Excess added sugar intake tied to death

In a recent study published in JAMA Internal Medicine, researchers from the Centers for Disease Control and Prevention found that participants who consumed more added sugar in their diet were more likely to die of heart disease. Of the 31,000 U.S. adults surveyed between 1988 and 2010, an average of 15 to 17 percent of their daily calorie intake was from added sugars. This is greater than the recommended amount set by the American Heart Association of 100 calories of added sugars per day for women and 150 calories for men and the World Health Organization’s recommendation of 10 percent as the limit. The results showed that participants who consumed between 10 and 25 percent were at a 30 percent increase for cardiovascular disease death and those who consumed 25 percent or more were twice as likely. What tips do you have for patients to minimize added sugar intake?

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Mediterranean diet may reduce Peripheral Artery Disease

A recent randomized trial published in the Journal of the American Medical Association examined the association between Mediterranean diet and the incidence of symptomatic peripheral artery disease (PAD). Patients were randomly selected to participate in one of the following groups: a Mediterranean diet high in extra-virgin olive oil; a Mediterranean diet high in nuts; or a low-fat diet. The results of the study found that both Mediterranean diet groups had a significantly lower occurrence of PAD compared to the low-fat diet group and no significant difference was found between the two intervention groups. How often do you recommend Mediterranean diet to your patients?

For additional information, please click JAMA.

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Vitamins for HIV Health?

According to a recent study published in the Journal of American Medical Association (JAMA), preventing HIV progression could be as simple as taking a daily multivitamin. This randomized clinical trial looked at a 897 HIV-positive patients in Sub-Saharan Africa who had not yet started therapy with antiretroviral agents (ARTs)  between 2004-2009. Patients were either given multivitamin containing vitamins B, C & E in combination with Selenium, Selenium without a multivitamin or placebo. Although the results do not show a reduction in viral load, patients taking a multivitamin in combination with Selenium were significantly less likely to have an increased CD-4 count and were less susceptible to immune decline and morbidity. It is thought that the multivitamins are essential in maintaining a functioning immune system and that Selenium may have a role in preventing HIV replication. Although Botswana is a population in Sub-Saharan Africa with the highest rates of HIV infection and limited in resources, this study may have an impact on any population of HIV-positive patients who are naive to ART therapy. What do you think of these findings? Do you think that preventing micronutrient deficiencies will help in any population at risk for HIV?

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A flu shot may protect your heart, study says

A meta-analysis published in JAMA that included 5 published and 1 unpublished clinical trial including 6735 patients compared the effects of receiving an influenza vaccine or placebo on cardiovascular events. Patients were generally in their late 60s and one-third had history of heart problems. Pooled results revealed a statistically significant reduced risk of composite cardiovascular events with the use of the vaccine, but greatest risk reduction was seen in patients with more active coronary artery disease. Researchers advise to remember that while the influenza vaccine will not prevent heart problems, this is strong evidence supporting that all patients with history of heart disease be vaccinated. How will this new data support your recommendation to patients about getting the flu shot this season?

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Popular morning sickness drug determined safe in pregnancy

More than 50% of pregnant women will experience nausea/vomiting symptoms in the early stages of their pregnancy. Though conservative treatment is often attempted, most women will eventually receive drug treatment. Currently metoclopramide is commonly prescribed for treatment of morning sickness in pregnant women and is considered to be safe, but large studies regarding specific malformations and fetal death are lacking. A large cohort study recently published in JAMA studied 1,222,503 pregnancies in Denmark from 1997-2011 and compared metoclopramide exposed and non-exposed women to investigate its safety. Findings showed that there was no significant association between metoclopramide use and risk of congenital malformations overall.  How often do you see metoclopramide prescribed for morning sickness? Have pregnant women asked you about its safety?

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Are Cranberry Products Good for UTI Prevention?

In a recent study published in the Journal of the American Medical Association (JAMA), researchers found that cranberry products were not shown to prevent urinary tract infections (UTIs). The study consolidated the data from 13 previous studies evaluating the efficacy of cranberry products in populations like women with recurrent UTIs, pregnant women, and the elderly. Cranberry products such as the juice, tablets, capsules, and syrup did not do better compared with placebo or no treatment. The authors did note however that low adherence occurred with the cranberry products (especially the juice) and the amount of active ingredient taken was not known. How often do you recommend cranberry products? What are your thoughts about study results? What counseling points would you offer to a patient seeking cranberry products?

Please check JAMA Network for more details.

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New Drug Combo Helps Hard-to-Treat Hepatitis.

A recent study published in the Journal of the American Medical Association describes a new drug combination that may be efficacious for patients with hard-to-treat hepatitis.  The therapy includes ribavirin and an experimental drug called sofosbuvir and appears to eliminate harsh side effects by excluding Interferon. Of the 60 patients in the trial, 48 to 68 percent had the virus cleared from their bodies. Are you optimistic about these findings? Have you seen any other promising therapy for hepatitis recently?

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Aspirin’s anti-colon cancer effect may depend on genes

Low dose aspirin has been used to decrease the risk of developing colon cancer. A recent cohort study published in JAMA suggests otherwise. Data from 127,000 people showed that the protective effect of aspirin is only found to be significant in patients with “typical” form of BRAF gene. Those who have BRAF-mutant colon tumor cells are less likely to benefit from this therapy due to decreased sensitivity of the tumor cells to aspirin. What are your thoughts about this study? How often do patients ask you about use of aspirin to decrease cancer risk?

To access the complete study, click here.

Changes in Direct-to-Consumer Pharmaceutical Advertising following Shifts from Prescription-Only to Over-the-Counter Status

Prescription drug advertising is regulated by theFood and Drug Administration (FDA) while over-the-counter drug advertising is overseen by the Federal Trade Commission (FTC), with both of the regulatory committee’s following different standards. A recent study published in the JAMA analyzed 133 television and direct-to-consumer ads for Claritin (generically known as loratidine), Zyrtec (cetirizine), Xenical/Alli (orlistat) and Prilosec (omeprazole), the four commonly used prescription drugs that received extensive promotion through ads both before and after OTC shift. Based on the results of the study, after the OTC switch, 97% of the ads described benefits of the drugs compared to 83% during the prescription only period and only 11% of the advertisements presented potential harms that are associated with the OTC medications compared to 70% during the prescription only period. Contraindications or adverse effects along with generic drugs were not mentioned for the drugs post the OTC switch except for Xenical/Alli (orlistat). What measures do you take to educate your patients regarding the potential harms associated with OTC products?
For more information, please see the abstract on JAMA.