Statins Reduce COPD Mortality
Statin therapy improves survival after an exacerbation of chronic obstructive pulmonary disease (COPD). This finding emerged from a retrospective study of 854 patients (mean age, 70.8 years) who had a COPD exacerbation who were followed for a mean of 1.9 years. A total of 333 patients died during follow-up. The crude mortality rate for 1000 patient-years was 110 in those using a statin and 191 in those not using a statin. The use of a statin reduced the mortality risk by 43%. Treatment with inhaled corticosteroids further increased the survival benefit associated with statin use.

Cold Remedies Can Cause Stroke
Taking small, divided doses of phenylpropanolamine (PPA) in cold remedies increases the risk of hemorrhagic stroke in women, a study of 940 patients with hemorrhagic stroke and a matched control group indicates. Overall, 1.7% of the patients had taken cold remedies containing PPA within 14 days of their stroke. The unadjusted and adjusted odds ratio for stroke following PPA exposure was 2.46 and 2.16, respectively. Among women, the unadjusted and adjusted odds ratio was 3.84 and 3.86, respectively. In men, the results did not achieve statistical significance.

Antidepressants Enhance Insulin Sensitivity
Successful treatment of depression with a selective serotonin reuptake inhibitor or a tricyclic antidepressant increases insulin sensitivity in nondiabetic patients. In a double-blind study, 80 patients with major depressive disorder were treated with either amitriptyline (Elavil) or paroxetine (Paxil) for 5 weeks. Oral glucose tolerance tests were performed after a minimum of 6 drug-free days. Insulin sensitivity increased significantly in patients who had a successful remission from major depressive disorder after treatment with either antidepressant. Saliva cortisol levels decreased significantly in remitters and responders to amitriptyline but not in any other subgroup.

Growth Hormone Unsafe in Healthy Elderly
Human growth hormone therapy offers little clinical benefit in healthy elderly patients (mean age, 69 years) and is associated with high rates of adverse events, concludes a new review of 31 trials in which growth hormone therapy was used for ?2 weeks. Treatment duration varied (mean, 27 weeks). In those treated with growth hormone (n = 220), overall fat mass decreased, and overall lean body mass increased compared with those not treated with growth hormone (n = 227). The treatment group was also significantly more likely to have soft-issue edema, arthralgias, carpal tunnel syndrome, and gynecomastia and was slightly more likely to have new-onset diabetes and impaired fasting glucose.

Opioid Efficacy for Chronic Back Pain Questioned
Although opioid therapy is often used for chronic back pain, its efficacy may only be for the short-term (<16 weeks), according to a recent meta-analysis of 39 studies of adults (aged ≥18 years) with chronic back pain. Review of 4 trials assessing the efficacy of opioids versus placebo or a nonopioid control failed to show that opioids helped relieve pain. An analysis of 5 trials comparing the efficacy of different opioids reported a nonsignificant reduction in pain. The prevalence of lifetime substance-use disorders in these patients ranged from 36% to 56%, and 43% had current substance-use disorders.

High-Dose Zinc Tied to Urinary Complications
A surprising association between high-dose zinc supplementation and increased risk of hospitalization for urinary complications was revealed in a study of 3640 men and women in the Age-Related Eye Disease Study. Patients were randomized to 1 of 4 groups to receive antioxidants, 80 mg zinc, antioxidants plus zinc, or placebo daily. The rate of hospital admissions for genitourinary disorders was 11.1% in patients receiving the high-dose (80 mg/d) zinc and 7.6% in those not receiving zinc (P = .003). Compared with the placebo group, patients receiving zinc had a significantly higher risk of urinary tract infections (P = .004). Among men, the risk of hospitalization for urinary lithiasis was 4 times greater in zinc recipients than in placebo recipients.

Declining Total Cholesterol Linked to Later Dementia
A decrease in serum total cholesterol levels may be an early warning sign of dementia. Serum total cholesterol levels were measured 5 times over a 26-year period in 1027 Japanese-American men. All participants were screened for dementia on 2 occasions near the end of the study. In men who were diagnosed with dementia or Alzheimer's disease, cholesterol levels had decreased at least 15 years before the diagnosis, and levels remained lower than in those without dementia. The association between declining total cholesterol levels and dementia was not influenced by vascular risk factors, weight change, alcohol intake, or the use of lipid-lowering drugs.

Diabetes Linked to Uric Acid Stones
Diabetes is an independent risk factor for nephrolithiasis, according to the results of a study of 3561 patients with nephrolithiasis and a matched control group. Compared with controls, patients with nephrolithiasis had an increased risk for diabetes, obesity, and hypertension. After adjusting for age, sex, hypertension, and other variables, diabetes was associated with a 22% increased risk of nephrolithiasis. Among patients with nephrolithiasis, the incidence of diabetes was 40% in those with uric acid stones and 9% in those with other stone types.

Adherence to Prescribed Drugs Improves Post-MI Survival
Drug adherence is associated with increased long-term survival after acute myocardial infarction (MI). The finding is based on a population-based, longitudinal study of 31,455 elderly survivors of acute MI who were followed for a median of 2.4 years. Drug adherence was categorized according to the number of days covered as high (?80%), intermediate (40%-79%), or low (<40%). Among statin users, the adjusted mortality risk was 25% greater in low adherers and 12% greater in intermediate adherers compared with high adherers. A similar but less pronounced association between adherence and mortality was observed in beta-blocker users, but no such association was observed in calcium channel blocker users. Adherence did not influence cancer-related admissions, suggesting that the survival benefits of adherence were attributable more to the effects of the medications than to behavioral attributes.

Cardiovascular Disease Common with Autoimmune Disorders
Patients with rheumatoid arthritis (RA), psoriatic arthritis, and ankylosing spondylitis are at increased risk for cardiovascular disease, according to a study of >33,000 patients with these autoimmune diseases. Compared with matched controls, patients with RA, psoriatic arthritis, and ankylosing spondylitis had an increased prevalence ratio of ischemic heart disease (1.5, 1.3, and 1.2, respectively), atherosclerosis (1.9, 1.4, and 1.5, respectively), peripheral vascular disease (2.4, 1.6, and 1.6, respectively), and congestive heart failure (2.0, 1.5, and 1.8, respectively), as well as of cerebrovascular disease, type 2 diabetes, hyperlipidemia, and hypertension. Patients with autoimmune disorders were also significantly more likely than the controls to be taking angiotensin-converting enzyme inhibitors, calcium channel blockers, diuretics, nitrates, anticoagulants, and/or lipid-lowering agents.

SIDS Heart Gene Discovered
Nearly 10% of sudden infant death syndrome (SIDS) cases have mutations or variations in genes associated with arrhythmias, 2 new studies have found. Seven arrhythmia-associated genes were screened in 201 SIDS cases. Of the SIDS victims, 9.5% harbored mutations in genes associated with inherited forms of cardiac arrhythmia, such as long-QT syndrome. Mutations and variations were identified in several genes, including the gene that encodes the cardiac sodium channel, a protein that regulates the electrical properties of heart cells. These findings may potentially allow the identification of infants who are carriers of such mutations before the syndrome strikes.