Mary Ann Moon

Waist-to-hip ratio is an independent predictor of cardiovascular risk in elderly women, but waist circumference is not, according to Dr. Marcos A.S. Cabrera of the State University of Londrina (Brazil) and his associates.

Abdominal adiposity, a component of metabolic syndrome, “is an important determinant of cardiovascular risk in middle-aged women, but its effects on the elderly are still poorly understood,” the researchers said.

They assessed abdominal adiposity, as measured by both waist circumference and waist-to-hip ratio, and cardiovascular events in a prospective cohort study of 516 women aged 60–84 years when they presented for health care at a geriatric clinic in 1997–1998. The women were followed every 6 months for approximately 7 years. During that time, 89 subjects (17%) died and 94 (18%) experienced cardiovascular events.

Most of the study subjects had abdominal adiposity at baseline: 63% of the subjects had a waist circumference greater than 88 cm, and 86% had a waist-to-hip ratio greater than 0.85. However, only 29% were obese.

There was a significant association between waist-to-hip ratio values above the 75th percentile and cardiovascular events, but no association between waist circumference above the 75th percentile and such events, Dr. Cabrera and his associates said (Int. J. Cardiol. 2007;114:224–9). This indicates that waist-to-hip ratio is a better measure of cardiovascular risk than is waist size in elderly women, they suggested.

Waist-to-hip ratio is an independent predictor of cardiovascular risk in elderly women, but waist circumference is not, according to Dr. Marcos A.S. Cabrera of the State University of Londrina (Brazil) and his associates.

Abdominal adiposity, a component of metabolic syndrome, “is an important determinant of cardiovascular risk in middle-aged women, but its effects on the elderly are still poorly understood,” the researchers said.

They assessed abdominal adiposity, as measured by both waist circumference and waist-to-hip ratio, and cardiovascular events in a prospective cohort study of 516 women aged 60–84 years when they presented for health care at a geriatric clinic in 1997–1998. The women were followed every 6 months for approximately 7 years. During that time, 89 subjects (17%) died and 94 (18%) experienced cardiovascular events.

Most of the study subjects had abdominal adiposity at baseline: 63% of the subjects had a waist circumference greater than 88 cm, and 86% had a waist-to-hip ratio greater than 0.85. However, only 29% were obese.

There was a significant association between waist-to-hip ratio values above the 75th percentile and cardiovascular events, but no association between waist circumference above the 75th percentile and such events, Dr. Cabrera and his associates said (Int. J. Cardiol. 2007;114:224–9). This indicates that waist-to-hip ratio is a better measure of cardiovascular risk than is waist size in elderly women, they suggested.

Waist-to-hip ratio is an independent predictor of cardiovascular risk in elderly women, but waist circumference is not, according to Dr. Marcos A.S. Cabrera of the State University of Londrina (Brazil) and his associates.

Abdominal adiposity, a component of metabolic syndrome, “is an important determinant of cardiovascular risk in middle-aged women, but its effects on the elderly are still poorly understood,” the researchers said.

They assessed abdominal adiposity, as measured by both waist circumference and waist-to-hip ratio, and cardiovascular events in a prospective cohort study of 516 women aged 60–84 years when they presented for health care at a geriatric clinic in 1997–1998. The women were followed every 6 months for approximately 7 years. During that time, 89 subjects (17%) died and 94 (18%) experienced cardiovascular events.

Most of the study subjects had abdominal adiposity at baseline: 63% of the subjects had a waist circumference greater than 88 cm, and 86% had a waist-to-hip ratio greater than 0.85. However, only 29% were obese.

There was a significant association between waist-to-hip ratio values above the 75th percentile and cardiovascular events, but no association between waist circumference above the 75th percentile and such events, Dr. Cabrera and his associates said (Int. J. Cardiol. 2007;114:224–9). This indicates that waist-to-hip ratio is a better measure of cardiovascular risk than is waist size in elderly women, they suggested.

Diabetic retinopathy is an independent risk factor for ischemic stroke, reported Dr. Ning Cheung of the University of Melbourne's Centre for Eye Research, and associates.

Since retinopathy is a common microvascular manifestation of diabetes, this finding indicates that microvascular disease is an important pathway for stroke in patients with diabetes. In contrast, large-vessel disease plays the central role in ischemic stroke in nondiabetic patients, the researchers said.

They used data from the Atherosclerosis Risk in Communities (ARIC) study to examine the relationship between diabetic retinopathy and ischemic stroke. Two previous population-based studies of the issue were inconclusive, “and few other data are available,” Dr. Cheung and associates noted (Stroke 2007 January [Epub doi:10.1161/01.STR.0000254547.91276.50]).

The ARIC study was a prospective, population-based, cohort study. Subjects were recruited during 1987–1989 and were aged 45–64 years at entry. A subset of 1,617 participants who had retinal photographs taken in the early 1990s accounted for the subjects for Dr. Cheung's study.

After the data were adjusted to account for several potentially confounding factors such as subject age, gender, blood pressure, and smoking status, those who had diabetic retinopathy were significantly more likely to develop ischemic stroke during 7 years of follow-up than were subjects who did not have diabetic retinopathy.

This association remained significant after the data were further adjusted to account for plasma fibrinogen levels and white blood cell count.

There was no dose-dependent association between the severity of retinopathy and the risk of ischemic stroke, the investigators added.

Diabetic retinopathy is an independent risk factor for ischemic stroke, reported Dr. Ning Cheung of the University of Melbourne's Centre for Eye Research, and associates.

Since retinopathy is a common microvascular manifestation of diabetes, this finding indicates that microvascular disease is an important pathway for stroke in patients with diabetes. In contrast, large-vessel disease plays the central role in ischemic stroke in nondiabetic patients, the researchers said.

They used data from the Atherosclerosis Risk in Communities (ARIC) study to examine the relationship between diabetic retinopathy and ischemic stroke. Two previous population-based studies of the issue were inconclusive, “and few other data are available,” Dr. Cheung and associates noted (Stroke 2007 January [Epub doi:10.1161/01.STR.0000254547.91276.50]).

The ARIC study was a prospective, population-based, cohort study. Subjects were recruited during 1987–1989 and were aged 45–64 years at entry. A subset of 1,617 participants who had retinal photographs taken in the early 1990s accounted for the subjects for Dr. Cheung's study.

After the data were adjusted to account for several potentially confounding factors such as subject age, gender, blood pressure, and smoking status, those who had diabetic retinopathy were significantly more likely to develop ischemic stroke during 7 years of follow-up than were subjects who did not have diabetic retinopathy.

This association remained significant after the data were further adjusted to account for plasma fibrinogen levels and white blood cell count.

There was no dose-dependent association between the severity of retinopathy and the risk of ischemic stroke, the investigators added.

Diabetic retinopathy is an independent risk factor for ischemic stroke, reported Dr. Ning Cheung of the University of Melbourne's Centre for Eye Research, and associates.

Since retinopathy is a common microvascular manifestation of diabetes, this finding indicates that microvascular disease is an important pathway for stroke in patients with diabetes. In contrast, large-vessel disease plays the central role in ischemic stroke in nondiabetic patients, the researchers said.

They used data from the Atherosclerosis Risk in Communities (ARIC) study to examine the relationship between diabetic retinopathy and ischemic stroke. Two previous population-based studies of the issue were inconclusive, “and few other data are available,” Dr. Cheung and associates noted (Stroke 2007 January [Epub doi:10.1161/01.STR.0000254547.91276.50]).

The ARIC study was a prospective, population-based, cohort study. Subjects were recruited during 1987–1989 and were aged 45–64 years at entry. A subset of 1,617 participants who had retinal photographs taken in the early 1990s accounted for the subjects for Dr. Cheung's study.

After the data were adjusted to account for several potentially confounding factors such as subject age, gender, blood pressure, and smoking status, those who had diabetic retinopathy were significantly more likely to develop ischemic stroke during 7 years of follow-up than were subjects who did not have diabetic retinopathy.

This association remained significant after the data were further adjusted to account for plasma fibrinogen levels and white blood cell count.

There was no dose-dependent association between the severity of retinopathy and the risk of ischemic stroke, the investigators added.

Severe heart failure can be reversed in some cases by using a left ventricular assist device to temporarily “unload” the myocardium plus a drug regimen to promote reverse remodeling, reported Dr. Emma J. Birks of the Royal Brompton and Harefield (England) National Health Service Trust and her associates.

In a study of 15 patients who received this treatment for nonischemic cardiomyopathy, 11 recovered sufficiently after a mean of 320 days to qualify for removal of the device. Ten of them survived with marked improvement that has persisted for over 4 years, the researchers said.

Following LVAD implantation, the patients received an ACE inhibitor (lisinopril), angiotensin-receptor blocker (losartan), a nonselective β-blocker (carvedilol), and an aldosterone antagonist (spironolactone) to enhance reverse remodeling. After maximal regression in the left ventricular end-diastolic diameter was achieved, the nonselective β-blocker was replaced with a selective β₁-blocker together with clenbuterol, a selective β₂-agonist, to prevent myocardial atrophy.

Eleven patients showed significant clinical improvement accompanied by marked functional changes in the myocardium and improved hemodynamics, exercise capacity, and quality of life. Ten (75%) fully recovered after the device was removed (N. Engl. J. Med. 2006;355:1873–84).

This study was supported in part by Thoratec, manufacturer of the HeartMate LVAD.

Severe heart failure can be reversed in some cases by using a left ventricular assist device to temporarily “unload” the myocardium plus a drug regimen to promote reverse remodeling, reported Dr. Emma J. Birks of the Royal Brompton and Harefield (England) National Health Service Trust and her associates.

In a study of 15 patients who received this treatment for nonischemic cardiomyopathy, 11 recovered sufficiently after a mean of 320 days to qualify for removal of the device. Ten of them survived with marked improvement that has persisted for over 4 years, the researchers said.

Following LVAD implantation, the patients received an ACE inhibitor (lisinopril), angiotensin-receptor blocker (losartan), a nonselective β-blocker (carvedilol), and an aldosterone antagonist (spironolactone) to enhance reverse remodeling. After maximal regression in the left ventricular end-diastolic diameter was achieved, the nonselective β-blocker was replaced with a selective β₁-blocker together with clenbuterol, a selective β₂-agonist, to prevent myocardial atrophy.

Eleven patients showed significant clinical improvement accompanied by marked functional changes in the myocardium and improved hemodynamics, exercise capacity, and quality of life. Ten (75%) fully recovered after the device was removed (N. Engl. J. Med. 2006;355:1873–84).

This study was supported in part by Thoratec, manufacturer of the HeartMate LVAD.

Severe heart failure can be reversed in some cases by using a left ventricular assist device to temporarily “unload” the myocardium plus a drug regimen to promote reverse remodeling, reported Dr. Emma J. Birks of the Royal Brompton and Harefield (England) National Health Service Trust and her associates.

In a study of 15 patients who received this treatment for nonischemic cardiomyopathy, 11 recovered sufficiently after a mean of 320 days to qualify for removal of the device. Ten of them survived with marked improvement that has persisted for over 4 years, the researchers said.

Following LVAD implantation, the patients received an ACE inhibitor (lisinopril), angiotensin-receptor blocker (losartan), a nonselective β-blocker (carvedilol), and an aldosterone antagonist (spironolactone) to enhance reverse remodeling. After maximal regression in the left ventricular end-diastolic diameter was achieved, the nonselective β-blocker was replaced with a selective β₁-blocker together with clenbuterol, a selective β₂-agonist, to prevent myocardial atrophy.

Eleven patients showed significant clinical improvement accompanied by marked functional changes in the myocardium and improved hemodynamics, exercise capacity, and quality of life. Ten (75%) fully recovered after the device was removed (N. Engl. J. Med. 2006;355:1873–84).

This study was supported in part by Thoratec, manufacturer of the HeartMate LVAD.

High intake of folate decreased the risk of Alzheimer's disease in a predominantly Hispanic and African American cohort of elderly people, according to a recently published study.

There was a statistically significant association between AD risk and combined dietary and supplemental folate consumption, but not between AD and either type of folate alone, suggesting that cumulative intake from both sources is important in assessing Alzheimer's risk, wrote Dr. Jose A. Luchsinger of Columbia University, New York, and his associates.

These results are consistent with those of several previous studies of folate and AD risk, but conflict with the results of several others. “Definitive conclusions about the value of higher folate intake in the prevention of AD cannot be made at this time,” Dr. Luchsinger and his associates said, adding that “the decision to increase folate intake to prevent AD should await clinical trials.”

In what they described as the first published study of the issue in a cohort that was predominantly black and Caribbean Hispanic, the researchers assessed diet and cognitive status in 965 subjects in 1992–1994 and thereafter at 18-month intervals.

The subjects were Medicare recipients aged 65 years and older whose folate intakes were estimated using 61-item food frequency questionnaires. The group had a high prevalence of cardiovascular disease. A total of 192 developed AD over a mean follow-up of 6 years.

The risk of AD decreased with increasing intake of folate but not of vitamins B₆ or B₁₂, the investigators said (Arch. Neurol. 2007;64:86–92).

People with AD had a total folate intake “that was almost statistically significantly lower” than that in subjects without AD.

There was a “modest” correlation between folate intake and plasma homocysteine levels, suggesting that folate's ability to lower homocysteine may account for some of its effect on AD risk, Dr. Luchsinger and his associates said.

And since folate is derived primarily from vegetable sources, folate intake may be a marker of a healthier diet or of other socioeconomic or lifestyle factors, they noted.

High intake of folate decreased the risk of Alzheimer's disease in a predominantly Hispanic and African American cohort of elderly people, according to a recently published study.

There was a statistically significant association between AD risk and combined dietary and supplemental folate consumption, but not between AD and either type of folate alone, suggesting that cumulative intake from both sources is important in assessing Alzheimer's risk, wrote Dr. Jose A. Luchsinger of Columbia University, New York, and his associates.

These results are consistent with those of several previous studies of folate and AD risk, but conflict with the results of several others. “Definitive conclusions about the value of higher folate intake in the prevention of AD cannot be made at this time,” Dr. Luchsinger and his associates said, adding that “the decision to increase folate intake to prevent AD should await clinical trials.”

In what they described as the first published study of the issue in a cohort that was predominantly black and Caribbean Hispanic, the researchers assessed diet and cognitive status in 965 subjects in 1992–1994 and thereafter at 18-month intervals.

The subjects were Medicare recipients aged 65 years and older whose folate intakes were estimated using 61-item food frequency questionnaires. The group had a high prevalence of cardiovascular disease. A total of 192 developed AD over a mean follow-up of 6 years.

The risk of AD decreased with increasing intake of folate but not of vitamins B₆ or B₁₂, the investigators said (Arch. Neurol. 2007;64:86–92).

People with AD had a total folate intake “that was almost statistically significantly lower” than that in subjects without AD.

There was a “modest” correlation between folate intake and plasma homocysteine levels, suggesting that folate's ability to lower homocysteine may account for some of its effect on AD risk, Dr. Luchsinger and his associates said.

And since folate is derived primarily from vegetable sources, folate intake may be a marker of a healthier diet or of other socioeconomic or lifestyle factors, they noted.

High intake of folate decreased the risk of Alzheimer's disease in a predominantly Hispanic and African American cohort of elderly people, according to a recently published study.

There was a statistically significant association between AD risk and combined dietary and supplemental folate consumption, but not between AD and either type of folate alone, suggesting that cumulative intake from both sources is important in assessing Alzheimer's risk, wrote Dr. Jose A. Luchsinger of Columbia University, New York, and his associates.

These results are consistent with those of several previous studies of folate and AD risk, but conflict with the results of several others. “Definitive conclusions about the value of higher folate intake in the prevention of AD cannot be made at this time,” Dr. Luchsinger and his associates said, adding that “the decision to increase folate intake to prevent AD should await clinical trials.”

In what they described as the first published study of the issue in a cohort that was predominantly black and Caribbean Hispanic, the researchers assessed diet and cognitive status in 965 subjects in 1992–1994 and thereafter at 18-month intervals.

The subjects were Medicare recipients aged 65 years and older whose folate intakes were estimated using 61-item food frequency questionnaires. The group had a high prevalence of cardiovascular disease. A total of 192 developed AD over a mean follow-up of 6 years.

The risk of AD decreased with increasing intake of folate but not of vitamins B₆ or B₁₂, the investigators said (Arch. Neurol. 2007;64:86–92).

People with AD had a total folate intake “that was almost statistically significantly lower” than that in subjects without AD.

There was a “modest” correlation between folate intake and plasma homocysteine levels, suggesting that folate's ability to lower homocysteine may account for some of its effect on AD risk, Dr. Luchsinger and his associates said.

And since folate is derived primarily from vegetable sources, folate intake may be a marker of a healthier diet or of other socioeconomic or lifestyle factors, they noted.

Treating maternal periodontitis before 21 weeks' gestation did improve the disease but failed to lower the risk of preterm delivery, increase fetal birth weight, improve Apgar scores, reduce the number of small-for-gestational-age neonates, or decrease the rate of neonatal intensive care unit admissions, reported Bryan S. Michalowicz, D.D.S., and his associates.

Several previous studies have reported a strong link between periodontal disease and preterm birth, but others have found no association. Similarly, two previous clinical trials have concluded that periodontal treatment during pregnancy cuts the risk of preterm birth, but another found no benefit, the researchers said (N. Engl. J. Med. 2006;355:1885–94).

Their Obstetrics and Periodontal Therapy (OPT) study was a randomized, blinded trial in which 823 pregnant women with early to moderate generalized periodontitis were assigned to receive nonsurgical treatment either before 21 weeks (treatment group) or after delivery (control group). The women were seen at four U.S. medical centers between 2003 and 2005.

Treatment comprised periodontal scaling and root planing—removal of dental plaque and calculus from the tooth enamel and root—with ultrasonic and hand instruments, using local anesthesia as needed. All clinical measures of disease improved in all treated patients.

However, treatment did not improve the rate of preterm delivery or other related outcomes, said Dr. Michalowicz of the department of developmental and surgical sciences at the University of Minnesota, Minneapolis.

There was a nonsignificant reduction in spontaneous abortion and stillbirths in the treated group. However, “we view this finding with particular caution because only 19 patients in our study had either a spontaneous abortion or stillbirth and because we began evaluating rates of earlier pregnancy losses only after seven such events had occurred,” Dr. Michalowicz and his associates wrote.

In an editorial comment accompanying this report, Dr. Robert L. Goldenberg and Jennifer F. Culhane, Ph.D., of Drexel University, Philadelphia, said that these results on miscarriages and stillbirths might be more significant than the authors believed.

Periodontal treatment may well have affected early adverse outcomes “since observational studies suggest that periodontal disease is much more strongly associated with late miscarriage, stillbirth, and early spontaneous preterm birth than with preterm birth in general.

“One could hypothesize that periodontal treatment might preferentially reduce these other outcomes but not late preterm birth,” they said (N. Engl. J. Med. 2006;355:1925–7).

Dr. Goldenberg and Dr. Culhane also noted that treatment during pregnancy might be too late, and that prepregnancy intervention is needed. “We have hypothesized that once the inflammatory cascade is activated during pregnancy, interventions targeting this pathway may be ineffective in reducing the rate of preterm birth,” they noted.

Three larger ongoing trials of the issue are underway, and their results “will help clarify whether periodontal treatment has any role in reducing the rate of preterm birth. In the meantime, the findings of Michalowicz et al. do not support the provision of periodontal treatment in pregnancy for the purpose of reducing preterm birth,” Dr. Goldenberg and Dr. Culhane said.

Treating maternal periodontitis before 21 weeks' gestation did improve the disease but failed to lower the risk of preterm delivery, increase fetal birth weight, improve Apgar scores, reduce the number of small-for-gestational-age neonates, or decrease the rate of neonatal intensive care unit admissions, reported Bryan S. Michalowicz, D.D.S., and his associates.

Several previous studies have reported a strong link between periodontal disease and preterm birth, but others have found no association. Similarly, two previous clinical trials have concluded that periodontal treatment during pregnancy cuts the risk of preterm birth, but another found no benefit, the researchers said (N. Engl. J. Med. 2006;355:1885–94).

Their Obstetrics and Periodontal Therapy (OPT) study was a randomized, blinded trial in which 823 pregnant women with early to moderate generalized periodontitis were assigned to receive nonsurgical treatment either before 21 weeks (treatment group) or after delivery (control group). The women were seen at four U.S. medical centers between 2003 and 2005.

Treatment comprised periodontal scaling and root planing—removal of dental plaque and calculus from the tooth enamel and root—with ultrasonic and hand instruments, using local anesthesia as needed. All clinical measures of disease improved in all treated patients.

However, treatment did not improve the rate of preterm delivery or other related outcomes, said Dr. Michalowicz of the department of developmental and surgical sciences at the University of Minnesota, Minneapolis.

There was a nonsignificant reduction in spontaneous abortion and stillbirths in the treated group. However, “we view this finding with particular caution because only 19 patients in our study had either a spontaneous abortion or stillbirth and because we began evaluating rates of earlier pregnancy losses only after seven such events had occurred,” Dr. Michalowicz and his associates wrote.

In an editorial comment accompanying this report, Dr. Robert L. Goldenberg and Jennifer F. Culhane, Ph.D., of Drexel University, Philadelphia, said that these results on miscarriages and stillbirths might be more significant than the authors believed.

Periodontal treatment may well have affected early adverse outcomes “since observational studies suggest that periodontal disease is much more strongly associated with late miscarriage, stillbirth, and early spontaneous preterm birth than with preterm birth in general.

“One could hypothesize that periodontal treatment might preferentially reduce these other outcomes but not late preterm birth,” they said (N. Engl. J. Med. 2006;355:1925–7).

Dr. Goldenberg and Dr. Culhane also noted that treatment during pregnancy might be too late, and that prepregnancy intervention is needed. “We have hypothesized that once the inflammatory cascade is activated during pregnancy, interventions targeting this pathway may be ineffective in reducing the rate of preterm birth,” they noted.

Three larger ongoing trials of the issue are underway, and their results “will help clarify whether periodontal treatment has any role in reducing the rate of preterm birth. In the meantime, the findings of Michalowicz et al. do not support the provision of periodontal treatment in pregnancy for the purpose of reducing preterm birth,” Dr. Goldenberg and Dr. Culhane said.

Treating maternal periodontitis before 21 weeks' gestation did improve the disease but failed to lower the risk of preterm delivery, increase fetal birth weight, improve Apgar scores, reduce the number of small-for-gestational-age neonates, or decrease the rate of neonatal intensive care unit admissions, reported Bryan S. Michalowicz, D.D.S., and his associates.

Several previous studies have reported a strong link between periodontal disease and preterm birth, but others have found no association. Similarly, two previous clinical trials have concluded that periodontal treatment during pregnancy cuts the risk of preterm birth, but another found no benefit, the researchers said (N. Engl. J. Med. 2006;355:1885–94).

Their Obstetrics and Periodontal Therapy (OPT) study was a randomized, blinded trial in which 823 pregnant women with early to moderate generalized periodontitis were assigned to receive nonsurgical treatment either before 21 weeks (treatment group) or after delivery (control group). The women were seen at four U.S. medical centers between 2003 and 2005.

Treatment comprised periodontal scaling and root planing—removal of dental plaque and calculus from the tooth enamel and root—with ultrasonic and hand instruments, using local anesthesia as needed. All clinical measures of disease improved in all treated patients.

However, treatment did not improve the rate of preterm delivery or other related outcomes, said Dr. Michalowicz of the department of developmental and surgical sciences at the University of Minnesota, Minneapolis.

There was a nonsignificant reduction in spontaneous abortion and stillbirths in the treated group. However, “we view this finding with particular caution because only 19 patients in our study had either a spontaneous abortion or stillbirth and because we began evaluating rates of earlier pregnancy losses only after seven such events had occurred,” Dr. Michalowicz and his associates wrote.

In an editorial comment accompanying this report, Dr. Robert L. Goldenberg and Jennifer F. Culhane, Ph.D., of Drexel University, Philadelphia, said that these results on miscarriages and stillbirths might be more significant than the authors believed.

Periodontal treatment may well have affected early adverse outcomes “since observational studies suggest that periodontal disease is much more strongly associated with late miscarriage, stillbirth, and early spontaneous preterm birth than with preterm birth in general.

“One could hypothesize that periodontal treatment might preferentially reduce these other outcomes but not late preterm birth,” they said (N. Engl. J. Med. 2006;355:1925–7).

Dr. Goldenberg and Dr. Culhane also noted that treatment during pregnancy might be too late, and that prepregnancy intervention is needed. “We have hypothesized that once the inflammatory cascade is activated during pregnancy, interventions targeting this pathway may be ineffective in reducing the rate of preterm birth,” they noted.

Three larger ongoing trials of the issue are underway, and their results “will help clarify whether periodontal treatment has any role in reducing the rate of preterm birth. In the meantime, the findings of Michalowicz et al. do not support the provision of periodontal treatment in pregnancy for the purpose of reducing preterm birth,” Dr. Goldenberg and Dr. Culhane said.

Both elevated acylated ghrelin levels and elevated ratios of acylated to nonacylated ghrelin are associated with insulin resistance in overweight or obese postmenopausal women, reported Dr. David H. St-Pierre of the University of Montreal and his associates.

Ghrelin, a peptide derived mainly from the stomach, is an important factor in the regulation of food intake as well as in energy metabolism and storage. Acylated and nonacylated forms of ghrelin appear to induce different physiologic and metabolic effects, but their roles regarding insulin resistance and insulin sensitivity are not well understood, the investigators said (J. Clin. Endocrin. Metab. 2006 Oct. 24 [Epub doi:10.1210/jc.2006–1603]).

Dr. St-Pierre and his associates analyzed ghrelin levels in 89 nondiabetic postmenopausal women who were overweight or obese. They found that insulin-resistant subjects had significantly higher levels of acylated ghrelin and higher ratios of acylated to nonacylated ghrelin, compared with insulin-sensitive subjects, during a test using a euglycemic/hyperinsulinemic clamp.

The results suggest that insulin-resistant women modulate ghrelin in a different way than do insulin-sensitive women. “The sustained elevation of acylated ghrelin circulating levels combined with lower nonacylated ghrelin concentrations might contribute in part to the development of insulin resistance in overweight or obese postmenopausal women,” the researchers said. “A ghrelin profile characterized by higher acylated/nonacylated ghrelin and decreased capacity of maximal reduction may be another indicator of insulin resistance in obese individuals.”

Both elevated acylated ghrelin levels and elevated ratios of acylated to nonacylated ghrelin are associated with insulin resistance in overweight or obese postmenopausal women, reported Dr. David H. St-Pierre of the University of Montreal and his associates.

Ghrelin, a peptide derived mainly from the stomach, is an important factor in the regulation of food intake as well as in energy metabolism and storage. Acylated and nonacylated forms of ghrelin appear to induce different physiologic and metabolic effects, but their roles regarding insulin resistance and insulin sensitivity are not well understood, the investigators said (J. Clin. Endocrin. Metab. 2006 Oct. 24 [Epub doi:10.1210/jc.2006–1603]).

Dr. St-Pierre and his associates analyzed ghrelin levels in 89 nondiabetic postmenopausal women who were overweight or obese. They found that insulin-resistant subjects had significantly higher levels of acylated ghrelin and higher ratios of acylated to nonacylated ghrelin, compared with insulin-sensitive subjects, during a test using a euglycemic/hyperinsulinemic clamp.

The results suggest that insulin-resistant women modulate ghrelin in a different way than do insulin-sensitive women. “The sustained elevation of acylated ghrelin circulating levels combined with lower nonacylated ghrelin concentrations might contribute in part to the development of insulin resistance in overweight or obese postmenopausal women,” the researchers said. “A ghrelin profile characterized by higher acylated/nonacylated ghrelin and decreased capacity of maximal reduction may be another indicator of insulin resistance in obese individuals.”

Both elevated acylated ghrelin levels and elevated ratios of acylated to nonacylated ghrelin are associated with insulin resistance in overweight or obese postmenopausal women, reported Dr. David H. St-Pierre of the University of Montreal and his associates.

Ghrelin, a peptide derived mainly from the stomach, is an important factor in the regulation of food intake as well as in energy metabolism and storage. Acylated and nonacylated forms of ghrelin appear to induce different physiologic and metabolic effects, but their roles regarding insulin resistance and insulin sensitivity are not well understood, the investigators said (J. Clin. Endocrin. Metab. 2006 Oct. 24 [Epub doi:10.1210/jc.2006–1603]).

Dr. St-Pierre and his associates analyzed ghrelin levels in 89 nondiabetic postmenopausal women who were overweight or obese. They found that insulin-resistant subjects had significantly higher levels of acylated ghrelin and higher ratios of acylated to nonacylated ghrelin, compared with insulin-sensitive subjects, during a test using a euglycemic/hyperinsulinemic clamp.

The results suggest that insulin-resistant women modulate ghrelin in a different way than do insulin-sensitive women. “The sustained elevation of acylated ghrelin circulating levels combined with lower nonacylated ghrelin concentrations might contribute in part to the development of insulin resistance in overweight or obese postmenopausal women,” the researchers said. “A ghrelin profile characterized by higher acylated/nonacylated ghrelin and decreased capacity of maximal reduction may be another indicator of insulin resistance in obese individuals.”

Irbesartan decreases biomarkers of inflammatory activity in patients who have type 2 diabetes with microalbuminuria, reported Dr. Frederik Persson, of the Steno Diabetes Center in Gentofte, Denmark, and his associates.

Further study is needed to determine whether this anti-inflammatory effect translates into fewer cardiovascular events in this high-risk population, the investigators noted.

The Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria (IRMA-2) study showed that daily irbesartan inhibited the angiotensin II type 1 receptor and protected against the development of overt nephropathy over the course of 2 years. It also hindered the progression of some cardiovascular outcomes, including heart failure. However, the mechanism of the drug's action was unclear.

The pathogenesis of nephropathy in diabetes is thought to involve endothelial dysfunction, low-grade inflammation, growth factors such as transforming growth factor (TGF)-β, and advanced glycation end product (AGE) peptides. Any or all of these may have been affected by irbesartan's influence on the renin-angiotensin-aldosterone system in IRMA-2.

Dr. Persson and his associates conducted a post hoc analysis in a subset of 269 of the IRMA-2 subjects to examine the drug's effect on a broad range of these biomarkers, all of which are associated with the progression of both nephropathy and cardiovascular disease.

Compared with placebo, irbesartan significantly decreased levels of the inflammatory biomarkers high-sensitivity C-reactive protein and fibrinogen. The drug also attenuated the time-related increase in another marker of inflammatory activity, interleukin-6, they said (Diabetes 2006;55:3550–5).

Irbesartan decreases biomarkers of inflammatory activity in patients who have type 2 diabetes with microalbuminuria, reported Dr. Frederik Persson, of the Steno Diabetes Center in Gentofte, Denmark, and his associates.

Further study is needed to determine whether this anti-inflammatory effect translates into fewer cardiovascular events in this high-risk population, the investigators noted.

The Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria (IRMA-2) study showed that daily irbesartan inhibited the angiotensin II type 1 receptor and protected against the development of overt nephropathy over the course of 2 years. It also hindered the progression of some cardiovascular outcomes, including heart failure. However, the mechanism of the drug's action was unclear.

The pathogenesis of nephropathy in diabetes is thought to involve endothelial dysfunction, low-grade inflammation, growth factors such as transforming growth factor (TGF)-β, and advanced glycation end product (AGE) peptides. Any or all of these may have been affected by irbesartan's influence on the renin-angiotensin-aldosterone system in IRMA-2.

Dr. Persson and his associates conducted a post hoc analysis in a subset of 269 of the IRMA-2 subjects to examine the drug's effect on a broad range of these biomarkers, all of which are associated with the progression of both nephropathy and cardiovascular disease.

Compared with placebo, irbesartan significantly decreased levels of the inflammatory biomarkers high-sensitivity C-reactive protein and fibrinogen. The drug also attenuated the time-related increase in another marker of inflammatory activity, interleukin-6, they said (Diabetes 2006;55:3550–5).

Irbesartan decreases biomarkers of inflammatory activity in patients who have type 2 diabetes with microalbuminuria, reported Dr. Frederik Persson, of the Steno Diabetes Center in Gentofte, Denmark, and his associates.

Further study is needed to determine whether this anti-inflammatory effect translates into fewer cardiovascular events in this high-risk population, the investigators noted.

The Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria (IRMA-2) study showed that daily irbesartan inhibited the angiotensin II type 1 receptor and protected against the development of overt nephropathy over the course of 2 years. It also hindered the progression of some cardiovascular outcomes, including heart failure. However, the mechanism of the drug's action was unclear.

The pathogenesis of nephropathy in diabetes is thought to involve endothelial dysfunction, low-grade inflammation, growth factors such as transforming growth factor (TGF)-β, and advanced glycation end product (AGE) peptides. Any or all of these may have been affected by irbesartan's influence on the renin-angiotensin-aldosterone system in IRMA-2.

Dr. Persson and his associates conducted a post hoc analysis in a subset of 269 of the IRMA-2 subjects to examine the drug's effect on a broad range of these biomarkers, all of which are associated with the progression of both nephropathy and cardiovascular disease.

Compared with placebo, irbesartan significantly decreased levels of the inflammatory biomarkers high-sensitivity C-reactive protein and fibrinogen. The drug also attenuated the time-related increase in another marker of inflammatory activity, interleukin-6, they said (Diabetes 2006;55:3550–5).

Pioglitazone appears to augment insulin sensitivity in overweight patients with type 2 diabetes by suppressing plasma levels of free fatty acids, reported Dr. Mireille J. Serlie of the Academic Medical Center, Amsterdam, and her associates.

“Our results indicate that dietary interventions aimed at lowering plasma-free fatty acids may be necessary to achieve the best effect of pioglitazone on peripheral insulin sensitivity,” the investigators said (J. Clin. Endocrin. Metab. 2006 Oct. 24 [Epub doi:10.1210/jc.2006–1518]).

Dr. Serlie and her associates studied the issue in 8 overweight patients with type 2 diabetes that was moderately controlled on a single oral medication. Patients were allowed to take statins (but not fibrates) and antihypertensive drugs. All patients served as their own controls.

The six men and two postmenopausal women took pioglitazone 30 mg/day for 4 months, which enhanced insulin sensitivity and significantly lowered plasma free fatty acid levels. When these levels were then induced to rise to pretreatment levels during an experiment, pioglitazone's insulin-sensitizing effect was nullified, the researchers said.

This study shows that lowering plasma levels of free fatty acids “is crucial in the insulin-sensitizing effect of pioglitazone,” they noted.

Dr. Serlie reported no conflicts of interest. Co-author Hans P. Sauerwein reported receiving lecture fees from Eli Lilly & Co., which provided the drug used in the study.

Pioglitazone appears to augment insulin sensitivity in overweight patients with type 2 diabetes by suppressing plasma levels of free fatty acids, reported Dr. Mireille J. Serlie of the Academic Medical Center, Amsterdam, and her associates.

“Our results indicate that dietary interventions aimed at lowering plasma-free fatty acids may be necessary to achieve the best effect of pioglitazone on peripheral insulin sensitivity,” the investigators said (J. Clin. Endocrin. Metab. 2006 Oct. 24 [Epub doi:10.1210/jc.2006–1518]).

Dr. Serlie and her associates studied the issue in 8 overweight patients with type 2 diabetes that was moderately controlled on a single oral medication. Patients were allowed to take statins (but not fibrates) and antihypertensive drugs. All patients served as their own controls.

The six men and two postmenopausal women took pioglitazone 30 mg/day for 4 months, which enhanced insulin sensitivity and significantly lowered plasma free fatty acid levels. When these levels were then induced to rise to pretreatment levels during an experiment, pioglitazone's insulin-sensitizing effect was nullified, the researchers said.

This study shows that lowering plasma levels of free fatty acids “is crucial in the insulin-sensitizing effect of pioglitazone,” they noted.

Dr. Serlie reported no conflicts of interest. Co-author Hans P. Sauerwein reported receiving lecture fees from Eli Lilly & Co., which provided the drug used in the study.

Pioglitazone appears to augment insulin sensitivity in overweight patients with type 2 diabetes by suppressing plasma levels of free fatty acids, reported Dr. Mireille J. Serlie of the Academic Medical Center, Amsterdam, and her associates.

“Our results indicate that dietary interventions aimed at lowering plasma-free fatty acids may be necessary to achieve the best effect of pioglitazone on peripheral insulin sensitivity,” the investigators said (J. Clin. Endocrin. Metab. 2006 Oct. 24 [Epub doi:10.1210/jc.2006–1518]).

Dr. Serlie and her associates studied the issue in 8 overweight patients with type 2 diabetes that was moderately controlled on a single oral medication. Patients were allowed to take statins (but not fibrates) and antihypertensive drugs. All patients served as their own controls.

The six men and two postmenopausal women took pioglitazone 30 mg/day for 4 months, which enhanced insulin sensitivity and significantly lowered plasma free fatty acid levels. When these levels were then induced to rise to pretreatment levels during an experiment, pioglitazone's insulin-sensitizing effect was nullified, the researchers said.

This study shows that lowering plasma levels of free fatty acids “is crucial in the insulin-sensitizing effect of pioglitazone,” they noted.

Dr. Serlie reported no conflicts of interest. Co-author Hans P. Sauerwein reported receiving lecture fees from Eli Lilly & Co., which provided the drug used in the study.

Mild gestational diabetes significantly raises the risk of cryptorchidism in male offspring, reported Dr. Helena E. Virtanen of the University of Turku, Finland, and her associates.

Even mothers who had an abnormal result on a single oral glucose tolerance test (OGTT) but no diabetes diagnosis were at increased risk of delivering a boy with cryptorchidism, the researchers reported (J. Clin. Endocrin. Metab. 2006 Oct. 10 [Epub doi:10.1210/jc.2006–1420]).

They reviewed the pregnancy records of 1,288 singleton boys born at one hospital who had participated in previous research. The 125 boys with congenital cryptorchidism served as cases in this study, and the 1,163 boys who had normal testicular descent at birth served as controls.

Among the cases, 13 mothers (10%) had diet-treated gestational diabetes, and an additional 7 (6%) had at least one abnormal result on OGTT but no diabetes diagnosis, for an overall 16%. In contrast, among the controls, only 47 mothers (4%) had a diabetes diagnosis and an additional 54 (5%) had an abnormal OGTT result, for an overall 9%.

The significantly elevated risk for cryptorchidism remained constant after the data were adjusted for known confounders such as advanced maternal age and maternal smoking, as well as for proposed risk factors that might confound the association, such as prematurity and low birth weight.

Maternal diabetes status had no apparent effect on the rate of spontaneous testicular descent by the age of 3 months or on the rate of bilateral vs. unilateral cryptorchidism. “Considering our results, the increasing prevalence of gestational diabetes may have considerable effect on [future] male reproductive health,” Dr. Virtanen and her associates noted.

Mild gestational diabetes significantly raises the risk of cryptorchidism in male offspring, reported Dr. Helena E. Virtanen of the University of Turku, Finland, and her associates.

Even mothers who had an abnormal result on a single oral glucose tolerance test (OGTT) but no diabetes diagnosis were at increased risk of delivering a boy with cryptorchidism, the researchers reported (J. Clin. Endocrin. Metab. 2006 Oct. 10 [Epub doi:10.1210/jc.2006–1420]).

They reviewed the pregnancy records of 1,288 singleton boys born at one hospital who had participated in previous research. The 125 boys with congenital cryptorchidism served as cases in this study, and the 1,163 boys who had normal testicular descent at birth served as controls.

Among the cases, 13 mothers (10%) had diet-treated gestational diabetes, and an additional 7 (6%) had at least one abnormal result on OGTT but no diabetes diagnosis, for an overall 16%. In contrast, among the controls, only 47 mothers (4%) had a diabetes diagnosis and an additional 54 (5%) had an abnormal OGTT result, for an overall 9%.

The significantly elevated risk for cryptorchidism remained constant after the data were adjusted for known confounders such as advanced maternal age and maternal smoking, as well as for proposed risk factors that might confound the association, such as prematurity and low birth weight.

Maternal diabetes status had no apparent effect on the rate of spontaneous testicular descent by the age of 3 months or on the rate of bilateral vs. unilateral cryptorchidism. “Considering our results, the increasing prevalence of gestational diabetes may have considerable effect on [future] male reproductive health,” Dr. Virtanen and her associates noted.

Mild gestational diabetes significantly raises the risk of cryptorchidism in male offspring, reported Dr. Helena E. Virtanen of the University of Turku, Finland, and her associates.

Even mothers who had an abnormal result on a single oral glucose tolerance test (OGTT) but no diabetes diagnosis were at increased risk of delivering a boy with cryptorchidism, the researchers reported (J. Clin. Endocrin. Metab. 2006 Oct. 10 [Epub doi:10.1210/jc.2006–1420]).

They reviewed the pregnancy records of 1,288 singleton boys born at one hospital who had participated in previous research. The 125 boys with congenital cryptorchidism served as cases in this study, and the 1,163 boys who had normal testicular descent at birth served as controls.

Among the cases, 13 mothers (10%) had diet-treated gestational diabetes, and an additional 7 (6%) had at least one abnormal result on OGTT but no diabetes diagnosis, for an overall 16%. In contrast, among the controls, only 47 mothers (4%) had a diabetes diagnosis and an additional 54 (5%) had an abnormal OGTT result, for an overall 9%.

The significantly elevated risk for cryptorchidism remained constant after the data were adjusted for known confounders such as advanced maternal age and maternal smoking, as well as for proposed risk factors that might confound the association, such as prematurity and low birth weight.

Maternal diabetes status had no apparent effect on the rate of spontaneous testicular descent by the age of 3 months or on the rate of bilateral vs. unilateral cryptorchidism. “Considering our results, the increasing prevalence of gestational diabetes may have considerable effect on [future] male reproductive health,” Dr. Virtanen and her associates noted.

More than 700,000 cases of adverse drug events are treated each year in emergency departments, according to estimates based on a nationally representative sampling of U.S. hospitals.

Of these, an estimated 117,000, or 1 in 6, are so severe that they require hospitalization, transfer to another health facility, or an ED admission for observation, according to the study, which was published in the Oct. 18 issue of the Journal of the American Medical Association.

People aged 65 years and older accounted for one-quarter of these adverse drug events and for more than half of those that required hospitalization, making the magnitude of the problem in this age group equivalent to that for injuries from motor vehicle accidents. People in this age group were more than twice as likely to need ED treatment and nearly seven times as likely to need hospitalization as younger people.

These findings, the first to be reported from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project, establish that adverse drug events are an important cause of morbidity, said Dr. Daniel S. Budnitz of the Centers for Disease Control and Prevention, Atlanta, and his associates.

The NEISS-CADES project assessed all incident ED visits explicitly attributed to the use of a drug at 63 hospitals that comprised a probability sample representative of all U.S. hospitals. The drugs included prescription and over-the-counter medications, vaccines, dietary supplements, and herbal products, but not illegal substances.

The adverse events included allergic reactions, undesirable pharmacologic or idiosyncratic effects that occur at recommended doses, toxic effects that stem from unintentional excess dosing or impaired excretion, and secondary effects such as falling because of drug-induced dizziness, the investigators said (JAMA 2006;296:1858–66).

Among the study's other findings:

▸ Most adverse drug events were due to unintentional overdoses. These include warfarin, insulin, and digoxin, which alone accounted for one-third of adverse events in older patients. Other such drugs were antidiabetic agents, anticonvulsants, theophylline, and lithium.

▸ The five most common drug classes implicated in adverse events were insulins, opioid-containing analgesics, anticoagulants, agents containing amoxicillin, and antihistamines/cold remedies.

▸ The most common drug reactions prompting the ED visits were dermatologic conditions, gastrointestinal problems, and neurologic conditions. Altered mental status, respiratory dysfunction, syncope, and cardiovascular effects also were common.

▸ About one-third of the adverse events were allergic reactions.

▸ Sixteen of the 18 drugs that caused most adverse events have been in use for over 20 years.

These results likely represent an underestimate of the total burden of adverse drug events, since they didn't include events treated in other settings, the researchers noted.

They also don't include adverse events unrecognized by ED physicians, according to Dr. Budnitz and his associates.

More than 700,000 cases of adverse drug events are treated each year in emergency departments, according to estimates based on a nationally representative sampling of U.S. hospitals.

Of these, an estimated 117,000, or 1 in 6, are so severe that they require hospitalization, transfer to another health facility, or an ED admission for observation, according to the study, which was published in the Oct. 18 issue of the Journal of the American Medical Association.

People aged 65 years and older accounted for one-quarter of these adverse drug events and for more than half of those that required hospitalization, making the magnitude of the problem in this age group equivalent to that for injuries from motor vehicle accidents. People in this age group were more than twice as likely to need ED treatment and nearly seven times as likely to need hospitalization as younger people.

These findings, the first to be reported from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project, establish that adverse drug events are an important cause of morbidity, said Dr. Daniel S. Budnitz of the Centers for Disease Control and Prevention, Atlanta, and his associates.

The NEISS-CADES project assessed all incident ED visits explicitly attributed to the use of a drug at 63 hospitals that comprised a probability sample representative of all U.S. hospitals. The drugs included prescription and over-the-counter medications, vaccines, dietary supplements, and herbal products, but not illegal substances.

The adverse events included allergic reactions, undesirable pharmacologic or idiosyncratic effects that occur at recommended doses, toxic effects that stem from unintentional excess dosing or impaired excretion, and secondary effects such as falling because of drug-induced dizziness, the investigators said (JAMA 2006;296:1858–66).

Among the study's other findings:

▸ Most adverse drug events were due to unintentional overdoses. These include warfarin, insulin, and digoxin, which alone accounted for one-third of adverse events in older patients. Other such drugs were antidiabetic agents, anticonvulsants, theophylline, and lithium.

▸ The five most common drug classes implicated in adverse events were insulins, opioid-containing analgesics, anticoagulants, agents containing amoxicillin, and antihistamines/cold remedies.

▸ The most common drug reactions prompting the ED visits were dermatologic conditions, gastrointestinal problems, and neurologic conditions. Altered mental status, respiratory dysfunction, syncope, and cardiovascular effects also were common.

▸ About one-third of the adverse events were allergic reactions.

▸ Sixteen of the 18 drugs that caused most adverse events have been in use for over 20 years.

These results likely represent an underestimate of the total burden of adverse drug events, since they didn't include events treated in other settings, the researchers noted.

They also don't include adverse events unrecognized by ED physicians, according to Dr. Budnitz and his associates.

More than 700,000 cases of adverse drug events are treated each year in emergency departments, according to estimates based on a nationally representative sampling of U.S. hospitals.

Of these, an estimated 117,000, or 1 in 6, are so severe that they require hospitalization, transfer to another health facility, or an ED admission for observation, according to the study, which was published in the Oct. 18 issue of the Journal of the American Medical Association.

People aged 65 years and older accounted for one-quarter of these adverse drug events and for more than half of those that required hospitalization, making the magnitude of the problem in this age group equivalent to that for injuries from motor vehicle accidents. People in this age group were more than twice as likely to need ED treatment and nearly seven times as likely to need hospitalization as younger people.

These findings, the first to be reported from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project, establish that adverse drug events are an important cause of morbidity, said Dr. Daniel S. Budnitz of the Centers for Disease Control and Prevention, Atlanta, and his associates.

The NEISS-CADES project assessed all incident ED visits explicitly attributed to the use of a drug at 63 hospitals that comprised a probability sample representative of all U.S. hospitals. The drugs included prescription and over-the-counter medications, vaccines, dietary supplements, and herbal products, but not illegal substances.

The adverse events included allergic reactions, undesirable pharmacologic or idiosyncratic effects that occur at recommended doses, toxic effects that stem from unintentional excess dosing or impaired excretion, and secondary effects such as falling because of drug-induced dizziness, the investigators said (JAMA 2006;296:1858–66).

Among the study's other findings:

▸ Most adverse drug events were due to unintentional overdoses. These include warfarin, insulin, and digoxin, which alone accounted for one-third of adverse events in older patients. Other such drugs were antidiabetic agents, anticonvulsants, theophylline, and lithium.

▸ The five most common drug classes implicated in adverse events were insulins, opioid-containing analgesics, anticoagulants, agents containing amoxicillin, and antihistamines/cold remedies.

▸ The most common drug reactions prompting the ED visits were dermatologic conditions, gastrointestinal problems, and neurologic conditions. Altered mental status, respiratory dysfunction, syncope, and cardiovascular effects also were common.

▸ About one-third of the adverse events were allergic reactions.

▸ Sixteen of the 18 drugs that caused most adverse events have been in use for over 20 years.

These results likely represent an underestimate of the total burden of adverse drug events, since they didn't include events treated in other settings, the researchers noted.

They also don't include adverse events unrecognized by ED physicians, according to Dr. Budnitz and his associates.