Nondiabetic Retinopathy Predicts Stroke

Internal Medicine World ReportOctober 2005

Nondiabetic Retinopathy Predicts Stroke

Retinopathy independently predicts stroke in older persons without diabetes. Retinal photographs were obtained at baseline from 3654 persons aged ³49 years who were followed for 7 years. The prevalence of stroke events was 5.7% in persons with retinopathy, 4.2% in those with moderate or severe arteriovenous nicking, 7.2% in those with focal arteriolar narrowing, and 1.9% in those without retinopathy. After controlling for variables such as age, sex, systolic blood pressure, the relative risk (RR) of combined stroke events was 1.7 in persons with evidence of retinopathy. The association between retinopathy and combined stroke events was stronger in persons without severe hypertension (RR, 2.7) and in those with ³2 retinal microvascular signs (RR, 2.7) (Neurology. 2005;65:1005-1009).

Relaxation Therapy Promotes Glycemic Control

Biofeedback-assisted relaxation appear to enhance glycemic control in patients with type 2 diabetes, according to a study of 30 patients with type 2 diabetes who were randomized to either 10 sessions of biofeedback-assisted relaxation or 3 sessions of education. As compared with the control group, patients in the biofeedback group experienced significant decreases in blood glucose, hemoglobin A1c, and muscle tension. These beneficial effects persisted for at least 3 months. Of note, depression and anxiety scores improved in both groups (Diabetes Care. 2005;28:2145-2149).

New Guidelines for HIV Prophylaxis after Occupational Exposure

Revised guidelines for the management of occupational HIV exposure and postexposure prophylaxis (PEP) have been released by the Centers for Disease Control and Prevention. The guidelines, last updated in 2001, provide expanded recommendations for the use of newer antiretroviral agents for PEP, the timing and duration of PEP, and the monitoring and management of PEP toxicity. Recommendations for PEP following percutaneous injuries vary based on the severity of exposure and HIV status of the source. Treatment with 3-drug PEP is recommended after severe exposures, including injury with a large-bore hollow needle, deep puncture, or a device contaminated with visible blood. Two- or three-drug PEP should be considered following large-volume mucous membrane and nonintact skin exposures, such as from a major blood splash (MMWR. 2005;54(RR-9):1-17). Available at www.cdc.gov/mmwr/preview/mmwrhtml/rr5409a1.htm.

Eating More Fish Slows Cognitive Decline in Elderly

Consuming ³1 serving of fish per week is associated with a significant decrease in age-related cognitive decline, according to community-based study of 6158 persons aged ³65 years who participated in the Chicago Health and Aging Project. During 6 years of follow-up, cognitive scores decreased at a mean rate of 0.04 standardized units annually. Compared with persons who consumed <1 serving of fish weekly, the rate of cognitive decline was 10% slower among those who consumed 1 fish meal weekly and 13% slower among those who consumed ³2 more fish meals weekly. The association between fish consumption and rate of cognitive decline was influenced by intakes of saturated, polyunsaturated, and trans fats but not by cardiovascular factors or fruit or vegetable consumption (Arch Neurol. 2005;62:doi:10.1001/archneur.62.12.noc50161).

Red Meat Linked to Pancreatic Cancer

Consumption of red meat—but not poultry, fish, or dairy products&mdash;may be associated with an increased risk of pancreatic cancer. Dietary intake was determined using a quantitative food frequency questionnaire in 190,545 persons who were followed for 7 years. The risk of pancreatic cancer was 68% higher in those in the highest quintile of daily processed meat intake compared with those in the lowest quintile. Persons in the highest quintiles of pork and red meat intake had a 50% greater risk of pancreatic cancer than those in the lowest quintiles. The risk of pancreatic cancer was not influenced by intake of poultry, fish, dairy products, eggs, total fat, saturated fat, or cholesterol (J Natl Cancer Inst. 2005;47:1458-1465).

Statins Reduce Fracture Incidence

Treatment with statins is associated with a significant decrease in the risk of fracture, according to a study of 91,052 patients enrolled in the New England Veterans Affairs health care system. In a pooled logistic regression analysis, statin use was associated with a 36% decrease in fracture risk when compared with no lipid-lowering therapy and a 32% decrease when compared with nonstatin lipid-lowering therapy. The effect of statin therapy on fracture risk was similar in both new and long-term statin users (Arch Intern Med. 2005;165:2007-2012).

Botulinum Toxin Type A Effective in Chronic Headache

Botulinum toxin type A (Botox) appears to be safe and effective when used as prophylactic treatment in patients with chronic daily headache. A group of 720 patients with chronic daily headache were randomized to receive botulinum toxin type A (225 U, 150 U, or 75 U) or placebo at baseline and again at day 90 and day 180. Among nonresponders to the baseline dose of placebo, the mean decreases in headache-free days per month at 180 days were 6.0, 7.9, 7.9, and 8.0 in those treated with 225 U, 150 U, or 75 U of botulinum toxin type A or placebo, respectively. At day 240, patients treated with 225 U or 150 U of botulinum toxin type A had a significantly greater decrease in headache frequency than did those in the placebo group (P =.03). Only 3.8% of patients withdrew from the study because of adverse events (Mayo Clin Proc. 2005;80:1126-1137).

High-dose Atypical Antipsychotics Increase Parkinsonism Risk

Treatment with high-dose atypical antipsychotics carries about the same risk for parkinsonism as treatment with typical antipsychotics, according to a retrospective cohort study of 25,769 adults. Compared with those treated with an atypical antipsychotic, those treated with a typical antipsychotic and those not treated with antipsychotics were 30% more likely and 60% less likely, respectively, to develop parkinsonism during 1 year of follow-up. The risk of parkinsonism was 50% greater in those treated with higher-potency typical antipsychotics than in those treated with atypical antipsychotics. However, the risk of parkinsonism was similar in those dispensed a higher-potency typical antipsychotic and in those dispensed a high-dose atypical antipsychotic (Arch Intern Med. 2005;165:1882-1888).

Serum GGT Levels Predict CV Mortality

An increased serum gamma-glutamyltransferase (GGT) level is independently associated with a greater risk of death from cardiovascular disease (CVD). The association between serum GGT and CVD mortality was examined in a cohort of 163,944 adults who were followed for up to 17 years. Elevated GGT was significantly (P <.001) and linearly associated with CVD mortality in both men and women. The risk of CVD mortality increased 66% in men and 64% in women per log GGT increase. Elevated GGT was significantly associated with hemorrhagic (P = .01) and ischemic stroke (P <.001) in men but not in women. The association between GGT and CVD mortality was stronger in those <60 years of age than in older persons (Circulation. 2005;112:2130—2137).

Pulse Pressure Best Predictor of CV Mortality?

Pulse pressure is the best forecaster of cardiovascular (CV) mortality in middle-aged men, according to a multinational study of 12,763 men aged 40 to 59 years who were followed for 25 years. The best predictors of CV death were pulse pressure and systolic and diastolic blood pressure (BP), followed by mean and mid BP. The age-adjusted hazard ratio for CV death per 10-mm Hg increase in pulse pressure ranged from 1.19 in the United States (P =.04) to 1.29 in southern Europe (P =.01). In all participants, the hazard ratio per 10-mm Hg increase in pulse pressure was 1.15 (P =.04) for coronary heart disease and 1.32 (P =.01) for stroke death (Arch Intern Med. 2005;165:2142-2147

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