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Effect of Systolic and Diastolic Blood Pressure on Cardiovascular Outcomes

Although systolic blood-pressure elevation had a greater effect on outcomes, both systolic and diastolic hypertension independently influenced the risk of adverse cardiovascular events, regardless of the definition of hypertension (≥140/90 mm Hg or ≥130/80 mm Hg)

Association of Lifestyle and Genetic Risk With Incidence of Dementia

Among older adults without cognitive impairment or dementia, both an unfavorable lifestyle and high genetic risk were significantly associated with higher dementia risk. A favorable lifestyle was associated with a lower dementia risk among participants with high genetic risk.

Opioids prescribed for ankle pain despite lack of guidelines

Opioid prescriptions were filled by 11.9% of patients with an ankle sprain within 7 days of diagnosis and 8.4% of opioid-naive patients had continued opioid use more than 90 days after injury, according to a study published in the Annals of Internal Medicine . Most opioid prescriptions for ankle pain were made by physicians in emergency medicine (38.2%) and primary care (31.6%) settings, according to study findings. “The opioid epidemic is a result of overprescribing by practitioners and misuse and diversion of opioids,” Fred T. Finney, MD, of the University of Michigan, and colleagues wrote. “Although the role of opioids in the treatment of ankle sprains has been discussed, these drugs have never been included in treatment recommendations,” they continued. Researchers used the Optum Clinformatics Data Mart, a database of commercial health insurance claims from patients insured by the UnitedHealth Group, to collect data on patients diagnosed with ankle sprain from January 2008 to Decem...

Most dietary supplements, interventions may not improve risk for CVD or death

Although reduced salt intake and certain supplements may decrease the risk for some cardiovascular outcomes, most nutritional supplements and dietary interventions do not improve risk for cardiovascular disease or death, according to an evidence review published in the Annals of Internal Medicine . In addition, the combined use of calcium and vitamin D may increase risk for stroke, according to researchers. “Current U.S. dietary guidelines recommend several healthy eating patterns, including U.S., Mediterranean and vegetarian diets,” Safi U. Khan, MD, of West Virginia University, and colleagues wrote. “Although the guidelines recognize the occasional need for nutritional supplementation or food fortification for specific nutrients that may be consumed in inadequate amounts, they do not recommend routine use of any dietary supplement to reduce risk for cardiovascular disease (CVD) or other chronic diseases. Despite these recommendations, most U.S. adults use supplements to enhance their...

CPAP reduces depressive symptoms in patients with sleep apnea, CVD

Continuous positive airway pressure treatment reduced depressive symptoms in patients with co-existing obstructive sleep apnea and cardiovascular disease, study findings showed. “The relationship between abnormal mood and [obstructive sleep apnea (OSA)] is complex and bidirectional,” Danni Zheng, PhD, of the University of New South Wales, Sydney, and colleagues wrote in EClinicalMedicine . “While continuous positive airway pressure (CPAP) , the most widely used treatment for OSA, improves subjective symptoms such as daytime sleepiness, the effects specifically on depression and anxiety are uncertain.” To determine whether CPAP can improve depression or anxiety symptoms in OSA, researchers conducted a secondary analysis of the Sleep Apnea Cardiovascular Endpoints (SAVE) trial, and a systematic review of randomized evidence. In the SAVE analyses, 2,410 patients with co-existing moderate-to-severe OSA and cardiovascular disorder were randomly allocated to receive CPAP treatments plus usua...

Identifying thrombotic, obstetric risk factors key to managing antiphospholipid syndrome

Identifying high-risk factors for thrombotic and obstetric events is crucial in managing antiphospholipid syndrome , and all women with antiphospholipid syndrome should be counseled on contraceptive use, pregnancy planning and postmenopausal hormone therapy, according to new EULAR recommendations published in the Annals of the Rheumatic Diseases . “Clinical practice in [antiphospholipid syndrome (APS)] is highly variable, in part because it is a rare disorder, and because knowledge about its diagnosis/classification, clinical spectrum and management is continuously advancing,” Maria G. Tektonidou, MD, PhD, of the University of Athens in Greece, and colleagues wrote. “There is a great heterogeneity among studies on the laboratory and clinical criteria used to define APS and the treatment approaches used over the past four decades. These factors make it often difficult to know the best approach to apply in daily practice.” To develop a set of evidence-based recommendations for the manage...

Investigating causal relations between sleep traits and risk of breast cancer in women: mendelian randomisation study

Conclusion : Findings showed consistent evidence for a protective effect of morning preference and suggestive evidence for an adverse effect of increased sleep duration on breast cancer risk. In this study, both multivariable regression and MR analysis were used to provide strong evidence for a causal effect of chronotype on breast cancer risk. Furthermore, some evidence suggested a causal effect of sleep duration on risk of breast cancer, although findings for these traits were less consistent across the different methods applied. However, the biological role of many of the genetic variants used to instrument these traits in MR and mechanistic pathways underlying the observed effects are not well understood. Previously reported pathways between sleep disruption and mammary oncogenesis include immunological, molecular, cellular, neuroendocrine, and metabolic processes. 5 Further work to uncover these possible mediating processes is required. Nonetheless, these findings have potential implicati...

Dietary fats and mortality among patients with type 2 diabetes: analysis in two population based cohort studies

Conclusion : In patients with type 2 diabetes, higher intake of PUFAs, in comparison with carbohydrates or saturated fatty acids, is associated with lower total mortality and cardiovascular disease mortality. These findings highlight the important role of quality of dietary fat in the prevention of cardiovascular disease and total mortality among adults with type 2 diabetes. Among US men and women with type 2 diabetes, dietary intake of PUFAs, especially linoleic acid and marine n-3 PUFAs, is associated with lower total and cardiovascular disease mortality. Our results suggest that dietary PUFAs, in replacement of saturated fatty acids or carbohydrates, may facilitate long term survival among adults with type 2 diabetes.

Vestibular migraine

TESTING...What you need to know A 63 year old woman presented to her general practitioner with episodes of severe dizziness, nausea, and vomiting associated with photophobia. On the first attack, symptoms were so severe she was admitted to hospital and underwent neuroimaging to exclude a stroke. Following recurrent episodes, she was given various diagnoses including benign paroxysmal positional vertigo and Ménière’s disease.