compared with 171 mg/dL to 145 mg/dL for the placebo group (&lt;em&gt;P&lt;/em&gt;=0.02).
              &lt;p&gt; 
              &lt;p&gt;Dr. Garvey said patients on the drug had a significant reduction in antidiabetic medication use compared with controls, as well as significant improvements in fasting glucose, systolic blood pressure, and waist circumference.
              &lt;p&gt; 
              &lt;p&gt;&quot;These results suggest that [the drug] has the potential to play an important role in diabetes management with respect to blood sugar control and sustained weight loss,&quot; he said.
              &lt;p&gt; 
              &lt;p&gt;He noted 65% of those on the drug lost at least 5% of their body weight, compared with 24% in the placebo group (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001). A total of 37% lost at least 10%, compared with 9% of placebo patients (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).
              &lt;p&gt; 
              &lt;p&gt;Among 756 nondiabetic obese patients, those who received the drug dropped their HbA1c levels by 0.01% and 0.02%, respectively, with regard to dose (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001).
              &lt;p&gt; 
              &lt;p&gt;In comparison, HbA1c rose by 0.09% over the six-month study period among placebo patients, said Dr. Aronne, who presented the findings of the EQUATE study at an oral session here.
              &lt;p&gt; 
              &lt;p&gt;The findings show that the drug can help &quot;halt the progression towards type 2 diabetes,&quot; he said.
              &lt;p&gt; 
              &lt;p&gt;Taken together, both trials show that the drug &quot;lowers HbA1c in diabetic patients, and for patients that haven&apos;t been diagnosed with diabetes, [it] can prevent increases in HbA1c levels,&quot; Dr. Aronne said.
              &lt;p&gt; 
              &lt;p&gt;Contrave also showed benefits for cardiometabolic parameters, but results of a late-stage phase III trial primarily focused on the drug&apos;s safety and efficacy with regard to weight loss.
              &lt;p&gt; 
              &lt;p&gt;Overall, 66.4% of patients on the drug lost at least 5% of their body weight, compared with 42.5% of placebo patients, and 41.5% lost at least 10% of their weight compared with 20.2% of placebo patients (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), according to Thomas Wadden, Ph.D., of the University of Pennsylvania, who presented the findings at an oral session here.
              &lt;p&gt; 
              &lt;p&gt;Dr. Wadden did not provide many details with regard to effects on diabetic and prediabetic patients, but he said those on the drug saw &quot;greater improvements in cardiometabolic risk factors such as waist circumference, triglycerides, and LDL cholesterol.&quot;
              &lt;p&gt; 
              &lt;p&gt;Nearly all of the researchers agreed that all three drugs, once approved, will play a role in both obesity and diabetes treatment.
              &lt;p&gt; 
              &lt;p&gt;&quot;There will definitely be a place for all three,&quot; Dr. Anderson said.
              &lt;p&gt; 
              &lt;p&gt;Dr. Aronne said that since one medication &quot;may work better for one person than for another,&quot; physicians &quot;need many different options.&quot;
              &lt;p&gt; 
              &lt;p&gt;&quot;We need this whole group of treatments,&quot; he said, &quot;in order to better manage both obesity and diabetes.&quot;
              &lt;p&gt; 
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;Dr. Anderson is an employee of Arena Pharmaceuticals.
              &lt;p&gt;Dr. Aronne reported relationships with Amylin, Arena Pharmaceuticals, Orexigen Therapeutics, sanofi-aventis, and Vivus.
              &lt;p&gt;Dr. Wadden is an adviser for Orexigen Therapeutics and Meck Pharmaceuticals.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
           
    </recommendedItem>
    <recommendedItem id="20090101_6_631"
                     title="ADA: Continuous Glucose Monitoring Leads to Improved Glycemic Control"
                     score="-0.005"
                     href="