In brief

Coffee and type 2 diabetes risk
Men who drink four or more cups of coffee (M0.95L) per day have a 23 per cent lower risk of type-2 diabetes compared with those who almost never drink it, according to a study of 12,204 non-diabetic middle-aged subjects. When the analysis used a combination of self-reported physician-diagnosed diabetes, diabetes treatment, and fasting or non-fasting blood glucose test, there was no significant risk reduction in women.
However, when self-reported diabetes or treatment alone were used, a stronger, significant inverse association between coffee drinking and diabetes was seen in men and women.
Paynter NP, Yeh HC, Voutilainen S et al. Am J Epidemiol 2006; 164(11): 1075-84

Heart tsar clarifies lipid targets
Clinicians should continue to aim for total and LDL cholesterol targets of 5mmol/L and 3mmol/L respectively, and not those stated in JBS-2, according to a statement from the national director for heart disease and stroke Professor Roger Boyle.
Professor Boyle has clarified that national policy remains based on the NSF for CHD targets and any update will only occur through NICE, which is not due to publish guidance on lipid management until December 2007.
Meanwhile, updated hyperlipidaemia guidelines from PRODIGY say NSF targets should be regarded as a minimum, and JBS-2, while more aspirational, should be the desired aim.
www.doh.gov.uk; www.prodigy.nhs.uk

Prescribing for kidney disease
Prescribing information for clinicians treating patients with kidney disease is too vague, according to Drug & Therapeutics Bulletin. It highlights the fact that many people with chronic kidney disease are elderly and taking several drugs. The effectiveness of certain drugs is altered by impaired renal function, while others can increase the risk of renal damage.
Therefore, health professionals need practical information on whether or how to use drugs that can cause, or are altered by, kidney disease. Product information that simply advises ‘use with caution’ is not enough, the article concludes.
Drug Ther Bull 2006; 44(12): 89-96

Relative efficacy of diabetes monotherapy
Researchers have compared glibenclamide, metformin and rosiglitazone as initial monotherapy in 4,360 type-2 diabetes patients treated for a median four years. They found the cumulative incidence of monotherapy failure at five years was 34 per cent for glibenclamide, 21 per cent for metformin and
15 per cent for rosiglitazone.
Glibenclamide was associated with a lower risk of cardiovascular events than metformin or rosiglitazone. Rosiglitazone was associated with more weight gain and oedema than glibenclamide or metformin, but with fewer GI events than metformin and less hypoglycaemia than glibenclamide.
Kahn SE, Haffner SM, Heise MA et al. N Engl J Med 2006; 355(23): 2427-43

Lifestyle change can be maintained
Lifestyle interventions for people at high risk of type-2 diabetes can produce changes that are maintained even after lifestyle counselling ends, according to a study in Finland.
Researchers assigned 172 men and 350 women, who were overweight, middle-aged and had impaired glucose tolerance, to intensive lifestyle intervention or a control group. After a median four years of active intervention, those still free of diabetes were followed up for a further median three years. During the total seven years of follow-up, intervention reduced diabetes risk by 43 per cent; even during post-intervention follow-up alone, diabetes risk was reduced by 36 per cent.
Lindstrom J, Ilanne-Parikka P, Peltonen M et al. Lancet 2006; 368: 1673-9

Treating anaemia in chronic kidney disease
Two new trials have examined whether treating anaemia in chronic kidney disease (CKD) patients who do not yet require transplant reduces the risk of cardiovascular events or provides any other benefit for the patient.
A three-year study of 603 patients with an eGFR of 15–35ml/ min/1.73m2 and mild to moderate anaemia found that early, complete correction of anaemia did not reduce the risk of cardiovascular events. A second study of 1,432 CKD patients found that achieving a target haemoglobin of 13.5g per decilitre compared with 11.3g per decilitre was associated with more events (MI, hospitalisation for heart failure, death) and no improvement in quality of life.
An accompanying editorial concludes that these collective results suggest clinicians should be cautious when aiming for full correction of anaemia in patients with CKD.
Drueke TB, Locatelli F, Clyne N et al. N Engl J Med 2006; 355(20): 2071-84.
Singh AK, Szczech L, Tang KL et al. N Engl J Med 2006; 355(20): 2085-98

Improving cardiovascular risk assessment
Researchers at the University of Dundee say that conventional cardiovascular risk scores fail to target social gradients in disease, and have developed their own risk score in collaboration with the Scottish Intercollegiate Guidelines Network .
The ASSIGN risk score was developed using health data gathered from 13,000 people in Scotland, aged 30 to 74 years, over a period of 10–20 years. It includes deprivation and family history, which the authors say helps to take account of ethnic susceptibility, as well as classic risk factors, such as smoking. Woodward M, Brindle P, Tunstall-Pedoe H. Heart 2006; doi:10.1136/hrt.2006.108167

Low carbohydrate diets and CHD risk
A study in the US has found no evidence to suggest that diets lower in carbohydrate and higher in protein and fat increase the risk of CHD.
Researchers evaluated data on 82,802 women involved in the Nurses’ Health Study who had completed a validated food frequency questionnaire. During the 20-year follow-up period, there were 1,994 new cases of CHD.
A low carbohydrate diet was not associated with increased risk of CHD, but a high glycaemic load almost doubled the risk. Furthermore, the researchers note that when vegetable sources of fat and protein are chosen, low carbohydrate diets may moderately reduce the risk of CHD.
Halton TL, Willett WC, Liu S et al. N Engl J Med 2006; 355(19): 1991-2002


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