Internal Medicine World ReportOctober 2007
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Issue 0

Stopping Statins After Stroke Worsens Outcomes



Statin withdrawal is associated with an increased risk of death or dependency at 90 days post?ischemic stroke. A total of 89 patients taking long-term statin therapy were admitted within 24 hours of ischemic stroke; they were randomly assigned to statin withdrawal for the first 3 days after admission or to immediately receive atorvastatin (Lipitor; 20 mg/d). Compared with the atorvastatin group, patients in the statin withdrawal group had greater infarct volume, greater early neurologic deterioration, and greater dependency at 3 months. Statin withdrawal was associated with a 4.66-fold increased risk of death or dependency, a 8.67-fold increased risk of early neurologic deterioration, and an increase in mean infarct volume of 37.63 mL ( <.001), after adjusting for age and baseline stroke severity. Blanco M, et al. Statin treatment withdrawal in ischemic stroke. 2007;69:904-910.

NSAIDs Protect Against Bladder Cancer

BMC Urology

Regular use of nonsteroidal antiinflammatory drugs (NSAIDs) is associated with a significant decrease in bladder cancer risk, according to a study of 376 patients (aged 25-74 years) with bladder cancer and 463 controls in whom information on regular use of analgesic drugs and NSAIDs was available. The regular use of any NSAID was associated with a 40% decrease in the risk of bladder cancer. For medications containing phenacetin (which were withdrawn from the US market in the 1980s), however, continued use for >8 years increased the risk of bladder cancer 3-fold. In contrast, the use of acetaminophen (the metabolite of phenacetin) did not increase bladder cancer risk. Regular NSAID use was most protective against invasive, high-grade bladder tumors. Fortuny J, et al. Analgesic and anti-inflammatory drug use and risk of bladder cancer. . 2007;7:13.

Coffee May Cause Hypertension

Am J Clin Nutr.

Drinking low-to-moderate amounts of coffee daily increases the risk for the onset of antihypertensive drug treatment for elevated blood pressure, according to a study of 24,710 Finnish persons (aged 25-64 years) who had no history of antihypertensive therapy, coronary heart disease, or stroke at baseline. During a mean follow-up of 13.2 years, 2505 participants started antihypertensive drug therapy. The multivariate-adjusted hazard ratio for antihypertensive drug treatment associated with drinking 0 to 1, 2 to 3, 4 to 5, 6 to 7, or &#8805;8 cups of coffee daily was 1.00, 1.29, 1.26, 1.24, and 1.14, respectively. Thus, the significantly increased risk with low-to-moderate coffee intake was not observed with low intake (about 1 cup/d) or with very high (&#8805;8 cups/d) coffee intake. Hu G, et al. Coffee consumption and the incidence of antihypertensive drug treatment in Finnish men and women. 2007;86:457-464.

Exercise Mitigates Negative Role of Folate in Dementia




J Am Geriatr Soc.

Older adults who exercise may be at lower risk for dementia and Alzheimer's disease (AD), according to a study of 466 older adults (aged &#8805;65 years) from the Canadian Study of Health and Aging who were not demented at baseline. After 5 years of follow-up, 194 patients had adverse cerebrovascular events, and 65 had dementia. A higher-than-normal serum folate level at baseline was associated with an increased risk for AD and adverse cerebrovascular outcomes in multivariate adjusted analyses before accounting for exercise, and it neared significance with all-cause dementia. After the inclusion of exercise, the association between folate and dementia and AD decreased by 29% and 25%, respectively, and neither association remained significant. Exercise was a significant confounder in the relationship between serum folate concentration and AD ( = .03) and dementia ( = .003) but not cerebrovascular outcomes ( = .64). Middleton LE, et al. Exercise: a potential contributing factor to the relationship between folate and dementia. 2007;55: 1095-1098.

Alcohol Lowers Renal Cancer Risk

Br J Cancer.

Drinking alcohol may offer some protection against renal-cell cancer. This relationship was examined in a population-based study of 855 patients with renal-cell cancer and 1204 controls. All participants completed mailed questionnaires. Total ethanol intake of >620 g/month was associated with a 40% reduced risk of renal-cell cancer compared with abstinence from alcohol. The risk of renal-cell cancer was reduced between 30% and 40% in those who drank >2 glasses weekly of red/white wine or strong beer. A clear linear trend for decreasing risk of renal-cell cancer was seen with increasing consumption of these beverages. Greving JP, et al. Alcoholic beverages and risk of renal cell cancer. 2007; 97:429-433.

Weight Loss Predates Dementia Onset in Women


Weight loss precedes the diagnosis of dementia in women by at least 10 years, according to a population-based study in which 481 incident cases of dementia were identified during a 5-year period; matched controls were randomly drawn from the same population. No differences in weight were found between cases and controls during the 21 to 30 years before the onset of dementia, but starting at 11 to 20 years before diagnosis, women with dementia weighed less than the controls. This difference increased up to the time of dementia diagnosis. The relationship between dementia risk and weight in women was significant at time of dementia diagnosis and at 9 to 10 years pre-diagnosis. Knopman DS, et al. Incident dementia in women is preceded by weight loss by at least a decade. 2007;69:739-746.

Penicillin Allergy Prevalent in Women



Ann Allergy Asthma Immunol.

Female gender is an independent risk factor for penicillin allergy. In a retrospective study, the rate of positive penicillin skin tests (PSTs) was determined in 1759 patients (mean age, 60 years) with a history of penicillin allergy. The PST was positive in 64 patients (4%). Of these, 53 (83%) were women, and 11 (17%) were men ( <.001). On multivariate logistic regression analysis, the odds ratio for a positive PST reaction associated with female gender was 3.2 ( = .001). Park MA, et al. Female sex as a risk factor for penicillin allergy. 2007;99:54-58.

Selenium May Raise, Not Lower, Diabetes Risk

Ann Intern Med.

Selenium, an antioxidant included in multivitamin tablets that is thought to have a protective effect against the development of type 2 diabetes, may actually increase the risk for the disease. Investigators analyzed data from 1202 people (mean age, 63 years) who did not have diabetes at baseline and who were randomized to supplementation with selenium (200 &#181;g/d) or placebo. At 7.7 years follow-up, 55% more cases of type 2 diabetes occurred among the selenium-alone group than among the placebo group. This absence of preventive benefits with selenium persisted in analyses stratified by age, gender, body mass index, and smoking status. Stranges S, et al. Effects of long-term selenium supplementation on the incidence of type 2 diabetes. 2007; 147:217-223.

Sweetened Drinks Linked to Uric Acid Levels in Men


Increased intake of added sugars and sugar-sweetened beverages is associated with higher serum uric acid levels in men. The relationship was examined in 4073 men and women aged >18 years enrolled in the National Health and Nutrition Examination Survey 2001-2002. Dietary intake was determined by a single 24-hour recall. After adjusting for age, gender, intake of alcohol, and other variables, men in the highest quartile of added sugar intake (157 g/d) or sugar-sweetened drink intake (5.2 servings/d) had significantly higher plasma uric acid levels than those in the lowest intake quartiles of 15 g/day and 0 servings/day, respectively. No significant association was observed in women. Gao X, et al. Intake of added sugar and sugar-sweetened drink and serum uric acid concentration in US men and women. 2007;50:306-312.

Sleep Apnea Linked to High Uric Acid Level


The more severe the sleep apnea, the higher the serum uric acid level, independent of abdominal adiposity, which may help explain the increased cardiovascular risk associated with sleep-disordered breathing. A group of 93 children and adolescents (mean age, 11.1 years) underwent polysomnography, fasting blood sampling, and 24-hour urine collection. Overall, 44% of the participants were male, and 73% were obese. Fasting serum uric acid level was significantly associated with the respiratory disturbance index (number of apneas and hypoxias/hour) and the percentage of total sleep time with oxyhemoglobin desaturation, defined as an arterial oxygen saturation &#8804;89%, after controlling for gender, puberty, and waist circumference. None of the sleep-disordered breathing variables correlated with uric acid excretion or with the urinary uric acid/creatinine ratio. Verhulst SL, et al. Sleep-disordered breathing and uric acid in overweight and obese children and adolescents. 2007;132:76-80.

LASIK Surgery Causes Night Vision Problems

Br J Ophthalmol.

Patients undergoing LASIK surgery demonstrate an increase of halo phenomena around lights in night vision conditions, even when the results of the surgery are considered entirely satisfactory according to current standards. In a prospective, observational study of 110 eyes that underwent successful LASIK surgery for myopia and astigmatism, visual disturbance caused by halo was measured with the Starlights v1.0 instrument. After successful LASIK surgery, the halo disturbance index increased by a factor of 2.15. Secondary astigmatism, coma, and spherical aberration were the higher-order imperfections up to the sixth order (irregular sphere and cylinder aberrations) that significantly correlated with the halo index. Villa C, et al. Night vision disturbances after successful LASIK surgery. 2007; 91:1031-1037.

Drug Can Reverse Cocaine's Sympathetic Effects


J Am Coll Cardiol.

Dexmedetomidine (Precedex) has been shown to counteract effects of cocaine on the human cardiovascular system, such as elevated heart rate and blood pressure (BP), according to a study of 22 healthy cocaine-na?ve adults. Measurements were taken of skin sympathetic nerve activity (SNA) and skin blood flow, as well as heart rate and BP before and after intranasal cocaine use (2 mg/kg), alone and in combination with IV dexmedetomidine or IV saline. With intranasal cocaine alone, SNA increased by 2-fold, and skin vascular resistance increased from 13.2 to 20.1 resistance units; mean arterial pressure increased by 14 mm Hg and heart rate by 18 beats/min ( <.01). Dexmedetomidine reversed these increases, whereas IV saline had no effect. Dexmedetomidine effectively blocked these sympathomimetic actions of cocaine, even in the 7 participants who had a rare genetic mutation thought to disrupt the effects of dexmedetomidine. Menon DV, et al. Central sympatholysis as a novel countermeasure for cocaine-induced sympathetic activation and vasoconstriction in humans. 2007;50:626-633.

New Insights into Vitamin C's Protective Power

Cancer Cell.

It has long been thought that vitamin C protects against cancer by capturing volatile oxygen free-radical molecules and preventing them from damaging DNA. New research indicates that vitamin C may inhibit the growth of some tumors via a different pathway: destabilizing the tumor's growth mechanism under oxygen-starved conditions. In this study, mice were implanted with either human lymphoma or human liver cancer cells. Both of these cancers produce high levels of free radicals in mice that can be suppressed by feeding them antioxidant supplements. The mice that were not fed antioxidants had no significant DNA damage, suggesting that DNA damage was not a cause of cancer, and thus vitamin C's cancer fighting effects occur through some other mechanism. One candidate involves the protein known as hypoxia-induced factor, which is dependent on free radicals. This protein was abundant in untreated cancer cells taken from mice, but it was absent from vitamin C-treated cells. Gao P, et al. HIF-dependent antitumorigenic effect of antioxidants in vivo. 2007;12:230-238.

Herbal Preparation Relieves Functional Dyspepsia

Iberis amara


Helicobacter pylori

Am J Gastroenterol.

The herbal product STW 5, which is mainly composed a fresh plant extract from , effectively relieves the symptoms of functional dyspepsia, according to the results of a randomized, double-blind study. The study group included 315 patients with functional dyspepsia who received 20 drops of STW 5 three times daily or placebo for 8 weeks. The primary outcome was the change in a validated Gastrointestinal Symptom Score (GIS). At 8 weeks, the mean GIS score improved 6.9 points in the STW 5 group and 5.9 points in the placebo group ( < .05). The response to STW 5 was not influenced by the presence of infection. Treatment tolerability, safety, and dropout numbers were similar in both groups. von Arnim U, et al. STW 5, a phytopharmacon for patients with functional dyspepsia. 2007;102:1268-1275.

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