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    <recommendedItem id="20100101_19_449"
                     title="FDA Okays Statin for Primary Prevention"
                     score="0.014"
                     href="http://www.medpagetoday.com/InfectiousDisease/PublicHealth/tb/18380?impressionId=1265794390716"
                     
      &lt;p&gt;WASHINGTON  --  The FDA has approved rosuvastatin (Crestor) for primary prevention of cardiovascular disease, making it the first statin to receive this indication.&lt;/p&gt;
&lt;p&gt;The new labeling, recommended by an FDA advisory panel late last year, also marks the first time that a drug label will include an indication based on the biomarker highly-sensitive C-reactive protein, an inflammatory marker.&lt;/p&gt;
&lt;p&gt;The new indication would be for men 50 or older and women 60 or older who have fasting LDL of less than 130 mg/dL, a highly-sensitive CRP of 2.0 mg/L or greater, triglycerides of less than 500 mg/dL, and no prior history of heart attack or stroke, or coronary heart disease risk.&lt;/p&gt;
&lt;p&gt;The basis for the new labeling was the JUPITER trial, a randomized, placebo-controlled trial of 17,802 men and women with a mean age of 66 and no history of atherosclerosis. All participants had LDL of less than 130 mg/dL and a highly-sensitive C-reactive protein concentration of 2 mg/L or higher.&lt;/p&gt;
&lt;p&gt;Patients were randomized to 20 mg of rosuvastatin for 1.9 years, which reduced median LDL cholesterol to 55 mg/dL, down from a median of 108 mg/dL at baseline. The corresponding relative reduction in the rate of MI, stroke, arterial revascularization, or cardiovascular death was 44% (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.00001).&lt;/p&gt;
&lt;p&gt;The number needed to treat to avoid one cardiovascular event was 25.&lt;/p&gt;
&lt;p&gt;Those results, according to Melvyn Rubenfire, MD, of the University of Michigan, were a &quot;home run for JUPITER,&quot; but it is not clear whether the results would be the same with another statin.&lt;/p&gt;
&lt;p&gt;And there were some risks associated with rosuvastatin, including 13 deaths due to gastrointestinal disorders in the rosuvastatin arm, and 18 patients reported experiencing a &quot;confused state&quot; while taking the drug.&lt;/p&gt;
&lt;p&gt;The most troubling adverse event, however, was an uptick in investigator-reported, new onset diabetes mellitus in the treatment arm, 2.8% versus 2.5%, for a hazard ratio of 1.27 (95% CI 1.05 to 1.53, &lt;em&gt;P&lt;/em&gt;=0.015).&lt;/p&gt;
&lt;p&gt;Rosuvastatin in marketed by AstraZeneca, which also sponsored the JUPITER trial.&lt;/p&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_222"
                     title="Benefits of Cutting Down on Salt Quantified (CME/CE)"
                     score="-0.001"
                     href="http://www.medpagetoday.com/Cardiology/Prevention/tb/18075?impressionId=1265794390716"
                     
      &lt;p&gt;Cutting daily salt intake by 3 grams a day  --  about 30% of the current average  --  could prevent 32,000 strokes and 54,000 myocardial infarctions a year, if a computer model developed by researchers at the University of California, San Francisco accurately depicts the clinical impact of salt reduction.&lt;/p&gt;
&lt;p&gt;The results of the analysis, which used a computer simulation of heart disease in U.S. adults ages 35 to 84, also suggest that even a 1 gram per day reduction in salt over the next decade would be a more cost-effective strategy for treating hypertension than use of even the cheapest antihypertensive, wrote Kirsten Bibbins-Domingo, MD, PhD, and colleagues in a paper published online by the &lt;em&gt;New England Journal of Medicine.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;Lee Goldman, MD, MPH, of Columbia University, who co-authored the paper, told &lt;em&gt;MedPage Today&lt;/em&gt; that their study builds on what has long been known about the adverse health effects of salt on a society that believes it to be the spice of life.&lt;/p&gt;
&lt;p&gt;For example, Goldman said that most people seeking a healthy choice will check food labels and restaurant menus for calorie counts and trans fats, but will not pay attention to salt.&lt;/p&gt;
&lt;p&gt;This is not the first time a call for salt reduction has been issued. As recently as last November, a meta-analysis published in &lt;em&gt;BMJ &lt;/em&gt;suggested that cutting salt intake in half  --  a reduction of about 5 grams a day or roughly a teaspoonful  --  would lower the stroke rate by 23% and reduce overall cardiovascular disease by as much as 17%.&lt;/p&gt;
&lt;p&gt;Americans, like those in many Western countries, take in an average of about 10 g of salt a day; whereas the World Health Organization recommends only 5 g per day, and the U.S. Department of Agriculture recommends daily intake be limited to 5.8 g.&lt;/p&gt;
&lt;p&gt;Bibbins-Domingo and colleagues reported that a 3 gram per day reduction in dietary salt would &quot;save 194,00 to 392,00 quality-adjusted life-years and $10 billion to $24 billion in healthcare costs annually.&quot;&lt;/p&gt;
&lt;p&gt;In an editorial that accompanied the study, Lawrence J. Appel, MD, MPH, and Cheryl A.M. Anderson, PhD, MPH, of Johns Hopkins University, wrote that &quot;the evidence supporting the call to reduce salt intake as a means of preventing cardiovascular disease is compelling.&quot;&lt;/p&gt;
&lt;p&gt;They concluded with this admonition: &quot;As we deliberate healthcare reform, let us not neglect this inexpensive, yet highly effective public health intervention for the prevention of disease.&quot;&lt;/p&gt;
&lt;p&gt;It should be noted that Appel was also first author on a position paper from the American Society of Hypertension that also called for salt reduction as public policy.&lt;/p&gt;
&lt;p&gt;Franz H. Messerli, MD, director of the hypertension program at St. Luke&apos;s-Roosevelt Hospital and a colleague of Goldman&apos;s, said the computer model used in the study was impressive but probably underestimates the benefit of reducing dietary salt &quot;because salt reduction has been shown to have a direct (blood pressure independent) effect on the heart, the brain, the kidneys, and also reduces stomach cancer and osteoporosis  --  factors that were not considered in this analysis.&quot;&lt;/p&gt;
&lt;p&gt;But Messerli found it difficult to lead the victory parade, noting &quot;this is a modeling study and statements such as &apos;A modest reduction of 1 gm per day would be more cost-effective than using medication to lower blood pressure in all persons with hypertension&apos; are to be taken with a good grain of salt.&quot;&lt;/p&gt;
&lt;p&gt;Messerli&apos;s measured response was not echoed by his colleagues in the hypertension world.&lt;/p&gt;
&lt;p&gt;For example, Henry Black, MD, president of the American Society of Hypertension, and director of hypertension research at the New York University School of Medicine said that, although the paper extended the findings of many other studies, it is &quot;more comprehensive and is especially useful by comparing the benefits of [sodium] and [salt] reduction to those of other widely accepted public health approaches that the public and governmental bodies have embraced, including drug treatment.&quot;&lt;/p&gt;
&lt;p&gt;Clyde Yancy, MD, president of the American Heart Association, said that while the study was a computer modeling analysis that may be as good as it gets because &quot;it would be impossible to do a randomized trial in large numbers of high versus low sodium consumption, and the use of modeling with reasonable assumptions represents a solid if not ideal alternative.&quot;&lt;/p&gt;
&lt;p&gt;Moreover, Yancy argued that &quot;the costs and effort involved in setting and/or changing policy&quot; require strong imperatives, and he thought the data reported today &quot;provide that imperative.&quot;&lt;/p&gt;
&lt;p&gt;Three grams of salt comes to about a teaspoonful, but Goldman said it was foolish to think of sodium reduction in terms of such measurements because so much sodium comes from processed foods and from restaurant food. Achieving the needed reduction requires a concerted national effort.&lt;/p&gt;
&lt;p&gt;Bibbins-Domingo noted that their study was limited &quot;by any uncertainty concerning the data entered into the model.&quot;&lt;/p&gt;
&lt;p&gt;Also they noted that they did not &quot;account fully for the possible effects of salt reduction that are unrelated to control of blood pressure  --  for example, potential improvements in outcomes for the increasing numbers of patients with heart failure or prevention of other serious conditions, such as end-stage renal disease.&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;The study was supported in part by a grant from the American Heart Association Western States Affiliate and a grant from the University of California, San Francisco Clinical and Translational Sciences Institute.&lt;/p&gt;&lt;p&gt;The authors said they had &quot;no potential conflicts of interest relevant to this article.&quot;&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_198"
                     title="Fish Oils May Slow Genetic Aging (CME/CE)"
                     score="-0.002"
                     href="http://www.medpagetoday.com/PrimaryCare/DietNutrition/tb/18043?impressionId=1265794390716"
                     
      For heart disease patients, omega-3 fatty acids may protect against morbidity and mortality by slowing biological aging, researchers say.&lt;br&gt;
&lt;br&gt;Patients who had the highest omega-3 fatty acid blood levels also had telomeres that shortened at a significantly slower rate than patients with lower intake, Ramin Farzaneh-Far, MD, of the University of California San Francisco, and colleagues reported in the Jan. 20 &lt;em&gt;JAMA&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;Patients in the lowest quartile of omega-3 fatty acid blood levels had the fastest rate of telomere shortening over five years: 0.13 telomere-to-single-copy gene ratio (95% CI 0.09 to 0.17).&lt;br&gt;
&lt;br&gt;Those who had the highest omega-3 fatty acid blood levels had the slowest rate of telomere shortening: 0.05 telomere-to-single copy ratio (95% CI 0.02 to 0.08, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Telomeres are the protective caps at the end of chromosomes that reveal how biological stress ages a person.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;&quot;Patients with the highest levels of omega-3 fish oils were found to display the slowest decrease in telomere length, whereas those with the lowest levels of omega-3 fish oils in the blood had the fastest rate of telomere shortening,&quot; Farzaneh-Far said. &quot;This suggests that these patients were aging faster than those with higher fish oil levels.&quot;&lt;/p&gt;
&lt;p&gt;They said omega-3s may protect against oxidative stress, or increase the activity of the telomerase enzyme, which would decrease telomere shortening by creating more accurate telomere copies.&lt;/p&gt;
&lt;p&gt;But some cardiologists were quick to point out that the results are preliminary and need to be replicated before physicians can use them in practice.&lt;/p&gt;
&lt;p&gt;Since the study was observational and couldn&apos;t prove cause-and-effect, &quot;we don&apos;t really know whether ingestion of omega-3 fatty acids resulted in this &apos;benefit,&apos;&quot; Steven E. Nissen, MD, of the Cleveland Clinic, noted in an e-mail. &quot;It remains entirely possible that individuals who consume more fish also have other favorable healthy habits.&quot;&lt;/p&gt;
&lt;p&gt;Nissen also pointed out that the study was not randomized to compare fish oil directly with a placebo treatment, and cautioned that &quot;the relationship between telomere shortening and cardiovascular health is not well established.&quot;&lt;/p&gt;
&lt;p&gt;Studies have shown that omega-3s appear to be effective for patients with coronary artery disease. Yet the underlying mechanisms are not well understood. Some researchers think it may have something to do with anti-inflammatory, triglyceride-lowering, antihypertensive, antiplatelet, or antiarrhythimic effects.&lt;/p&gt;
&lt;p&gt;Research has shown that the length of telomeres  --  chromosome caps that have long been compared to the plastic ends of shoelaces  --  may be a marker of biological age. Biological age is independent of chronological age, and takes into account genetic and environmental stressors that may wreak havoc on cells.&lt;/p&gt;
&lt;p&gt;Since there&apos;s been increasing evidence that omega-3s exert direct effects on aging and age-related diseases, the researchers decided to investigate them as a potential mechanism for protective effects in heart patients.&lt;/p&gt;
&lt;p&gt;So they conducted a prospective cohort study of 608 patients in California with stable coronary artery disease. Patients were recruited from the Heart and Soul Study between September 2000 and December 2002.&lt;/p&gt;
&lt;p&gt;They were followed for five years, and the researchers assessed telomere length of their leukocytes at baseline and again at the end of follow-up.&lt;/p&gt;
&lt;p&gt;&quot;By measuring telomere length at two different times,&quot; Farzaneh-Far said, &quot;we were able to see the speed at which the telomers are shortening and that gives us some indication of how rapidly the biological aging process is taking place in these patients.&quot;&lt;/p&gt;
&lt;p&gt;The researchers found that baseline omega-3 fatty acid levels were positively correlated with changes in telomere length over five years (&lt;em&gt;P&lt;/em&gt;=0.001).&lt;/p&gt;
&lt;p&gt;The relationships remained after controlling for potential confounders including demographics, blood pressure, serum lipids, and inflammatory biomarkers.&lt;/p&gt;
&lt;p&gt;The researchers noted that each standard-deviation increase in fatty acid levels was associated with a 32% reduction in the odds of telomere shortening (95% CI 0.47 to 0.98).&lt;/p&gt;
&lt;p&gt;So how do omega-3s stop telomeres from getting smaller?&lt;/p&gt;
&lt;p&gt;They may protect against oxidative stress, which is a major driver of telomere shortening and aging. Or, fatty acids may increase the activity of the enzyme telomerase, which can result in more accurate copying and hence, longer telomeres, the researchers suggested.&lt;/p&gt;
&lt;p&gt;The researchers agreed that the study was limited by its observational nature, which leaves no room for definitive conclusions about causality. Also, they only measured telomere length in leukocytes, which means the findings may not translate to other cell types, including myocardial or endothelial cells.&lt;/p&gt;
&lt;p&gt;Researchers who were not involved in the study noted that omega-3s have been shown to have effects on other factors that contribute to heart disease risk.&lt;/p&gt;
&lt;p&gt;&quot;Omega-3 fatty acids have a potent positive impact on lipids that circulate in the blood stream and damage the heart,&quot; said Cam Patterson, MD, of the University of North Carolina Chapel Hill McAllister Heart Institute. &quot;The effects of omega-3 fatty acids on lipids are still the best advertisement for their use to prevent heart disease.&quot;&lt;/p&gt;
&lt;p&gt;Merle Myerson, MD, of Columbia University, agreed. &quot;[The researchers] don&apos;t mention that omega-3 fatty acids lower triglycerides and non-HDL cholesterol, and stabilize cell membranes  --  all of which may reduce risk for coronary artery disease and sudden cardiac death.&quot;&lt;/p&gt;
&lt;p&gt;Myerson said the findings need to be replicated in future studies.&lt;/p&gt;
&lt;p&gt;While their study may not have implications for intake of omega-3s among the general population, the researchers said it upholds recommendations for patients with heart disease.&lt;/p&gt;
&lt;p&gt;&quot;The results of our study underscore the recommendations of the American Heart Association, that patients with known coronary artery disease should be getting at least one gram a day of omega-3 fish oil,&quot; Farzaneh-Far 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 grants from the American Heart Association and the Bernard and Barbro Foundation.&lt;/p&gt;&lt;p&gt;The Heart and Soul Study was supported by the Department of Veterans Affairs, the National Heart, Lung, and Blood Institute, the Robert Wood Johnson Foundation, the American Federation for Aging Research, the Ischemia Research and Education Foundation, and the Nancy Kirwan Heart Research Fund.&lt;/p&gt;&lt;p&gt;A co-author reported financial conflicts with GlaxoSmithKline and Monsanto, and founded OmegaQuant Analytics to offer blood omega-3 fatty acid testing.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_169"
                     title="Hospitals Post Gains in Evidence-Based Care"
                     score="-0.003"
                     href="http://www.medpagetoday.com/HospitalBasedMedicine/Hospitalists/tb/17989?impressionId=1265794390716"
                     
      &lt;p&gt;WASHINGTON  --  The latest report from the nation&apos;s official hospital oversight agency, the Joint Commission, found more good than bad  --  overall, hospitals are following evidence-based standards for treatment of myocardial infarction, heart failure, and pneumonia.&lt;/p&gt;
&lt;p&gt;The annual report, &quot;Improving America&apos;s Hospitals: The Joint Commission&apos;s Annual Report on Quality and Safety,&quot; found that hospitals provided evidence-based heart attack treatments  --  including giving patients aspirin when they admitted  --  nearly 97% of the time in 2008, up 10% from the rate in 2002.&lt;/p&gt;
&lt;p&gt;Adherence was even better for treating heart failure. Back in 2002, hospitals treating heart failure patients were only following about 60% of evidence-based recommendations, but in 2008 hospitals were providing evidence-based treatment, including offering smoking cessation counseling and testing left ventricular systolic function, about 92% of the time.&lt;/p&gt;
&lt;p&gt;But mixed in with the glowing words there was a handful of cautions about areas where hospitals still fall short of the mark.&lt;/p&gt;
&lt;p&gt;Hospitals are still often doing too little, too late when it comes to the use of fibrinolytic therapy for MI  --  door-to-needle time only makes the 30-minute threshold about half of the time. A single but important pneumonia measure, initiation of antibiotics within 24 hours of admittance, was also disappointing, with just 60% of hospitals adhering to that measure.&lt;/p&gt;
&lt;p&gt;The Joint Commission&apos;s report tracks hospital use of 31 evidence-based measures.&lt;/p&gt;
&lt;p&gt;On the plus side, hospitals did improve overall adherence to care measures for pneumonia patients, following evidence-based treatment recommendations 93% of the time in 2008, versus 73% in 2002.&lt;/p&gt;
&lt;p&gt;Current guidelines recommend that smokers who are admitted for treatment of acute coronary syndromes, heart failure, or pneumonia should receive smoking cessation counseling, a recommendation that had often been ignored.&lt;/p&gt;
&lt;p&gt;In 2002 hospitals reported providing smoking cessation counseling to about 67% of heart attack patients, 42% of heart failure patients, and 37% of pneumonia patients  --  in 2008 the counseling rate for each of those three admitting diagnoses had climbed to 96% to 99%.&lt;/p&gt;
&lt;p&gt;In the report Mark R. Chassin, MD, Joint Commission president, wrote that improved adherence to evidence-based guidelines should not only improve outcomes, but also save money by reducing both complications and readmissions.&lt;/p&gt;
&lt;p&gt;The report also found that hospitals adhered to quality measures relating to inpatient treatment of childhood asthma  --  which includes giving relievers and systematic corticosteroids for asthmatic kids  --  in nearly 100% of eligible cases. &lt;ul&gt; &lt;/ul&gt;&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20090101_6_625"
                     title="Study Finds Coronary Prevention in General Practice Feasible"
                     score="-0.005"
                     href="