Health Updates 6 July 2012

  • Women may benefit less from statins“Many studies have found that statins reduce the risk for recurring cardiac problems, but not the risk of death.  Now an analysis suggests that the drugs may reduce mortality significantly only in men.  For the report, which appears in Archives of Internal Medicineresearchers reviewed 11 randomized, double-blinded, placebo-controlled studies of statins that included 43,191 people, one-fifth of them women.  For both sexes, statins were effective compared with placebos in preventing cardiovascular events and led to lower rates of coronary mortality and heart attacks.  But two of the five trials that reported on “all-cause mortality” showed a reduced risk for men, while none did for women.  Over all, statins did not reduce stroke in women, but were linked to a 16 percent lower risk for men. The scientists said the disparity might be explained by technical factors like less vigorous recruitment of women or a worse cardiovascular profile for those women, or by the undertreatment of women for other conditions that could contribute to disease.  ‘Our intention is not to have women stop using statins,’ said the lead author, Dr. Jose Gutierrez, a clinical instructor in neurology at Columbia.  ‘For overall secondary prevention, statins work for women.  But for two outcomes – stroke and all-cause mortality – they are not as beneficial’.” (NY Times)
  • Patients, and their meds, need to keep cool: “With heavy heat suffocating much of the country, physicians aren’t just warning patients to keep themselves cool — they also want patients to prevent their medications from overheating.  Temperatures above 86 degrees Fahrenheit can render some medications useless, according to Robert Glatter, MD, an emergency medicine physician at Lenox Hill Hospital in New York.  ‘I’ve noticed an increase in the number of ED visits related to mental illness in the recent heat wave,’ Glatter told MedPage Today, noting that most complaints have been related to anxiety or mood swings.  He said the effects could be tied to improper storage of medications in the heat, which may affect the bioavailability of the active agents in these drugs.  The US Pharmacopeia, a medication standards agency, states that drugs generally should be stored at room temperature — between 68 and 77 degrees Fahrenheit — with only brief excursions to temps as low as 59 degrees or as high as 86 degrees.  Above or below that, there’s no guarantee medications will work, the agency says.  Add to the decreased efficacy the common problem of dehydration on high-heat days, and that makes for packed ED departments, Glatter said.  He said patients should be sure to keep their prescriptions with them in cool places, paying particular mind to where they’re stored during travel.  That means keeping medications in pockets or purses when luggage gets tossed into cargo holds that might overheat, he said.  But patients also have to be careful even when their medications are stored properly, Glatter added, since some drugs increase dehydration or interfere with the body’s own cooling mechanisms.”  Of particular concern are medications that affect water intake or how the  blood vessels work, most especially blood pressure medications.  Seizure medications, antihistamines and Parkinson’s disease medications work to inhibit sweat production, a problem during heat emergencies, and any diuretics could also lead to dangerous dehydration.  And forecasts continue to call for excessive heat throughout most of the nation.  (Kristina Fiore, MedPage Today)
  • Some crash-avoidance systems may work better than others: “Certain new crash-avoidance systems are effective in preventing car accidents, while others may do more harm than good, researchers say.  The analysis, conducted by the nonprofit organization Highway Loss Data Institute, found two crash-avoidance features provide the biggest benefits: autonomous braking (the car will brake on its own if the driver doesn’t) and adaptive headlights (headlights that shift directions as the driver steers).  The researchers pointed out, however, that lane-departure warnings actually cause more accidents.  Other crash-avoidance features, such as blind-spot detection and park assist, have yet to show an effect on the number of crashes, they noted.  ‘As more automakers offer advanced technologies on their vehicles, insurance data provides an early glimpse of how these features perform in the real world,’ Matt Moore, vice president of the Highway Loss Dates Institute, an affiliate of the Insurance Institute for Highway Safety, said in an insurance institute news release.  ‘Forward collision technology is reducing claims, particularly for damage to other vehicles, and adaptive headlights are having a even bigger impact than we had anticipated’….In contrast, lane-departure warning systems from Buick and Mercedes increased claim rates under collision and property damage liability coverages.  The increases, however, were not statistically significant….[perhaps because] drifting off the road is not common.  The study authors also suggested that because the technology relies on cameras to track lane markings it may not be effective unless markings are clearly visible.” (HealthDay)
  • Post-op delirium’s toll on mental function may linger: “The delirium that sometimes follows surgery may leave older heart patients with lingering problems with their mental function, including memory and attention, a new study shows.  The findings call into question the prevailing belief that postoperative delirium — which is very common among older people hospitalized for surgery — usually gets better quickly, researchers said.  ‘Delirium after cardiac surgery has been thought of as a brief, reversible condition, but new research is suggesting that [mental] recovery for some people may take much longer than thought, and that there are long-term cognitive consequences,’ said study co-lead author Jane Saczynski, assistant professor of medicine at the University of Massachusetts Medical School in Worcester.”  The study tracked  the one-year outcomes of 225 patients aged 60 to 90 who underwent cardiac surgical procedures.  “About half the patients (46 percent) developed post-operative delirium, which often involved symptoms such as confusion, disorientation about place and time, agitation and other changes in thinking and behavior.  Among those patients who developed delirium, 55 percent reported it lasted for two days or less and 35 percent said it lasted for three or more days.  Most surgical patients experienced a drop in mental functioning right after surgery, whether they experienced delirium or not.  Among patients who became delirious after surgery, however, this drop in mental acuity was much steeper.  ‘More surprisingly is this impairment in [mental] function persisted for six months to a year after surgery,’ Saczynski said.  ‘In comparison, patients who did not develop delirium had recovered their pre-surgical level of function by about one month after surgery.” According to the study physicians, this means rehabilitation and counseling services need to take into account this much longer recovery time, and patients need to understand these risks. (MedlinePlus)

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