Salt reduction benefits confirmed
A SERIES of articles published in the BMJ has outlined the major health benefits around the world of reducing salt consumption and increasing levels of potassium in the diet. A Cochrane review found that a modest reduction in salt for 4 or more weeks caused significant and important falls in blood pressure in both hypertensive and non-hypertensive adults irrespective of sex and ethnic group. The researchers wrote that current WHO recommendations to reduce salt intake from 9‒12 g to 5‒6 g of salt per day would have a major impact on blood pressure but “are not ideal” and called for a further reduction to 3 g per day as the “long term target for population salt intake”. The second paper, a meta-analysis of 56 studies, found high-quality evidence that in adults who were not acutely ill reducing sodium intake reduced blood pressure and the risk of stroke and fatal coronary heart disease with no adverse effect on blood lipids, catecholamine levels, or renal function. There was moderate-quality evidence in children to show that a reduction in sodium intake reduced blood pressure. The third paper analysed data on potassium intake and health from 33 trials involving more than 128 000 healthy participants. It found high-quality evidence to show increased potassium intake reduced blood pressure in people with hypertension and had no adverse effect on blood lipid concentrations, catecholamine concentrations, or renal function in adults. Higher potassium intake was associated with a 24% lower risk of stroke.

Baldness associated with cardio risks
CARDIOVASCULAR risk factors should be reviewed carefully in men with vertex baldness, especially younger men, according to the authors of a meta-analysis published in BMJ Open which confirmed the significant association between vertex baldness and an increased risk of coronary heart disease (CHD). The meta-analysis of six observational studies from Europe and the US involved almost 40 000 men with follow-up periods of between 11 and 14 years. The authors wrote that based on the results, young men with vertex baldness should be encouraged to improve their cardiovascular risk profile. The association between vertex baldness and an increased risk of CHD was dependent on the severity of baldness. “Interestingly, frontal baldness was non-significantly associated with CHD”, the authors wrote. “These findings support the hypothesis that vertex baldness is a local manifestation of factors promoting systemic atherosclerosis, such as metabolic syndrome, hypertension and smoking.”

Statin rechallenge worth it
DOCTORS should consider rechallenging patients who had statins discontinued after statin-related events to identify those who can continue taking them, according to the authors of a retrospective cohort study published in Annals of Internal Medicine. The researchers said patients who had statin-related clinical events might be able to tolerate statins in the long-term. The research involved 107 835 patients taking statins, with 57 292 patients discontinuing the drug at least temporarily. Statin-related events were documented for 18 778 (17.4%) patients, with statins discontinued for 11 124. Of these, 6579 were rechallenged with a statin over the subsequent 12 months, with more than 92% still taking a statin 12 months after the adverse event. In 2721 patients who were rechallenged with the same statin to which they had an adverse event, 1295 were still taking the same statin 12 months later, and 996 were receiving the same or a higher dose. Few of the rechallenged patients had another statin-related event. “Discontinuation of statins, particularly in high-risk patients, is associated with increased risk for cardiovascular events and may even affect overall mortality”, the authors wrote. An accompanying editorial said good adherence to preventive therapies carried the potential to greatly reduce population prevalence of atherosclerotic cardiovascular disease. “Better strategies to promote statin adherence are essential to realizing this potential”, the editorial said.

VTE risks after giving birth
A LARGE UK study of more than 370 000 pregnancies has shown that women who have a stillbirth or medical conditions such as varicose veins, inflammatory bowel disease or obesity are at greater risk of developing venous thromboembolism (VTE) after giving birth. The population-based cohort study, published in Blood, used primary care records to show women with stillbirths, preterm births, obstetric haemorrhage, caesarean section delivery, medical comorbidities or a body mass index (BMI) of 30 kg/m2 or more were are at much higher risk of VTE following delivery. “Our results may have important implications for the way obstetric thromboprophylaxis is delivered in the health care settings of developed countries and we hope that they will aid the targeting of such prophylaxis …”, the authors wrote. They said targeting should include consideration of risk in women with preterm birth or stillbirth, following existing national guideline recommendations, and carefully considering the risk in women with a BMI between 30–40 and those with varicose veins, even if those risks occurred in isolation.

Early puberty signals behaviour problems
AN Australian population-based study, published in the Journal of Adolescent Health, shows children with early puberty have different patterns of behaviour and social adjustment from preschool through to early adolescence. The research, based on the Longitudinal Study of Australian Children, included 3491 children from age 4–5 years through to 10–11 years. Parents reported on stage of pubertal maturation including behaviour difficulties and psychosocial adjustment. Boys and girls who entered puberty by age 8–9 years experienced poorer psychosocial adjustment at this age and these differences were already evident at ages 4–5 and 6–7 years, and persisted to at least age 10–11 years. Similar patterns were evident for behaviour difficulties, but only for boys. “This population-based study provides new evidence of pre-existing and persistent early childhood differences in mental health-related indicators among children who experience early puberty”, the researchers wrote. “These differences are apparent from the preschool years and continue into early adolescence. These findings are consistent with the idea that early puberty may be part of an accelerated trajectory of transition to adult development that begins early in life, and which includes heightened risks for childhood behaviour and social adjustment problems”, they said.

Weight loss jackpot
GROUP-based financial incentives for weight loss are more effective than individual incentives among obese employees, according to research published in Annals of Internal Medicine. The weight-loss trial compared two forms of financial incentive with an equal up-front allocation of resources among 105 employees with a body mass index between 30 and 40 kg/m2. Individual incentives were $100 a month for meeting or exceeding weight loss goals and group incentives were $500 a month split between five group members who met or exceeded weight loss goals. Group incentive participants lost more weight than control participants (mean between-group difference, 4.4 kg) and individual incentive participants (mean between-group difference, 3.2 kg). Twelve weeks after incentives ended and after adjustment the group incentive participants maintained greater weight loss than control group participants (2.9 kg) but not greater than individual incentive participants (2.7 kg). “The greater effectiveness of the group incentive could be due to several factors. Above all, the opportunity to earn a reward larger than $100 for achieving a weight-loss goal probably was a strong motivator”, the researchers wrote. An accompanying editorial said the most important way for employers to get the most out of a financial incentive weight loss scheme was to make efforts to manage access to calorie-dense foods and beverages in the workplace.

Posted 8 April 2013

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