Mediterranean Diet Linked to Lower Long-Term Cardiovascular Events in Women

MedicalResearch.com Interview with:

Samia Mora, MD, MHS Associate Professor of Medicine Harvard Medical School Director, Center for Lipid Metabolomics Brigham and Women’s Hospital Boston, MA

Dr. Mora

Samia Mora, MD, MHS
Associate Professor of Medicine
Harvard Medical School
Director, Center for Lipid Metabolomics
Brigham and Women’s Hospital
Boston, MA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Mediterranean diet is rich in plants (nuts, seeds, fruits, vegetables, whole grains, legumes) and olive oil, and includes moderate intake of fish, poultry, dairy, and eggs, and alcohol, and rare use of meats and sweets.The Mediterranean diet has been associated with lower risk of cardiovascular disease (CVD) events but the precise mechanisms through which Mediterranean diet intake may reduce long-term risk of CVD are not well understood. We aimed to investigate the biological mechanisms that may mediate this cardiovascular benefit.

Using a prospective study of 25,994 initially healthy women enrolled in the Women’s Health Study who were followed up to 12-years, we evaluated potential mediating effects of a panel of biomarkers (in total 40 biomarkers) that represent different CVD pathways and clinical factors.

Higher baseline intake of a Mediterranean-type diet was associated with approximately one quarter lower risk of CVD events during the 12 year follow up. For the MED-CVD risk reduction, biomarkers of inflammation, glucose-metabolism/insulin-resistance, and adiposity contributed most to explaining the association, with additional contributions from pathways related to blood pressure, lipids – in particular HDL or triglyceride-rich lipoprotein metabolism, and to a lesser extent LDL cholesterol, branched chain amino acids, and small molecule metabolites.  Continue reading

Eat Carbs in the Morning, Fat at Night?

MedicalResearch.com Interview with:
"Compare-the-Use-of-Carbohydrates-and-Lipids-in-Energy-Storage" by Zappys Technology Solutions is licensed under CC BY 2.0Kirsi-Marja Zitting, Ph.D.

Instructor in Medicine, Harvard Medical School
Division of Sleep and Circadian Disorders
Departments of Medicine and Neurology
Brigham and Women’s Hospital
Boston, MA 02115

MedicalResearch.com: What is the background for this study?

Response: This study is a follow-up study to our previous study where we found that chronic insufficient sleep together with chronic jet lag is associated with adverse changes in metabolism, including increase in blood sugar levels (Buxton et al. Science Translational Medicine, 2012). The present study focuses on the influence of the time of day on metabolism, which has not been investigated in humans independent of the effects of sleep, physical activity and diet.

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Dysplastic Moles Not Necessarily Precursor to Melanoma But Indicate Increased Risk

MedicalResearch.com Interview with:

Caroline C. Kim, M.D. Associate Professor, Department of Dermatology Harvard Medical School Director, Pigmented Lesion Clinic Associate Director, Cutaneous Oncology Program Beth Israel Deaconess Medical Center Boston, MA 02215

Dr. Kim

Caroline C. Kim, M.D.
Associate Professor, Department of Dermatology
Harvard Medical School
Director, Pigmented Lesion Clinic
Associate Director, Cutaneous Oncology Program
Beth Israel Deaconess Medical Center
Boston, MA 02215

MedicalResearch.com:  What is the background for this study?  What are the main findings?

Response: Atypical/dysplastic nevi have been identified as risk factors for melanoma, however the majority of melanomas arise as new lesions on the skin.

Unlike other models of dysplasia having a clear trajectory towards cancer as seen in cervical dysplasia, dysplastic nevi are not proven to be obligate precursors for melanoma.  However, there is little evidence to guide the management of biopsied dysplastic nevi with positive margins, with much clinical variation in the management of moderately dysplastic nevi in particular.

In this multi-center national study of 9 U.S. academic centers, we examined outcomes of 467 moderately dysplastic nevi excisionally biopsied without residual clinical pigmentation but with positive histologic margins with at least 3 years of clinical follow-up.  We found that no cases developed into a same-site melanoma with a mean follow-up time of 6.9 years. However, 22.8% of our patients went on to develop a future separate site melanoma.

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MidLife PSA Can Risk-Stratify Prostate Cancer in African American Men

MedicalResearch.com Interview with:

Mark Preston, MD, MPH Associate Surgeon, Brigham and Women's Hospital Assistant Professor of Surgery, Harvard Medical School Brigham and Women's Hospital Department of Surgery, Urology Boston, MA

Dr. Preston

Mark Preston, MD, MPH
Associate Surgeon, Brigham and Women’s Hospital
Assistant Professor of Surgery, Harvard Medical School
Brigham and Women’s Hospital
Department of Surgery, Urology
Boston, MA
MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Black men are at significantly increased risk of developing and dying from prostate cancer. Unfortunately, there is limited research on screening strategies in this high-risk population. In this original investigation, we studied how baseline PSA levels measured in midlife predict later risk of aggressive prostate cancer in a population of black men. This study used stored blood samples and over a decade of follow-up in the Southern Community Cohort Study, an on-going cohort study with the highest representation of black men in the U.S.

We demonstrated that PSA levels in midlife very strongly predict future aggressive prostate cancer. Our data identify subgroups of black men who have widely divergent long-term risk of aggressive prostate cancer based on baseline PSA during midlife. We suggest that these groups could benefit from screening intervals tailored to their actual magnitude of disease risk.

These important findings build on our previous work on baseline PSA and subsequent risk of lethal prostate cancer in mainly white men, which was published in the Journal of Clinical Oncology in August 2016. 

MedicalResearch.com: What should readers take away from your report? 

Response: One strategy for improving PSA screening is to do an earlier measurement of PSA during midlife (aged 40-55). PSA levels during midlife have been shown by our group and others to strongly predict long-term risk of prostate cancer, particularly risk of aggressive disease, in now both black and white men.

This baseline PSA level during midlife can be used to risk-stratify PSA screening, targeting higher risk men for screening in order to diagnosis and treat them early while an opportunity exists for cure.  In addition, men at low risk could safely be screened less frequently. As a result, much of the benefit of PSA screening on prostate cancer mortality could be maintained, while overdiagnosis and overtreatment would be reduced.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Prospective studies of a risk stratified screening program should be conducted.  We are also studying ways to further improve risk prediction and to explore biologic mechanisms why a midlife PSA is so predictive.

Disclosures. I have no disclosures. Disclosures for other authors are listed in the manuscript.

Citation:

Eur Urol. 2018 Sep 17. pii: S0302-2838(18)30627-4. doi: 10.1016/j.eururo.2018.08.032. [Epub ahead of print]

Baseline Prostate-specific Antigen Level in Midlife and Aggressive Prostate Cancer in Black Men.

Preston MA1, Gerke T2, Carlsson SV3, Signorello L4, Sjoberg DD5, Markt SC6, Kibel AS7, Trinh QD7, Steinwandel M8, Blot W9, Vickers AJ5, Lilja H10, Mucci LA6, Wilson KM11.

Oct 14, 2018 @ 12:36 pm

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Gene Variants Can Alter Glucose Absorption and Cardiometabolic Risks

MedicalResearch.com Interview with:

Scott David Solomon, MD Director, Noninvasive Cardiology Professor, Harvard Medical School Brigham and Women's Hospital

Dr. Solomon

Scott David Solomon, MD
Director, Noninvasive Cardiology
Professor, Harvard Medical School
Brigham and Women’s Hospital 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: The sodium glucose transport proteins are known to be important in regulating uptake of glucose. SGLT-1 is predominantly located in the gut and is responsible for uptake of glucose and galactose in the small intestine. Individuals born with severe mutations of this gene have severe malabsorption syndrome.

We looked at genetic variants that lead to reduced function of the protein, but not complete loss of function, in a large cohort of individuals in the NIH funded Atherosclerosis Risk in Communities Study. We found that those with mutations in the gene had reduced glucose uptake, as measured by an oral glucose tolerance test, as well as less obesity, diabetes, heart failure and death.

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Insufficient Sleep in Adolescence May Be A Driver of Risky Behaviors

MedicalResearch.com Interview with:

Matthew D. Weaver, PhD Instructor in Medicine · Harvard Medical School Associate Epidemiologist · Division of Sleep and Circadian Disorders Brigham and Women's Hospital Boston, MA 02215

Dr. Weaver

Matthew D. Weaver, PhD
Instructor in Medicine · Harvard Medical School
Associate Epidemiologist · Division of Sleep and Circadian Disorders
Brigham and Women’s Hospital
Boston, MA 02215

MedicalResearch.com: What is the background for this study?

Response: We were interested whether high school students who tended to sleep less than 8 hours per night reported more risk-taking behaviors compared to high school students who slept at least 8 hours per night on a school night. We utilized a nationally representative dataset from the CDC of surveys that were completed by high school students between 2007 and 2015. Over that time, approximately 67,000 students were surveyed. Students were asked about the hours of sleep that they obtained on an average school night. They were also asked how often, in the month prior to the survey, they engaged in a number of risk-taking behaviors. Some behaviors were related to driving, like driving without a seatbelt or driving drunk, while others were related to using alcohol, doing drugs, or being involved in a fight. They were also asked about their mood, including whether they felt sad or hopeless, considered suicide, and whether they had attempted suicide. 

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Combination Brand Name Drugs Cost Medicare Millions More Than Separate Generic Pills

MedicalResearch.com Interview with:

Chana A. Sacks, MD, MPH Program On Regulation, Therapeutics, And Law (PORTAL) Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s Hospital

Dr. Sacks

Chana A. Sacks, MD, MPH
Program On Regulation, Therapeutics, And Law (PORTAL)
Division of Pharmacoepidemiology and Pharmacoeconomics
Brigham and Women’s Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Combination pills combine multiple medications into a single dosage form. There have been case reports in recent years of high prices for certain brand-name combination drugs – even those that are made up of generic medications.

Our study looks at this phenomenon in a systematic way using recently released Medicare spending data. We evaluated 29 combination drugs and found that approximately $925 million dollars could potentially have been saved in 2016 alone had generic constituents been prescribed as individual pills instead of using the combination products.

For example, Medicare reported spending more than $20 per dose of the combination pill Duexis, more than 70 times the price of its two over-the-counter constituent medications, famotidine and ibuprofen.

The findings in this study held true even for brand-name combination products that have generic versions of the combination pill. For example, Medicare reported spending more than $14 for each dose of brand-name Percocet for more than 4,000 patients, despite the existence of a generic combination oxycodone/acetaminophen product. Continue reading