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Volume 2 - 2008

Topics

Nutrition
Hormones
Exercise and Fitness
Cardiovascular
Diabetes
Other

* Please find glossary at the bottom of this e-newsletter.

Nutrition

Low-Fat or Mediterranean-Style Diet Reduces Cardiovascular Events

Comparison of Low-Fat Versus Mediterranean-Style Dietary Intervention After First Myocardial Infarction

Abbreviated Abstract: Whether a Mediterranean-style diet reduces cardiovascular events and mortality more than a low-fat diet is uncertain. The objectives of this study were to actively compare low-fat and Mediterranean-style diets after first myocardial infarction (MI) in a randomized, controlled clinical trial and to compare dietary intervention per se with usual care in a case-control analysis. First MI survivors were randomized to a low-fat (n = 50) or Mediterranean-style (n = 51) diet. The 2 diets were low in saturated fat (0.75% kcal). Primary-outcome-free survival (a composite of all-cause and cardiac deaths, MI, hospital admissions for heart failure, unstable angina pectoris, or stroke) did not differ between low-fat (42 of 50) and Mediterranean-style (43 of 51) diet groups over a median follow-up period of 46 months (range 18 to 72; log-rank p = 0.81). In conclusion, active intervention with either a low-fat or a Mediterranean-style diet similarly and significantly benefits overall and cardiovascular-event-free survival after MI.

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Tuttle KR, Shuler LA, Packard DP, Milton JE, Daratha KB, Bibus DM, Short RA. Am J Cardiol. 2008 Jun 1;101(11):1523-30. Epub 2008 Mar 26.

Dietary Calcium and Dairy Products Suppress Oxidative and Inflammatory Stress

Dietary Calcium and Dairy Products Modulate Oxidative and Inflammatory Stress in Mice and Humans

Abbreviated Abstract: We have recently shown 1alpha, 25-dihydroxycholecalciferol increased oxidative stress and inflammatory stress in vitro, whereas suppression of 1alpha, 25-dihydroxycholecalciferol with dietary calcium (Ca) decreased oxidative and inflammatory stress in vivo. However, dairy products contains additional factors, such as angiotensin-converting enzyme inhibitors, which may further suppress oxidative and inflammatory stress. Accordingly, this study was designed to study the effects of the short-term (3 wk) basal suboptimal Ca (0.4%), high-Ca (1.2% from CaCO(3)), and high-dairy (1.2% Ca from milk) obesigenic diets on oxidative and inflammatory stress in adipocyte fatty acid-binding protein-agouti transgenic mice. Adipose tissue reactive oxygen species (ROS) production and NADPH oxidase mRNA and plasma malondialdehyde (MDA) were reduced by the high-Ca diet (P < 0.001) compared with the basal diet and ROS and MDA were further decreased by the high-dairy diet (P < 0.001). These data demonstrate that dietary Ca suppresses adipose tissue oxidative and inflammatory stress.

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Must be a subscriber of The Journal of Nutrition to access full article. Click here to sign in.

Zemel MB, Sun X. J Nutr. 2008 Jun; 138(6):1047-52.

Fish Oil Supplementation Enhances Memory Performance

Fish Oil Supplementation of Control and (n-3) Fatty Acid-Deficient Male Rats Enhances References and Working Memory Performance and Increases Brain Regional Docosahexaenoic Acid Levels

Abbreviated Abstract: Most previous studies have focused on improved reference memory and recovery of whole brain docosahexaenoic acid [DHA, 22:6(n-3)] levels in DHA-deficient animals supplemented with fish oil (FO) or switched to an adequate DHA-enriched diet. The aims of this study were to determine whether reference and working memory performance can be enhanced in control male rats and improved in (n-3) fatty acid-deficient male rats given an FO supplement and whether brain DHA accumulation, deficiency, and recovery are region specific. Rats fed the (n-3) fatty acid-deficient diet showed significantly poorer reference and working memory, and FO supplementation partially rescued both memory performances. Furthermore, FO supplementation during brain development and adulthood in normal rats resulted in significant enhancement of both memories. Following dietary DHA repletion, the hippocampus and olfactory bulbs accumulated more DHA, were more resistant to dietary DHA deprivation, and showed better DHA recovery than the visual cortex, frontal cortex, and cerebellum. These results suggest that DHA is critical for the development and maintenance of learning memory performance.

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Chung WL, Chen JJ, Su HM. J Nutr. 2008 Jun; 138(6):1165-71.

Biomarkers of Inflammation and Malnutrition Predict Early Death

Biomarkers of Inflammation and Malnutrition Associated with Early Death in Healthy Elderly People

Abbreviated Abstract: To determine whether malnutrition and biomarkers of inflammation predict all-cause, cancer, and cardiovascular mortality in healthy elderly subjects. PARTICIPANTS: Five hundred and fifty-three men and 888 women aged 60 and older from the Pathologies Oculaires Liées à l'Age cohort free of known comorbidities. MEASUREMENTS: To investigate the risks of 5-year (early) and 5- to 9-year (late) mortality, hazard ratios (HR) were evaluated using Cox models. RESULTS: In men, early death was associated with high C-reactive protein (CRP) and alpha-1 acid glycoprotein (AAG) and low albumin and transthyretin (TTR). In women, early death was associated with high AAG, low TTR and low cholesterol. For late death, the only significant association was with CRP in men. A synergistic effect was observed between biomarkers of inflammation and malnutrition. Cancer mortality was greater for high CRP and AAG and for low albumin and TTR in men but not in women. CONCLUSION: Biomarkers of inflammation and malnutrition together predict early mortality. In healthy elderly subjects, TTR and AAG could be helpful in identifying elderly subjects at higher risk of death.

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Carriere I, Dupuy AM, Lacroux A, Cristol JP, Delcourt C; Pathologies Oculaires Liées à l'Age Study Group. J Am Geriatr Soc. 2008 May; 56(5):840-6. Epub 2008 Apr 9.

Hormones

Growth Hormones Can Enhance Vascular Health in Older Adults

Low-Dose Growth Hormone Administration Mobilizes Endothelial Progenitor Cells in Healthy Older Adults

Abbreviated Abstract: Endothelial progenitor cells (EPCs) mobilize from the bone marrow secondary to a stimulus and home to sites of injury, where they differentiate into endothelial cells and contribute to the repair of damaged vasculature. We hypothesized that growth hormone (GH) administration would increase the number of circulating EPCs in adults and thereby represent a mechanism to enhance vascular health. DESIGN: A prospective trial of low-dose GH (0.03mg/kg/week for 4 weeks followed by 0.06mg/kg/week for a maximum of four additional weeks) in 10 healthy adults (6 males and 4 females; mean age 37 years, range 26-65). RESULTS: GH administration increased serum IGF-1 (143ng/mL [IQR 121-164] to 222 [IQR 194-244]; P=0.005). CONCLUSIONS: GH administration selectively augments the early-outgrowth EPC population in healthy individuals. These findings both support GH replacement in the setting of GH deficiency to maintain vascular integrity and have implications for the use of GH in future regenerative cell-based therapies. Furthermore, the decrease in EPCs observed with aging may in part be explained by the declining somatotropic axis, and thereby contribute to cardiovascular senescence.

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Devin JK, Vaughan DE, Blevins LS Jr, Chen Q, Covington J, Verity DK, Young PP. Growth Horm IGF Res. 2008 Jun; 18(3):253-63. Epub 2007 Dec 31.

Lipid Levels Predict Risk of Coronary Heart Disease While on Hormone Therapy

Usefulness of Baseline Lipids and C-Reactive Protein in Women Receiving Menopausal Hormone Therapy as Predictors of Treatment-Related Coronary Events

Abbreviated Abstract: Blood lipids and high-sensitivity C-reactive protein (hs-CRP) are altered by hormone therapy. The goal of the present study was to determine whether lipids and hs-CRP have predictive value for hormone therapy benefit or risk for coronary heart disease events in postmenopausal women without previous cardiovascular disease. A nested case-control study was performed in the Women's Health Initiative hormone trials. Baseline lipids and hs-CRP were obtained from 271 incident patients with coronary heart disease (cases) and 707 controls. In a combined trial analysis, favorable lipid status at baseline tended to predict better coronary heart disease outcomes when using conjugated equine estrogen (CEE) with or without medroxyprogesterone acetate (MPA). Women with a low-density lipoprotein (LDL)/high-density lipoprotein (HDL) cholesterol ratio <2.5 had no increase in risk of coronary heart disease when using CEE with or without MPA (odds ratio 0.60, 95% confidence interval 0.34 to 1.06), whereas women with an LDL/HDL cholesterol ratio >/=2.5 had increased risk of coronary heart disease (odds ratio 1.73, 95% confidence interval 1.18 to 2.53, p for interaction = 0.02). Low hs-CRP added marginally to the value of LDL/HDL ratio <2.5 when predicting coronary heart disease benefit on hormone therapy. In conclusion, postmenopausal women with undesirable lipid levels had excess coronary heart disease risk when using CEE with or without MPA. However, women with favorable lipid levels, especially LDL/HDL cholesterol ratio <2.5, did not have increased risk of coronary heart disease with CEE with or without MPA irrespective of hs-CRP.

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Bray PF, Larson JC, Lacroix AZ, Manson J, Limacher MC, Rossouw JE, Lasser NL, Lawson WE, Stefanick ML, Langer RD, Margolis KL; Women's Health Initiative Investigators. Am J Cardiol. 2008 Jun 1;101(11):1599-1605. Epub 2008 Apr 2

Testosterone Therapy Improves Sexual Function in Postmenopausal Women

Testosterone Therapy For Sexual Dysfunction in Postmenopausal Women Abbreviated Abstract: Background After menopause, both surgical and natural, increases occur in the number of women experiencing sexual dysfunction. Although a direct link between sexual dysfunction and endogenous testosterone levels has not been clearly established, testosterone therapy is known to improve the signs and symptoms related to hypoactive sexual desire. Results Randomized trials have demonstrated an improvement in sexual function with testosterone in postmenopausal women with hypoactive sexual desire disorder, particularly after oophorectomies. Side-effects have been well tolerated and reversible upon discontinuation. Conclusion Exogenous testosterone treatment provides a rational therapeutic alternative to consider in women whose hypoactive sexual desire disorder negatively affects their quality of life and who have no biologic or psychosocial causes not related to decreased androgen levels for their sexual disorder. Women receiving testosterone should be monitored for clinical improvement and for adverse reactions. Transdermal patches and topical gels avoid the hepatic first-pass metabolism and are the preferred formulations. Testosterone therapy is usually administered concomitantly with estrogen therapy due to a lack of adequate safety and efficacy data on testosterone alone.

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Z. Hubayter; J. A. Simon. Climacteric. 11(3):181-191

Prolactin and Cortisol Increase During Nighttime in Postmenopausal Women

24-Hour Serum Levels of Growth Hormone, Prolactin, and Cortisol in Pre- and Postmenopausal Women: The Effect of Combined Estrogen and Progestin Treatment

Abbreviated Abstract: Our objective was to study the 24-h profiles of GH, prolactin (PRL), and cortisol concentrations in older postmenopausal and middle-aged premenopausal women, before and after estrogen-progestin treatment (EPT). DESIGN: The study was a randomized, placebo-controlled, double-blind trial. GH, PRL, and cortisol were sampled every 20 min for 24 h in 18 postmenopausal (aged 58-70 yr) and 17 premenopausal (aged 45-51 yr) women before and after 6 months of EPT. RESULTS: The mean 24-h GH (1.0 vs. 1.8 mU/liter, P = 0.033) and PRL (6.8 vs. 10.0 ng/ml, P = 0.009) concentrations were lower in postmenopausal than in premenopausal women. After EPT, the postmenopausal GH and PRL did not differ from premenopausal baseline levels. Postmenopausal mean 24-h GH (P < 0.001) and PRL (P = 0.002), daytime GH (P < 0.001) and nighttime PRL (P = 0.004) were higher during EPT compared with placebo. Cortisol levels did not differ. Premenopausal mean nighttime PRL (P = 0.026) and cortisol (P = 0.018) were higher during EPT compared with placebo. Postmenopausal PRL and premenopausal GH and PRL concentrations were higher at night than during the day. EPT did not alter this pattern. CONCLUSIONS: Menopause was associated with decreased 24-h levels of GH and PRL, which were reversible with EPT. In contrast, cortisol levels were not affected by menopause or EPT. In middle-aged premenopausal women, the studied effects of EPT were limited to nighttime increases of PRL and cortisol.

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Kalleinen N, Polo-Kantola P, Irjala K, Porkka-Heiskanen T, Vahlberg T, Virkki A, Polo O. J Clin Endocrinol Metab. 2008 May; 93(5):1655-61. Epub 2008 Mar 4. The Effects of Different Hormone Replacement Therapies Effects in Postmenopausal Women of Estradiol and Medroxyprogesterone Alone and Combined on Resistance Artery Function and Endothelial Morphology and Movement

Abbreviated Abstract: Endothelial dysfunction in resistance arteries after menopause is important for the development of high blood pressure and cardiovascular disease. OBJECTIVES: Our objectives were to study the effects of different hormone replacement therapies on the function and morphology of isolated resistance arteries, and to look for their mechanistic basis. PATIENTS AND INTERVENTIONS: We isolated resistance arteries in sc biopsies from 55 postmenopausal women before and after 3-month therapy with estradiol (E2), medroxyprogesterone acetate (MPA), E2 plus MPA, or placebo. In addition, we studied isolated human endothelial cells. MAIN OUTCOME MEASURES AND RESULTS: Artery flow-mediated dilatation was augmented after treatment with E2 or E2 plus MPA, whereas MPA or placebo had no effect. Pressure-induced myogenic tone was reduced by E2 plus MPA, whereas it was unchanged in the other groups. Scanning microscopy showed that E2 improved endothelial cell morphology and decreased signs of endothelial apoptosis, but the addition of MPA impaired these events. E2, MPA, or the combination all increased the expression and phosphorylation of the actin-binding protein, moesin and of the focal adhesion complex controller, focal adhesion kinase, and induced the rearrangement of cytoskeletal actin and vinculin fibers. All treatments promoted endothelial cell horizontal migration, with E2 inducing the strongest effect. CONCLUSIONS: This study suggests that hormone replacement therapy with estrogens or in combination with MPA may benefit the function of resistance arteries and may preserve the morphological integrity of endothelial cells by regulatory actions on the cytoskeleton.

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Kublickiene K, Fu XD, Svedas E, Landgren BM, Genazzani AR, Simoncini T. J Clin Endocrinol Metab. 2008 May; 93(5):1874-83. Epub 2008 Mar 4.

Declining Estrogen Levels During Menopause Increases Risk of Cardiovascular Disease

Associations of Endogenous Sex Hormones with the Vasculature in Menopausal Women: the Study of Women's Health Across the Nation (SWAN).

Abbreviated Abstract: As associations between endogenous sex hormones and the vasculature are not well characterized, the objective was to examine the cross-sectional associations of menopausal status and endogenous sex hormones with vascular characteristics. DESIGN: Common carotid artery adventitial diameter and intima-media thickness were determined using B-mode ultrasonography among 483 middle-aged women enrolled in the Pittsburgh and Chicago sites of the Study of Women's Health Across the Nation. RESULTS: Sixty-two percent of women were pre- or early perimenopausal (<3 mo amenorrhea), 12% were late perimenopausal (3-12 mo amenorrhea), and 27% were postmenopausal (>or=12 mo amenorrhea). After adjustment for age, compared with pre-/early perimenopause, late perimenopause was associated with a 0.28-mm larger adventitial diameter (P=0.001), whereas postmenopause was associated with a 0.15-mm larger adventitial diameter (P=0.040). Adjustment for traditional cardiovascular risk factors slightly attenuated these associations, but the association with late perimenopause remained statistically significant (P=0.001). Each SD lower log estradiol value was associated with a 0.07-mm larger adventitial diameter after adjustment for traditional cardiovascular risk factors (P=0.023), whereas other endogenous hormones showed no associations. Intima-media thickness values were not significantly associated with menopausal status or endogenous sex hormones after adjustment for age. CONCLUSIONS: The menopausal transition and declining estrogen levels are associated with alterations of the peripheral vasculature, which may help to explain the increased risk of cardiovascular disease with postmenopause.

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Wildman RP, Colvin AB, Powell LH, Matthews KA, Everson-Rose SA, Hollenberg S, Johnston JM, Sutton-Tyrrell K. Menopause. 2008 May-Jun; 15(3):414-21.

Poor Quality of Life Does Not Affect Likelihood of Starting Hormone Therapy

The Impact of Hormone Therapy on Health-Related Quality of Life: Longitudinal Results from the Study of Women's Health Across the Nation.

Abbreviated Abstract: To determine the impact of hormone therapy (HT) on health-related quality of life (HRQOL) during the menopausal transition and to examine variation based on menopausal symptom status. RESULTS: Of the 3,102 participants, 813 initiated HT during the 6-year follow-up period. At baseline, women who subsequently initiated HT were more likely to report poor role physical functioning, higher socioeconomic status, and frequent symptoms and to be white. In longitudinal analyses, women reporting poor role emotional and physical functioning at the visit before initiation were less likely to subsequently initiate (hazard ratio [95% CI]: 0.76 [0.62-0.91] and 0.58 [0.47-0.71]; P<0.01 and <0.0001, respectively), and initiation was associated with subsequent poorer role physical functioning (odds ratio [95% CI]: 1.26 [1.02-1.56]; P=0.03). Among HT initiators, frequent symptom reporters showed improvements in vitality (+2.7) compared with other initiators (-2.9) (P<0.01). CONCLUSIONS: Poor HRQOL does not increase the likelihood of initiating HT, nor is HT use associated with HRQOL improvements. The exception is women reporting frequent symptoms who report improved vitality after initiation. Future studies may employ more frequent HRQOL measures to further discern this trend.

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Hess R, Colvin A, Avis NE, Bromberger JT, Schocken M, Johnston JM, Matthews KA. Menopause. 2008 May-Jun; 15(3):422-8.

Exercise and Fitness

High Intensity Exercise Enhances Capacity to Oxidate Carbohydrates

Training at High Exercise Intensity Promotes Qualitative Adaptations of Mitochondrial Function in Human Skeletal Muscle

Abbreviated Abstract: This study explored mitochondrial capacities to oxidize carbohydrate and fatty acids and functional optimization of mitochondrial respiratory chain complexes in athletes who regularly train at high exercise intensity (ATH, n = 7) compared with sedentary (SED, n = 7). In conclusion, comparison of ATH vs. SED subjects suggests that regular endurance training at high intensity promotes the enhancement of maximal mitochondrial capacities to oxidize carbohydrate rather than fatty acid and induce specific adaptations of the mitochondrial respiratory chain at the level of complex I.

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Daussin FN, Zoll J, Ponsot E, Dufour SP, Doutreleau S, Lonsdorfer E, Ventura-Clapier R, Mettauer B, Piquard F, Geny B, Richard R. J Appl Physiol. 2008 May; 104(5):1436-41. Epub 2008 Feb 21.

Physical Fitness Does Not Affect C-Reactive Protein Levels

Increasing Physical Fitness Does Not Proportionally Decrease Circulating C-Reactive Protein Level in Men with Varying Fitness

Abbreviated Abstract: Several studies have shown that low physical fitness is associated with high levels of C-reactive protein (CRP), a marker of future cardiovascular events. However, whether increasing physical fitness proportionally decreases the circulating CRP level has not been evaluated. We first evaluated the basic relationship between physical fitness, assessed by running velocity, and circulating CRP level along with cardiovascular risk factors in 1065 healthy middle-aged men. Afterward, we examined the association between annual change in fitness and changes in CRP level in 482 subjects who had the same parameters measured 1 year later without any intervention. In the cross-sectional study, physical fitness was significantly correlated with circulating CRP level (r=0.28, P<.0001). This significance still remained after adjustment for other cardiovascular risks (beta=-.12, P=.0004). In conclusion, although physical fitness was significantly associated with circulating CRP level in a cross-sectional study, increasing fitness did not proportionally decrease circulating CRP level. Improving coincidental risks, relieving intensity of exercise-induced muscle damage, or both, in addition to increasing fitness, might be important to effectively reduce CRP level.

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Nakajima K, Kusuhara M, Yonemura A, Ayaori M, Saionji K, Tamai S, Ohsuzu F. Metabolism. 2008 May; 57(5):650-7.

Cardiovascular

The Management of Myocardial Infarction Is The Same for Men and Women

Gender Differences in the Management and Prognosis of Myocardial Infarction Among Patients >/= 65 Years of Age

Abbreviated Abstract: Conflicting evidence exists regarding gender differences in the management and outcomes of myocardial infarctions (MIs). In this study, it was hypothesized that the management and outcomes of MIs would not differ by gender after proper adjustment for age, access to care, MI characteristics, and co-morbidities. Data from a published MI validation study, which sampled 2,200 MI hospitalizations in Medicare beneficiaries with the prescription drug benefit for detailed hospital chart review, were used. Gender differences in the use of MI-related procedures and recommended cardiovascular medications as well as short- and long-term mortality were assessed using multivariate regression. A total of 1,625 patients were identified (80% women) with confirmed MIs for whom complete clinical information was available. Compared with men, women were older and had higher body mass index. Women were more likely to have diabetes, renal dysfunction, and depression, but less likely to have had previous MIs, chronic lung disease, cancer, and to use tobacco. In conclusion, for older patients, the management of MIs did not significantly differ between men and women. Men, especially those aged >/=75 years, however, had worse short- and long-term prognoses compared with women of a similar age. The mortality was highest and the gender effect was more pronounced during the MI hospitalizations.

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Setoguchi S, Solomon DH, Levin R, Winkelmayer WC. Am J Cardiol. 2008 Jun 1;101(11):1531-6. Epub 2008 Mar 26.

Exercise Blood Pressure Predicts Incident Cardiovascular Disease

Exercise Blood Pressure and the Risk of Incident Cardiovascular Disease

Abbreviated Abstract: Exaggerated systolic blood pressure (BP) augmentation with exercise has been associated with impaired endothelial function and cardiovascular risk. However, previous studies were largely restricted to men, did not evaluate diastolic BP, and focused on peak exercise measures, which are influenced by effort and fitness level. The aim of this study was to determine the association of exercise BP responses with risk of incident cardiovascular disease (CVD). BP was assessed during stage 2 of the Bruce protocol and during recovery in 3,045 Framingham Study subjects (mean age 43 years; 53% women). In conclusion, in middle-aged adults, diastolic BP during low-intensity exercise and recovery predicted incident CVD. Our findings support the concept that dynamic BP provides incremental information to BP at rest and suggest that exercise diastolic BP may be a better predictor than exercise systolic BP in this age group.
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Lewis GD, Gona P, Larson MG, Plehn JF, Benjamin EJ, O'Donnell CJ, Levy D, Vasan RS, Wang TJ. Am J Cardiol. 2008 Jun 1;101(11):1614-20. Epub 2008 Mar 28.

Obesity Is Prevalent In Most Racial Groups

The Impact of Obesity on Cardiovascular Disease Risk Factors and Subclinical Vascular Disease: The Multi-Ethnic Study of Atherosclerosis

Abbreviated Abstract: To assess the importance of the obesity epidemic on cardiovascular disease (CVD) risk, we determined the prevalence of obesity and the relationship of obesity to CVD risk factors and subclinical vascular disease. METHODS: The Multi-Ethnic Study of Atherosclerosis is an observational cohort study involving 6814 persons aged 45 to 84 years who were free of clinical CVD at baseline (2000-2002). The study assessed the association between body size and CVD risk factors, medication use, and subclinical vascular disease (coronary artery calcium, carotid artery intimal medial thickness, and left ventricular mass). RESULTS: A large proportion of white, African American, and Hispanic participants were overweight (60% to 85%) and obese (30% to 50%), while fewer Chinese American participants were overweight (33%) or obese (5%). Hypertension and diabetes were more prevalent in obese participants despite a much higher use of antihypertensive and/or antidiabetic medications. Obesity was associated with a greater risk of coronary artery calcium (17%), internal carotid artery intimal medial thickness greater than 80th percentile (32%), common carotid artery intimal medial thickness greater than 80th percentile (45%), and left ventricular mass greater than 80th percentile (2.7-fold greater) compared with normal body size. These associations persisted after adjustment for traditional CVD risk factors. CONCLUSIONS: These data confirm the epidemic of obesity in most but not all racial and ethnic groups. The observed low prevalence of obesity in Chinese American participants indicates that high rates of obesity should not be considered inevitable. These findings may be viewed as indicators of potential future increases in vascular disease burden and health care costs associated with the obesity epidemic.

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Burke GL, Bertoni AG, Shea S, Tracy R, Watson KE, Blumenthal RS, Chung H, Carnethon MR. Arch Intern Med. 2008 May 12; 168(9):928-35

Diabetes

Testosterone Deficiency Common in Men with Diabetes

Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes

Abbreviated Abstract: Low testosterone levels are common in men with type 2 diabetes and may be associated with insulin resistance. OBJECTIVE: We investigated prevalence of testosterone deficiency and the relationship between testosterone and insulin resistance in a large cohort of men with type 2 and type 1 diabetes. DESIGN: The study was a cross-sectional survey of 580 men with type 2 diabetes and 69 men with type 1 diabetes. A subgroup of 262 men with type 2 diabetes was then reassessed after a median of 6 months. RESULTS: Forty-three percent of men with type 2 diabetes had a reduced total testosterone, and 57% had a reduced calculated free testosterone. Only 7% of men with type 1 diabetes had low total testosterone. By contrast, 20.3% of men with type 1 diabetes had low calculated free testosterone, similar to that observed in type 2 diabetes CONCLUSIONS: Testosterone deficiency is common in men with diabetes, regardless of the type. Testosterone levels are partly influenced by insulin resistance, which may represent an important avenue for intervention, whereas the utility of testosterone replacement remains to be established in prospective trials.

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Grossmann M, Thomas MC, Panagiotopoulos S, Sharpe K, Macisaac RJ, Clarke S, Zajac JD, Jerums G. J Clin Endocrinol Metab. 2008 May;93(5):1834-40. Epub 2008 Mar 4.

Insulin-like Growth Factor Binding Protein 1 Are Involved in Insulin-like Activity

The Change in Circulating Insulin-Like Growth Factor in Binding Protein 1 Isoform Pattern During the Course of Oral Glucose Tolerance Test

Abbreviated Abstract: There is a tight connection between insulin-like growth factor binding protein 1 (IGFBP-1) and nutrient/energy supply, suggesting modulation of the short-term insulin-like activity and glucose homeostasis by IGFBP-1. Differential phosphorylation of IGFBP-1 alters its affinity for insulin-like growth factors (IGFs) and its capacity to modulate cellular response. The object of this study was to define the time course of changes in the IGFBP-1 isoform pattern during an oral glucose tolerance test. Our data show that both a change in the total amount of IGFBP-1 and an alteration in the relative amount (ratio) of the specific phosphoforms of IGFBP-1 are part of the mechanism involved in modulation of the insulin-like activity.

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Nedić O, Masnikosa R. Metabolism. 2008 May;57(5):658-61.

Diabetic Patients with a Diabetic Foot are at a Higher Risk for Cardiovascular Disease

Cardiovascular Risk Profile and Morbidity In Subjects Affected by Type 2 Diabetes Mellitus with and without Diabetic Foot

Abbreviated Abstract: Diabetic foot syndrome (DFS) is the most frequent cause of hospitalization of diabetic patients and one of the most economically demanding complications of diabetes. People with diabetes have been shown to have higher mortality than people without diabetes. On this basis, the aim of our study was to evaluate the possible role of diabetic foot as a cardiovascular risk marker in patients with type 2 diabetes mellitus. Diabetic patients with diabetic foot were more likely to have a higher prevalence of cardiovascular risk factors such as hypercholesterolemia, hypertriglyceridemia, hyperuricemia, and microalbuminuria or proteinuria, a higher prevalence of a previous cardiovascular morbidity (coronary artery disease, transient ischemic attack/ischemic stroke, diabetic retinopathy), and a higher prevalence of subclinical cardiovascular disease. Furthermore, diabetic patients with foot ulceration showed, on a 5-year follow-up, a higher incidence of new-onset vascular events (coronary artery disease, transient ischemic attack/ischemic stroke, diabetic retinopathy). At multivariate analysis, duration of diabetes, age, hemoglobin A1c, and DFS maintained a significant association with cardiovascular morbidity; but DFS presence showed the highest hazard ratio.

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Other

Statin Use Has No Effect On Frailty

Statin Use and Incident Frailty in Women Aged 65 Years or Older: Prospective Findings from the Women’s Health Initiative Observational Study

Abbreviated Abstract: Inflammatory biomarkers have shown consistent associations with disability and frailty in older adults. Statin medications may reduce the incidence the frailty because of their anti-inflammatory effects. This study examines associations between current use, duration, and potency of statin medications and incident frailty in initially nonfrail women 65 years old or older. METHODS: The authors conducted a prospective analysis of data from the Women's Health Initiative Observational Study (WHI-OS) conducted at 40 clinical centers in the United States. Eligible women were nonfrail and 65-79 years old at baseline (n = 25,378). Current statin use at baseline was ascertained through direct inspection of medicine containers during clinic visits. RESULTS: Among the 25,378 eligible women, 3453 (13.6%) developed frailty by the 3-year follow-up contact. Current statin use had no association with incident frailty (multivariate-adjusted odds ratio [OR] = 1.00; 95% confidence interval [CI], 0.85-1.16). Duration and potency of statin use were also not significantly associated with incident frailty. Among low potency statin users, longer duration of use was associated with reduced risk of frailty (p for trend =.02). A similar pattern of results was observed when frailty was studied in the absence of intervening, incident cardiovascular events. CONCLUSIONS: Overall, incidence of frailty was similar in current statin users and nonusers.

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LaCroix AZ, Gray SL, Aragaki A, Cochrane BB, Newman AB, Kooperberg CL, Black H, Curb JD, Greenland P, Woods NF; Women's Health Initiative. J Gerontol A Biol Sci Med Sci. 2008 Apr; 63(4):369-75.

Osteoporosis is Prevalent in Turkey

Prevalence of Osteoporosis in Middle Anatolian Population Using Calcaneal Ultrasonography Method

Abbreviated Abstract: There are a few studies on the prevalence of osteoporosis in Turkey. Most of such studies have been performed using classical diagnostic methods. Quantitative calcaneal ultrasonography is a contemporary procedure used in the diagnosis of osteoporosis. OBJECTIVE: The aim of this study is to determine the prevalence of the osteoporosis and risk factors in middle Anatolian population aged more than 40, using quantitative calcaneal ultrasonography. Osteoporosis prevalence increased with increasing ages. The highest prevalence value was determined in the individuals older than 70 years of age. Osteoporosis was more common among women compared to men. Osteoporosis prevalence increased in consistent with a decrease in the amount of milk, yoghurt and cheese consumption. CONCLUSION: Based on current study, it is concluded that osteoporosis is an important health problem. Requiring health education about life styles (activity and nutrition) to avoid and even control osteoporosis.

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Arslantas D, Metintas S, Unsal A, Isikli B, Kalyoncu C, Arslantas A. Maturitas. 2008 Mar 20; 59(3):234-41. Epub 2008 Mar 14.

Glossary

Myocardial Infarction: An acute episode of heart disease marked by the death or damage of heart muscle due to insufficient blood supply to the heart muscle usually as a result of a coronary thrombosis or a coronary occlusion and that is characterized especially by chest pain.

Docosahexaenoic Acid: An omega-3 fatty acid C22H32O2 found especially in fish of cold waters.

C-reactive protein (CRP): A protein produced by the liver that is normally present in trace amounts in the blood serum but is elevated during episodes of acute inflammation (as those associated with neoplastic disease, chronic infection, or coronary artery disease).

Albumin: Any of numerous simple heat-coagulable water-soluble proteins that occur in blood plasma or serum, muscle, the whites of eggs, milk, and other animal substances and in many plant tissues and fluid.

Transthyretin (TTR): A protein component of blood serum that functions especially in the transport of thyroxine.

Vasculature: The disposition or arrangement of blood vessels in an organ or part.

Lipids: Any of various substances that are soluble in nonpolar organic solvents (as chloroform and ether), that with proteins and carbohydrates constitute the principal structural components of living cells, and that include fats, waxes, phospholipids, cerebrosides, and related and derived compounds.

Prolactin (PRL): A protein hormone of the adenohypophysis of the pituitary gland that induces and maintains lactation in the postpartum mammalian female.

Cytoskeletal: The network of protein filaments and microtubules in the cytoplasm that controls cell shape, maintains intracellular organization, and is involved in cell movement.

Apoptosis: A genetically determined process of cell self-destruction that is marked by the fragmentation of nuclear DNA, is activated either by the presence of a stimulus or by the removal of a stimulus or suppressing agent, is a normal physiological process eliminating DNA-damaged, superfluous, or unwanted cells (as immune cells targeted against the self in the development of self-tolerance or larval cells in amphibians undergoing metamorphosis), and when halted (as by genetic mutation) may result in uncontrolled cell growth and tumor formation.

Atherosclerosis: An arteriosclerosis characterized by atheromatous deposits in and fibrosis of the inner layer of the arteries.