Thursday, December 10, 2009

Ezetimibe vs. niacin added to statins for secondary prevention of CAD

Penelitian ini membandingkan efektivitas NIACIN vs EZETIMIBE dalam hal meningkatkan kadar kolesterol HDL dan menurunkan kadar kolesterol LDL serta perbedaan rerata ketebalan carotid intima media setelah 14 bulan intervensi pada pasien yang mendapatkan preparat statin.
 
Hasilnya pada kelompok niacin terjadi peningkatan HDL, penurunan LDL dan trigliserida secara signifikan. Kelompok ezetimibe terjadi penurunan HDL, LDL dan trigliserida. Dalam hal ketebalan carotid intima media niacin lebih unggul.
Anehnya pada kelompok ezetimibe penurunan LDL berhubungan signifikan dengan penebalan carotid intima media (R=–0.31, P<0.001).
Insiden kejadian kardiovaskuler mayor pada kelompok niacin lebih rendah dibanding kelompok ezetimibe (1% vs. 5%, P=0.04 by the chi-square test).
 

 
N Engl J Med 361(22):2113-2122, 26 November 2009. © 2009 to the Massachusetts Medical Society
Extended-Release Niacin or Ezetimibe and Carotid Intima-Media Thickness. Allen J. Taylor, Todd C. Villines, Eric J. Stanek, et al. 

ABSTRACT

Background Treatment added to statin monotherapy to further modify the lipid profile may include combination therapy to either raise the high-density lipoprotein (HDL) cholesterol level or further lower the low-density lipoprotein (LDL) cholesterol level.

Methods We enrolled patients who had coronary heart disease or a coronary heart disease risk equivalent, who were receiving long-term statin therapy, and in whom an LDL cholesterol level under 100 mg per deciliter (2.6 mmol per liter) and an HDL cholesterol level under 50 mg per deciliter for men or 55 mg per deciliter for women (1.3 or 1.4 mmol per liter, respectively) had been achieved. The patients were randomly assigned to receive extended-release niacin (target dose, 2000 mg per day) or ezetimibe (10 mg per day). The primary end point was the between-group difference in the change from baseline in the mean common carotid intima–media thickness after 14 months. The trial was terminated early, on the basis of efficacy, according to a prespecified analysisconducted after 208 patients had completed the trial.

Results The mean HDL cholesterol level in the niacin group increased by 18.4% over the 14-month study period, to 50 mg per deciliter (P<0.001), and the mean LDL cholesterol level in the ezetimibe group decreased by 19.2%, to 66 mg per deciliter (1.7 mmol per liter) (P<0.001). Niacin therapy significantly reduced LDL cholesterol and triglyceride levels; ezetimibe reduced the HDL cholesterol and triglyceride levels. As compared with ezetimibe,niacin had greater efficacy regarding the change in mean carotid intima–media thickness over 14 months (P=0.003), leading to significant reduction of both mean (P=0.001) and maximal carotid intima–media thickness (P≤0.001 for all comparisons). Paradoxically, greater reductions in the LDL cholesterol level in association with ezetimibe were significantly associated with an increase in the carotid intima–media thickness (R=–0.31, P<0.001). The incidence of major cardiovascular events was lower in the niacin group than in the ezetimibe group (1% vs. 5%, P=0.04 by the chi-square test).

Conclusions This comparative-effectiveness trial shows that the use of extended-release niacin causes a significant regression of carotid intima–media thickness when combined with a statin and that niacin is superior to ezetimibe. 

Physical activity in early adolescence predicts later adiposity

Anak yang aktif berolah raga pada awal pubertas mempunyai massa lemak yang lebih kecil.
Kesimpulan anak perlu aktif berolah raga dalam upaya pencegahan obesitas.
 
Abstract
 
BMJ 339:b4544, 26 November 2009. © 2009 to the BMJ Publishing Group Ltd.
Prospective associations between objective measures of physical activity and fat mass in 12-14 year old children: the Avon Longitudinal Study of Parents and Children (ALSPAC). Chris J Riddoch, Sam D Leary, Andy R Ness, et al.
 
Objective To investigate associations between physical activity at age 12 and subsequent adiposity at age 14.

Design Prospective birth cohort study with data collected between 2003 and 2007.

Setting Original recruitment in 1991-2 of 14 541 pregnant women living in the former County of Avon (United Kingdom).

Participants At age 12, 11 952 children were invited to attend the research clinic. Of these, 7159 attended, and 4150 (1964 boys, 2186 girls) provided sufficient data on exposure, outcome, and confounding variables.

Main outcome measure Fat mass at age 14, measured by dual emission x ray absorptiometry, associated with physical activity at age 12, measured by accelerometry.

Results Prospective associations of fat mass at age 14 (outcome) with physical activity at age 12 (exposure) were strong for both total activity (accelerometer counts/min) and for daily amount of moderate-vigorous physical activity (min/day). An extra 15 minutes of moderate-vigorous physical activity per day at age 12 was associated with lower fat mass at age 14 in boys (by 11.9% (95% confidence interval 9.5% to 14.3%)) and girls (by 9.8% (6.7% to 12.8%)). The proportion of physical activity due to moderate-vigorous physical activity was between 20% and 30% in boys and girls at the two ages.

Conclusions Higher levels of physical activity, in particular activity of moderate to higher intensities, are prospectively associated with lower levels of fat mass in early adolescence. Interventions to raise levels of physical activity in children are likely to be important in the fight against obesity.

Thursday, December 3, 2009

Cancer Incidence and Mortality After Treatment With Folic Acid and Vitamin B12

Hati2 mengkonsumsi suplemen asam folat dan vitamin B12
 
Dua penelitian dengan desain randomized controlled trials terhadap 6.837 pasien penyakit jantung iskemik dari tahun 1998-2005 yang dilakukan di Norwegia mendapatkan bahwa suplementasi dengan asam folat dan vitamin B12 meningkatkan risiko kanker (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.03-1.41; P = .02). Dan meningkatkan kematian (from any cause) (HR, 1.18; 95% CI, 1.04-1.33; P = .01). Ini terutama disebabkan peningkatan insiden kanker paru pada kelompok yang mendapatkan asam folat dan vitamin B12.
 

JAMA302(19):2119-2126, 18 November 2009. © 2009 to the American Medical Association.
Cancer Incidence and Mortality After Treatment With Folic Acid and Vitamin B12. Marta Ebbing, Kaare Harald Bønaa, Ottar Nygård, et al.

Context  Recently, concern has been raised about the safety of folic acid, particularly in relation to cancer risk.

Objective  To evaluate effects of treatment with B vitamins on cancer outcomes and all-cause mortality in 2 randomized controlled trials.

Design, Setting, and Participants  Combined analysis and extended follow-up of participants from 2 randomized, double-blind, placebo-controlled clinical trials (Norwegian Vitamin Trial and Western Norway B Vitamin Intervention Trial). A total of6837 patients with ischemic heart disease were treated with B vitamins or placebo between 1998 and 2005, and were followed up through December 31, 2007.

Interventions  Oral treatment with folic acid (0.8 mg/d) plus vitamin B12 (0.4 mg/d) and vitamin B6 (40 mg/d) (n = 1708);folic acid (0.8 mg/d) plus vitamin B12 (0.4 mg/d) (n = 1703); vitamin B6 alone (40 mg/d) (n = 1705); or placebo (n = 1721).

Main Outcome Measures  Cancer incidence, cancer mortality, and all-cause mortality.

Results  During study treatment, median serum folate concentration increased more than 6-fold among participants given folic acid. After a median 39 months of treatment and an additional 38 months of posttrial observational follow-up, 341 participants (10.0%) who received folic acid plus vitamin B12 vs 288 participants (8.4%) who did not receive such treatment were diagnosed with cancer (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.03-1.41; P = .02). A total of 136 (4.0%) who received folic acid plus vitamin B12 vs 100 (2.9%) who did not receive such treatment died from cancer (HR, 1.38; 95% CI, 1.07-1.79; P = .01). A total of 548 patients (16.1%) who received folic acid plus vitamin B12 vs 473 (13.8%) who did not receive such treatment died from any cause (HR, 1.18; 95% CI, 1.04-1.33; P = .01). Results were mainly driven by increased lung cancer incidence in participants who received folic acid plus vitamin B12. Vitamin B6treatment was not associated with any significant effects.

Conclusion  Treatment with folic acid plus vitamin B12 was associated with increased cancer outcomes and all-causemortality in patients with ischemic heart disease in Norway, where there is no folic acid fortification of foods.