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Saturday, October 6, 2012
Friday, October 5, 2012
Don't Just Sit There, Do Something! Part 12 Chronic Kidney Disease
Exercise vs sitting makes intuitive sense when it comes to heart disease & mortality. If you've been following along, there's quite a number of studies looking at how physical (in)activity affects our health. But what about our kidneys? We know that our renal function declines w/age. We know that certain medications are bad for our kidneys, eg NSAIDs.
The authors used criteria as espoused by the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative to make determinations of renal function. Of note, they only measured estimated glomerular filtration rate & microalbuminuria and then only just once in classifying the participants.
They concluded that lower levels of physical activity and higher levels of sitting time were associated with higher risk of chronic kidney disease after taking into account the usual suspects. Interestingly enough, sitting time appeared to play a stronger role in women compared to physical activity in men.
Bottom line: don't just sit there, do something!
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Thursday, October 4, 2012
CRP + Fibrinogen: That Extra Edge Against Heart Disease
We're all looking for that extra edge, that little bit that will get us in front of the competition & help us win. Sometimes we don't condone that something extra, like performance enhancing drugs, while at other times we do, like Gordon Gekko in Wall Street & Wall Street 2: Money Never Sleeps. Currently, we use a heart disease risk calculator based upon the Framingham Heart Study as espoused by the Adult Treatment Panel III. However, its accuracy leaves much to be desired.
But as much as I attempt to stay on the cutting edge (not the bleeding edge, mind you!), I don't find myself ordering these additional tests and more in most patients. Why? Because they haven't even reached their baseline goals, eg LDL-C less than 160md/dL for those at low 10 year risk of heart disease, much less those at highest risk who have not yet reached an LDL of <70mg/dl.
In other words, as I teach the residents, order tests because the results will guide/affect your decision making process. Don't order tests just because you can! Well, in a meta-analysis or 52 prospective studies involving 246,669 participants published in today's New England Journal of Medicine, the authors concluded that the additional testing of CRP & fibrinogen in those patients w/o known heart disease but deemed to be at intermediate risk of 10-20% over the next 10 years would prevent one additional event for every 400-500 people tested.
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Wednesday, October 3, 2012
Long Work Hours & Lack of Sleep
You want hazard pay (don't we all?). You work long hours and you don't get enough sleep (doesn't this apply to each of us?). But how do you convince your boss that you need (not just want) more pay to compensate for the additional risks engendered by your efforts?
Well, in a meta-analysis of 12 studies published in this month's issue of the American Journal of Epidemiology, the authors found that working long hours (defined as >10hrs/d) was associated with a 40% increase risk of heart disease in 4 prospective studies and 143% increase risk in 7 case-control studies. With the addition of a single cross-sectional study, the authors assessed risk in 22,518 participants in widely different types of research studies. But the important point is that the studies all have similar conclusions.
But while these are but observational or epidemiologic studies capable only of helping to develop hypotheses but not at generating proof of cause & effect, it does give one pause to think about why this relationship exists and what can be done to prevent the proof from getting stronger.
On the other hand, if long work hours leads to insomnia & inadequate sleep, it might reflect in performance issues as noted in a survey of 4,991 employees as published in this month's Archives of General Psychiatry. In fact, insomnia-related errors rang up an average of $32,062 compared to $21,914 for non-insomnia related accidents w/projected costs of $31.1B due to insomnia in the States. Hmmm . . . on second thought, perhaps I shouldn't mention this study? And when did I miss my bedtime again?
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Tuesday, October 2, 2012
Gout vs Cherries Part 2
Serendipity is good. I went to sleep Sunday night after writing about the possibly beneficial effect of cherry consumption on gout attacks and woke up yesterday morning to read about the American College of Rheumatology's latest guidelines on gout published in this month's issue of Arthritis Care & Research.
In part 2, the ACR recommended the use of non-steroidal anti-inflammatory drugs, corticosteroids or colchicine within 24 hours of onset of symptoms. In those without contraindications, low dose NSAIDs can be considered for prophylaxis, too.
If you don't want to wade through several pages of recommendations, check out MedPageToday for a quick summary. In the meantime, pay attention to your eating habits and stay hydrated!
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Monday, October 1, 2012
Gout vs Cherries
So what's the practical application of these 2 analyses of the same small population found via a Google ad? Well, first the authors confirmed that consumption of purine-rich foods can increase one's risk for a gouty attack. But it's a bit too early based upon such a small sample in an observational study w/o evidence of cause & effect to recommend eating cherries regularly, especially when these fruits are not typically found year round in any part of the globe but in fact must be flown in. So much for the locavore movement. Tweet
Sunday, September 30, 2012
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