Emerging economies must act immediately to halt rising obesity rates before the epidemic becomes as severe as it is in first-world countries, according to new report by the Organization for Economic Cooperation and Development.

The OECD report was published in the Lancet. It characterizes the prevalence of obesity in Brazil, China, India, Mexico, Russia and South Africa. Obesity rates were found to vary dramatically across these 6 countries. In Mexico, a stunning 70% of adults were reported to be overweight or obese. Nearly half of all Brazilians, Russians and South Africans fell into these categories. China and India had a lower prevalence of overweight and obesity, but were moving rapidly in the wrong direction, according to the OECD.
 
Developing nations don’t have enough resources to handle the health consequences of obesity, which include an increased risk of cardiac disease, stroke, cancer, diabetes, arthritis and disability from all causes.
 
As a result, the OECD has implored these countries to head-off the worsening crisis now, “as part of wider comprehensive health prevention strategies, rather than (waiting) until the costs of treating obesity-related illness (becomes) much more expensive.”
 
The OECD estimates that the per capita cost per year of a national campaign to prevent obesity and other health threats like cigarette smoking, excessive alcohol intake and high blood pressure would be less than $2 per-person in China and India, about $3 in Brazil, and $4 in Mexico, Russia and South Africa.
 
The campaign would include a mass media blitz designed to promote healthy lifestyles, taxes and subsidies aimed at improving diet, improved federal regulation of food labeling, and restrictions on advertising for fast food. It would add 1 million years of life in good health in India alone, and 4 million years in China during the next 2 decades. It would pay for itself immediately via reduced health care costs in 3 of the 6 countries surveyed, and would become cost-effective in the other three within 15 years.
 
“A multiple intervention strategy would achieve substantially larger health gains than individual programs, with better cost-effectiveness,” OECD health policy analyst and lead author Michele Cecchini said in a press release.

Allopurinol, for 40 years a mainstay in the treatment of gout, has been shown to work for angina too, according to scientists at the University of Dundee.

To reach this surprising conclusion, Awsan Noman and colleagues enrolled 65 patients with chronic stable angina pectoris and angiographically proven coronary artery disease into a randomized, controlled trial of high-dose allpurinol (600 mg per day) vs. placebo.

The scientists found that patients randomized to receive allopurinol increased the median time to ST depression (a sine qua none of coronary ischemia) from 232 seconds to 298 seconds, whereas in placebo-treated subjects that statistic increased from 232 seconds to 249 seconds, a significant difference.

Allopurinol also increased total exercise time and the time before onset of chest pain. There were no adverse treatment effects.
 
Noman’s group suspects the beneficial effects of Allopurinol are caused by its ability to inhibit an enzyme known as xanthine oxidase. This in turn reduces myocardial oxygen (energy) consumption for a particular stroke volume.
 
Next up for the scientists is to determine how best to use allopurinol in the management of chronic stable angina. They were optimistic in this regard, noting that compared with nitrates and beta blockers allopurinol does not reduce blood pressure or heart rate, or trigger headaches and tiredness, which commonly accompany standard drug treatments.

They also noted that allopurinol may be quite useful in developing countries where the incidence of coronary artery disease is exploding and access to more expensive drugs and invasive therapies is limited.

The article appears in Lancet.

A prospective clinical trial of the diabetes drug Avandia has failed to clear the air regarding the blockbuster’s potential to raise cardiac risk.

GlaxoSmithKline, the drug’s maker had hoped that the so-called Record trial would quell concerns that have dogged Avandia since 2007, when a report suggested it was associated with an increased risk of heart attacks compared with other diabetes drugs.

Avandia’s annual sales fell 55% to $1.29 billion since that report surfaced.

On the surface, the Glaxo-funded trial looked promising. Newcastle University’s Philip Home and colleagues reported in last week’s Lancet that people taking Avandia did not experience increased hospitalization rates or cardiovascular mortality compared with those taking other diabetes drugs.

Home’s position on the matter, as reported by the Wall Street Journal, was that Record provided “a robust assessment of [Avandia's] cardiovascular safety.”
 
But in an accompanying editorial, Ravi Retnakaran and Bernard Zinman of Mount Sinai Hospital in Toronto said “definitive conclusions” about the drugs cardiovascular risk “remain elusive” because of the study’s methodological problems.

The cardiovascular event rate observed in Record was lower than expected, they said. That meant it wasn’t possible to reach firm conclusions.

The low event rate might have been caused by the coincident use of cholesterol-lowering statins in the Avandia group, or by the unexpectedly high patient drop-out rate from the study, which may have been prompted by safety concerns about Avandia that arose during the trial.

Roughly 45% of the subjects dropped out of the study before it concluded.

Amid the controversy, David Robbins, a professor of medicine at Kansas found a common denominator everyone could agree with. Avandia certainly did not improve cardiovascular outcomes, he reasoned to the Journal. “What we really want in diabetes is…drugs that are reducing cardiovascular events.”

The millions of folks with no cardiac history who have been diligently popping baby aspirin to prevent future cardiovascular events might as well flush ‘em down the toilet, according to the results of a meta-analysis performed by Oxford University scientists.

In such people, aspirin did reduce the combined risk of heart attack, stroke, and vascular death from 0.57% per year to 0.51%, a significant finding, but it also bumped the risk of gastrointestinal and all extracranial bleeding from 0.07% per year to 0.10%, negating any overall benefit.

Colin Baigent and colleagues oversaw the trial, known as Antithrombotic Trialists’ Collaboration, and published their findings in Lancet.

Current American Heart Association and US Preventive Services Task Force guidelines recommend baby aspirin for primary cardioprevention in those deemed to have a moderately high risk for developing heart disease.

The “current guidelines may need to be reviewed,” Biagent stated matter-of-factly to MedPageToday. For primary prevention, “the main strategies ought to be stopping smoking — if people smoke – and then if further measures are needed, lowering blood pressure, lowering cholesterol.” Baigent added.
 
The scientists had pooled data from 6 randomized, controlled trials of aspirin for the primary prevention of cardiovascular disease. Collectively, the trials had enrolled 95,000 individuals.

Subset analyses involving gender, older age, and a history of either diabetes or high blood pressure revealed nothing to chirp about. In these groups as well, any benefits in cardiovascular risk were offset by increased bleeding.

By the way, Biagent’s group also took a quick peek at secondary prevention, and confirmed that the benefits of aspirin outweigh the risks in individuals with a history of cardiac disease.

Extreme obesity, defined as a Body Mass Index of 40 or higher, which for most people means being about a hundred pounds overweight, cuts life expectancy by 10 years, according to Richard Peto and colleagues at Oxford University in England.

That deleterious impact is the equivalent of a lifelong cigarette smoking habit.

The merely obese, who have a BMI in the range of 30-35, are sacrificing 2-4 years, while overweight folks, who have BMIs in the 25-29.9 range, short themselves and their loved ones by a year or so.

(If you know your height and weight, you can calculate your BMI here.)

The relationship between excessive weight and premature mortality turns out to be linear; for every 5-point jump in BMI above the optimal range, the risk of early death jumps by 30%.

The scientists reached these conclusions after pooling data from 57 studies of nearly 900,000 US and Western European adults that had been followed for 10-15 years.

Nearly 70,000 people died during the observation period. The scientists adjusted the data for age, smoking status and gender.

Almost all excess mortality was caused by cardiovascular disease and stroke, study co-author Gary Whitlock told USA Today. The epidemiologist explained that “obesity causes heart disease and stroke by pushing up blood pressure, mucking up blood cholesterol and triggering diabetes.”

The write-up appears in Lancet.

This is a “valuable study that provides a much clearer picture of the risk associated with various levels of being overweight or obese,” Michael Thun, an emeritus vice president of epidemiological research at the American Cancer Society told USA Today.

Nearly two-thirds of US adults are either overweight or obese, and fully half of those are obese.

“Once you gain weight, it’s hard to lose it and easy to gain more. So the goal to stop your weight gain now,” Thun warned.

Antipsychotic drugs increase one-year mortality by 42% in patients with Alzheimer’s disease, according to the Dementia Antipsychotic Withdrawal Trial published in Lancet Neurology.

Clive Ballard and colleagues at King’s College London reached this conclusion after analyzing data from a randomized controlled discontinuation study of 165 Alzheimer’s disease patients living at 4 skilled nursing or long-term care facilities in the UK.

And the mortality gap widened thereafter such that at 42 months, more than twice as many placebo-treated patients survived as those treated with antipsychotics.

The DART findings extend earlier findings that had demonstrated increased mortality in trials with 12-week endpoints.

DART patients were taking one of 5 commonly prescribed antipsychotics for 3 or more months prior to enrollment. They were randomized to receive continued antipsychotic drug therapy for 12 months or a placebo.

The scientists concluded that “the accumulating safety concerns, including the substantial increase in long-term mortality emphasize the urgent need to put an end to unnecessary and prolonged prescribing.”

They recommended replacing antipsychotics with safer alternatives such as psychotherapy or, depending on the syndrome, alternative agents like antidepressants.

The antipsychotic drugs in the London study carry black box warnings cautioning about mortality risk, yet 30% to 60% of dementia patients in North American and European long-term care facilities receive them, according to MedPageToday.

The mechanism by which antipsychotics mediate increased mortality is not known. It’s possible their sedative effects render patients more susceptible to infections and less able to stay fit.

In a stunning policy turnabout made possible by its swollen coffers, China announced that it will cover health care costs for 90% of its population by 2010 and implement universal coverage by 2020.

The plan has global implications given China’s enormous population, its questionable capacity to address epidemics of communicable diseases such as avian influenza and SARS, and its troubled pharmaceutical and food processing industries.

For 35 years after Mao Zedong assumed control of China, the government employed physicians and owned, funded and operated China’s health care system. During this time, China achieved dramatic improvements (albeit from a very low baseline) in life expectancy, infant mortality and other measures of population health.

Then in the early 1980s, in what appears to have been collateral damage from a larger effort to privatize its economy, China essentially dismantled its health care system overnight, replacing it with nothing. Central government spending on health evaporated, leaving overwhelmed provincial and local authorities to coordinate care, physicians to fend for themselves and normal citizens with no choice but to pay for health services out of pocket.

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