Day: 07/01/2010

Risk Factors for Suicide

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Biological risk factors for suicide include:

  • Low cerebrospinal fluid 5-hydroxyindolacetic acid levels

  • Hypothalamic-pituitary-adrenal axis dysregulation

  • Low blood cholesterol levels

  • Medical or neurological illnesses (such as multiple sclerosis, stroke, Huntington disease, and epilepsy)

  • Cigarette smoking

Psychological risk factors include:

  • Acceptability of suicide

  • A childhood history of physical or sexual abuse

  • Discouraged help-seeking behavior

  • Aggressive/impulsive traits

  • Pessimism

  • Hopelessness

  • Low self-esteem

  • Poor access to psychiatric treatment

More proximal stressors that indicate an increased suicide risk include:

  • Relationship problems

  • Financial troubles

  • A family or personal history of suicide

  • Major depression

  • Substance use

Is the loss of the sense of smell related toAlzheimer’s disease or Parkinson’s disease?

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There are numerous studies indicating thatanosmia, or the loss of the sense of smell, is associated with dementia andneurodegenerative diseases such as Alzheimer’s disease (AD), Parkinson’s disease (PD), and Lewy body disease (LBD). Even though the scientific community seems to be in agreement that there is a relationship between olfactory impairments and neurodegenerative diseases, the nature of this relationship has not been fully established. For example, some research indicates that the loss of smell can be a predictive factor for developing AD, PD, or LBD, but other studies report that this symptom is not pronounced enough to be of diagnostic value. Additionally, it does not appear that an impaired sense of smell can be used in the absence of other symptoms or diagnostic tests to differentiate between the different neurodegenerative conditions.

More Bad News for Rosiglitazone

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For more than 10 years, thiazolidinediones (TZDs) have been prescribed for diabetes therapy in the U.S. on the sole basis of evidence that they improve glycemic control. An association of TZDs withheart failure is relatively well-established; however, recent data have implicated rosiglitazone in other adverse cardiovascular events as well.

Two new studies further address the risks of rosiglitazone. In an observational cohort study, 227,571 Medicare patients (median age, 74.4) began therapy with either rosiglitazone or pioglitazone between July 2006 and June 2009. During a median follow-up of 105 days, rosiglitazone recipients were significantly more likely than pioglitazone recipients to experience adverse events including stroke (hazard ratio, 1.27); heart failure (HR, 1.25); death from any cause (HR, 1.14); and a composite ofacute myocardial infarction (AMI), stroke, heart failure, and death (HR, 1.18). The risk for AMI alone did not differ between the two groups. For the composite endpoint, the estimated overall number needed to harm was 60 patients treated for 1 year.

In an extension of a well-known 2007 meta-analysis of clinical trials of rosiglitazone (JW Cardiol May 21 2007), researchers examined 56 trials involving 35,531 patients randomized to receive rosiglitazone or a control therapy for more than 24 weeks. Treatments used in the control groups included placebo, usual care, and non-TZD antidiabetic therapies. Compared with controls, patients in the rosiglitazone groups had a significantly higher risk for MI (odds ratio, 1.28) but not for cardiovascular mortality. Separate analyses that either included or excluded studies with no adverse cardiovascular events yielded similar results.

Comment: These studies add to growing evidence that, despite lowering glucose levels, rosiglitazone causes important adverse cardiovascular events. The different rosiglitazone-associated adverse outcomes in the studies may be explained by differences in study designs, patient populations, comparison groups, lengths of follow-up, and methods of outcomes ascertainment. Althoughobservational studies are prone to confounding, and meta-analyses have their own limitations, these findings will increase pressure on the FDA to reconsider whether rosiglitazone should remain on the market, bearing in mind the availability of pioglitazone, which appears to be a safer alternative.


Published in Journal Watch Cardiology June 30, 2010

Adverse Events Associated with Testosterone Administration

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Methods Community-dwelling men, 65 years of age or older, with limitations in mobility and a total serum testosterone level of 100 to 350 ng per deciliter (3.5 to 12.1 nmol per liter) or a free serum testosterone level of less than 50 pg per milliliter (173 pmol per liter) were randomly assigned to receive placebo gel or testosterone gel, to be applied daily for 6 months. Adverse events were categorized with the use of the Medical Dictionary for Regulatory Activities classification. The data and safety monitoring board recommended that the trial be discontinued early because there was a significantly higher rate of adverse cardiovascular events in the testosterone group than in the placebo group.

Results A total of 209 men (mean age, 74 years) were enrolled at the time the trial was terminated. At baseline, there was a high prevalence of hypertension, diabetes, hyperlipidemia, and obesity among the participants. During the course of the study, the testosterone group had higher rates of cardiac, respiratory, and dermatologic events than did the placebo group. A total of 23 subjects in the testosterone group, as compared with 5 in the placebo group, had cardiovascular-related adverse events. The relative risk of a cardiovascular-related adverse event remained constant throughout the 6-month treatment period. As compared with the placebo group, the testosterone group had significantly greater improvements in leg-press and chest-press strength and in stair climbing while carrying a load.

Conclusions In this population of older men with limitations in mobility and a high prevalence of chronic disease, the application of a testosterone gel was associated with an increased risk of cardiovascular adverse events. The small size of the trial and the unique population prevent broader inferences from being made about the safety of testosterone therapy.

source:NEJM

medTitans – Knowledge Sharing and Social Networking for Doctors

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medTitans – Knowledge Sharing and Social Networking for Doctors.