<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_3239"
                     title="Selenium Linked to Lower Bladder Cancer Risk (CME/CE)"
                     score="0.014"
                     href="http://www.medpagetoday.com/PrimaryCare/DietNutrition/tb/21995?impressionId=1283458818675"
                     
      &lt;p&gt;The trace mineral selenium may help prevent bladder cancer, especially in women, according to a meta-analysis.&lt;/p&gt;
&lt;p&gt;Bladder cancer risk overall fell with higher levels of selenium for a pooled odds ratio of 0.61 (95% confidence interval 0.42 to 0.87) for the highest versus lowest selenium levels, found N&amp;#250;ria Malats, MD, PhD, of the Spanish National Cancer Research Center in Madrid, Spain, and colleagues.&lt;/p&gt;
&lt;p&gt;Women appeared to show a stronger protective effect than men, the researchers reported in the September issue of &lt;em&gt;Cancer Epidemiology, Biomarkers &amp;amp; Prevention&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;But physicians should hold off on suggesting selenium supplementation to patients until large observational studies or randomized trials can confirm a benefit, Malats&apos; group cautioned.&lt;/p&gt;
&lt;p&gt;Indeed, further work on the dose-response relationship is needed even in setting recommended daily intakes for the mineral, according to comments attributed to Elizabeth A. Platz, ScD, MPH, of the Johns Hopkins School of Public Health, in a press release.&lt;/p&gt;
&lt;p&gt;But Platz, a member of the editorial board of the journal, agreed with the researchers that the meta-analysis findings provide a valuable early step toward determining a possible role in bladder cancer prevention.&lt;/p&gt;
&lt;p&gt;Dietary selenium predominantly comes from bread and meats, particularly when they come from areas where soil has higher selenium levels.&lt;/p&gt;
&lt;p&gt;Selenium forms compounds with dozens of proteins in the body, together making enzymes that act as antioxidants, although the researchers noted that the specific anticarcinogenic mechanisms are not yet fully known.&lt;/p&gt;
&lt;p&gt;The meta-analysis included seven epidemiologic studies published prior to March 2010 for a total of 1,910 bladder cancer cases and 17,339 controls.&lt;/p&gt;
&lt;p&gt;Among the studies, three used a case-control design, three a nested case-control design, and one a case-cohort design. The patient populations were predominantly in the United States (four studies) as well as Northern Europe (three studies).&lt;/p&gt;
&lt;p&gt;Selenium status appeared inversely linked to bladder cancer risk in each of the studies, although it was not significant in all of them.&lt;/p&gt;
&lt;p&gt;The definition of selenium &quot;exposed&quot; individuals considered to have elevated selenium levels varied from over 0.630 &amp;#956;g/g to more than 0.95 &amp;#956;g/g in toenail samples as a measure of longer-term exposure, and from at least 96.00 &amp;#956;g/L to at least 133.1 &amp;#956;g/L in serum, which led to some overlap with the control groups between studies.&lt;/p&gt;
&lt;p&gt;Stratifying the results by gender showed a significantly decreased risk of bladder cancer with elevated selenium intake in women (odds ratio 0.55, 95% CI 0.32 to 0.95).&lt;/p&gt;
&lt;p&gt;For men, the effect was virtually nil. Elevated selenium levels yielded an odds ratio of only 0.95 for bladder cancer risk, which was not significant (95% CI 0.69 to 1.27).&lt;/p&gt;
&lt;p&gt;The divergence in selenium&apos;s effect &quot;may result from gender-specific differences in its accumulation and excretion,&quot; Malats&apos; group suggested in the paper.&lt;/p&gt;
&lt;p&gt;Another source of heterogeneity in the meta-analysis was how selenium was measured  --  from toenail samples in four studies and from serum in the other three.&lt;/p&gt;
&lt;p&gt;Both sample sources led to significant inverse correlations between selenium levels and bladder cancer risk, but serum levels were more strongly linked to a protective effect with an odds ratio of 0.33 (95% CI 0.21 to 0.51).&lt;/p&gt;
&lt;p&gt;Smoking status  --  a known risk factor for bladder cancer  --  also appeared to contribute to heterogeneity in the meta-analysis.&lt;/p&gt;
&lt;p&gt;The researchers cautioned about the small number of studies included in the meta-analysis and the heterogeneity seen among them.&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 Red Tem&amp;#225;tica de Investigaci&amp;#243;n Cooperativa en C&amp;#225;ncer, Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, and by the Association for International Cancer Research.&lt;/p&gt;&lt;p&gt;The researchers reported having no potential conflicts of interest to disclose.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3203"
                     title="Vitamin A Hikes HIV Loads in Breast Milk (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/HIVAIDS/HIVAIDS/tb/21944?impressionId=1283458818675"
                     
      &lt;p&gt;HIV-positive mothers may be more likely to infect infants via breast milk if they take vitamin A and beta-carotene supplements, researchers have found.&lt;/p&gt;
&lt;p&gt;In two analyses of a cohort of HIV-positive Tanzanian women, those who took the vitamins had significantly higher viral loads in their breast milk than those who didn&apos;t take them (&lt;em&gt;P&lt;/em&gt;=0.02), according to Eduardo Villamor, MD, PhD, of the University of Michigan, and colleagues.&lt;/p&gt;
&lt;p&gt;They also had a higher risk of subclinical mastitis, an inflammatory response that causes tight junctions in the mammary epithelium to open, allowing extracellular fluid to flow from plasma to milk. Villamor said this could be the mechanism explaining the association with viral load.&lt;/p&gt;
&lt;p&gt;&quot;Daily supplementation with these nutrients at the doses tested in the trial should probably not be given to HIV-infected lactating women,&quot; Villamor told &lt;em&gt;MedPage Today&lt;/em&gt; in an e-mail.&lt;/p&gt;
&lt;p&gt;The analyses were published in separate papers in the &lt;em&gt;American Journal of Clinical Nutrition&lt;/em&gt; and the &lt;em&gt;Journal of Nutrition&lt;/em&gt;, respectively.&lt;/p&gt;
&lt;p&gt;Both come from a randomized, controlled trial of 1,078 HIV-infected women in Dar es Salaam, Tanzania, who received one of four regimens: vitamin A and beta-carotene (5,000 IU and 30 mg, respectively); B-complex vitamins along with vitamins C and E; a multivitamin plus vitamin A and beta-carotene; or placebo.&lt;/p&gt;
&lt;p&gt;The &lt;em&gt;American Journal of Clinical Nutrition&lt;/em&gt; study looked at 594 of these women who were infected with HIV and had breast milk samples taken.&lt;/p&gt;
&lt;p&gt;The researchers found that the proportion of breast milk samples with detectable viral load was significantly higher in women who received regimens with vitamin A and beta-carotene than in the other groups (51.3% versus 44.8%, &lt;em&gt;P&lt;/em&gt;=0.02).&lt;/p&gt;
&lt;p&gt;The effect was apparent at least six months postpartum, they said, with a 34% increased risk of HIV shedding in milk at that time (relative risk 1.34, 95% CI 1.04 to 1.73).&lt;/p&gt;
&lt;p&gt;There were no significant differences between women who received multivitamins and those who took placebo, they added.&lt;/p&gt;
&lt;p&gt;They also found that breast milk concentrations of beta-carotene were related to increased detectable viral load in milk.&lt;/p&gt;
&lt;p&gt;One mechanism by which this occurs may be subclinical mastitis, assessed in the &lt;em&gt;Journal of Nutrition&lt;/em&gt; study.&lt;/p&gt;
&lt;p&gt;A subset of 674 participants had subclinical mastitis assessed, measured by sodium-to-potassium ratio in breast milk.&lt;/p&gt;
&lt;p&gt;The researchers found that those on vitamin A and beta-carotene had a 45% increased risk of severe subclinical mastitis (&lt;em&gt;P&lt;/em&gt;=0.03), with nonsignificant trends toward greater risk of moderate subclinical mastitis or any degree of the condition.&lt;/p&gt;
&lt;p&gt;Those taking multivitamins without vitamin A and beta-carotene had a 33% greater risk of subclinical mastitis (&lt;em&gt;P&lt;/em&gt;=0.005) and a 75% greater risk of severe subclinical mastitis (&lt;em&gt;P&lt;/em&gt;=0.0006) than women on placebo.&lt;/p&gt;
&lt;p&gt;The researchers called these findings &quot;unexpected,&quot; attributing their effects to an increased inflammatory response.&lt;/p&gt;
&lt;p&gt;Women taking multivitamins plus vitamin A and beta-carotene had trends toward increased risks, but again they were not significant.&lt;/p&gt;
&lt;p&gt;The researchers also found that among women with CD4+ T-cell counts of 350 or greater, multivitamin intake resulted in a 49% increased risk of any subclinical mastitis (&lt;em&gt;P&lt;/em&gt;=0.006).&lt;/p&gt;
&lt;p&gt;However, multivitamins had no effects among those with lower counts.&lt;/p&gt;
&lt;p&gt;The analyses were limited because they lacked details on clinical breast symptoms and on breast-feeding practices.&lt;/p&gt;
&lt;p&gt;Villamor told &lt;em&gt;MedPage Today&lt;/em&gt; that the findings about vitamins other than vitamin A and beta-carotene are not immediately concerning, because in previous studies, these nutrients have shown benefits in terms of disease progression, child growth, diarrhea, and anemia.&lt;/p&gt;
&lt;p&gt;But vitamin A and beta-carotene do seem clearly problematic, he said.&lt;/p&gt;
&lt;p&gt;There are now &quot;strong arguments to consider the implications of supplementation to pregnant or lactating women who are HIV-positive. It does not look like it&apos;s a safe intervention for them,&quot; Villamor 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 National Institutes of Health.&lt;/p&gt;&lt;p&gt;The researchers 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_3199"
                     title="ESC: Simple Clinical Factors May Provide Clues to Future Ischemic Events (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/MeetingCoverage/ESCCongress/tb/21940?impressionId=1283458818675"
                     
      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_3191"
                     title="ESC: It&apos;s Not Butter and It&apos;s Not Better (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/MeetingCoverage/ESCCongress/tb/21921?impressionId=1283458818675"
                     
      STOCKHOLM  --  Adding margarine enriched with omega-3 fatty acids as a dietary intervention did not prevent second heart attacks in older men and women at risk for worsening heart disease, researchers said here.&lt;br&gt;
&lt;br&gt;The study results are doubly disappointing since the margarine intervention did initially reduce events, but by 30 months the evidence of that benefit had disappeared, said Daan Kromhout, MPH, PhD, of Wageningen University in the Netherlands.&lt;br&gt;
&lt;br&gt;After more than 40 months, consumption of the omega-3 fatty acid fortified margarines &quot;had no effect on the rate of major cardiovascular events,&quot; he reported at a Hot Line session today at the European Society of Cardiology meeting. The findings were simultaneously published online by the &lt;em&gt;New England Journal of Medicine.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;The ALPHA-OMEGA trial randomized 4,837 MI survivors, 60 to 80 years old, to margarine supplemented with a combination of eicosapentaenoic acid and docosahexaenoic acid (EPA and DHA), or with 2 grams of the plant-derived fatty acid alpha-linolenic acid (ALA), or a third supplemented with all three versus a placebo margarine.&lt;/p&gt;
&lt;p&gt;The primary endpoint was the combined rate of fatal and non-fatal cardiovascular events and cardiac interventions.&lt;/p&gt;
&lt;p&gt;Neither EPA-DHA nor ALA reduced this endpoint, the researchers reported (hazard ratio with EPA-DHA, 1.01; 95% confidence interval 0.87 to 1.17, &lt;em&gt;P &lt;/em&gt;=0.93).&lt;/p&gt;
&lt;p&gt;A prespecified subgroup analysis in women found that use of the ALA-fortified margarine reduced the rate of cardiovascular events compared with placebo or with the EPA-DHA margarine, but the difference failed to reach statistical significance (HR 0.73, 95% CI 0.51 to 1.03, &lt;em&gt;P&lt;/em&gt;=0.07).&lt;/p&gt;
&lt;p&gt;Alfred Bove, MD, of Temple University in Philadelphia, said the findings surprised him &quot;because most of the data on omega-3 fatty acids come from epidemiologic studies and those were positive.&quot;&lt;/p&gt;
&lt;p&gt;He likened the situation to hormone therapy, which had been widely recommended to reduce cardiovascular risk in postmenopausal women based on data from epidemiologic studies.&lt;/p&gt;
&lt;p&gt;That hypothesis was initially questioned when a randomized controlled trial (Estrogen/Progestin Replacement Study [HERS]) linked hormones to increased risk of events. The HERS finding was confirmed in the landmark Women&apos;s Health Initiative trial in which ischemic events were more common among women randomized to estrogen/progestin.&lt;/p&gt;
&lt;p&gt;R. Scott Wright, MD, of the Mayo Clinic in Rochester, Minn., told &lt;em&gt;MedPage Today&lt;/em&gt; that the trial design was faulty, in that margarine was a bad choice of vehicle for omega-3 fatty acids.&lt;/p&gt;
&lt;p&gt;&quot;It needs to be combined with another food  --  bread,&quot; he said. &quot;So this not a good option for Americans because it would mean eating more bread, which is likely to lead to weight gain and bread is high in sodium, so blood pressure would be a factor.&quot;&lt;/p&gt;
&lt;p&gt;Wright noted that the ALPHA-OMEGA study did not include information on weight or blood pressure, so he considered the findings at best incomplete.&lt;/p&gt;
&lt;p&gt;All of the patients received &quot;state-of-the-art antihypertensive, antithrombotic, and lipid-modifying therapy,&quot; according to Kromhout and colleagues, in addition to margarine, and it may have been that optimal therapy that limited the potential for an omega-3 benefit.&lt;/p&gt;
&lt;p&gt;Statin therapy, along with other improvements in cardiovascular care, means &quot;a beneficial effect of low doses of EPA-DHA is difficult to prove,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;Wright said he wasn&apos;t persuaded by that explanation since, even after optimal therapy, there is about a 30% residual risk. &quot;There is plenty of room to show a benefit,&quot; he declared.&lt;/p&gt;
&lt;p&gt;Most of the patients in ALPHA-OMEGA were men (78%) and 24% were obese, but they differed from the typical high-risk American in at least one way: at baseline they consumed about three times more fish than does the typical American, a median of 15 grams a day.&lt;/p&gt;
&lt;p&gt;According to a report from the Environmental Protection Agency, average fish consumption in the U.S. works out to 4.58 &amp;#177; 0.42 grams a day.&lt;/p&gt;
&lt;p&gt;The authors conducted a post hoc exploratory analysis in patients with diabetes, finding significant reductions in events among patients in the EPA-DHA group. But the authors noted that &quot;[the] results with respect to patients with diabetes are only hypothesis-generating and do not permit definitive conclusions to be drawn.&quot;&lt;/p&gt;
&lt;p&gt;Bove, a former president of the American College of Cardiology, added that the results from the subset analysis in diabetics was reassuring, since patients with diabetes and elevated triglycerides are the patients that &quot;we have believed would be most likely to benefit&quot; from omega-3 fatty acids.&lt;/p&gt;
&lt;p&gt;The margarines used in the trial were supplied by Unilever, an international maker of food and consumer goods, and included the well-known &quot;I Can&apos;t Believe It&apos;s Not Butter,&quot; which contains 420 mg of ALA per serving.&lt;/p&gt;

&lt;p&gt;In a statement released after the ALPHA-OMEGA trial findings were presented, Unilever said the &quot;study outcome for EPA and DHA is surprising considering the weight of evidence published to date. This could be the result of methodological issues such as the relatively low daily dosage compared with previous studies or the fact that in this study serious cardiovascular events were much lower than in studies performed in the past. This is probably due to extensive drug treatment that is nowadays applied. The finding needs further study, but given the totality of evidence does not immediately impact the current advice on fish and fish oil consumption for prevention of cardiovascular 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 trial was supported by the Netherlands Heart Foundation, the National Institutes of Health, and Unilever.&lt;/p&gt;&lt;p&gt;Kromhout reported that his institution received grant support form Unilever to cover distribution of the trial margarines to patients. His institution also received a grant from the Product Board for Margarine Fats and Oils to support research on polyunsaturated fats and cardiovascular diseases done by a PhD student.&lt;/p&gt;&lt;p&gt;Bove said he had no financial conflicts.&lt;/p&gt;&lt;p&gt;Wright said he consults for Roche and Genentech and conducts trial work for 3M/Littman.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3180"
                     title="ESC: ECG Not Much Help for Screening Athletes&apos; Hearts (CME/CE)"
                     score="0.012"
                     href="http://www.medpagetoday.com/MeetingCoverage/ESCCongress/tb/21911?impressionId=1283458818675"
                     
      STOCKHOLM  --  While hypertrophic cardiomyopathy is the most common cause of sudden death in competitive soccer players, when pro players were screened for the problem with electrocardiography (ECG), the positive results all turned out to be false positives, according to a small study.&lt;br&gt;
&lt;br&gt;The study of 30 pro soccer players who underwent 12-lead ECG screening showed that nearly 60% displayed abnormalities suggestive of cardiac hypertrophy  --  but none were confirmed with MRI scans, according to Jose Angel Cabrera, MD, of Hospital Quiron in Madrid, Spain, and colleagues.&lt;br&gt;
&lt;br&gt;In an abstract scheduled for presentation here at the European Society of Cardiology (ESC) annual meeting, the researchers indicated that recommendations for routine ECG-based screening of athletes &quot;should be reevaluated.&quot;&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Some earlier studies, particularly from Italy, had indicated that 12-lead ECG screening &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/ESCCongress/10738&quot; mce_href=&quot;http://www.medpagetoday.com/MeetingCoverage/ESCCongress/10738&quot; target=&quot;_blank&quot;&gt;could identify athletes&lt;/a&gt; with hypertrophic cardiomyopathy, putting them at risk for sudden cardiac death. Making such screening routine in Italy was said to &lt;a href=&quot;http://www.medpagetoday.com/Cardiology/Arrhythmias/4230&quot; mce_href=&quot;http://www.medpagetoday.com/Cardiology/Arrhythmias/4230&quot; target=&quot;_blank&quot;&gt;reduce cardiac arrests&lt;/a&gt; among athletes by 90%.&lt;/p&gt;
&lt;p&gt;However, the new Spanish study suggests that instituting such screening may also involve a great deal of waste  --  since positive findings typically result in expensive follow-up evaluations.&lt;/p&gt;
&lt;p&gt;Cabrera and colleagues reported on their experience with 30 professional soccer players, mean age 31 (SD 4), who underwent 12-lead ECG screening conducted and interpreted according to proposed ESC guidelines.&lt;/p&gt;
&lt;p&gt;The participants also underwent MRI cardiac scans and genotyping for mutations in nine genes known to be associated with various types of heart disease.&lt;/p&gt;
&lt;p&gt;ECG results in 17 of the players showed abnormalities that, under the guidelines, were indicative of cardiac hypertrophy warranting follow-up.&lt;/p&gt;
&lt;p&gt;But the MRI results in all 17 showed normal left ventricular wall thickness and no signs of systolic anterior mitral valve motion or left ventricular outflow obstruction.&lt;/p&gt;
&lt;p&gt;On the other hand, the evaluations failed to identify minor pericardial effusion in two players and persistent ductus arteriosus in another.&lt;/p&gt;
&lt;p&gt;None of the participants had risk-associated genotype findings.&lt;/p&gt;
&lt;p&gt;Alfred Bove, MD, of Temple University in Philadelphia and past president of the American College of Cardiology, told &lt;em&gt;MedPage Today&lt;/em&gt; in an interview that the findings are plausible but at the same time pose a conundrum for clinical practice.&lt;/p&gt;
&lt;p&gt;&quot;It&apos;s a tough call,&quot; he said. &quot;How do you find these kids [with serious cardiac abnormalities]? It&apos;s very small numbers, one in 100,000 or something like that. How many do you screen with expensive tests to find the one kid  --  it becomes a big issue.&quot;&lt;/p&gt;
&lt;p&gt;He noted that ECG screening is relatively cheap and easy to perform, and there is nothing else available for mass use that would not cost substantially more.&lt;/p&gt;
&lt;p&gt;But Bove agreed that relying on ECG causes problems, particularly in the U.S. where rates of actual cardiac abnormalities are much lower than in northern Italy, where the research underlying the current recommendations was conducted.&lt;/p&gt;
&lt;p&gt;&quot;The Italians have convinced the world that everybody should have an electrocardiogram,&quot; he quipped.&lt;/p&gt;
&lt;p&gt;Bove, who said he sometimes helps evaluate young athletes with suspected heart problems, indicated that, as a result, it&apos;s common to see one athlete &quot;with a very bizarre-looking electrocardiogram  --  perfectly normal kid, playing excellent sports, no history of anything ... and everybody gets all upset.&quot;&lt;/p&gt;
&lt;p&gt;He said these athletes can get &quot;million-dollar workups&quot; that, most times, show nothing abnormal other than the &quot;weird&quot; ECG.&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 external funding for the study was reported.&lt;/p&gt;&lt;p&gt;Cabrera had no conflict of interest disclosures.&lt;/p&gt;&lt;p&gt;Bove said he had no relationships with commercial entities relevant to the research.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>