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Take Note – June 2009


Reduced HRT use linked to dramatic decline in MIs

Since 2002, use of hormone replacement therapy (HRT) in women ages 50 to 69 declined from more than 30% to less than 15%. A new study correlates this decline to a drop in acute myocardial infarctions (MIs), but not a decreased rate of strokes, in American women. However, experts point out that other factors, such as better heart disease screening, may have played a role in the lower MI incidence. Thus attributing the drop to reduced HRT use may be premature.

Read the May 2009 abstract from Medical Care.

Pediatricians adopt new term for shaken baby syndrome

The American Academy of Pediatrics (AAP) is recommending healthcare professionals use the term “abusive head trauma” instead of “shaken baby syndrome.” According to the AAP, the new diagnostic term is a more comprehensive diagnosis for brain, skull, and spinal injuries associated with shaking and other head injuries inflicted on infants and young children. It can also help avoid legal challenges to the term “shaken baby syndrome,” which can detract from more important questions about whether abuse occurred.

Read the release from the American Academy of Pediatrics.

Experts disagree on early prostate cancer screening

Does early prostate cancer screening save lives? The American Urological Association (AUA) thinks so. Recently it issued new guidelines urging men to start getting screened for prostate-specific antigen (PSA) at age 40—10 years sooner than its previous recommendation. The change is based on data showing that unusually high PSA levels at age 40 strongly predict prostate cancer. Such testing, the group says, “may not only allow for earlier detection of more curable cancers, but may also allow for more efficient, less frequent testing.”

But some leading cancer specialists disagree. Otis Brawley, chief medical officer of the American Cancer Society (ACS), points out that “absolutely no data” exist to show that screening in the younger age-group saves lives. ACS doesn’t recommend PSA tests for all men, and the U.S. Preventive Services Task Force says there isn’t enough evidence to recommend either for or against routine PSA testing. Last month, a U.S. study showed men who’d had PSA screening tests were no less likely to die of prostate cancer than unscreened men. Yet a European study found a modest survival benefit for screened men after at least 7 years of follow-up.

Depression after CAD tied to increased heart failure risk

Depression after a diagnosis of coronary artery disease (CAD) is associated with heart failure (HF) whether or not the patient receives antidepressants. Researchers pro­spec­tive­ly followed nearly 14,000 CAD patients who had no previous diagnosis of depression or HF. They found that 10% experienced depression after their CAD diagnosis and that the HF incidence in depressed patients was four times higher than that in nondepressed patients. HF was just as likely to occur in depressed patients whether or not they received antidepressants.

Diabetics don’t benefit from asymptomatic CAD screening

Screening for inducible myocardial ischemia yields little benefit for patients with type 2 diabetes who lack symptoms of coronary artery disease (CAD). In a new study, about 1,100 patients ages 50 to 75 with type 2 diabetes and no CAD symptoms were randomized to undergo stress myo­cardial perfusion imaging or to remain unscreened. During 5 years of follow-up, both groups had the same incidence (about 3%) of a composite of nonfatal MI and cardiac death. Among screened patients, moderate or large perfusion defects were linked to a greater risk of coronary events, but only 12% of patients with such defects had an event.

Cognitive-behavioral therapy reduces worry in older primary care patients

Cognitive-behavioral therapy (CBT) seems to decrease worry among older primary care patients with anxiety. Researchers randomized 134 patients ages 60 or older with generalized anxiety disorder to receive CBT or usual care for 3 months. Those in the CBT group had up to 10 individual sessions with a trained therapist in their primary care clinic. Patients in the other group received biweekly telephone calls from therapists. At the end of treatment, the CBT group showed significant improvements in worry, depression, and general mental health compared to the usual-care group.

Earlier hypoglycemia episodes linked to increased dementia risk

Over time, the risk of dementia rises with the number of hypoglycemic episodes a diabetic experiences. Researchers retrospectively studied about 17,000 older patients with type 2 diabetes for the occurrence of hypoglycemic episodes requiring hospitalization or emergency department visits over 22 years. Then they followed these patients prospectively for incident dementia for 4 years or longer. They found that patients with a single hypoglycemic episode were at significantly higher risk for later dementia; the more episodes, the greater the risk. Hypoglycemic patients had a 2.4% increase in absolute risk per year of follow-up over those without hypoglycemia.

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