Subject: MI & Diabetes Risk / Calcium & Fracture / Pertussis

From: Physician's First Watch <[email-masked]>
Date: Fri, 24 Aug 2007 07:31:00 -0400 (EDT)

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PHYSICIAN'S FIRST WATCH for August 24, 2007
David G. Fairchild, MD, MPH, Editor-in-Chief

- MI Heightens Risk for Developing Diabetes
- Calcium Supplements Linked to Lower Fracture Risk in Older Adults
- Respiratory Illness Outbreaks Mistaken for Pertussis

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MI Heightens Risk for Developing Diabetes

After MI, patients carry a high risk for developing impaired fasting glucose and diabetes, reports a study in Lancet.

Researchers prospectively investigated some 8300 Italian patients with a recent MI who were free of diabetes or impaired fasting glucose at baseline exam. By 3-year follow-up, 12% developed diabetes. Using the lower cutoff point of 100 mg/dL suggested by the American Diabetes Association, researchers found 62% developed either diabetes or prediabetes. They also found that patients' adherence to a traditional Mediterranean diet lowered diabetes incidence.

The authors speculate that the MI-diabetes association is "at least partly due to shared pathways between risk factors for acute plaque rupture and a propensity toward metabolic dysfunction."

An editorialist writes that combining the Mediterranean diet with n-3 fatty acids found in fish "might give increased postinfarct dietary protection both from cardiovascular deaths and new diabetes, potentially a double benefit."

Link(s):
Lancet article (Free abstract; full text requires subscription) http://click2.nejm.org/cts/click?q=227%3B297254%3BbBxleK7dI7B2nYqaox%2FpQwTT5EJ%2BG4GZ9qaqs%2BbEVWo%3D
Lancet comment (Subscription required) http://click2.nejm.org/cts/click?q=227%3B297254%3BbBxleK7dI7B2nYqaox%2FpQwv5oP3UHefN9qaqs%2BbEVWo%3D

Related Journal Watch link(s):
Journal Watch Cardiology summary (Free) http://click2.nejm.org/cts/click?q=227%3B297254%3BbBxleK7dI7B2nYqaox%2FpQ7cSAZsuWshx9qaqs%2BbEVWo%3D

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Calcium Supplements Linked to Lower Fracture Risk in Older Adults

Calcium supplementation lowers fracture risk among older adults, according to a meta-analysis published in Lancet.

Data were extracted from 29 placebo-controlled trials of calcium supplementation (with or without vitamin D) that enrolled people aged 50 or older.

Seventeen trials reporting fracture as an endpoint found a 12% reduction in risk with calcium or calcium plus vitamin D. The treatment effect was largest among adults older than 70, as well as for calcium doses of 1200 mg or more, or vitamin D doses of 800 IU or more. In 24 trials reporting on bone mineral density, supplementation was associated with a significant reduction in bone loss at the hip and spine.

The authors say that to prevent one fracture, 63 patients would need to receive calcium supplements for 3.5 years -- making calcium "comparable to other preventive treatments such as statins." To prevent one fracture among "elderly" adults, they note, the NNT dropped to 30 or fewer.

Link(s):
Lancet article (Free abstract; full text requires subscription) http://click2.nejm.org/cts/click?q=227%3B297254%3BbBxleK7dI7B2nYqaox%2FpQzlRj5%2Fm%2Fv4J9qaqs%2BbEVWo%3D
Lancet comment (Subscription required) http://click2.nejm.org/cts/click?q=227%3B297254%3BbBxleK7dI7B2nYqaox%2FpQ%2Ff4F2WP3n6s9qaqs%2BbEVWo%3D

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Respiratory Illness Outbreaks Mistaken for Pertussis

Three outbreaks initially attributed to pertussis were likely caused by other respiratory pathologies, according to a report in MMWR.

During these outbreaks, which occurred in hospitals and community settings in New Hampshire, Massachusetts, and Tennessee in 2004 and 2006, thousands of people who were thought to have been exposed to pertussis were offered prophylactic antibiotics. 

Lab results from each outbreak indicated signs of pertussis, but not overwhelmingly. Use of PCR testing to confirm pertussis has increased dramatically since 1997, but there are no standardized PCR protocols for pertussis, raising concerns about its reliability. 

"The outbreaks described in this report illustrate the limitations of relying solely on PCR assays to confirm pertussis," the CDC says. 

Asked to comment, Stephen G. Baum of Journal Watch Infectious Diseases pointed out the increasing incidence of (and the need to vaccinate against) the disease; but, as these cases show, "everything that whoops isn't pertussis."

Link(s):
Guidelines for Tdap vaccinaction (Free) http://click2.nejm.org/cts/click?q=227%3B297254%3BbBxleK7dI7B2nYqaox%2FpQ%2FoKq35oweLX9qaqs%2BbEVWo%3D
MMWR article (Free) http://click2.nejm.org/cts/click?q=227%3B297254%3BbBxleK7dI7B2nYqaox%2FpQ%2BIbN9qTTxTb9qaqs%2BbEVWo%3D
March 2007 CDC presentation on diagnosing pertussis (Free) http://click2.nejm.org/cts/click?q=227%3B297254%3BbBxleK7dI7B2nYqaox%2FpQ%2FMn1wC%2BW7Nw9qaqs%2BbEVWo%3D

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