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Weight and Cardiovascular Health

Excess Weight Hikes Cardiac Risk All on Its Own
Published: Nov 11, 2013 | Updated: Nov 12, 2013, By Elizabeth DeVita Raeburn, Contributing Writer, MedPage Today, Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Being overweight or obese were risk factors for myocardial infarction (MI) and ischemic heart disease (IHD), even in the absence of metabolic syndrome, researchers found.

Among participants with and without metabolic syndrome, there were "increasing and cumulative incidences" of both MI and IHD along the continuum of weight from normal to obese (log-rank trend P=0.006 and P<0.001 respectively), according to Borge G. Nordestgaard, MD, DMSc, and his co-author, Mette Thomsen, MD, both of Copenhagen University Hospital.

In participants without metabolic syndrome, the hazard ratios for MI compared with normal weight participants were 1.26 (95% CI, 1.00-1.61) in overweight individuals and 1.88 (95% CI, 1.34-2.63) in those who were obese, they wrote online in JAMA Internal Medicine.

The hazard ratios for MI among those with metabolic syndrome were 1.39 (95% CI, 0.96-2.02) in those of normal weight, 1.70 (95% CI, 1.35-2.15) in the overweight, and 2.33 (95% CI, 1.81-3.00) in obese participants.

"For IHD, results were similar but attenuated," the authors wrote, possibly because the diagnostic criteria for IHD include subjective symptoms of angina pectoris, which could have resulted in misclassification. Overall, the findings suggest that "metabolic syndrome is no more valuable than BMI in identifying individual risk," the authors wrote.


Patient Compliance

Change in Pill Color Plays Role in Rx Adherence

By Michael Smith, North American Correspondent, MedPage Today. Published: January 02, 2013. Reviewed by F. Perry Wilson, MD, MSCE; Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania

Something as small as the color of a generic medication can confuse patients enough to interrupt their treatment, researchers reported.

In a case-control study, changes in pill color increased the risk that patients would not refill their anti-epileptic drug prescriptions, according to Aaron Kesselheim, MD, JD, of Brigham and Women's Hospital in Boston, and colleagues.

There was no statistically significant effect on refill rates based upon changes in pill shape, Kesselheim and colleagues reported online inArchives of Internal Medicine.

The researchers noted that generic medicines account for over 70% of U.S. prescriptions, and the proportion is expected to increase as some widely used drugs come off patent.

Such generic drugs must be biologically equivalent to the approved brand-name product, but they often vary in size, shape, and color, they noted.

"A patient taking five medicines, each produced by five generic manufacturers, theoretically faces over 3,000 possible arrays of pill appearances for what are, chemically and clinically speaking, the same drugs," Kesselheim and colleagues noted.

Those choices could confuse patients and result in poor adherence to therapy, they noted.


Healthy Living in Middle Age

Healthy Habits in 40s Pay Off in 70s

By Chris Kaiser, Cardiology Editor, MedPage Today, Published: November 05, 2012
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston

Healthy living in middle age can add more than a decade of heart attack-free living to old age, researchers found.

The overall lifetime risk for total cardiovascular disease from ages 45 to 95 was 60% for men and 55% for women, according to John T. Wilkins, MD, of Northwestern University Feinberg School of Medicine in Chicago, and colleagues.

But those with optimal risk factor profiles at age 45 lived about 14 years longer than those with at least two major risk factors in middle age, they reported online Nov. 5 in the Journal of the American Medical Association.

Not surprising, the total cardiovascular risk for men was greater than that for women across all ages, Wilkins and colleagues said.

And despite living a life within the bounds of optimal risk factors, the lifetime risk for cardiovascular disease was still 30% or greater for both sexes.

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