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<recommendedContent xmlns="http://api.mspoke.com">
    <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=1265730984973"
                     
      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_189"
                     title="Tailoring Trumps Targeting for Cholesterol Control (CME/CE)"
                     score="-0.002"
                     href="http://www.medpagetoday.com/Cardiology/Dyslipidemia/tb/18023?impressionId=1265730984973"
                     
      &lt;p&gt;Lipid control is more than a simple matter of &quot;knowing your numbers,&quot; according to a computer model that found tailoring statin therapy to fit an individual&apos;s five-year risk of heart attack or stroke is a better prevention strategy than treating to preset goals.&lt;/p&gt;
&lt;p&gt;In the model, patients who whose five-year coronary artery disease risk was 5% to 15% received 40 mg of simvastatin (Zocor), while those whose risk was greater were given 40 mg of atorvastatin (Lipitor).&lt;/p&gt;
&lt;p&gt;In every scenario, the tailored approach was preferable, Rodney A. Hayward, MD, of the University of Michigan and the Veterans Affairs Ann Arbor Healthcare System, and colleagues wrote in the Jan. 19 &lt;em&gt;Annals of Internal Medicine.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;While treating-to-target is appealingly simple, that simplicity may be its main limitation, the researchers argued.&lt;/p&gt;
&lt;p&gt;Treating to a single target means that one risk factor receives &quot;dramatically more weight than all other predictors of treatment benefit, resulting in other highly relevant information being either ignored or underweighted,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;That approach, tailoring treatment to reflect multiple risk factors rather than treating-to-target, is an &quot;interesting&quot; one, according to Christopher Cannon, MD, of Brigham and Women&apos;s Hospital in Boston, who was not involved in the study.&lt;/p&gt;
&lt;p&gt;But Cannon, principal investigator of a number of statin trials, said the idea may be a little too late to impact clinical practice.&lt;/p&gt;
&lt;p&gt;&quot;The guidelines won&apos;t shift to this approach any time soon, and in two years, atorvastatin will be generic, so all patients can inexpensively be treated with more intensive therapy (which is better for everyone at all risk levels),&quot; Cannon wrote in an e-mail.&lt;/p&gt;
&lt;p&gt;Although intensive therapy may be better as a rule, he conceded, it&apos;s less cost-effective when an expensive drug is used. When atorvastatin becomes available as a generic, he wrote, for &quot;$4 a month at Walmart it is simply cheaper  --  and of course better  --  to treat everyone with atorvastatin 80 mg.&quot;&lt;/p&gt;
&lt;p&gt;Assuming a population of Americans ages 30 to 75 with no history of myocardial infarction, the authors developed three treatment models: &lt;ul&gt; &lt;li&gt;Standard National Cholesterol Education Program III (NCEP) treat-to-target recommendation, which requires treatment to an LDL target of less than 190 mg/dL for low-risk individuals, less than 160 mg/dL for moderate-risk, and less than 130 mg/dL for high-risk individuals&lt;/li&gt; &lt;li&gt;Intensive NCEP III treat-to-target approach, with targets of less than 100 mg/dL for high-risk individuals&lt;/li&gt; &lt;li&gt;The tailored model, with 40 mg of simvastatin for patients who whose five-year coronary artery disease risk was 5% to 15% and 40 mg of atorvastatin (Lipitor) for higher-risk patients&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;(In both NCEP III strategies statins would be used in a stepwise fashion  --  20 mg simvastatin, 40 mg simvastatin, 40 mg atorvastatin, and, finally, 80 mg atorvastatin  --  to achieve targets).&lt;/p&gt;
&lt;p&gt;Using standard NCEP III treat-to-target recommendations, &quot;37.9 million U.S. persons should receive statins, of which 7.9 million should receive high dose-potency therapy (atorvastatin 40 to 80 mg),&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;Compared with no treatment, the standard strategy would save an estimated 48 quality adjusted life years (QALYs) per 1,000 Americans treated for five years, or a total of 1.83 million total QALYs.&lt;/p&gt;
&lt;p&gt;The intensive NCEP III treat-to-target recommendations would &quot;recommend that 53.4 million U.S. persons receive statins&quot; and would save about 570,000 more QALYs than the standard treatment.&lt;/p&gt;
&lt;p&gt;Using the computer model, this strategy prevented &quot;about 720,000 more nonfatal CAD events and 30,000 more deaths&quot; than the standard treatment.&lt;/p&gt;
&lt;p&gt;Tailored treatment, by contrast, would require that about the same number of people receive a statin  --  53 million. But only 13.3 million would require high-dose statin therapy, versus roughly 18 million who would be given high-dose statin therapy using the intensive NCEP III strategy.&lt;/p&gt;
&lt;p&gt;Even so, the tailored approach would save 520,000 more QALYs than the intensive treatment approach, the authors found.&lt;/p&gt;
&lt;p&gt;&quot;The tailored treatment approach was superior to both NCEP III approaches, resulting in both more CAD morbidity and mortality prevented in the overall population and higher treatment efficiency (greater benefit per person treated),&quot; they wrote.&lt;/p&gt;
&lt;p&gt;The authors noted a number of limitations, including the paucity of clinical trial data on statin therapy in persons ages 75 or older.&lt;/p&gt;
&lt;p&gt;Moreover, although the model suggested a robust benefit for tailored treatment, &quot;the absolute population-level benefit of the tailored treatment over the treat-to-target approaches are much less certain and can vary substantially on the basis of several factors, such as statin&apos;s effect on total mortality (estimates of which are less precise in the literature than estimates for nonfatal CAD events) and the level of treatment adherence that is achievable in real-world clinical practice.&lt;/p&gt;
&lt;p&gt;&quot;Whether a tailored treatment approach is superior for other conditions in which treat-to-target strategies are currently recommended, such as blood pressure and glycemic control, warrants examination,&quot; they concluded.&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 funded in part by the Department of Veteran Affairs Health Services Research &amp;amp; Development Service&apos;s Quality Enhancement Research Initiative.&lt;/p&gt;&lt;p&gt;Hayward did not report any financial disclosures.&lt;/p&gt;&lt;p&gt;Cannon reported receiving research/grants/suport from Accumetrics, AstraZeneca, Bristol-Myers Squibb/Sanofi Partnership, GlaxoSmithKline, Intekrin Therapeutics, Merck, Merck/Schering-Plough Partnership, Novartis, and Takeda. He is a clinical adviser with equity in Automedics Medical Systems.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_3749"
                     title="AHA: ARBITER 6-HALTS -- Are There Any Clinical Implications? (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/AHA/tb/17067?impressionId=1265730984973"
                     
      ORLANDO  --  By a margin of 0.014 mm in carotid intima-media thickness (CIMT), extended-release niacin (Niaspan) demonstrated superiority over ezetimibe (Zetia) as an add-on for high risk patients on long term statin therapy.&lt;br&gt;
&lt;br&gt;But is a difference of 0.014 mm clinically significant?&lt;br&gt;
&lt;br&gt;The niacin versus ezetimibe findings come from the ARBITER 6-HALTS trial, a late-breaker reported at the American Heart Association and simultaneously published in the &lt;em&gt;New England Journal of Medicine.&lt;/em&gt;&lt;br&gt;
&lt;br&gt;The trial, which involved 208 patients, has become a flashpoint in the continuing debate about the use of surrogate endpoints in clinical trials, and &lt;em&gt;the &lt;/em&gt;hot topic here.&lt;/p&gt;
&lt;p&gt;The margin of victory was the change in CIMT from baseline to eight months, and finally at 14 months. During that time, patients were taking either two grams of niacin or 10 mg of ezetimibe in addition to standard statin therapy.&lt;/p&gt;
&lt;p&gt;Niacin-treated patients achieved that 0.014 mm regression. Ezetimibe-treated patients showed no evidence of regression, and in those who achieved the greatest reduction in LDL cholesterol, CIMT paradoxically increased.&lt;/p&gt;
&lt;p&gt;Niacin led to a significant increase in HDL compared to ezetimibe, while ezetimibe decreased LDL significantly compared to niacin. Both drugs significantly decreased triglycerides.&lt;/p&gt;
&lt;p&gt;For weeks leading up to the meeting, ARBITER was the focus of both speculation and skepticism -- focus that evolved to frenzy as events unfolded.&lt;/p&gt;
&lt;p&gt;The results were embargoed for release at 8 a.m. Monday morning, but that plan was scuttled Sunday afternoon when an Associated Press story with the results was briefly posted on a TV station Web site  --  long enough to be aggregated by Google.&lt;/p&gt;
&lt;p&gt;That snafu caused a stir among the more than 200 journalists covering the meeting, and near panic by Abbott, which makes Niaspan and sponsored the trial, and Merck/Schering-Plough, the makers of ezetimibe.&lt;/p&gt;
&lt;p&gt;The &quot;embargo break&quot; led the AHA to hastily assemble a press conference (recalling the lead author from a theme park where he was enjoying a day with his family) in order to officially lift the embargo at 6 p.m. Sunday.&lt;/p&gt;
&lt;p&gt;The AHA then repeated the briefing -- with all the same players -- at 8 a.m. Monday, which was the originally scheduled time. (Both briefings were streamed live by &lt;em&gt;MedPage Today&lt;/em&gt; and are now available on-demand.)&lt;/p&gt;
&lt;p&gt;The plenary session at which the results were formally reported didn&apos;t occur until late Monday morning -- long enough for the correct interpretation of the results to finally emerge, said Mariell Jessup, MD, who chaired the scientific program for this year&apos;s AHA meeting.&lt;/p&gt;
&lt;p&gt;Jessup, a professor of medicine at the University of Pennsylvania, pointed out that &quot;this was not a trial with clinical endpoints and so it cannot be interpreted as a clinical endpoint trial.&quot;&lt;/p&gt;
&lt;p&gt;In the rush to report the &quot;news.&quot; Jessup said, that distinction, while not subtle, was often lost.&lt;/p&gt;
&lt;p&gt;And that, according to Jessup and others, is a common affliction when the primary endpoint of a study is a surrogate.&lt;/p&gt;
&lt;p&gt;Stephen Kopecky, MD, a cardiologist at the Mayo Clinic, in Rochester, Minn., said there was no doubt that &quot;surrogate endpoints are being overused. In cardiology trials, the most important endpoints are the &apos;hard&apos; major adverse cardiovascular events, which include cardiovascular death and nonfatal heart attack and stroke, among other things.&quot;&lt;/p&gt;
&lt;p&gt;The difficulty arises, he said, when clinicians overinterpret the results of a study based on surrogate markers.&lt;/p&gt;
&lt;p&gt;&quot;The best endpoints are living long and living happy,&quot; said Anthony DeMaria, MD, editor-in-chief of the &lt;em&gt;Journal of the American College of Cardiology.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;Hard endpoint trials, especially survival trials, require thousands -- not hundreds -- of patients and extend over years, not months. More patients and more time means more money.&lt;/p&gt;
&lt;p&gt;In 2009, neither time nor money is available in abundance.&lt;/p&gt;
&lt;p&gt;Surrogate endpoints, on the other hand, give researchers a way to answer narrowly focused research questions using fewer patients over shorter periods of time.&lt;/p&gt;
&lt;p&gt;But surrogate endpoints, whether they are findings from imaging such as CIMT, or intravascular ultrasound or biomarkers such as highly sensitive C-reactive protein or even lipid measures, don&apos;t necessarily translate easily into clinical endpoints.&lt;/p&gt;
&lt;p&gt;&quot;You can end up with a dead patient and nice lab results,&quot; said Harlan Krumholz, MD, of Yale University.&lt;/p&gt;
&lt;p&gt;For many the textbook example of this problem is torcetrapib  --  an investigational HDL-boosting drug that looked exceptional until excess mortality emerged in Phase III studies. The problem was later determined to be an off-target toxicity, something that was not detected by HDL measurements.&lt;/p&gt;
&lt;p&gt;Despite that concern, DeMaria said that some surrogates are, in his opinion, better than others, and he would put CIMT in that category because it does provide a measurement of the arterial bed.&lt;/p&gt;
&lt;p&gt;Valentin Fuster, MD, PhD, director of the Cardiovascular Institute at Mount Sinai in New York, disagreed.&lt;/p&gt;
&lt;p&gt;&quot;The disease [atherosclerosis] is too diffuse for a measurement taken in one area. This is not a good marker,&quot; Fuster said.&lt;/p&gt;
&lt;p&gt;Other imaging techniques, MRI for example, provide more valuable information, according to Fuster, who has been a champion of cardiac imaging and is currently conducting a study that compares the predictive value of different imaging technologies.&lt;/p&gt;
&lt;p&gt;Allan Taylor, MD, a Walter Reed Army Medical Center cardiologist and principal investigator for ARBITER, rejected broad stroke characterizations of CIMT.&lt;/p&gt;
&lt;p&gt;He noted that the technology for this imaging has improved from primitive  --  with studies that relied on two images from 7-10 megahertz machines involving two measurements  --  to precise, with the 13 megahertz scanner used in ARBITER to collect eight images and 16 measurements.&lt;/p&gt;
&lt;p&gt;That&apos;s not precise enough to guide clinical decisions, said Kopecky.&lt;/p&gt;
&lt;p&gt;&quot;CIMT has been shown to be beneficially affected by estrogens and thiazolidinediones, but these drugs have not been shown to reduce major cardiovascular events; in fact, they have increased events in some studies,&quot; he noted.&lt;/p&gt;
&lt;p&gt;&quot;On the other hand, other agents such as rosuvastatin (Crestor) have shown decreased major cardiac events, but have not caused regression of carotid intima-medial thickness in some studies.&quot;&lt;/p&gt;
&lt;p&gt;Krumholz, who serves on a committee drafting an Institute of Medicine report on surrogate markers, said, &quot;My focus at the end of the day has to be on clinical results.&quot;&lt;/p&gt;
&lt;p&gt;Krumholz said he personally remains highly skeptical of using surrogate endpoints to approve drugs: case-in-point being ezetimibe, which was approved on the basis of its demonstrated ability to achieve significant reductions in LDL.&lt;/p&gt;
&lt;p&gt;Ezetimibe has yet to demonstrate a clinical benefit, he said. For that reason, Krumholz said current clinical practice  --  an estimated nine million Americans are taking the drug  --  is &quot;overly exuberant for the amount of evidence available.&quot;&lt;/p&gt;
&lt;p&gt;However, the same criticism can be leveled against niacin, said Rory Collins, MB, BS, an epidemiologist in the clinical trials unit at Oxford University in England.&lt;/p&gt;
&lt;p&gt;Collins, who is chairman of the steering committee of an ongoing trial of ezetimibe, said there is no &quot;evidence that raising HDL improves outcomes, whereas there is abundant evidence that there is benefit in lowering LDL.&quot;&lt;/p&gt;
&lt;p&gt;Raymond Gibbons, MD, of the Mayo Clinic agreed with this point. &quot;That is why HDL is not included as a target in current guidelines,&quot; he said.&lt;/p&gt;
&lt;p&gt;As currently written, the cholesterol guidelines have as a secondary target management of non-HDL cholesterol to less than 130 mg/dL, he said.&lt;/p&gt;
&lt;p&gt;Moreover, Collins said, it&apos;s inappropriate to use a surrogate such as CIMT to guide clinical practice.&lt;/p&gt;
&lt;p&gt;But Collins told &lt;em&gt;MedPage Today&lt;/em&gt; that the bigger problem with ARBITER was that it asked a question that was &quot;scientifically insignificant and irrelevant.&quot;&lt;/p&gt;
&lt;p&gt;His reasoning was simple: ezetimibe and niacin were not mutually exclusive, since they could be used in combination, so testing them as opposing strategies would not provide useful clinical information.&lt;/p&gt;
&lt;p&gt;Sidney Smith, MD, of the University of North Carolina, Chapel Hill, said that while there may be problems with the ARBITER trial, he did not believe that it asked an irrelevant question.&lt;/p&gt;
&lt;p&gt;The question, which drug to add when a patient is maxed out on statin therapy, &quot;mirrors what is happening in clinical practice,&quot; he said.&lt;/p&gt;
&lt;p&gt;Unfortunately, he said, a surrogate endpoint can&apos;t provide the answer. &quot;We need clinical data to answer the question and we don&apos;t yet have that data,&quot; he 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 trial was supported by Abbott.&lt;/p&gt;&lt;p&gt;Taylor reported receiving lecture fees from Abbott.&lt;/p&gt;&lt;p&gt;Krumholz had developed and maintain risk-standardized mortality rates for acute MI under contract with the Colorado Foundation for Medical Care, and he chairs a scientific advisory board for UnitedHealthcare.&lt;/p&gt;&lt;p&gt;Jessup reported no conflicts of interest.&lt;/p&gt;&lt;p&gt;DeMaria reported no conflicts of interest.&lt;/p&gt;&lt;p&gt;Collins reported reported being paid by the British Heart Foundation and UK Biobank, and having received research funding from Merck/Schering-Plough, AstraZeneca, Bayer, Bristol Myers Squibb, British Heart Foundation, Cancer Research UK, European Union, Kadoorie Trust, the Medical Research Council, Roche, Sanofi, and Solvay.&lt;/p&gt;&lt;p&gt;Gibbons reported potential conflicts of interest with KAI Pharmaceuticals, TherOx, King Pharmaceuticals, TargeGen, and Radiant Medical.&lt;/p&gt;&lt;p&gt;Smith has disclosed that he has received research support from Merck &amp;amp; Co. and is a Johnson &amp;amp; Johnson stock shareholder.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_3790"
                     title="AHA: Obesity Okay with Some People (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/AHA/tb/17112?impressionId=1265730984973"
                     
      &lt;p&gt;ORLANDO  --  Nearly one obese person in 10 feels no need to lose weight or prevent further weight gain, researchers found.&lt;/p&gt;
&lt;p&gt;Most obese people with these body size misperceptions thought their health was above average and their lifetime cardiovascular and diabetes risk low, said Tiffany M. Powell, MD, of the University of Texas Southwestern Medical Center in Dallas, and colleagues.&lt;/p&gt;
&lt;p&gt;Their analysis of the Dallas Heart Study, reported here at the American Heart Association meeting, suggested that physicians have a role in correcting these impressions.&lt;/p&gt;
&lt;p&gt;&quot;We can&apos;t necessarily just say you have to be comfortable with who you are,&quot; Powell said. &quot;We have to really emphasize the direct link between obesity, risk factors, and cardiovascular disease.&quot;&lt;/p&gt;
&lt;p&gt;Obese individuals in the study who didn&apos;t think they needed to lose weight appeared not to be getting those messages.&lt;/p&gt;
&lt;p&gt;They were much less likely than other obese individuals to have heard from any healthcare professional about diet (38% versus 64%), exercise (45% versus 66%), or losing weight (38% versus 68%, all &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001).&lt;/p&gt; 
&lt;p&gt;Rather than trying to find and target patients with an unrealistic body image, physicians need to step up efforts to ensure that all patients understand their risk and what to do about it, she recommended.&lt;/p&gt;
&lt;p&gt;Powell&apos;s group analyzed the Dallas Heart Study, a representative population-based study of 6,101 residents of Dallas County ages 18 to 65.&lt;/p&gt;
&lt;p&gt;To measure body perception, the participants were asked to choose a silhouette on the gender-specific Stunkard figure-rating scale that they thought best represented how they looked and also to select one that represented how they would ideally like to look.&lt;/p&gt;
&lt;p&gt;Of the 2,056 individuals with a body mass index of 30 kg/m2 or greater, 266 (8%) reported an ideal body size that was greater than or equal to perceived body size.&lt;/p&gt;
&lt;p&gt;Half of the individuals with these misperceptions thought they were in better health than most for their age compared with 32% of those who knew they needed to lose weight (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001).&lt;/p&gt;
&lt;p&gt;They were also more likely than other obese people to think of themselves as low risk for MI, diabetes, hypertension, and even obesity, despite the fact that they already fell in that category (all &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001).&lt;/p&gt;
&lt;p&gt;But this body image was unrealistic as they were just as likely to have cardiovascular risk factors as other obese individuals.&lt;/p&gt;
&lt;p&gt;Dyslipidemia, diabetes, family history of MI at a young age, and current smoking were just as common. The only significant difference was a lower prevalence of hypertension among those with body size misperception (35% versus 43%, &lt;em&gt;P&lt;/em&gt;=0.020).&lt;/p&gt;
&lt;p&gt;Those who thought they didn&apos;t need to lose weight did have somewhat lower BMIs (34.6 versus 36.6 kg/m2, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001) and waist circumference (110.8 versus 113.6 cm, &lt;em&gt;P&lt;/em&gt;=0.02). Other measures of adiposity appeared largely similar, though, with no difference in lean body mass (&lt;em&gt;P&lt;/em&gt;=0.1) or waist-to-hip ratio (&lt;em&gt;P&lt;/em&gt;=0.5). 
&lt;p&gt;Because the population was highly diverse with African-Americans accounting for half and Hispanics for another 20%, the researchers stratified by ethnicity.&lt;/p&gt;
&lt;p&gt;The body size misperceptions were significantly more common among African-Americans and Hispanics at 14% and 11%, respectively, compared with just 2% in Caucasians.&lt;/p&gt;
&lt;p&gt;This may reflect a higher cultural acceptance of overweight and obesity, Powell said.&lt;/p&gt;
&lt;p&gt;&quot;We have to help people understand that despite loving what you look like, if you are obese you are at risk,&quot; Powell said. &quot;We walk a fine line in helping people understand the impact of obesity without making them feel bad about themselves.&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;Powell reported no conflicts of interest. Co-authors reported conflicts of interest with Merck and Pfizer.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_3792"
                     title="AHA: Drilling Down in JUPITER Confirms Benefit for Women (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/AHA/tb/17116?impressionId=1265730984973"
                     
      &lt;p&gt;ORLANDO  --  A subset analysis of data from the JUPITER trial indicates that apparently healthy women treated with rosuvastatin (Crestor) reduced their relative risk of major cardiovascular events by 46%, slightly higher than the 42% reduction seen in men.&lt;/p&gt;
&lt;p&gt;Analysis of outcomes from the 6,801 women enrolled in the 17,802-patient trial suggests that the benefit of statin therapy in patients whose only risk factors are age and an elevated level of C-reactive protein is not gender-specific, as had been suggested by some skeptics when full JUPITER results were reported a year ago.&lt;/p&gt;
&lt;p&gt;The benefit in women was mainly driven by a 76% reduction in the need for arterial revascularization compared with placebo (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), Samia Mora, MD, MPH, of the Brigham and Women&apos;s Hospital in Boston, reported at the American Heart Association meeting here.&lt;/p&gt;
&lt;p&gt;In terms of safety, rosuvastatin was not associated with a significant increase in myopathy or cancer in men or women, but, compared with placebo, there was a higher incidence of physician-reported diabetes in women on rosuvastatin (1.59% versus 1.05%, respectively, &lt;em&gt;P&lt;/em&gt;=0.008) but not in men (1.48% versus 1.32%, respectively, &lt;em&gt;P&lt;/em&gt;=0.29).&lt;/p&gt;
&lt;p&gt;Over the course of the past year a number of additional analyses of the data have been reported at cardiology meetings, and the publication list of JUPITER findings has grown almost monthly.&lt;/p&gt;
&lt;p&gt;In each case those additional analyses have targeted areas  --  such as gender  --  that were flagged as possibly problematic when the results were initially reported, and in each case the observed benefit has been similar and significant, for example a 46% risk reduction versus placebo for women (&lt;em&gt;P&lt;/em&gt;=0.002) and 42% versus placebo for men (&lt;em&gt;P&lt;/em&gt;=0.001).&lt;/p&gt;
&lt;p&gt;Here at AHA, another post-hoc analysis drilled down to patients who achieved LDL levels of less than 50 mg/dL and found that they had no increased risk of adverse events but did achieve a reduction in cardiovascular events similar to that seen in patients with levels above 50 mg/dL.&lt;/p&gt;
&lt;p&gt;A third analysis found that the subset of patients with impaired fasting glucose at baseline also achieved similar benefits from rosuvastatin versus placebo.&lt;/p&gt;
&lt;p&gt;&quot;The JUPITER trial is phenomenal in that it provides information on a very important topic; the use of statins for primary prevention of cardiovascular disease in men and in women at risk based on elevated C-reactive protein,&quot; said Mary Cushman, MD, of the University of Vermont in Burlington.&lt;/p&gt;
&lt;p&gt;&quot;The findings of relative risk reduction with statin treatment in women is important and was observed in all subgroups shown. The number needed to treat in women was higher in order to prevent one cardiovascular event over five years; however, this number was still very reasonable,&quot; Cushman, who was not involved in the trial, added.&lt;/p&gt;
&lt;p&gt;Based on this analysis, treating 36 women with 20 mg of rosuvastatin for less than two years would prevent one heart attack, cardiovascular death, stroke, or revascularization, which was slightly higher than the NNT of 25 reported for the total JUPITER population, &quot;but still a very reasonable number,&quot; said Cushman.&lt;/p&gt;
&lt;p&gt;In the landmark trial, 17,802 men and women, mean age 66 and no history of atherosclerosis, who had an elevated biomarker for inflammation  --  highly sensitive C-reactive protein  --  were randomized to aggressive lipid therapy with 20 mg rosuvastatin or to placebo.&lt;/p&gt;
&lt;p&gt;Participants who took rosuvastatin for 1.9 years reduced median LDL cholesterol to 55 mg/dL, down from a median of 108 mg/dL. The corresponding 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;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 JUPITER trial was funded by AstraZeneca.&lt;/p&gt;&lt;p&gt;Mora has disclosed research grants from Merck and AstraZeneca, and grants for educational activities from Pfizer.&lt;/p&gt;&lt;p&gt;Cushman disclosed research funding from Amgen.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
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