Medical News: HbA1c Predicts Cardiovascular Risk – in Cardiovascular, Diabetes from MedPage Today
Medical News
Taking Asprin? Don’t Stop
Medical News: Aspirin Holiday Is a Bad Idea – in Cardiovascular, Prevention from MedPage Today
A case-control study found that patients taking low-dose aspirin for secondary prevention who had recently discontinued the drug had a higher risk of nonfatal myocardial infarction than those who continued to take the aspirin.
Mom Was Right – Eat Your Veggies
To Tweet or Not To Tweet
Read this article. The authors of the respective Twitter posts mentioned in the article are irresponsible and the misinformation potentially damaging.
Albuminuria and Mortality
Predictive Ability of CRP Questioned
Medical News: AHA: Value of Measuring CRP Questioned – in Meeting Coverage, AHA from MedPage Today
“In patients who already have a reason to be on a statin, C-reactive protein (CRP) measurement does not appear to provide any additional information about cardiovascular risk beyond traditional factors, a secondary analysis of the ASCOT trial showed.”
Silent Heart Damage and Cocaine
“Heavy cocaine users have a high prevalence of cardiac damage as seen by cardiac MRI.”
NEJM Teaching Topic – MCI
The NEJM Resident e-Bulletin is one of the ways I keep up with medical information. While it will not be possible for me to reproduce every email that comes from this service, on occasion I will post topics of interest. Copyright remains vested with the NEJM so don’t try and steal this to make money.
Teaching Topic
Mild Cognitive Impairment
Clinical Practice
Mild Cognitive Impairment
R.C. Petersen
MCI represents an intermediate state of cognitive function between the changes seen in aging and those fulfilling criteria for dementia, often Alzheimer’s disease (AD).
Clinical Pearls
What is the estimated prevalence of MCI?
The estimated prevalence of MCI in population-based studies ranges from 10 to 20%. In the Mayo Clinic Study of Aging, a prospective, population-based study of non-demented persons ages 70 to 89 years at enrollment, the prevalence of amnestic MCI was 11.1% and of nonamnestic MCI, 4.9%.
How can the “worried well” be differentiated from patients with MCI?
Neuropsychological testing may be necessary to corroborate a history of decline in cognition, usually memory. At times, the “worried well” can give a convincing history for memory loss, but neuropsychological testing reveals normal performance.
Figure 1. Diagnostic Algorithm for Amnestic and Nonamnestic Mild Cognitive Impairment.
Morning Report Questions
Q. What factors predict a more rapid progression of cognitive impairment among patients with MCI?
A. As compared with the incidence rate for dementia in the general population of 1 to 2% per year, the incidence of dementia in patients with MCI is significantly increased, with an annual rate of 5 to 10% in community-based populations and 10 to 15% in clinic-based populations. The degree of cognitive impairment at presentation is a clinical predictor of progression; those with greater baseline impairment appear more likely to progress more rapidly. The presence of the apolipoprotein E ε4 allele is also predictive of progression rate. Several MRI measures have also been reported to predict a faster rate of progression, including atrophic hippocampi, dilated ventricles, reduced total brain volume, and the presence of white matter hyperintensities.
Q. How can patients with MCI be managed?
A. Limited data support the potential benefit of cognitive rehabilitation approaches. Several clinical trials that treated persons with MCI with cholinesterase inhibitors used for AD (donepezil, galantamine, and rivastigmine) at standard AD treatment doses for 2 to 4 years have shown no significant reduction in the rates of progression to dementia.
More EVO = Lower Stroke Risk
Medical News: Olive Oil Protects Against Stroke – in Neurology, Strokes from MedPage Today
Observational study on French people.
I wonder if the researchers controlled for red wine consumption.
Globalization of Diabetes
Abstract
Type 2 diabetes is a global public health crisis that threatens the economies of all nations, particularly developing countries. Fueled by rapid urbanization, nutrition transition, and increasingly sedentary lifestyles, the epidemic has grown in parallel with the worldwide rise in obesity. Asia’s large population and rapid economic development have made it an epicenter of the epidemic. Asian populations tend to develop diabetes at younger ages and lower BMI levels than Caucasians. Several factors contribute to accelerated diabetes epidemic in Asians, including the “normal-weight metabolically obese” phenotype; high prevalence of smoking and heavy alcohol use; high intake of refined carbohydrates (e.g., white rice); and dramatically decreased physical activity levels. Poor nutrition in utero and in early life combined with overnutrition in later life may also play a role in Asia’s diabetes epidemic. Recent advances in genome-wide association studies have contributed substantially to our understanding of diabetes pathophysiology, but currently identified genetic loci are insufficient to explain ethnic differences in diabetes risk. Nonetheless, interactions between Westernized diet and lifestyle and genetic background may accelerate the growth of diabetes in the context of rapid nutrition transition. Epidemiologic studies and randomized clinical trials show that type 2 diabetes is largely preventable through diet and lifestyle modifications. Translating these findings into practice, however, requires fundamental changes in public policies, the food and built environments, and health systems. To curb the escalating diabetes epidemic, primary prevention through promotion of a healthy diet and lifestyle should be a global public policy priority.
© 2011 by the American Diabetes Association. Reproduced on this blog under a Creative Commons license. Source attribution is provided via link.
lifeunderwriter.net 
You must be logged in to post a comment.