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    <recommendedItem id="20100101_19_449"
                     title="FDA Okays Statin for Primary Prevention"
                     score="0.011"
                     href="http://www.medpagetoday.com/InfectiousDisease/PublicHealth/tb/18380?impressionId=1265766094432"
                     
      &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_198"
                     title="Fish Oils May Slow Genetic Aging (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/PrimaryCare/DietNutrition/tb/18043?impressionId=1265766094432"
                     
      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="20090101_10_981"
                     title="For Heart Risk in Men, Type of Fat May Outweigh Quantity Consumed"
                     score="-0.005"
                     href="