<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_352"
                     title="ICAO: Future Chronic Disease Risk Goes Beyond BMI (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/Endocrinology/Diabetes/tb/18233?impressionId=1265746579681"
                     
      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_150"
                     title="Circulatory Effects Seen with A-Bomb Radiation (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Cardiology/Atherosclerosis/tb/17977?impressionId=1265746579681"
                     
      &lt;p&gt;Survivors of the atomic bomb blasts at Hiroshima and Nagasaki have an increased risk of dying from heart disease and stroke, researchers found.&lt;/p&gt;
&lt;p&gt;The estimated excess relative risk per Gy was 9% for stroke and 14% for heart disease (&lt;em&gt;P&lt;/em&gt;&amp;#8804;0.02 for both), Yukiko Shimizu, DMSc, of the Radiation Effects Research Foundation in Hiroshima, and colleagues reported online in &lt;em&gt;BMJ&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Significant estimated increases in risk started at doses of 0.5 Gy and higher.&lt;/p&gt;
&lt;p&gt;&quot;The effect of radiation on risk of circulatory disease is potentially a very important public health concern,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;&quot;Given the widespread use of multiple computed tomography scans, and other relatively high-dose diagnostic medical procedures, as well as radiotherapy that exposes the heart, the implications are substantial insofar as effects occur at doses under 1 Gy.&quot;&lt;/p&gt;
&lt;p&gt;But they cautioned that &quot;robust confirmatory evidence from other studies is needed.&quot;&lt;/p&gt;
&lt;p&gt;To explore the relationship between radiation exposure and circulatory disease, Shimizu and colleagues looked at more than 50 years of data from the Life Span Study, which has prospectively followed survivors of the atomic bomb blasts in Japan since 1950.&lt;/p&gt;
&lt;p&gt;The analysis included 86,611 individuals who were exposed to radiation at doses ranging from 0 to more than 3 Gy, although 86% received less than 0.2 Gy.&lt;/p&gt;
&lt;p&gt;Through 2003, 9,622 of the participants died from stroke and 8,463 died from heart disease.&lt;/p&gt;
&lt;p&gt;For stroke, a quadratic formula fit the data better than a linear dose-response model, indicating relatively low risk of stroke at lower radiation doses. The linear dose-response model provided the best fit to the data for heart disease, suggesting an excess risk even at lower doses. However, there was not a significant increase in estimated risk for exposures less than 0.5 Gy.&lt;/p&gt;
&lt;p&gt;Adjusting for smoking, alcohol intake, education, occupation, obesity, and diabetes had very little effect on the risk estimates, the researchers wrote.&lt;/p&gt;
&lt;p&gt;To control for the possible misclassification of cancers as circulatory diseases, the researchers re-ran their analysis after excluding those individuals with a history of cancer.&lt;/p&gt;
&lt;p&gt;In this analysis, the excess relative risk for stroke became nonsignificant (&lt;em&gt;P&lt;/em&gt;=0.11), but that for heart disease remained significant (&lt;em&gt;P&lt;/em&gt;=0.03).&lt;/p&gt;
&lt;p&gt;In an accompanying editorial, Mark Little, PhD, of Imperial College London, said the study &quot;adds to a growing body of evidence suggesting an association between cardiovascular disease and exposure to low-moderate levels of radiation, as well as the well-known (and mechanistically well-understood) association at high doses.&quot;&lt;/p&gt;
&lt;p&gt;&quot;However,&quot; he continued, &quot;statistical associations do not prove a causal association, and it is unclear whether the biological mechanisms operating at high doses of radiation apply to low doses.&quot;&lt;/p&gt;
&lt;p&gt;Previous studies, including some randomized controlled trials, have linked high doses of radiation from treatment for Hodgkin&apos;s disease and breast cancer to excess deaths from cardiovascular disease.&lt;/p&gt;
&lt;p&gt;Studies looking at lower doses, however, have yielded mixed results.&lt;/p&gt;
&lt;p&gt;James Thrall, MD, radiologist-in-chief at Massachusetts General Hospital and chair of the American College of Radiology&apos;s board of chancellors, said the results of the current study were not surprising.&lt;/p&gt;
&lt;p&gt;&quot;We have known for a long time that sufficient radiation can have adverse effects on the circulation,&quot; Thrall said in an interview.&lt;/p&gt;
&lt;p&gt;However, he noted that significant associations among the atomic bomb survivors were identified only for doses higher than 0.5 Gy, which is roughly equal to 500 mSv.&lt;/p&gt;
&lt;p&gt;Radiation exposure from typical CT scans ranged from 2 to 31 mSv in a recent study. (See &lt;a href=&quot;http://www.medpagetoday.com/Radiology/DiagnosticRadiology/17530&quot; mce_href=&quot;http://www.medpagetoday.com/Radiology/DiagnosticRadiology/17530&quot; target=&quot;_blank&quot;&gt;CT Scans May Deliver Higher-than-Expected Radiation Doses&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;Thrall said that risk of circulatory disease is not a consideration when clinicians are weighing the risks and benefits of a CT scan.&lt;/p&gt;
&lt;p&gt;&quot;And I would say that this article does not suggest that that&apos;s a serious concern.&quot;&lt;/p&gt;
&lt;p&gt;The potential mechanisms underlying the association between radiation exposure and circulatory disease remains unclear, but the researchers said &quot;evidence suggests that pro-inflammatory responses to radiation, cellular loss or functional changes in the endothelium, or microvascular damage&quot; may be involved.&lt;/p&gt;
&lt;p&gt;The editorialist Little noted, however, &quot;although we have evidence for [inflammation&apos;s] involvement in the development of cardiovascular disease at high doses of radiation, the mechanism is unclear at low and moderate doses, particularly for occupational exposure, where people receive on average much less than one electron track per cell per day.&quot;&lt;/p&gt;
&lt;p&gt;The study authors noted some limitations of the study: &lt;ul&gt; &lt;li&gt;The ascertainment of circulatory disease from death certificates has limited diagnostic accuracy.&lt;/li&gt; &lt;li&gt;Analyses for potential confounders were incomplete.&lt;/li&gt; &lt;li&gt;There were uncertain associations for exposures below 0.5 Gy.&lt;/li&gt; &lt;li&gt;There is inadequate information about biological mechanisms.&lt;/li&gt; &lt;li&gt;Generalizability to Western populations is uncertain.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Little also pointed to the selection of patients, particularly in the early years of follow-up, as a weakness because these individuals would have been exposed to war and stressful conditions, which increase the risk of cardiovascular disease.&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 Radiation Effects Research Foundation in Hiroshima and Nagasaki is a private nonprofit foundation funded by the Japanese Ministry of Health, Labor, and Welfare and the U.S. Department of Energy, the latter in part through the National Academy of Sciences.&lt;/p&gt;&lt;p&gt;Neither the study authors nor the editorialist reported any conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_8_245"
                     title="ASNC: CTA-Detected Coronary Placque Predicts Risk of Cardiac Events"
                     score="-0.005"
                     href="