Oct 192008
 

Contradicting current recommendations, a new trial finds that aspirin does not reduce the risk of heart attack and stroke for people with diabetes or peripheral arterial disease.

Aspirin clearly is effective in secondary prevention, reducing the risk for people who already have had a heart attack or stroke, said study author Dr. Jill Belch, a professor of vascular medicine at the University of Dundee in Scotland. Her report was published in the online issue of the BMJ.

However, in the study of 1,276 people who had not yet suffered a heart attack or stroke but were at high risk because they had diabetes or peripheral arterial disease (partial blockage of leg arteries), “we found that they did not benefit from daily aspirin,” Belch said. The study showed that aspirin is ineffective in primary prevention, she noted.

“The number of heart attacks and strokes was exactly the same over eight years for those taking aspirin and those taking placebo,” Belch said.

The same was true of the antioxidants given in the trial, she said, which was no surprise. “All the antioxidant studies over the past 10 years have been negative,” Belch said.

Both the American Heart Association and the U.S. government recommend aspirin for people who have not had heart attacks or strokes but are at high risk for cardiovascular trouble because of conditions such as diabetes.

Those recommendations probably should be changed, said Dr. William R. Hiatt, a professor of medicine at the University of Colorado, who wrote an accompanying editorial.

The newly reported study “is consistent with six other studies on primary prevention, and all those studies were negative,” Hiatt said.

The current recommendations are based on analysis of studies that found some primary prevention benefit in subgroups, he said. “Overall, if you do not have heart disease, the risk of bleeding outweighs any benefit you get from aspirin,” Hiatt said.

The U.S. Preventive Services Task Force recommendation for use of aspirin in people at high risk of heart disease cited five studies that included 50,000 people. But its report noted that “no trial showed a significant all-cause mortality difference between aspirin-treated and control groups.”

Hiatt said that he served on an advisory committee of the U.S. Food and Drug Administration that reviewed a request in 2003 by Bayer to extending the labeling of aspirin to include primary prevention in heart disease. “We couldn’t support that request,” he said.

Advertisements urging people to take aspirin to benefit the heart are accurate for those who already have had an event, both Belch and Hiatt said.

“It works if you’ve already had a heart attack,” Belch said. “But there is no proof for primary prevention, no proof at all.”

“The evidence is solid that aspirin should be given to people with known heart disease,” Hiatt said. “But the evidence for people who have risk factors for heart disease is different.”

Doctors Often Overestimate Patients’ Health Literacy: Many patients misunderstand the written questions American doctors have them answer before physical exams, a finding that calls into question the usefulness of these screening tools, new reports say.

Two studies, presented earlier this year at the 2008 Clinical Congress of the American College of Surgeons, found that lower-than-expected literacy levels among patients and a failure to understand basic numerical measurements hurt the validity of the questionnaire results. A third study, though, found promise in using computer programs to “speak” the questions to patients.

The studies, by researchers at the Emory University School of Medicine in Atlanta, noted shocking literacy issues. In the first, it was found that of 300 men at an inner-city hospital — average age 61 and average reading level of fourth grade — only one in six understood all seven questions used for in the International Prostate Symptom Score (IPSS). In all, only 38 percent of patients understood more than half the questions, such as: “During the last month or so, how often have you had to push or strain to urinate?”

“Possibly the most worrisome thing was the number of patients who thought they understood this test — the most commonly used instrument in urology worldwide — but did not,” Dr. Viraj A. Master, an assistant professor of urology at Emory, said in a news release issued by the American College of Surgeons.

The study also found that many patients were not capable of discussing numbers and quantities, such as rating something on a scale of one to 10 or saying whether a symptom occurred “a third of the time.”

In the second study, less than a third of 266 patients — average age of 58 — understood numbers and quantities well enough to pass a three-question Woloshin-Schwartz numeracy quiz. The quiz asked questions such as “Imagine that we flip a coin 1,000 times. What is your best guess about how many times the coin will come up heads in 1,000 flips?” (Answer: 500 times).

Most respondents were considered “innumerate,” with 33 percent answering only one question correctly and 35 percent having no correct answers.

“Even after controlling for age, race, homelessness, English as a second language, income, and a host of other variables — including educational level — numeracy was shown to be an independent predictor of misunderstanding,” Master said. “Being innumerate, in addition to being illiterate, results in high levels of misunderstanding that severely limit access to appropriate health care for millions of patients.”

Master and his colleagues tried adding pictures to their screening tests to help illustrate the concept being discussed, but this did not improve understanding in a randomized prospective trial. However, in a third study, when the team designed a computer program in which a figure speaks to the patient, asking the IPSS questions, the level of understanding increased dramatically.

“The computer program improved understanding for all patients at all educational levels. Importantly, it even improved understanding for individuals who had no familiarity with computers,” Master said.

Spices, herbs boost health for diabetics : Spices may do more than flavor your food: New research suggests a shake of this and a pinch of that could also boost the health of diabetics.

Researchers bought 24 herbs and spices and found that many appear to have the power to inhibit tissue damage and inflammation brought on by high blood-sugar levels in the body.

The study didn’t examine the direct effects of spices on diabetics. Also, spices are typically used in small amounts, making it unclear if those who eat them would get much benefit.

Still, “this gives people a tool to work with in terms of keeping their health as they want it to be,” said study co-author James Hargrove, an associate professor at the University of Georgia.

Hargrove and his colleagues were intrigued by spices because they’re rich in antioxidants, which are thought to protect cells from damage. “One can put a lot of antioxidant power into meals by using spices” without making people fatter, he said. “Because of the way they’re prepared, herbs and spices tend to have low calorie contents.”

In addition, spices are cheaper than many other food products, he said.

The researchers decided to look into the anti-inflammatory properties of spices. “We said, ‘Let’s just go to Wal-Mart, get all the McCormick brand spices we can find, and check those. That was as complicated as our study design was.”

The findings appear in a recent issue of the Journal of Medicinal Food.

In laboratory tests, the researchers found that many of the spices and extracts appeared to inhibit a process known as glycation, which has been linked to inflammation and tissue damage in diabetics.

The spices that seemed most likely to help diabetics included cloves, cinnamon (previously pegged as a possible blood-sugar reducer), allspice, apple pie spice and pumpkin pie spice, Hargrove said. Top herbs included marjoram, sage and thyme.

Other spices and herbs were “still rich compared to other foods” when it comes to the effect, he said.

Lona Sandon, national spokesperson for the American Dietetic Association, said that while research does suggest that spices are high in antioxidants and may reduce blood-sugar levels, it’s difficult to make recommendations about how much to use.

Even so, “I say add as much herbs and spices as your taste buds and tummy can take,” she said. “They add flavor and fun to foods without adding calories or fat. Their potential for promoting health outweighs any risks, unless, of course, you have an allergy to a particular spice.”

Blood protein tied to Alzheimer’s disease risk : Low levels of cystatin C — a blood protein commonly used as a measure of kidney function — may be a risk factor for the development of Alzheimer’s disease in elderly men, researchers report.

Cystatin C is produced by nearly all human cells and available in all body fluids. During the past decade, studies have suggested that cystatin C activity in the brain may protect against the development of Alzheimer’s disease by inhibiting amyloid-beta — a protein in the body that forms amyloid plaques in the brain, a key feature of Alzheimer’s disease.

To further explore this idea, Dr. Johan Sundelof, of Uppsala University, Sweden, and colleagues examined the association between blood levels of cystatin C and the development of Alzheimer’s disease in a group of 1,230 men in their early 70s, who were re-assessed when they were about 77 years old.

A total of 82 subjects were diagnosed with Alzheimer’s disease during follow-up.

The researchers observed an association between lower cystatin C levels and higher risk of Alzheimer’s disease.According to the researchers, a 0.1-mcmol/L decrease of cystatin C between ages 70 and 77 was associated with a 29 percent higher risk of developing Alzheimer’s disease.

“Our findings strengthen the evidence of a role for cystatin C in Alzheimer’s disease pathogenesis,” Sundelof said in an interview with Reuters Health.

Disinfectants can boost bacteria’s resistance to treatment: Improper use of chemical disinfectants might actually make the bacteria they are trying to kill stronger and more resistant over time, a new report says.

When these chemicals, called biocides, are used at lower-than-lethal concentrations, the bacteria can survive and eventually become resistant to the chemical and antibiotics, according to a paper published in the October issue of Microbiology. In experiments done on the potentially lethal bacterium Staphylococcus aureus, researchers found the samples mutated when exposed to low concentrations of several biocides and dyes regular used in hospitals for disinfecting. The mutated bacterium had increased numbers of efflux pumps, which remove toxins from its cells. The pumps eliminate antibiotics from the cell and can make the bacteria resistant to those drugs.

“Pathogenic bacteria with more pumps are a threat to patients, as they could be more resistant to treatment,” author Dr. Glenn Kaatz, head of infectious diseases for the Department of Veterans Affairs Medical Center in Detroit, said in a society news release.

If the surviving bacteria are exposed repeatedly to biocides, they may build up resistance to disinfectants and antibiotics. Such bacteria contribute to hospital-acquired infections.“Careful use of antibiotics and the use of biocides that are not known to be recognized by efflux pumps may reduce the frequency at which resistant strains are found,” Kaatz said. “Alternatively, the combination of a pump inhibitor with an antimicrobial agent or biocide will reduce the emergence of such strains and their clinical impact.”

Make time for breakfast: Your mother probably urged you to eat a healthy breakfast, noting it was the day’s most important meal. She was right, says the Nemours Foundation, which offers these suggestions on how to refuel your kids to begin their day:

Keep your kitchen full of healthy, quick and easy breakfast choices. If morning time is at a premium, try to prepare for breakfast the night before. Set out dishes, prepare and cut up food, etc.

Wake your family 10 minutes earlier than usual to allow time for breakfast. Encourage your child to help decide what to have for breakfast. The child can even help prepare it. Have on-the-go breakfast options ready for mornings when you’re running late, including fresh fruit, yogurt, trail mix, and individual boxes of cereal. Pack a nutritious snack for your child if he or she isn’t hungry first thing in the morning. The News

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