Morning MEDtalks with Dr KK Aggarwal 1^st July 2018

Work stress may be deadly for men with heart disease and diabetes

Men with heart disease, diabetes or a history of stroke are more likely to die prematurely when they have a stressful job even when they’re relatively healthy, a large European study suggests and published in the Lancet Diabetes & Endocrinology.

For the current study, they examined data on 102,633 men and women living in Finland, France, Sweden and the UK who participated in one of seven studies examining the relationship between work stress and mortality. They found that work stress is particularly harmful for those with problems in the cardiovascular and metabolic systems, such as those with diabetes, heart disease or a history of stroke and this excess risk remained even if the person was free of conventional risk factors, such as smoking, high blood pressure or high cholesterol concentration.

Researchers examined two aspects of work stress: having high demands or responsibility but little control or authority, and having a large difference between effort and reward.

Levamisole in Relapsing Nephrotic Syndrome

EUVAS conference in Italy (hosted by the European Vasculitis Society, April 19-21, 2018

Children with nephrotic syndrome are put on steroids for initial management of glomerular injury. While steroids are generally quite effective, the duration of dosing puts many children at risk for long-term complications.

Researchers in Europe and India have revisited levamisole, a drug considered to be the least toxic and least expensive steroid alternative. In a randomized clinical trial, this drug was administered to children, who experienced a complete remission of nephrotic syndrome (whether steroid-free or steroid-dependent). The primary outcome was the time to relapse after randomization. Levamisole significantly lowered the risk for relapse compared with placebo, and the earliest therapeutic response to levamisole was seen beginning at 100 days.

Mantra meditation

Mindful repetition of a mantra, a sacred word, effectively reduces symptoms of combat-related posttraumatic stress disorder (PTSD) and insomnia as per a randomized controlled trial published in The June 20 in the American Journal of Psychiatry.

Investigators compared mantra repetition to present-centered therapy in veterans with PTSD. Both interventions were offered weekly for a total of 8 weeks. Those in the mantra group had significantly greater improvements in both PTSD and insomnia. Benefits continued to be present at 2-month follow-up.

The study was a two-site, open-allocation, blinded-assessment randomized trial involving 173 veterans diagnosed with military-related PTSD from two Veterans Affairs outpatient clinics (January 2012 to March 2014). The mantram group (N=89) learned skills for silent mantram repetition, slowing thoughts, and one-pointed attention. The comparison group (N=84) received present-centered therapy, focusing on currently stressful events and problem-solving skills. Both treatments were delivered individually in eight weekly 1-hour sessions. The primary outcome measure was change in PTSD symptom severity, as measured by the Clinician-Administered PTSD Scale (CAPS) and by self-report. Secondary outcome measures included insomnia, depression, anger, spiritual well-being, mindfulness, and quality of life. Intent-to-treat analysis was conducted using linear mixed models.

Exercise may help outrun a family risk for heart disease

Staying physically fit helps lower your risk of heart disease — even if the condition runs in your family.

Researchers relied on data from nearly half a million middle-aged and older adults in the United Kingdom. Over the six-year study, people with high levels of grip strength, self-reported physical activity, and cardiorespiratory fitness (as measured by a stationary bike test) were less likely than others to have a heart attack or stroke. That was true even among people with high genetic risk, based on whether they carried certain gene variants that have been linked to heart disease.

Among the one-third of people at the highest genetic risk, higher fitness levels were linked to a 49% lower risk for coronary artery disease compared with those who were the least fit. They were also 60% less likely to have atrial fibrillation, a heart rhythm disorder that raises the risk of stroke. The study was published April 9 in the journal Circulation. (Harvard News Letter).

Metformin for dementia in diabetics

In elderly diabetics with dementia metformin was associated with a reduction in all-cause mortality while insulin was associated with an increased risk for heart failure said Juraj Secnik, MD, and doctoral candidate, Department of Neurobiology, Karolinska Institute, Sweden.

The longitudinal, register-based cohort study also showed that diabetic patients with dementia who take a dipeptidyl peptidase-4 inhibitor (DPP-4i) have a higher rate of myocardial infarction (MI). The study was presented at the Congress of the European Academy of Neurology (EAN) 2018.

Should DCGI withdraw febuxostat from the market

The nonprofit advocacy group Public Citizen has asked the US FDA to immediately pull the gout drug febuxostat from the market following results of a large postmarketing study that showed higher rates of fatal cardiovascular events and all-cause mortality in patients taking the drug. 

There is "overwhelming evidence that the serious cardiovascular harms of febuxostat outweigh any purported clinical benefit," the group writes in a citizen petition filed June 21.

The FDA initially rejected the new drug application for febuxostat twice, citing concerns over CV risks seen in initial clinical trials and approved the drug in 2009 on the condition that Takeda conduct a large post-market randomized clinical trial to further evaluate CV risks.

The results of that study, known as CARES, was published March 12 in the New England Journal of Medicine (NEJM) to coincide with presentation at the American College of Cardiology (ACC) 2018 Annual Scientific Session.

Diabetic treatment over 15 years

The Veterans Administration Diabetes Trial (VADT) in patients who had longstanding uncontrolled type 2 diabetes did not find a "legacy effect" of fewer future cardiovascular events in the 15-year follow-up.

Compared with patients in the standard treatment group, those in the intensive glucose-lowering group had fewer cardiovascular events (a composite of myocardial infarction [MI], stroke, cardiovascular death, congestive heart failure, and amputation) at the 10-year follow-up, but this did not extend out to 15 years.  

Rresearchers reported these latest findings from the VADT follow-up study (VADT-F) on June 24 here at the American Diabetes Association (ADA) 2018 Scientific Sessions.  

Superbugs in meat

Canada: The latest round of tests by federal scientists found antibiotic-resistant bacteria on nearly 80 percent of supermarket meat in 2015, according to a new analysis by the Environmental Working Group. Those bacteria were resistant to at least one of 14 antibiotics tested for by the National Antimicrobial Resistance Monitoring System, a federal public health partnership.

Penicillin allergy

Patients with a documented penicillin allergy have a higher risk of developing new methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile infections, a study has shown. The population-based matched cohort study was published online June 27 in the British Medical Journal.

Dr KK Aggarwal

Padma Shri Awardee

President HCFI

Vice President CMAAO