Risk Of New Onset Research Articles

Effect of oxidized phospholipids on the inflammatory response in pancreatic acini

Acute pancreatitis (AP) is marked by a strong pro-inflammatory response, which may cause a systemic inflammatory response syndrome (SIRS), organ failure, and death. Early administration of omega-3 fatty acids (FA) may reduce the pro-inflammatory response and improve outcome in AP. A systematic review focusing on the safety and efficacy of omega-3 FA in AP is lacking.Evaluate the safety and efficacy of an intervention with omega-3 FA in acute pancreatitis and additionally in sepsis.A systematic review and meta-analysis was performed using the PubMed, Embase, and Cochrane databases including only randomized controlled trials in AP and, for safety endpoints, in sepsis investigating intervention including omega-3 FA without other active components (e.g. addition of glutamine to the intervention). The primary outcome was mortality.After screening 1186 studies, five randomized trials (n = 229) with omega-3 FA in AP were included. In AP patients treated with omega-3 FA within 48 h after hospitalization, a non-significant reduction of mortality was seen (OR 0∙50, 95%CI 0∙13–1∙99, p = 0∙33), compared to controls. In two studies (n = 85), omega-3 FA reduced the risk of new onset of organ failure (OR 0∙33, 95%CI 0∙12–0∙93, p = 0∙04). Nine randomized trials with 312 patients suffering from sepsis (not pancreatitis related) demonstrated a reduced mortality (OR 0∙52, 95%CI 0∙28–0∙97, p = 0·04). None of these 14 randomized trials reported safety concerns.Administration of omega-3 FA could reduce the risk of new-organ failure in patients with AP. There were no safety issues reported of the early administration of omega-3 FA in any of the included studies. To show the real clinical benefit of omega-3 FA in AP, a large and pragmatic randomized controlled trial is needed.

PCV6 - Effect of Spironolactone on The Risk of New Onset of Diabetes Among Patients with Heart Failure: A Population-Based Study

PCV6 - Effect of Spironolactone on The Risk of New Onset of Diabetes Among Patients with Heart Failure: A Population-Based Study

Risk of new onset autoimmune disease in 9- to 25-year-old women exposed to human papillomavirus-16/18 AS04-adjuvanted vaccine in the United Kingdom

ABSTRACTTo assess the risk of autoimmune disease (AD) in 9–25 year-old women within 1 year after the first AS04-HPV-16/18vaccine dose, a retrospective, observational database cohort study was conducted using CPRD GOLD. From CPRD GOLD 4 cohorts (65,000 subjects each) were retrieved: 1 exposed female cohort (received ≥1 AS04-HPV-16/18 vaccine dose between Sep2008–Aug2010) and 3 unexposed cohorts: historical female (Sep2005–Aug2007), concurrent male, and historical male. Co-primary endpoints were confirmed neuroinflammatory/ophthalmic AD and other AD, secondary endpoints were confirmed individual AD. Risk of new onset of AD was compared between cohorts (reference: historical cohort) using Poisson regression. The main analysis using confirmed cases showed no neuroinflammatory/ophthalmic AD cases in the female exposed cohort. Incidence rate ratio (IRR) (95% CI) of other AD was 1.41 (0.86 to 2.31) in female and 1.77 (0.94 to 3.35) in male cohorts when compared to the female and male historical cohort, respectively. Secondary endpoints were evaluated for diseases with >10 cases, which were Crohn's disease (IRR: 1.21 [0.37 to 3.95] for female and 4.22 [0.47 to 38.02] for male cohorts), autoimmune thyroiditis (IRR: 3.75 [1.25 to 11.31] for female and no confirmed cases for male cohorts) and type 1 diabetes (IRR: 0.30 [0.11 to 0.83] for female and 2.46 [1.08 to 5.60] for male cohorts). Analysis using confirmed and non-confirmed cases showed similar results, except for autoimmune thyroiditis in females, IRR: 1.45 (0.79 to 2.64). There was no evidence of an increased risk of AD in women aged 9 to 25 years after AS04-HPV-16/18 vaccination.

Association between long-term prescription of aldosterone antagonist and the progression of heart failure with preserved ejection fraction in hypertensive patients

BackgroundHypertension complicated with left ventricular hypertrophy (LVH) and diastolic dysfunction is independently related to increasing risk of subsequent incident heart failure with preserved ejection fraction (HFpEF). This study was designed to evaluate the influences of long-term aldosterone antagonist prescription in these patients. MethodsUsing a propensity score matching of 1:2 ratio, this retrospective claims database study compared spironolactone prescription (n=65) and non-spironolactone therapy (n=130) in hypertensive patients with LVH [left ventricular mass index (LVMI)>125g/m2 for men and >110g/m2 for women] and suspected diastolic dysfunction (E/E′ ratio between 8 and 15) and without clinical signs or symptoms of heart failure. ResultsWith a median follow-up of 7.4years, the new-onset symptomatic HFpEF occurred in 3 of 65 patients in the spironolactone group and 21 of 130 patients in the non-spironolactone group (P=0.021). Spironolactone also generated more prominent improvement in diastolic function and LVH. And multivariate logistic regression model revealed that spironolactone prescription (OR 0.177, 95% CI: 0.045–0.687, P=0.012) was associated with a reduced risk of new onset of symptomatic HFpEF, and the elevation of LVMI (OR 1.053, 95% CI: 1.011–1.097, P=0.012) or E/E′ (OR 1.280, 95% CI: 1.015–1.615, P=0.037) was associated with a high risk of new onset of symptomatic HFpEF. ConclusionsLong-term aldosterone antagonist exposure was associated with protective effects in terms of the incidence of new-onset symptomatic HFpEF, LV diastolic dysfunction and LVH in hypertensive patients, which might be beneficial for the delay of HFpEF progression.

Exercise capacity and risk of new onset of atrial fibrillation in hypertensive and diabetic patients

Objective: Sleep quantity and quality have been known to be associated with blood pressure (BP) or the risk of incident hypertension. However, there have been few studies regarding the effect of sleep duration and quality on blood pressure variability (BPV). Methods: We analyzed the data of 4,002 participants of the Korean ambulatory BP (KOR-ABP) registry. The average real variability (ARV) of systolic and diastolic BP was analyzed as an index for 24hour BPV. Sleep duration was calculated with the participants’ record and sleep quality was categorized as the participants’ subjective evaluation. Results: The mean age was 54.7 ( 15.0) years and 2,183 (54.5%) participants were men. 2,357 patients had hypertension (58.9%), of whom 1,279 (54.3%) were taking anti-hypertensive medication. Mean sleep duration was 7:09 ( 1:42) hours and mean 24-hour systolic and diastolic BP were 135.3 ( 16.7) and 84.4 ( 11.4) mmHg, respectively. There were significant differences in mean 24-hour BP and BPV among the participants who slept < 7 hour, 7 w 8 hours and 8 hours. In multivariate analysis, short sleep duration (< 7 hours) is associated with higher risk of having increased 24-hour systolic and diastolic BP as well as BPV even after adjusting age, sex, clinic BP, and anti-hypertension medication. Conclusion: Short sleep duration is associated with increased 24-hour BP levels and has an independent influence on BPV. This finding can explain the adverse clinical outcome related with short sleep duration.

Impact of combined systolic blood pressure and body mass index on the risk of new-onset atrial fibrillation

To observe the impact of combined systolic blood pressure and body mass index (BMI) on the risk of new-onset atrial fibrillation. The participants who participated the health examination between July 2006 and October 2007 at Kailuan medical group and had no history of atrial fibrillation were selected as the observation cohort.The second, the third and the fourth health examination were conducted between July 2008 and October 2009, July 2010 and October 2011, July 2012 and October 2013, respectively.The participants were stratified by 3 systolic blood pressure levels (≤120, 120-140, ≥140 mmHg (1 mmHg=0.133 kPa))×3 BMI levels (≤24, 24-28, ≥28 kg/m(2)) at baseline.The combined effect of systolic blood pressure and BMI on the risk of new-onset atrial fibrillation was analyzed by multiple Cox regression analysis. A total of 99 206 participants were recruited and 88 715 participants were included in the final analysis after excluding participants who had new-onset valvular atrial fibrillation or lost to follow-up.A total of 265 participants developed atrial fibrillation during the 5.6 years follow-up.The incidence of atrial fibrillation increased with the BMI and systolic blood pressure, the incidence of new onset of atrial fibrillation was significantly higher in the group with systolic blood pressure≥140 mmHg and BMI≥28 kg/m(2) than the group with systolic blood pressure≤120 mmHg and BMI≤24 kg/m(2)(1.15/1 000 person-year vs. 0.25/1 000 person-year). Multiple Cox regression analysis showed that participants in the group with systolic blood pressure≥140 mmHg and BMI≥28 kg/m(2) carried 2.08 (95%CI 1.18-3.67) times higher risk for atrial fibrillation than the group with systolic blood pressure≤120 mmHg and BMI≤24 kg/m(2) after adjustment for age, gender and other confounders at baseline. Participants with systolic blood pressure≥140 mmHg and BMI≥28 kg/m(2) are at high risk for new onset of atrial fibrillation.

Fatigue and Comorbidities in Multiple Sclerosis.

Fatigue is commonly reported by people with multiple sclerosis (MS). Comorbidity is also common in MS, but its association with the presence of fatigue or fatigue changes over time is poorly understood. Nine hundred forty-nine people with definite MS were recruited from four Canadian centers. The Fatigue Impact Scale for Daily Use and a validated comorbidity questionnaire were completed at three visits over 2 years. Participants were classified into groups with no fatigue versus any fatigue. Logistic regression was used to determine the relationship between fatigue and each comorbidity at baseline, year 1, year 2, and overall. The incidence of fatigue during the study was 38.8%. The prevalence of fatigue was greater in those who were older (P = .0004), had a longer time since symptom onset (P = .005), and had greater disability (P < .0001). After adjustment, depression (odds ratio [OR], 2.58; 95% confidence interval [CI], 2.03-3.27), irritable bowel syndrome (OR, 1.71; 95% CI, 1.18-2.48), migraine (OR, 1.69; 95% CI, 1.27-2.27), and anxiety (OR, 1.57; 95% CI, 1.15-2.16) were independently associated with fatigue that persisted during the study. There was also an individual-level effect of depression on worsening fatigue (OR, 1.49; 95% CI, 1.08-2.07). Comorbidity is associated with fatigue in MS. Depression is associated with fatigue and with increased risk of worsening fatigue over 2 years. However, other comorbid conditions commonly associated with MS are also associated with persistent fatigue, even after accounting for depression. Further investigation is required to understand the mechanisms by which comorbidities influence fatigue.

Risk of Tics with Psychostimulants for ADHD

Investigators at Yale University, New Haven, CT, conducted a meta-analysis to examine the risk of new onset or worsening of tics caused by psychostimulants used in the treatment of children with ADHD.

PROSPECTIVE STUDY OF TABLE SALT TASTE SENSITIVITY THRESHOLD INFLUENCE ON CARDIOVASCULAR COMPLICATIONS

Aim. To evaluate prognostic significance of TSTST in cardiovascular complications development. Material and methods. Totally 162 persons studied, of those 67 with arterial hypertension (AH) and 95 their close relatives of the 1 grade of relativity, healthy at the moment of the first examination in 1998. Second study of the group has been done in 16 years, in 2014. Totally 28 families studied. In 16 years, 101 person had arterial hypertension, and in 34 it had been developed during the observation period. Ischemic heart disease (IHD) was diagnosed in 38 patients, diabetes (DM) — in 21 (all had 2nd type). For 16 years, the brain stroke (BS) developed in 15 participants, in 6 cases it was fatal, and myocardial infarction (MI) — in 13 participants, in 10 cases fatal. Totally 15 patients died (9,3%), one — from melanoma. The participants at the baseline were studied for the TSTST by Henkin R. J. method under Konstantinov E. N. modification. For the second study in 16 years a protocol was created included the results of anthropometric and hemodynamic data, and the cases of AH, IHD, MI and BS, and the death. Results. In the group of those died comparing to the others, were higher levels of TSTST at the baseline (2,52±0,39 vs 1,38±0,16, р<0,05). During 16 years among 54 participants with high TSTST (more than 0,64) died 14 — 25,9%, and from 47 participants with normal TSTST died 1 — 2,13%. In analysis of the influence of TSTST on cardiovascular outcomes, it was shown that the risk of fatal and nonfatal cases of BS increased with TSTST, but the risk of MI did not differ significantly. In addition, the survival of the patients was significantly lower in the case of higher TSTST in BS, as in MI. In survival analysis for the influence of TSTST on nonfatal cases of MI and BS there were no such influence. Conclusion. High TSTST in AH patients increases the risk of fatal and nonfatal cases of BS, fatal MI during 16 years of study. High TSTST is followed by the increase of the risk of new onset of AH, and higher mean values of BP in AH. The decrease of general survival and 16-year survival of AH patients due to fatal cases of BS and MI is caused by higher TSTST.

Meta-Analysis: Risk of Tics Associated With Psychostimulant Use in Randomized, Placebo-Controlled Trials

Clinical practice currently restricts the use of psychostimulant medications in children with tics or a family history of tics for fear that tics will develop or worsen as a side effect of treatment. Our goal was to conduct a meta-analysis to examine the risk of new onset or worsening of tics as an adverse event of psychostimulants in randomized, placebo-controlled trials. We conducted a PubMed search to identify all double-blind, randomized, placebo-controlled trials examining the efficacy of psychostimulant medications in the treatment of children with attention-deficit/hyperactivity disorder (ADHD). We used a fixed effects meta-analysis with risk ratio of new onset or worsening tics in children treated with psychostimulants compared to placebo. We used stratified subgroup analysis and meta-regression to examine the effects of stimulant type, dose, duration of treatment, recorder of side effect data, trial design, and mean age of participants on the measured risk of tics. We identified 22 studies involving 2,385 children with ADHD for inclusion in our meta-analysis. New onset tics or worsening of tic symptoms were commonly reported in the psychostimulant (event rate = 5.7%, 95% CI = 3.7%-8.6%) and placebo groups (event rate = 6.5%, 95% CI = 4.4%-9.5%). The risk of new onset or worsening of tics associated with psychostimulant treatment was similar to that observed with placebo (risk ratio = 0.99, 95% CI = 0.78-1.27, z = -0.05, p = .962). Type of psychostimulant, dose, duration of treatment, recorder, and participant age did not affect risk of new onset or worsening of tics. Crossover studies were associated with a significantly greater measured risk of tics with psychostimulant use compared to parallel group trials. Meta-analysis of controlled trials does not support an association between new onset or worsening of tics and psychostimulant use. Clinicians may want to consider rechallenging children who report new onset or worsening of tics with psychostimulant use, as these symptoms are much more likely to be coincidental rather than caused by psychostimulants.

Complications and cancer rates in spine fusion with recombinant human bone morphogenetic protein-2 (rhBMP-2).

To quantitatively synthesize the available best evidence for general complications, heterotopic ossification (HO), retrograde ejaculation, cervical swelling, and cancer rates with the use of rhBMP-2 in lumbar and cervical spine fusion. We conducted an online search for relevant controlled trials and extracted data on the abovementioned endpoints. Studies were eligible for inclusion if they reported on spinal fusion with rhBMP-2 in humans. Publication bias and heterogeneity were assessed mathematically. These data were synthesized in a meta-analysis using DerSimonian-Laird random effects modeling to calculate pooled odds ratios. We identified 26 studies reporting on a total of 184,324 patients (28,815 experimental, 155,509 controls) with a mean age of 51.1±1.8years. There was a significantly higher risk of general complications with rhBMP-2 compared to iliac crest bone graft (ICBG) with an odds ratio (OR) of 1.78 (95%CI 1.20-2.63), (p=0.004). The odds ratio for HO was 5.57 (95%CI 1.90-16.36), (p=0.002), for retrograde ejaculation 3.31 (95%CI 1.20-9.09), (p=0.020), and for cervical swelling 4.72 (95%CI 1.42-15.67), (p=0.011), all significantly higher in the rhBMP-2 group. The pooled odds ratio for new onset of tumor was 1.35 (95%CI 0.93-1.96), which represents no statistically significant difference between the groups (p=0.111). rhBMP-2 is associated with a higher rate of general complications as well as retrograde ejaculation, HO, and cervical tissue swelling in spine fusion. There is a slightly increased risk of new onset of tumors, however, without statistical significance.

Sequelae in 145 patients with drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms: survey conducted by the Asian Research Committee on Severe Cutaneous Adverse Reactions (ASCAR).

Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS) is a severe adverse drug reaction caused by specific drug. It is characterized by visceral organ involvement and reactivation of various human herpesviruses. Although sporadic reports have documented certain conditions that appear after the resolution of DIHS/DRESS, little information is available on sequelae after resolution of DIHS/DRESS in a large patient population. The Asian Research Committee on Severe Cutaneous Adverse Reactions, comprised of doctors from Japan and Taiwan, conducted a survey on sequelae and deterioration of the underlying disease in patients with DIHS/DRESS. This was achieved by directly interviewing patients who had been followed-up by experts or through a questionnaire mailed to patients. Questions were asked about new onset cardiovascular disease, collagen disease or autoimmune disease, gastrointestinal disease, renal disease, respiratory disease, neoplasms, and other diseases such as herpes zoster and diabetes mellitus, as well as deterioration of the underlying disease. A total of 145 patients were analyzed in this study. The following newly developed diseases after recovery from DIHS/DRESS were observed: Graves' disease (n = 2), Hashimoto's disease (n = 3), painless thyroiditis (n = 2), fulminant type 1 diabetes mellitus (n = 5), and infectious diseases (n = 7). Several DIHS/DRESS patients with pre-existing renal dysfunction required lifelong hemodialysis. DIHS/DRESS is a condition that increases the risk of new onset of disease. Long-term observation of DIHS/DRESS can provide an opportunity to investigate substantial diseases from onset to the full-blown stage. Patients with DIHS/DRESS require careful long-term follow-up.

A 10-year prospective study of respiratory disease and depression and anxiety in adulthood

BackgroundSeveral cross-sectional studies have found an association between respiratory disease and increased mood or anxiety disorders among adults. Little is known about the nature of these associations over time or the role of potential confounders in these links. ObjectivesTo investigate the association between respiratory disease and incident and persistent depression or anxiety disorders 10 years later and to examine potential pathways of these associations. MethodsData were drawn from the Midlife Development in the United States survey, a representative sample of adults in the United States ages 18 to 74 years. Participants (N = 2,101) were interviewed on a range of health domains at baseline at wave 1 (1994) and again at wave 2 (2005). ResultsRespiratory disease was associated with increased odds of depression and anxiety disorders cross-sectionally at both time points. Respiratory disease at wave 1 was not associated with incident depression or anxiety disorders at wave 2. Respiratory disease at wave 1 was associated with increased odds of persistent depression or anxiety disorders 10 years later among those with depression or anxiety disorders at wave 1. Associations were not explained by differences in demographic characteristics, secondhand smoke exposure, cigarette smoking, or history of exposure to childhood maltreatment. ConclusionFindings shed new light on the association between respiratory disease and depression or anxiety disorders. Individuals with respiratory disease appear to have higher prevalence of concurrent depression or anxiety disorders and persistent depression or anxiety disorders compared with those without respiratory disease. However, a history of respiratory disease does not appear to confer increased risk of new onset of depression or anxiety disorders.

A randomised controlled trial for the evaluation of risk for type 2 diabetes in hypertensive patients receiving thiazide diuretics: Diuretics In the Management of Essential hypertension (DIME) study

ObjectivesThiazide diuretics are one of the first choice antihypertensives but not optimally utilised because of concerns regarding their adverse effects on glucose metabolism. The Diuretics In the Management of Essential...

Fluoxetine-induced pancreatic beta cell dysfunction: New insight into the benefits of folic acid in the treatment of depression

BackgroundMajor depressive disorder is a common psychiatric illness with reported prevalence rates of 12–16% in persons aged 12 and over. Depression is also associated with a high risk of new onset of type 2 diabetes (T2D). This relationship between depression and diabetes may be related to depression itself and/or drugs prescribed. Importantly, the use of selective serotonin reuptake inhibitors (SSRIs), the most commonly prescribed class of antidepressants, increases the risk of developing T2D. However, the mechanism(s) underlying this association remains elusive. MethodsHere we examine the effects of the SSRI fluoxetine (Prozac®) on beta cell function utilizing INS-1E cells, a rat beta cell line, to elucidate the underlying molecular mechanisms. ResultsFluoxetine treatment significantly reduced glucose stimulated insulin secretion (GSIS). This decreased beta cell function was concomitant with an increased production of reactive oxygen species and oxidative damage which may contribute to decreased mitochondrial electron transport chain enzyme (ETC) activity. Importantly the fluoxetine-induced deficits in beta cell function were prevented by the addition of the antioxidant folic acid. LimitationsThese studies were conducted in vitro; the in vivo relevance remains to be determined. ConclusionsThese findings suggest that use of SSRI antidepressants may increase the risk of new-onset T2D by causing oxidative stress in pancreatic beta cells. However, folic acid supplementation in patients taking SSRIs may reduce the risk of new onset diabetes via protection of normal beta cell function.

The effect of the polymorphisms of 5-HTTLPR on new onset of depression in patients who underwent pacemaker implantation

To study the role of serotonin transporter gene (5-HTTLPR) polymorphisms in the incidence of depression in a Chinese cohort who underwent pacemaker (PM) implantation. A total of 294 patients treated with PMs were enrolled. The 5-HTTLPR gene polymorphism was determined. We found that the 5-HTTLPR SS genotype was significantly associated with the risk of depression after PM implantation (odds ratio=3.916, compared with LL carriers, P<0.001), especially in female patients and patients who are smokers. Female SS genotype carries 9.75 times higher risk for depression, and smokers with the SS genotype had 9.45 times higher risk for new onset of depression after the procedure. Pace mode had no influence on the onset of depression. This study suggests a significant association between the 5-HTTLPR gene polymorphism and the new onset of depression after PM implantation, especially in women or those who were smokers.

Statins and risk of treated incident diabetes in a primary care population

(i) To examine the incidence of new onset treated diabetes in patients treated with different types of statins and (ii) the relationship between the duration and dose of statins and the subsequent development of new onset treated diabetes. A retrospective cohort study was performed using the Irish Health Services Executive Primary Care Reimbursement Services national pharmacy claims database. Individuals who received any medicines were identified from January 2001 to January 2009 (n = 1 235 671). Patients newly treated with statins from 1 January 2002 to 31 December 2007 were identified (n = 239 628). Cases were identified as individuals newly treated with antidiabetic medication (n = 38 503). Adjusted hazards ratios (HR) with 95% confidence intervals (CI) were calculated to examine the association between statins (any vs. none) and time to new onset treated diabetes using Cox proportional hazard regression. The dose and duration response relationship between statins and new onset treated diabetes was examined using restricted spline functions to assess the linearity of the relationship. Statin use was associated with an increased risk of new onset treated diabetes (HR = 1.18, 95% CI 1.15, 1.22). Increased risk of new onset treated diabetes was found with rosuvastatin (HR = 1.41, 95% CI 1.31, 1.52), atorvastatin (HR = 1.23, 95% CI 1.19, 1.27) and simvastatin (HR = 1.15, 95% CI 1.05, 1.25). There were statistically significant overall dose and duration effects for all statins, excepting fluvastatin, which only demonstrated a duration effect. An increased risk of new onset treated diabetes was found in those treated with statins showing significant duration and dose effect. Further study is required to confirm this association.

Antihypertensive agents for preventing diabetic kidney disease.

Various blood pressure-lowering agents, and particularly inhibitors of the renin-angiotensin system (RAS), are widely used for people with diabetes to prevent the onset of diabetic kidney disease (DKD) and adverse cardiovascular outcomes. This is an update of a Cochrane review first published in 2003 and updated in 2005. This systematic review aimed to assess the benefits and harms of blood pressure lowering agents in people with diabetes mellitus and a normal amount of albumin in the urine (normoalbuminuria). In January 2011 we searched the Cochrane Renal Group's Specialised Register through contact with the Trials Search Co-ordinator. Randomised controlled trials (RCTs) comparing any antihypertensive agent with placebo or another agent in hypertensive or normotensive patients with diabetes and no kidney disease (albumin excretion rate < 30 mg/d) were included. Two investigators independently extracted data on kidney and other patient-relevant outcomes (all-cause mortality and serious cardiovascular events), and assessed study quality. Analysis was by a random effects model was applied to analyse results which were expressed as risk ratio (RR) and 95% confidence intervals (CI). We identified 26 studies that enrolling 61,264 participants. Angiotensin-converting enzyme inhibitors (ACEi) reduced the risk of new onset of microalbuminuria, macroalbuminuria or both when compared to placebo (8 studies, 11,906 patients: RR 0.71, 95% CI 0.56 to 0.89), with similar benefits in people with and without hypertension (P = 0.74), and when compared to calcium channel blockers (5 studies, 1253 participants: RR 0.60, 95% CI 0.42 to 0.85). ACEi reduced the risk of death when compared to placebo (6 studies, 11,350 participants: RR 0.84, 95% CI 0.73 to 0.97). No effect was observed for angiotensin receptor blockers (ARB) when compared to placebo for new microalbuminuria, macroalbuminuria or both (5 studies, 7653 participants: RR 0.90, 95% CI 0.68 to 1.19) or death (5 studies, 7653 participants: RR 1.12, 95% CI 0.88 to 1.41); however, meta-regression suggested possible benefits from ARB for preventing kidney disease in high risk patients. There was a trend towards benefit from use of combined ACEi and ARB for prevention of DKD compared with ACEi alone (2 studies, 4171 participants: RR 0.88, 95% CI 0.78 to 1.00).The risk of cough was significantly increased with ACEi when compared to placebo (6 studies, 11,791 patients: RR 1.84, 95% CI 1.24 to 2.72), however there was no significant difference in the risk of headache or hyperkalaemia. There was no significant difference in the risk of cough, headache or hyperkalaemia when ARB was to placebo. On average risk of bias was judged to be either low (27% to 69%) or unclear (i.e. no information available) (8% to 73%). Blinding of participants, incomplete outcome data and selective reporting were judged to be high in 23%, 31% and 31% of studies, respectively. ACEi were found to prevent new onset DKD and death in normoalbuminuric people with diabetes, and could therefore be used in this population. More data are needed to clarify the role of ARB and other drug classes in preventing DKD.

Heart failure and dysrhythmias after maternal placental syndromes: HAD MPS Study

BackgroundMaternal placental syndromes (MPS)—gestational hypertension, pre-eclampsia and placental abruption/infarction—are more prevalent in women with features of the metabolic syndrome (MetSyn). Both MPS and the MetSyn predispose to left ventricular impairment...

The Natural History of Insomnia in the Ibadan Study of Ageing

To determine the incidence and risk factors for insomnia among an under-studied population of elderly persons in Sub-Saharan Africa. Eight contiguous predominantly Yoruba-speaking states in south-west and north-central Nigeria representing about 22% of the national population. 1307 elderly community-dwelling persons, aged 65 years and older. Face-to-face assessment with the Composite International Diagnostic Interview, version 3 (CIDI.3) in 2007 and 12 months later in 2008 to determine the occurrence and risk factors of incident and persistent insomnia, defined as syndrome or symptom. The incidence of insomnia syndrome in 2008 at 12 months was 7.97% (95% CI, 6.60-9.60), while that of insomnia symptom was 25.68% (22.68-28.66). Females were at elevated risk for both syndrome and symptom. Among persons with insomnia symptom or syndrome at the baseline, 47.36% (95% CI 43.07-51.68) continued to have it one year later. Decreasing economic status was associated with increasing incidence of insomnia. Persons with chronic medical conditions at baseline were at increased risk for new onset of insomnia. Compared to persons with the lowest body mass index (BMI) (< 18.5), those with higher BMI were at elevated risk for persistence of their insomnia, with those in the obese range (≥ 30) having a 4-fold risk. There is a high incidence and chronicity of insomnia in this elderly population. Persons with chronic health conditions are particularly at risk of new onset as well as persistence of insomnia.