Archive for March 9th, 2009

Few Kids Need Cholesterol Busters

March 9th, 2009 | No Comments | Source: Circulation, MedPageToday

lipitorLast summer, the American Academy of Pediatrics caused a stir by recommending for the first time, statins as first-line cholesterol-lowering drugs for kids in whom weight loss and exercise failed to do the trick.

How could they do that when no one’s sure statins are safe in kids?

That’s still a matter of debate, which is why the recent research by Earl Ford and colleagues at the CDC adds some reassuring context.

These scientists matched the Academy guidelines against actual prevalence data for high cholesterol levels in this age range and determined that only 0.8% of kids between 12 and 17 qualify for the drugs.

That’s about 200,000 adolescents nationwide. The study appears in Circulation.

Academy guidelines say cholesterol-lowering drugs can be considered for children with LDL (bad) cholesterol levels in excess of 190 mg/dL, or levels in excess of 160 mg/dL if cigarette smoking, hypertension, obesity or a positive family history is present.

oprahthisisasitupChildren with diabetes and LDL over 130 mg/dL also qualify according to Academy guidelines.

The scientists examined data from the National Health and Nutrition Examination Survey. They found 2,724 adolescents in whom LDL values were available and 9,868 participants aged 6-17 years in whom a total cholesterol value was available.

It turned out that only 26 participants qualified for drug treatment according to Academy guidelines. Eleven of these had LDLs greater than 190, while 15 had a risk factor plus an LDL level higher than 160 mg/dL.

Only one subject was actually taking a cholesterol-lowering drug. 

Then again, it’s “a matter of opinion whether…0.8% is a small or large percentage,” Ford told MedPageToday.

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Coffee Cuts Dementia Risk

March 9th, 2009 | No Comments | Source: J. Alzheimer's Disease

Looking for a reason to down another cup of Joe?

Scandinavian scientists have reported that people who drank 3-5 cups of coffee per day while in their 20s were 65% less likely to develop dementia than those who drank 2 cups or less.

The Danish-Swedish research group managed to follow 1,409 middle-age people for an averageof 21 years after collecting dietary information at the beginning of the study. In all, 61 study participants developed dementia, including 48 with Alzheimer’s disease.

The scientists excluded the possibilities that age, family history, high cholesterol, hypertension or diabetes were driving the apparent association.

The jittery few who downed more than 5 cups per day experienced a similar benefit, but numbers were so small in this subset that no one could say for sure whether the differences were significant.

Nevertheless, lead author Miia Kivipelto, of Stockholm’s Karolinska Institute was in no mood to set up a Dunkin’ Donuts outside her ER. “This is an observational study,” she reminded the New York Times.

“We have no evidence that for people who are not drinking coffee, (starting) will have a protective effect.”

Kivipelto and colleagues think the association is mediated through a known link between coffee consumption and a diminished risk of type 2 diabetes, which increases dementia risk.

Caffeine has also been shown in animal studies to cut amyloid plaque formation in the brain and to have weak antioxidant effects.

The paper appears in the Journal of Alzheimer’s Disease.

lifeisgoodCoincidentally, another Karolinska research group just published a similarly designed study which showed dementia was less common in people with a laid-back personality.

And researchers at Durham University have observed that people who consume prodigious quantities of caffeine are more likely to experience hallucinations. Imagine that!

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Adverse Drug Events in Hospitals

March 9th, 2009 | No Comments | Source: PLoS Medicine

Fifteen percent of all hospitalized patients experience at least one adverse drug reaction during their stay, and each ADR adds about 0.25 days onto the length of stay, according to Munir Pirmohamed and colleagues at the University of Liverpool.

accidentwaitingtohappenTo reach this conclusion, the scientists tracked the hospital stays of 3,695 consecutive patients admitted to 12 hospital wards during a 6-month stretch in 2005.

They reviewed charts to assess causality, severity and preventability, and performed multivariate analysis to identify ADR risk factors.

In all, 545 patients experienced at least one ADR. The report is in Plos One
 
The most common ADRs included bleeding, constipation, confusion, renal problems, and nosocomial infections involving Clostridia, Staph and other potentially life-threatening bacteria.  Half of all ADRs were felt to be definitely or possibly preventable.

The most commonly offending drugs were narcotic analgesics, anticoagulants and diuretics.
 
The number of drugs being taken by a patient turned out to be the most significant predictor of ADRs, with each additional medication multiplying the risk by about 14%.

Elderly people, who tend to be taking many medications, were therefore found to be at high risk for ADRs.
 
“Our results show that the overall burden of ADRs on hospitals is high and therefore new methods of intervention are needed to reduce this,” Pirmohamed told BurrillReports. 
 
“We are currently looking at…ways of improving the safety of medicines, including increased monitoring…and identification of genetic factors that increase the risk of…adverse effects,” he added.

GoDonGoOther groups, particularly Boston’s Institute for Healthcare Improvement have made progress in this area. Even so, IHI estimates there are as many as 15 million incidents of medical harm each year in US hospitals.

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