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Harvard Commentaries
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School

What Your Doctor Is Reading What Your Doctor Is Reading

Update From the Medical Journals: July 2013

July 31, 2013

By Mary Pickett M.D.

Harvard Medical School

What's the latest news in the medical journals this month? Find out what your doctor is reading.

Anti-inflammatory Drug Shows Benefit in Diabetes

 A surprising study has shown that salsalate,  a common non-steroidal anti-inflammatory drug (NSAID), might improve glucose control in diabetes. This study was published by the Annals of Internal Medicine July 1. It included 286 adults with type 2 diabetes.

All of the participants had poor control of their blood sugar (glucose) levels. Researchers  randomly divided the participants into two groups. One group took salsalate and the other group took a placebo pill. They continued to treat their diabetes with usual medications to lower blood sugar levels. People who received salsalate had  signs of less inflammation in their blood compared to people who got the placebo pill. They also had better fasting blood glucose levels and lower hemoglobin A1C test results. (The A1C test is used to show average glucose control over recent weeks.) There were also more hypoglycemic events (low-blood sugar events) among people in the group receiving salsalate.
Diabetes experts are cautious about the results  because of the  side effects the drug had. People who took salsalate  gained more weight  during the study (possibly the result of fluid retention, which is a common side effect of NSAIDs). They also had higher LDL cholesterol levels. Kidney function was temporarily reduced for the patients who took salicylate. Kidney function returned to normal when they stopped taking the drug. Before salsalate can be recommended for people with diabetes, its long-term effects on the heart and kidneys will need to be studied and considered.

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Moderate Weight Loss Doesn't Cut Heart Risk for People with Diabetes

Lifestyle changes are important treatment for people with type 2 diabetes. Adequate exercise and diet changes help people with type 2 diabetes lose weight and become more fit. And lifestyle changes help lower their blood sugar levels  with fewer drugs.

Doctors and patients have assumed that people with diabetes could also lower their risk of heart attack and stroke with diet and exercise. But that's not what a new study found. The New England Journal of Medicine published the study online June 24.

The study included more than 5,000 adults with type 2 diabetes. Their average weight was 220 pounds when the study started. People were randomly divided into 2 groups. One group ate a reduced-calorie diet and participated in  175 minutes of moderate-intensity exercise per week. They received instruction and coaching to help them. The other group got instruction on diet and exercise with minimal ongoing support.

After a year, the first group had lost 8.6% of body weight while the second group lost less than 1%. By the end of 9.6 years, weight loss was 6% in the first group and 3.5% in the second. But both groups had similar rates of heart attack, stroke, hospital stays for angina and death from these events. This was a disappointment to diabetes experts.

 Even though heart attack and stroke rates were no different, there were clear benefits to people in the group that had intensive exercise and diet support. They needed less medicine to control blood sugar. They also were less likely to develop kidney or eye disease or severe depression. Doctors and diabetes experts will continue to recommend diet and exercise as mainstays of diabetes treatment. Some medications (such as blood pressure drugs, aspirin and cholesterol medications) can offer a modest amount of protection. Even for people with diabetes who take exceptionally good care of themselves, heart attack and stroke are common. This makes it really important that they recognize symptoms early and seek immediate care for these events.

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More News In Brief

  • Popular Anti-Acid Drugs May Stiffen Arteries. The popular anti-acid drug omeprazole (Prilosec) and other drugs in the same family might be harmful to your heart. Several researchers have recently pointed out a possible association between these medications, called "proton pump inhibitors" (PPIs), and heart events. New research may explain why, according to a study published online July 3 by the journal Circulation. Researchers exposed animal and human tissue cultures to these strong anti-acid medications. The medicines changed the chemistry that controls blood vessel constriction. They  affected the amount of nitric oxide in the surroundings of blood vessels, and they made blood vessels about 30% less able to relax. Over time, this could lead to heart disease. Since this was not a study of living human patients, it is hard to know how well this finding might translate to real disease. But it will absolutely lead to additional research.
  • Cancer Survivors Enjoy Low Risk for Alzheimer's. Cancer survivors have an unusually low likelihood of developing Alzheimer's disease, particularly if they have been through intensive chemotherapy. This  interesting finding comes from a large study that reviewed the medical histories of almost 3.5 million people. It is giving Alzheimer's researchers a lot to think about, including whether we might some day be able to use chemotherapy to treat or prevent dementia.
    Findings from this study were reported July 15 at the Alzheimer's Association International Conference. Survivors of liver cancer have a 51% reduced risk for Alzheimer's. Survivors of pancreatic cancer have a 44% reduced risk. Other cancers that – if survived—predict a lowered risk for Alzheimer's are esophageal cancer, leukemia, lung and kidney cancer. Breast cancer was not studied, because the database used in the study came from veterans, and 98% of the study group was made up of men. Among cancer survivors, those who had received chemotherapy were 20% to 45% less likely to develop Alzheimer's than were cancer survivors whose treatments had not included chemotherapy.
  • Most Women with Childhood Cancer History Are Still Able to Become Pregnant. Women who have survived childhood cancer are at risk for infertility later. But a new large study shows that two thirds of these women are able to get pregnant eventually. The study, published in The Lancet Oncology July 12, looked at 3,531 women who had all been diagnosed with cancer when they were younger than 21. The study only included sexually active women. Many of these women did see infertility specialists, and some received fertility treatments to improve their chances of becoming pregnant.
  • Aspirin Lowers Colon Cancer Risk for Women. Women can lower their risk for colon cancer by taking a baby aspirin every other day. But there is a risk of digestive tract bleeding. The Annals of Internal Medicine reported this finding on July 16. Researchers assigned 38,876 women who were 45 years or older to either take 100 milligrams of aspirin every other day, or to take a placebo pill. The assignments were random, and women did not know which  pill they were taking. Researchers monitored  the women's health over  more than a decade. Some women were tracked for as long as 18 years. Over the  18 years of follow up, colorectal cancer rates were 20% lower in the aspirin group. But the difference for people who were followed out to years 10 through 18 was much larger—the cancer risk was 42% lower. The study did not include men, so it is not known whether aspirin would protect men against  colon cancer.

Aspirin lowers stroke risk in women over age 45. Now, it is clear there is some benefit against colon cancer as well. For women over age 45 who have a low risk for bleeding based on their previous history, aspirin has more benefit than risk. The benefits of aspirin are subtle enough that people who have a history of bleeding from the gastrointestinal tract are generally advised against aspirin use.

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Mary Pickett, M.D. is an Associate professor at Oregon Health & Science University where she is a primary care doctor for adults. She supervises and educates residents in the field of Internal Medicine, for outpatient and hospital care. She is a Lecturer for Harvard Medical School and a Senior Medical Editor for Harvard Health Publications.

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