doi: 10.1001/archinte.1996.00440100004001pmid: N/A
This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.
doi: 10.1001/archinte.1996.00440100015002pmid: N/A
Abstract GLUCOCORTICOIDS ARE used for immunosuppressive or anti-inflammatory treatment of a wide range of diseases, including nephrotic syndrome, asthma, rheumatoid arthritis, polymyalgia rheumatica, various vasculitides, atopic dermatitis, and inflammatory bowel disease. Although glucocorticoids have shown beneficial effects on treating these diseases, long-term glucocorticoid treatment may have severe adverse effects; these side effects include osteoporosis and fracturing, diabetes mellitus, dramatic weight gain, accelerated atherosclerosis, hypertension, and decreased muscle mass and strength (steroid-induced myopathy).1 In fact, the Cushing syndrome that is produced by exogenous steroid treatment can, in some instances, be worse than the disease that is being treated. It has been estimated that the prevalence of vertebral fractures in asthmatic patients who receive oral glucocorticoids for at least 1 year is 11% and that 30% to 35% of patients who take oral glucocorticoids for prolonged periods will experience a vertebral fracture.2 In previous studies, oral prednisone (10-25 mg) that was References 1. Cushing's syndrome . In: DeGroot L, Besser H, Burger J, et al, eds. Endocrinology. 3rd ed. Philadelphia, Pa: WB Saunders Co; 1995:1741-1769. 2. Adinoff AD, Hollister JR. Steroid-induced fractures and bone loss in patients with asthma . N Engl J Med. 1983;309:265-268.Crossref 3. Grecu EV, Weinshelbaum A, Simmons R. Effective therapy of glucocorticoid-induced osteoporosis with medroxyprogesterone acetate . Calcif Tissue Int. 1990; 46:294-299.Crossref 4. LoCascio V, Bonucci E, Imbimbo B, et al. Bone loss after glucocorticoid therapy . Calcif Tissue Int. 1984;36:435-438.Crossref 5. Lukert BP, Raisz LG. Glucocorticoid-induced osteoporosis: pathogenesis and management . Rheum Dis Clin North Am. 1994;20:629-651. 6. Odell WD, Heath H III. Osteoporosis: pathophysiology, prevention, diagnosis and treatment . Dis Mon. 1993;39:789-868. 7. Meunier PJ. Is steroid-induced osteoporosis preventable? N Engl J Med. 1993; 328:1781-1782.Crossref 8. Reid IR, France JT, Pybus J, Ibbertson HK. Low plasma testosterone levels in glucocorticoid-treated male asthmatics . BMJ. 1985;291:574.Crossref 9. MacAdams MR, White RH, Chipps BE. Reduction of serum testosterone levels during chronic glucocorticoid therapy . Ann Intern Med. 1986;104:648-651.Crossref 10. Hall GM, Daniels M, Doyle DV, Spector TD. Effect of hormone replacement therapy on bone mass in rheumatoid arthritis patients treated with and without steroids . Arthritis Rheum. 1994;37:1499-1505.Crossref 11. Reid IR, Wattie DJ, Evans MC, Stapleton JP. Testosterone therapy in glucocorticoid-treated men . Arch Intern Med. 1996;156:1173-1177.Crossref 12. Toogood JH, Baskerville J, Jennings B, Lefoe NM, Johansson SA. Bioequivalent doses of budesonide and prednisone in moderate and severe asthma . J Allergy Clin Immunol. 1989;84:688-799.Crossref
doi: 10.1001/archinte.1996.00440100022003pmid: N/A
Abstract THERE IS now incontrovertible evidence that dyslipidemia is fundamental to the atherosclerotic process and that correction of the disorder slows atherogenesis, stabilizes lesions, and reduces the morbidity and mortality of coronary heart disease (CHD).1,2 There is also ample evidence that faulty nutrition, ie, a diet consisting of too much saturated fat and cholesterol, too little fiber, and too many calories for the level of activity, is the chief determinant of blood lipid values in the general population.3 The average serum total cholesterol level of the general population has declined over the years.4 In the Framingham Study cohort it has declined each calendar decade, almost certainly as a result of changes in fat and cholesterol intake.5 Migrants from low to high CHD areas of the world raise their cholesterol level, and along with this, their CHD mortality rate.6 Thus, for the general population, attention to nutrition References 1. National Cholesterol Education Program. Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). Circulation. 1994;89:1333-1445. 2. Pyorala K, DeBacher G, Graham I, Poole-Wilson P, Wood D. Prevention of coronary heart disease in clinical practice: recommendations of the Task Force of the European Society of Cardiology, European Atherosclerosis Society, and European Society of Hypertension. Eur Heart J. 1994;15:1300-1331. 3. LaRosa JC, Hunninghake D, Bush D, et al. The cholesterol facts: a summary of the evidence relating dietary fats, serum cholesterol and coronary heart disease: a joint American Heart Association and the National Heart, Lung and Blood Institute . Circulation. 1990;81:1721-1733.Crossref 4. Johnson CL, Rifkind BM, Sempos CT, et al. Declining serum total cholesterol levels among US adults: the National Health and Nutrition Examination surveys . JAMA. 1993;269:3002-3008.Crossref 5. Kannel WB. Range of serum cholesterol values in the population developing coronary artery disease . Am J Cardiol. 1995;76:69C-77C.Crossref 6. Kagan A, Harris BR, Winkelstein W Jr, et al. Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: demographic, physical, dietary and biochemical characteristics . J Chronic Dis. 1974;27:345-364.Crossref 7. Caggiula AW, Watson JE, Kuller LH, et al. Cholesterol-Lowering Intervention Program: effect of the Step I Diet in community office practices. Arch Intern Med. 1996;156:1205-1213. 8. Keyserling TC, Ammerman AS, Davis CE, Metcalf PA, Simpson RJ. One-year results of a physician-directed treatment program for low income patients with hypercholesterolemia . Circulation. 1993( (suppl) );88:l-385. Abstract. 9. Ims, DG, Kuller LH, Traver ND. Use and outcomes of a cholesterol-lowering intervention for rural elderly subjects . Am J Prev Med. 1993;9:274-281. 10. Hunninghake DB, Stein EA, Dujorne CA, et al. The efficacy of intensive dietary therapy alone or combined with lovastatin in outpatients with hypercholesterolemia . New Engl J Med. 1993;328:1213-1219.Crossref 11. Shepherd J, Cobbe SM, Ford l, et al, for the West of Scotland Study. Prevention of coronary heart disease in men with hypercholesterolemia . New Engl J Med. 1995;333:1301-1307.Crossref 12. Scandinavian Simvastatin Survival Study Group. Randomized trial of cholesterol lowering in 444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S) . Lancet. 1994;344:1383-1389. 13. Anderson KM, Wilson PWF, Odell PM, Kannel WB. An updated coronary risk profile: a statement for health professionals . Circulation. 1991;83:356-362.Crossref
doi: 10.1001/archinte.1996.00440100024004pmid: N/A
This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.
doi: 10.1001/archinte.1996.00440100029005pmid: N/A
Abstract Hypomagnesemia has long been known to be associated with diabetes mellitus. Mather et al1 confirmed the presence of hypomagnesemia in nearly 25% of their diabetic outpatients. Low serum magnesium level has been reported in children with insulin-dependent diabetes2,3 and through the entire spectrum of adult type I and type II diabetics regardless of the type of therapy.4-6 Hypomagnesemia has been correlated with both poor diabetic control7-9 and insulin resistance in nondiabetic elderly patients.10 References 1. Mather HM, Nisbet JA, Burton GH, et al. Hypomagnesemia in diabetes . Clin Chim Acta. 1979; 95:235-242.Crossref 2. Fort P, Lifshitz F. Magnesium status in children with insulin-dependent diabetes mellitus . J Am Coll Nutr. 1986;5:69-78.Crossref 3. Ewald U, Gebre-Medhin M, Turemo T. Hypomagnesemia in diabetic children . Acta Paediatr Scand. 1983;72:367-371.Crossref 4. Paolisso G, Scheen A, D'Onofrio F, Lefebvre P. Magnesium and glucose homeostasis . Diabetologia . 1990;33:2511-2514. 5. Sheehan J. Magnesium deficiency and diabetes mellitus . Magnes Trace Elem. 1991 -1992;10:215-219. 6. Schnack C, Bauer I, Pregant P, et al. Hypomagnesemia in type 2 diabetes mellitus is not corrected by improvement of long-term metabolic control . Diabetologia. 1992;35:77-79.Crossref 7. Pon KK, Ho PWM. Subclinical hyponatremia, hyperkalemia and hypomagnesemia in patients with poorly controlled diabetes mellitus . Diabetes Res Clin Pract. 1989;7:163-167.Crossref 8. Mather HM. Levin GE, Nisbet JA , Hadley LA. Oakley NW. Pilkington TRE. Diurnal profiles of plasma magnesium and blood glucose in diabetes. Diabetologia. 1982;22:180-183. 9. Sjogren A, Floren CH, Nilsson A. Magnesium deficiency in IDDM related to level of glycosylated hemoglobin . Diabetes. 1986;35:459-463.Crossref 10. Paolisso G, Sgambato S, Gambardella A, et al. Daily magnesium supplements improve glucose handling in elderly subjects . Am J Clin Nutr. 1992;55:1161-1167. 11. Ceriello A, Giugliano D, DelloRusso P, Passariello N. Hypomagnesemia in relation to diabetic retinopathy. Diabetes Care. 1982;5:558-559. 12. Wada M, Fujii S, Takemura T, et al. Magnesium levels and diabetic retinopathy . Magnes Bull. 1983; 1:12-14. 13. Whelton PK, Klag MJ. Magnesium and blood pressure: review of the epidemiologic and clinical trial experience . Am J Cardiol. 1989;63:26G-30G.Crossref 14. Nadler J, Malayan S, Luong H, Shaw S, Natarajan R, Rude R. Intracellular free magnesium deficiency plays a key role in increased platelet reactivity in type II diabetes mellitus . Diabetes Care. 1992;15:835-841.Crossref 15. Dzurik R, Stetikova K, Spustova V, Fetkovska N. The role of magnesium deficiency in insulin resistance: an in vitro study . J Hypertens. 1991; 9( (suppl 6) ):S312-S313.Crossref 16. Moles K, McMullen JK. Insulin resistance and hypomagnesemia: a case report . BMJ. 1982; 285:262.Crossref 17. Paolisso G, Pizza G, De Riu S, Marrazzo G, Sgambato S, Varricchio M. Impaired insulin-mediated erythrocyte magnesium accumulation is correlated to impaired insulin-mediated glucose disposal in aged nondiabetic obese patients . Diabetes Metab. 1990;16:328-333. 18. Modan M, Halkin H, Almog S, et al. Hyperinsulinemia: a link between hypertension, obesity and glucose intolerance . J Clin Invest. 1985;75:809-817.Crossref 19. Reaven GM. Role of insulin resistance in human disease . Diabetes. 1988;37:1595-1607.Crossref 20. American Diabetes Association. Magnesium supplementation in the treatment of diabetes. Diabetes Care. 1992;15:1065-1067. 21. McNair P, Christensen MS, Christiansen C, Madsbad S, Transbol I. Renal hypomagnesemia in human diabetes mellitus: its relation to glucose homeostasis . Eur J Clin Invest. 1982;12:81-85.Crossref 22. Garland HO. New experimental data on the relationship between diabetes mellitus and magnesium . Magnes Res. 1992;5:193-202. 23. Shah G, Kirschenbaum M. Renal magnesium wasting associated with therapeutic agents . Miner Electrolyte Metab. 1991;17:58-64. 24. Garland HO, Harris PJ, Morgan TO. Calcium transport in the proximal convoluted tubule and loop of Henle of rats made diabetic with streptozotocin . J Endocrinol. 1991;131:373-380.Crossref 25. Bundy JT, Connito D, Mahoney M, Pontier P. Treatment of idiopathic renal magnesium wasting with amiloride . Am J Nephrol. 1995;15:75-77.Crossref 26. Mavichak V, Wong NLM, Quamme GA, Magil AB, Sutton RAL, Dirks JH. Studies on the pathogenesis of cisplatin-induced hypomagnesemia in rats . Kidney Int. 1985;28:914-921.Crossref 27. Raskin P, Stevenson MRM, Barila DE, Pak CYC. The hypercalcuria of DM: its amelioration with insulin . Clin Endocrinol. 1978;9:329-335.Crossref 28. Grafton G, Baxter MA. The role of magnesium in diabetes mellitus . J Diabetes Complications. 1992;6:143-149.Crossref 29. Durlach J, Altura B, Altura BM. Highlights and summary of the 10th Annual French Colloquium on Magnesium . Magnesium. 1983;2:330-336. 30. Yajnikcs CS, Smith RF, Hockaday TDR, Ward NI. Fasting plasma magnesium concentrations and glucose disposal in diabetes . BMJ. 1984;288:1032-1034.Crossref 31. Alzaida A, Dinneen SF, Moyer TP, Rizza RA. Effects of insulin on plasma magnesium in non-insulin dependent diabetes mellitus: evidence for insulin resistance . J Clin Endocrinol Metab. 1995; 80:1376-1381. 32. Nadler J, Buchanan T, Natarajan R, Antoipillai I, Bergman R, Rude R. Magnesium deficiency produces insulin resistance and increased thromboxane synthesis . Hypertension. 1993;21:1024-1029.Crossref 33. Tonyai S, Motto C, Rayssiguer Y, Heaton FW. Erythrocyte membrane in magnesium deficiency . Am J Nutr. 1985;4:399. Abstract. 34. Ewald U, Tuvemo T. Reduced vascular reactivity in diabetic children and its relation to diabetic control . Acta Paediatr Scand. 1985;74:77-85.Crossref 35. McNair P, Christiansen C, Madsbad S. Hypomagnesemia, a risk factor in diabetic retinopathy. Diabetes. 1978;27:1075-1077. 36. Resnick LM. Cellular calcium and magnesium metabolism in the pathophysiology and treatment of hypertension and related metabolic disorders . Am J Med. 1992;93(suppl 2A):2A11S-2A20S. 37. Arsenian M. Magnesium and cardiovascular disease . Prog Cardiovasc Dis. 1993;35:271-310.Crossref 38. Grafton G, Bunce C, Sheppard M, Brown G, Baxter M. Effect of Mg+ + on Na+ dependent inositol transport . Diabetes. 1992;41:35-39.Crossref 39. Elamin A, Tuvemo T. Magnesium and insulin-dependent diabetes mellitus . Diabetes Res Clin Pract. 1990;10:203-209.Crossref 40. Sjogren A, Floren CH, Nilsson A. Oral administration of magnesium hydroxide to subjects with insulin dependent diabetes mellitus . Magnesium. 1988;7:117-122. 41. Paolisso G, Passariello N, Pizza G, et al. Dietary magnesium supplements improve B-cell response to glucose and arginine in elderly non-insulin dependent diabetic subjects. Acta Endocrinol. 1989;121:16-20. 42. Paolisso G, Sgambato S, Pizza G, Passariello N, Vaccicchio M, D'onofrio F. Improved insulin response and action by chronic magnesium administration in aged NIDDM subjects . Diabetes Care. 1989;12:265-269.Crossref 43. Balon TW, Jasman A, Scott S, Woerner P, Rude R, Nadler J. Dietary magnesium prevents fructose-induced insulin insensitivity in rats. Hypertension. 1994;23(pt 2):1036-1039. 44. Trip MD, Cats VM, Van Capelle FJ, Vreeken J. Platelet hyperactivity and prognosis in survivors of myocardial infarction . N Engl J Med. 1990; 322:1549-1554.Crossref 45. Purvis JR, Cummings DM, Landsman P, et al. Effect of oral magnesium supplementation on selected cardiovascular risk factors in non-insulin dependent diabetics . Arch Fam Med. 1994;3:503-508.Crossref 46. Gullestad L, Midtvedt K, Dolva L, Norseth J, Kjekshus J. The magnesium loading test: reference values in healthy subjects. Scand J Clin Lab Invest. 1994;54:23-31. 47. Gullestad L, Dolva L, Waage A, Falch D, Fagerthun H, Kjekshus J. Magnesium deficiency diagnosed by an intravenous loading test . Scand J Clin Lab Invest. 1992;52:245-253.Crossref 48. Rude R. Magnesium metabolism and deficiency . Endocrinol Metab Clin North Am. 1993; 22:377-395. 49. Martin BJ, Lyon TDB, Walker W, Fell GS. Mononuclear blood cell magnesium in older subjects: evaluation of its use in clinical practice . Ann Clin Biochem. 1993;30:23-27.Crossref 50. Kemp PM, McGrann RG, Sampson WFD. Mononuclear blood cell magnesium . Ann Clin Biochem. 1993;30:507-508.Crossref 51. Nozue T, Kodoma T, Kobayashi A. Improved method for the determination of the magnesium concentration of mononuclear blood cells . Clin Chim Acta. 1991;203:411-412.Crossref 52. Borella P, Ambrosini G, Concari M. Bargellini A. Is magnesium content in erythrocytes suitable for evaluating cation retention after oral physiological supplementation in marginally magnesium-deficient subjects? Magnes Res. 1993;6:149-153. 53. Touyz R, Milne F. A method for determining the total magnesium, calcium, sodium and potassium contents of human platelets . Miner Electrolyte Metab. 1991;17:173-178. 54. Rude R, Stephen A, Nadler J. Determination of red blood cell intracellular free magnesium depletion . Magnes Trace Elem. 1991 -1992;10:117-121. 55. White JW, Campbell RK. Magnesium and diabetes: a review . Ann Pharmacother. 1993;27:775-780. 56. Baker D, Campbell RK. Vitamin and mineral supplementation in patients with diabetes mellitus . Diabetes Educ. 1992;18:420-427.Crossref 57. Campbell RK. Magnesium and diabetes: a clinical concern ? Pract Diabetes. May/June 1987:8-9. 58. Rude R. Magnesium deficiency and diabetes mellitus . Postgrad Med. 1992;92:217-224.
Fink, Arlene;Hays, Ron D.;Moore, Alison A.;Beck, John C.
doi: 10.1001/archinte.1996.00440100038006pmid: N/A
Abstract Demographic trends reveal the elderly to be the fastest growing segment of the population. Physicians can therefore anticipate encountering increasing numbers of older patients with alcohol-related problems. These problems include liver disease, dementia, confusion (masquerading as dementia), peripheral neuropathy, insomnia, late-onset seizure disorder, poor nutrition, incontinence, diarrhea, myopathy, inadequate self-care, macrocytosis, depression, fractures, and adverse reactions to medications. Despite the prevalence of alcohol use in older people, their risks and problems are often unrecognized. We reviewed published literature on the determinants and consequences of alcohol-related problems in persons aged 65 years and older and the usefulness of available screening measures. Thirteen of 25 eligible studies on determinants and consequences met quality criteria and were reviewed. Nine additional studies on screening tests were also evaluated. Determinants include history of alcohol use and abuse, social isolation, and reduced mobility; consequences consist of risks of hip fracture from falls, neoplasms, and psychiatric illness. Currently accessible screening tests focus on high levels of alcoholic beverage use and abuse and dependence. They are not useful in screening for hazardous consumption that may result from relatively low levels of alcohol use alone or in combination with medications, medical illness, or preexisting diminished physical, emotional, or social function. Research is needed on the consequences of lower levels of alcohol consumption on the physical and psychosocial health of older individuals and on methods for distinguishing alcohol-related from age-related problems. Existing screening tests should be expanded or new screening methods developed in anticipation of a growing public health problem. (Arch Intern Med. 1996;156:1150-1156) References 1. Taeuber C. Sixty-five plus in America. In: Current Population Reports. Washington, DC: US Government Printing Office; 1992. Series P-23, No. 178. 2. US Department of Health and Human Services. A Profile of Older Americans: 1994. Washington, DC: American Association of Retired Persons and Administration on Aging; 1994. 3. Hartford JT, Samorajski T. Alcoholism in the geriatric population . J Am Geriatr Soc. 1982;30:18-24. 4. Atkinson RM. Aging and alcohol use disorders: diagnostic issues in the elderly. Int Psychogeriatr. 1990;2:55-72. 5. Jarman CMB, Kellett JM. Alcoholism in the general hospital . BMJ. 1979;2:469-472.Crossref 6. Adams WL, Garry PJ, Rhyne R, Hunt WC, Goodwin JS. Alcohol intake in the healthy elderly: changes with age in a cross-sectional and longitudinal study . J Am Geriatr Soc. 1990;38:211-216. 7. Glynn RJ, Bouchard GR, LoCastro JS, Laird NM. Aging and generational effects on drinking behaviors in men: results from the Normative Aging Study . Am J Public Health. 1985;75:1413-1419.Crossref 8. Institute of Medicine. Broadening the Base of Treatment for Alcohol Problems . Washington, DC: National Academy Press; 1990. 9. Brody JA. Aging and alcohol abuse . J Am Geriatr Soc. 1982;30:123-126. 10. Bailey MD, Haberman PW, Alksne H. The epidemiology of alcoholism in an urban residential area . Q J Stud Alcohol. 1965;26:20-40. 11. Barnes GM. Alcohol use among older persons: findings from a western New York State general population survey . J Am Geriatr Soc. 1979;27:244-250. 12. Saunders WMN, Kershaw PW. Screening tests for alcoholism-findings from a community study . Br J Addict. 1980;75:37-41.Crossref 13. Myers JK, et al. Six-month prevalence of psychiatric disorders in three communities . Arch Gen Psychiatry. 1984;41:959-967.Crossref 14. Kramer M, German PS, Anthony JC, Von Korff M, Skinner EA. Patterns of mental disorders among the elderly residents of eastern Baltimore . J Am Geriatr Soc. 1985;33:236-245. 15. Regier DA, Boyd JH, Burke JD, Rae DS. One-month prevalence of mental disorders in the United States . Arch Gen Psychiatry. 1988;45:977-986.Crossref 16. Busby WJ, Campbell AJ, Borrie MJ, Spears GFS. Alcohol use in a community-based sample of subjects aged 70 years and older . J Am Geriatr Soc. 1988;36:301-305. 17. lliffe S, Haines A, Booroff A, Goldenberg E, Morgan P, Gallivan S. Alcohol consumption by elderly people: a general practice survey. Age Ageing. 1991;20:120-123. 18. Mangion DM, Platt JS, Syam V. Alcohol and acute medical admission of elderly people . Age Ageing. 1991;21:362-367.Crossref 19. Curtis JR, Geller G, Stokes EJ, Levine DM, Moore RD. Characteristics, diagnosis, and treatment of alcoholism in elderly patients . J Am Geriatr Soc. 1989;37:310-316. 20. McCusker J, Cherubin CF, Zimberg S. Prevalence of alcoholism in municipal hospital population . N Y State J Med. 1971;71:751-754. 21. Schuckit MA, Miller PL. Alcoholism in elderly men: a survey of a general medical ward . Am N Y Acad Sci. 1975;275:558-571. 22. Simon A, Epstein LJ, Reynolds L. Alcoholism in the geriatric mentally ill . Geriatrics. 1968;23:125-131. 23. Gaitz CM, Baer PE. Characteristics of elderly persons with alcoholism . Arch Gen Psychiatry. 1971; 24:372-378.Crossref 24. Williams GD, DeBakey SF. Changes in levels of alcohol consumption: United States, 1983-1988 . Br J Addict. 1992;87:643-648.Crossref 25. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders , Third Edition. Washington, DC: American Psychiatric Association; 1987. 26. Adams WL, Yuan Z, Barboriak JJ, Rimm AA. Alcohol-related hospitalizations of elderly people: prevalence and geographic variation in the United States . JAMA. 1993;270:1222-1225.Crossref 27. Adams WL. Magruder-Habib K. Trued S, Broome HL. Alcohol abuse in elderly emergency department patients . J Am Geriatr Soc. 1992;40:1236-1240. 28. Graham K. Identifying and measuring alcohol abuse among the elderly: serious problems with existing instrumentation . J Stud Alcohol. 1986; 47:322-326. 29. Schuckit MA. A clinical review of alcohol, alcoholism, and the elderly patient . J Clin Psychiatry. 1982;43:396-399. 30. Fink A, Yano EM, Goya D. Prenatal programs: what the literature reveals. Obstet Gynecol. 1992; 5:867-872. 31. Powe NR, Turner JA, Maklan NR, Ersek M. Alternative methods for formal literature review and meta-analysis in AHCPR patient outcomes research teams . Med Care. 1994;32:JS22-37. 32. Baker DW, Jones R, Hodges J, Massie BM, Konstam MA, Rose EA. Management of heart failure: the role of revascularization in the treatment of patients with moderate or severe left ventricular systolic dysfunction . JAMA. 1994;272:1528-1534.Crossref 33. Steinberg KK, Smith SJ, Thacker SB, Stroup DF. A meta-analysis of the effect of estrogen replacement therapy on the risk of breast cancer . JAMA. 1991;265:1985-1990.Crossref 34. Bercsi SJ, Brickner PW, Saha DC. Alcohol use and abuse in the frail , homebound elderly: a clinical analysis of 103 persons. Drug Alcohol Depend. 1993;33:139-149. 35. Brennan PL, Moos RH. Life stressors, social resources, and late-life problem drinking . Psychol Aging. 1990;5:314-325.Crossref 36. Bristow MF, Clare AW. Prevalence and characteristics of at-risk drinkers among elderly acute medical in-patients . Br J Addict. 1992;87:291-294.Crossref 37. Christopherson VA, Escher MC, Bainton BR. Reasons for drinking among the elderly in rural Arizona . J Stud Alcohol. 1984;45:417-423. 38. Colsher PL. Wallace RB. Elderly men with histories of heavy drinking: correlates and consequences . J Stud Alcohol. 1990;51:528-535. 39. Felson DT, Kiel DP, Anderson JJ, Kannel WB. Alcohol consumption and hip fractures : The Framingham Study. Am J Epidemiol. 1988;128:1102-1110. 40. Forster LE, Pollow R, Stoller EP. Alcohol use and potential risk for alcohol-related adverse drug reactions among community-based elderly . J Commun Health. 1993:18:225-239. 41. Goldberg RJ, Burchfiel CM, Reed DWM, Wergowske G, Chiu D. A prospective study of the health effects of alcohol consumption in middle-aged and elderly men: The Honolulu Heart Program . Circulation. 1994;89:651-659.Crossref 42. Goodwin JS, Sanchez CJ, Thomas P, Hunt C, Garry PJ, Goodwin JM. Alcohol intake in a healthy elderly population . Am J Public Health. 1987; 77:173-177.Crossref 43. Saunders PA, Copeland JR, Dewey ME, et al. Heavy drinking as a risk factor for depression and dementia in elderly men: finding from the Liverpool longitudinal community study. Br J Psychiatry. 1991;159:213-216. 44. Ewing JA. Detecting alcoholism . JAMA. 1984; 252:1905-1907.Crossref 45. Selzer ML. The Michigan Alcoholism Screening Test: the quest for a new diagnostic instrument . Am J Psychiatry. 1971;127:1653-1658. 46. Pokorney AD, Miller BA, Kaplan HB. The brief MAST: a shortened version of the Michigan Alcoholism Screening Test . Am J Psychiatry. 1972; 129:342-345. 47. Selzer ML, Vinokur A, von Rooijen L. A self-administered short Michigan Alcoholism Screening Test (SMAST) . J Stud Alcohol. 1975;36:117-126. 48. Willenbring ML, Christensen KJ, Spring WD Jr, Rasmussen R. Alcoholism screening in the elderly . J Am Geriatr Soc. 1987;35:864-869. 49. Tucker JA, Gavornik MG, Vuchinich RE, Rudd EJ, Harris CV. Brief report predicting the drinking behavior of older adults from questionnaire measures of alcohol consumption . Addict Behav. 1989;14:655-658.Crossref 50. Werch CE. Quantity-frequency and diary measures of alcohol consumption for elderly drinkers . Int J Addict. 1989;24:859-865. 51. Colsher PL, Wallace RB. Elderly men with histories of heavy drinking: correlates and consequences . J Stud Alcohol. 1990;51:528-535. 52. Moran MB, Naughton BJ, Hughes SL. Screening elderly veterans for alcoholism . J Gen Intern Med. 1990;5:361-364.Crossref 53. Buchsbaum DG, Buchanan RG, Welsh J, Centor RM, Schnoll SH. Screening for drinking disorders in the elderly using the CAGE questionnaire. J Am Geriatr Soc. 1992;40:662-665. 54. Fulop G, Reinhardt J, Strain JJ, Paris B, Miller M, Fillit H. Identification of alcoholism and depression in a geriatric medicine outpatient clinic . J Am Geriatr Soc. 1993;41:737-741. 55. Jones TV, Lindsey BA, Yount P, Soltys R, Farani-Enayat B. Alcoholism screening questionnaires: are they valid in elderly medical outpatients? J Gen Intern Med. 1993;8:674-678.Crossref 56. Chaikelson JS, Arbuckle TY, Lapidus S, Gold DP. Measurement of lifetime alcohol consumption . J Stud Alcohol. 1994;55:133-140. 57. Kroenke K, Pinholt EM. Reducing polypharmacy in the elderly: a controlled trial of physician feedback . J Am Geriatr Soc. 1990;38:32-36. 58. Stuck AE, Beers MH, Steiner A, Arnow HU, Rubenstein LZ, Beck JC. Inappropriate medication use in community-residing older persons . Arch Intern Med. 1994;154:2195-2200.Crossref 59. Atkinson RM, Kofoed LL. Alcohol and drug abuse in old age: a clinical perspective . Subs Alcohol Act Misuse. 1982;3:353-368. 60. Meyers AR, Goldman E, Hingson R, Scotch N, Mangione T. Evidence for cohort or generational differences in the drinking behavior of older adults . Int J Aging Hum Develop. 1981/1982;14:31-45.Crossref 61. Ekerdt DJ, de Labry LO, Glynn RJ, Davis R. Change in drinking behaviors with retirement: findings from the Normative Aging Study. J Stud Alcohol. 1989;50:347-353. 62. Dawson DA, Archer LD. Relative frequency of heavy drinking and the risk of alcohol dependence . Addiction. 1993;88:1209-1218. 63. Blume SB. Women and alcohol: a review . JAMA. 1986;256:1467-1470.Crossref 64. Klatsky AL, Armstrong MA, Friedman GD. Alcohol and mortality . Ann Intern Med. 1992;117:646-654.Crossref 65. de Labry LO, Glynn RJ, Levenson MR, Hermos JA, LoCastro JS, Vokonas PS. Alcohol consumption and mortality in an American male population: recovering the U-shaped curve: findings from the Normative Aging Study . J Stud Alcohol. 1992; 53:25-32. 66. Fuchs CS, Stampfer MJ, Colditz GA, et al. Alcohol consumption and mortality among women . N Engl J Med. 1995;332:1245-1250.Crossref 67. Holbrook TL, Barrett-Connor EA. A prospective study of alcohol consumption and bone mineral density . BMJ. 1993;306:1506-1509.Crossref 68. Barrett DH, Anda RF, Croft JB, Serdula MK, Lane MJ. The association between alcohol use and health behaviors related to the risk of cardiovascular disease: The South Carolina Cardiovascular Disease Prevention Project . J Stud Alcohol. 1995;56:1-15. 69. Beresford TP, Gordis E. Alcoholism and the elderly patient . In: Evans JG, Williams TF, eds. Oxford Textbook of Geriatric Medicine. New York, NY: Oxford University Press Inc; 1992:639-646. 70. Kitchens JM. Does this patient have an alcohol problem? JAMA. 1994;272:1782-1787.Crossref 71. World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines , 10th Revision. Geneva, Switzerland: World Health Organization; 1992. 72. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition. Washington, DC: American Psychiatric Association; 1994. 73. Institute of Medicine. Guidelines for Clinical Practice: From Development to Use . Washington, DC: National Academy Press; 1992. 74. Cahalan D, Cisin IH, Crossley HM. American Drinking Practices: A National Study of Drinking Behavior and Patterns. New Brunswick, NJ: Rutgers Center for Alcohol Studies; 1969. 75. Mehrabian A, Russell JA. A questionnaire measure of habitual alcohol use . Psychol Rep. 1978; 43:803-806.Crossref 76. Cyr MG, Wartman SA. The effectiveness of routine screening questions on the detection of alcoholism . JAMA. 1988;259:51-54.Crossref
Marchioli, Roberto;Marfisi, Rosa Maria;Carinci, Fabrizio;Tognoni, Gianni
doi: 10.1001/archinte.1996.00440100050007pmid: N/A
Abstract Objective: To evaluate, in the comprehensive scenario of "evidence-based" medicine, the transferability of the results of published randomized clinical trials and meta-analyses on cholesterol-lowering interventions to clinical practice. Method: Overview of randomized clinical trials on cholesterol-lowering interventions in the secondary prevention of coronary heart disease. Results: The present overview on secondary prevention of coronary heart disease included 34 trials with cholesterol-lowering interventions in 24 968 individuals. There was a 12.5% mortality in the group that was allocated active intervention and a 17.2% mortality in the control group (risk reduction, 13%; 95% confidence interval, —19% to —6%). Coronary and cardiovascular odds of deaths were significantly reduced. No clear association was found between noncoronary mortality and cholesterol-lowering interventions. Baseline total cholesterol levels had no clear influence on total mortality. Intermediate (10%-20%) and high (>20%) total cholesterol reductions were associated with similar reductions in the odds of death (—23% and —30%, respectively). No conclusion could be reached for patients who were less represented in the studies (ie, women and elderly persons). Patients with more complicated baseline clinical conditions (eg, congestive heart failure) had little nonsignificant benefit from cholesterol-lowering interventions. Conclusions: The effect of cholesterol-lowering interventions at least in the secondary prevention of coronary heart disease can be considered as established, but the transferability of such results to real-life patients remains the critical, unanswered question.(Arch Intern Med. 1996;156:1158-1172) References 1. Sackett KDL. Applying overviews and meta-analyses at the bedside . J Clin Epidemiol. 1995;48:61-66.Crossref 2. Evidence-based Medicine Working Group. Evidence-based medicine: a new approach to teaching the practice of medicine . JAMA. 1992;268:2420-2425.Crossref 3. Peto R, Yusuf S, Collins R. Cholesterol-lowering trial results in their epidemiologic context . Circulation. 1985;72( (suppl 3) ):451. 4. Yusuf S, Furberg CD. Studi su singoli fattori di rischio: controllo attraverso i cambiamenti di stile di vita . In: Olsson AG, ed. Aterosclerosi: biologia e clinica . Turin, Italy: Centro Scientifico Editore; 1989:493-496. 5. Yusuf S, Cutler J. Trials su singoli fattori: studi con farmaci . In: Olsson AG, ed. Aterosclerosi: biologia e clinica . Turin, Italy: Centro Scientifico Editore; 1989:497-502. 6. Yusuf S, Wittes J, Friedman L. Overview of results of randomized clinical trials in heart disease, II: unstable angina, heart failure, primary prevention with aspirin, and risk factor modification . JAMA. 1988;260:2259-2263.Crossref 7. Tyroler HA. Overview of clinical trials of cholesterol lowering in relationship to epidemiologic studies . Am J Med. 1989;87( (suppl 4A) ):14-19.Crossref 8. Rossouw JE, Lewis B, Rifkind BM. The value of lowering cholesterol after myocardial infarction . N Engl J Med. 1990;323:1112-1119.Crossref 9. Rossouw JE, Lewis B, Rifkind BM. Mortality experience in cholesterol-reduction trials . N Engl J Med. 1991;324:923.Crossref 10. Holme I. An analysis of randomized trials evaluating the effect of cholesterol reduction on total mortality and coronary heart disease incidence . Circulation. 1990;82:1916-1924.Crossref 11. Muldoon MF, Manuck SB, Matthews KA. Lowering cholesterol concentrations and mortality: a quantitative review of primary prevention trials . BMJ. 1990;301:309-314.Crossref 12. Muldoon MF, Manuck SB, Matthews KA. Mortality experience in cholesterol-reduction trials . N Engl J Med. 1991;324:922-923.Crossref 13. Silverberg JS, Henry DA. The benefits of reducing cholesterol levels: the need to distinguish primary from secondary prevention, I: a meta-analysis of cholesterol-lowering trials . Med J Aust. 1991;155:665-670. 14. Ravnskov U. Cholesterol lowering trials in coronary heart disease: frequency of citation and outcome . BMJ. 1992;305:15-19.Crossref 15. Schmidt JG. Cholesterol lowering treatment and mortality . BMJ. 1992;305:1226-1227.Crossref 16. Davey Smith G, Pekkanen J. Should there be a moratorium on the use of cholesterol lowering drugs? BMJ. 1992;304:431-434.Crossref 17. MacMahon S. Lowering cholesterol: effects on trauma death, cancer death and total mortality . Aust N Z J Med. 1992;22:580-582.Crossref 18. Lau J, Antman EM, Jimenez-Silva J, Kupelnick B, Mosteller F, Chalmers TC. Cumulative meta-analysis of therapeutic trials for myocardial infarction . N Engl J Med. 1992;327:248-254.Crossref 19. Antman EM, Lau J, Kupelnick B, Mosteller F, Chalmers TC. A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts: treatments for myocardial infarction. JAMA. 1992;268:240-248. 20. Cucherat M, Boissel J-P. Meta-analysis of results from clinical trials on prevention of coronary heart disease by lipid-lowering interventions . Clin Trials Meta-Anal. 1993;28:109-129. 21. Davey Smith G, Song F, Sheldon TA. Cholesterol lowering and mortality: the importance of considering initial level of risk . BMJ. 1993;306:1367-1373.Crossref 22. Atkins D, Psaty BM, Koepsell TD, Longstreth WT, Larson EB. Cholesterol reduction and the risk for stroke in men: a meta-analysis of randomized, controlled trials . Ann Intern Med. 1993;119:136-145.Crossref 23. Holme I. Relation of coronary heart disease incidence and total mortality to plasma cholesterol reduction in randomised trials: use of meta-analysis . Br Heart J. 1993;69( (suppl 1) ):S42-S47.Crossref 24. Cummings P, Psaty BM. The association between cholesterol and death from injury . Ann Intern Med. 1994;120:848-855.Crossref 25. Hong MK, Mintz GS, Popma JJ, et al. Limitations of angiography for analyzing coronary atherosclerosis progression or regression . Ann Intern Med. 1994; 121:348-354.Crossref 26. Law MR, Wald NJ, Thompson SG. By how much and how quickly does reduction in serum cholesterol concentration lower risk of ischaemic heart disease? BMJ. 1994;308:367-373.Crossref 27. Law MR, Thompson SG, Wald NJ. Assessing possible hazards of reducing serum cholesterol . BMJ. 1994;308:373-379.Crossref 28. Paterson RW, Paat JJ, Steele GH, Hathaway SC, Wong JC. Impact of intensive lipid modulation on angiographically defined coronary disease: clinical implications . South Med J. 1994;87:236-242.Crossref 29. Superko RH, Krauss RM. Coronary artery disease regression: convincing evidence for the benefit of aggressive lipoprotein management . Circulation. 1994; 90:1056-1069.Crossref 30. Marchioli R, Prieto JC, Tognoni G. Surrogate end-points: the case of trials on coronary atherosclerotic plaque regression . Clin Trials Meta-Anal. 1994;29:139-176. 31. Hebert PR, Gaziano JM, Hennekens CH. An overview of trials on cholesterol lowering and risk of stroke . Arch Intern Med. 1995;155:50-55.Crossref 32. Denke MA. Cholesterol-lowering diets: a review of the evidence . Arch Intern Med. 1995;155:17-26.Crossref 33. Gould AL, Rossouw JE, Santanello NC, Heiyse JF, Furberg C. Cholesterol reduction yields clinical benefit: a new look at old data . Circulation. 1995;91:2274-2282.Crossref 34. Collins R, Keech A, Peto R, et al. Cholesterol and total mortality: need for larger trials . BMJ. 1992;304:1689.Crossref 35. LaRosa JC. Cholesterol lowering as a treatment for established coronary heart disease . Circulation. 1992;85:1229-1235.Crossref 36. Roberts WC. Atherosclerotic risk factors: are there ten or is there only one? Am J Cardiol. 1989;64:552-554.Crossref 37. Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S) . Lancet. 1994;344:1383-1389. 38. Shepherd J, Cobbe SM, Ford I, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia . N Engl J Med. 1995;333:1301-1307.Crossref 39. Sacks FM, Pfeffer MA, Moyé L, et al. Rationale and design of a secondary prevention trial of lowering normal plasma cholesterol levels after acute myocardial infarction: the Cholesterol and Recurrent Events Trial (CARE) . Am J Cardiol. 1991;68:1436-1446.Crossref 40. Dower M, ed. Heart Prevention Study . SCRIP . (August 27) , 1993:19. 41. GISSI-Prevenzione Investigators. Protocollo dello studio GISSI-Prevenzione: studio di intervento preventivo sulle componenti aterosclerotica e trombotica del rischio post-infarto . G Ital Cardiol. 1993;23:1053-1061. 42. Tognoni G, Franzosi MG, Garattini S, et al. The case of GISSI in changing the attitudes and practice of Italian cardiologists . Stat Med. 1990;9:17-27.Crossref 43. Marchioli R, Di Pasquale A, for the GISSI-Prevenzione Investigators. II quadro di riferimento biochimico, farmacologico, epidemiologico del GISS I- Prevenzione. G Ital Cardiol. 1993;23:933-964. 44. Sacks HS, Berrier J, Reitman D, Ancona-Berk VA, Chalmers TC. Meta-analyses of randomized controlled trials . N Engl J Med. 1987;316:450-455.Crossref 45. Rose GA, Thomson WB, Williams RT. Corn oil in treatment of ischaemic heart disease . BMJ. 1965;1:1531-1533.Crossref 46. Low-fat diet in myocardial infarction: a controlled trial. Lancet. 1965;2:501-504. 47. Leren P. The effect of plasma cholesterol lowering diet in male survivors of myocardial infarction: a controlled clinical trial . Acta Med Scand Suppl. 1966; 466:1-92. 48. Leren P. The Oslo Diet Heart Study: eleven year report . Circulation. 1970;42:935-942.Crossref 49. Ederer F, Leren P, Turpeinen O, Frantz ID Jr. Cancer among men on cholesterol-lowering diets: experience from five clinical trials . Lancet. 1971;2:203-206.Crossref 50. Report of a Research Committee to the Medical Research Council. Controlled trial of soya-bean oil in myocardial infarction . Lancet. 1968;2:693-770. 51. Five year Study by a Group of Physicians of the Newcastle upon Tyne Region. Trial of clofibrate in the treatment of ischaemic heart disease . BMJ. 1971;4:767-775.Crossref 52. Report by a Research Committee of the Scottish Society of Physicians. Ischemic heart disease: a secondary prevention trial using clofibrate . BMJ. 1971; 4:775-784.Crossref 53. Dewar HA, Oliver MF. Trial of clofibrate . BMJ. 1972;1:506.Crossref 54. Acheson J, Hutchinson EC. Controlled trial of clofibrate in cerebral vascular disease . Atherosclerosis. 1972;15:177-183.Crossref 55. Schoch HK. The U.S. Veterans Administration cardiology drug-lipid study: an interim report . Adv Exp Med Biol. 1968;4:405-420. 56. Detre KM, Shaw L. Long-term changes of serum cholesterol with cholesterol-altering drugs in patients with coronary heart disease: Veterans Administration drug-lipid cooperative study . Circulation. 1974;50:998-1005.Crossref 57. The Coronary Drug Project Research Group. The Coronary Drug Poject: initial findings leading to modification of its research protocol . JAMA. 1970; 214:1303-1313.Crossref 58. The Coronary Drug Project Research Group. Clofibrate and niacin in coronary heart disease . JAMA. 1975;231:360-381.Crossref 59. The Coronary Drug Project Research Group. Natural history of myocardial infarction in the Coronary Drug Project: long-term prognostic importance of serum lipid levels . Am J Cardiol. 1978;42:489-498.Crossref 60. Canner PL, Berge KG, Wenger NK, et al. Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin . J Am Coll Cardiol. 1986; 8:1245-1255.Crossref 61. Woodhill JM, Palmer AJ, Leelarthaepin B, McGilchrist C, Blacket RB. Low fat, low cholesterol diet in secondary prevention of coronary heart disease . Adv Exp Med Biol. 1978;109:317-330. 62. Woodhill JM, Palmer AJ, Leelarthaepin B, McGilchrist C, Blacket RB. Low fat, low cholesterol diet in secondary prevention of coronary heart disease . In: Kritchevsky D, Paoletti R, Holmes WL, eds. Drugs, Lipid Metabolism, and Atherosclerosis . New York, NY: Plenum Press; 1978. 63. Dorr AE, Gundersen K, Schneider JC Jr, Spencer TW, Martin WB. Colestipol hydrochloride in hypercholesterolemic patients—effect on serum cholesterol and mortality . J Chronic Dis. 1978;31:5-14.Crossref 64. McCaughan D. The long-term effects of probucol on serum lipid levels . Arch Intern Med. 1981;141:1428-1432.Crossref 65. Brensike JF, Levy RI, Kelsey SF, et al. Effects of therapy with cholestyramine on progression of coronary arteriosclerosis: results of the NHLBI type II coronary intervention study . Circulation. 1984;69:313-324.Crossref 66. Cashin-Hemphill L, Mack WJ, Pogoda JM, Sanmarco ME, Azen SP, Blankenhorn DH. Beneficial effects of colestipol-niacin on coronary atherosclerosis: a 4-year follow-up . JAMA. 1990;264:3013-3017.Crossref 67. Blankenhorn DH, Nessim SA, Johnson RL, Sanmarco ME, Azen SP, Cashin-Hemphill L. Beneficial effects of combined colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass grafts . JAMA. 1987;257:3233-3340.Crossref 68. Carlson LA, Danielson M, Ekberg I, Klintemar B, Rosenhamer G. Reduction of myocardial reinfarction by the combined treatment with clofibrate and nicotinic acid . Atherosclerosis. 1977;28:81-86.Crossref 69. Carlson LA, Rosenhamer G. Reduction of mortality in the Stockholm ischaemic heart disease secondary prevention study by combined treatment with clofibrate and nicotinic acid . Acta Med Scand. 1988;223:405-418.Crossref 70. Burr ML, Fehily AM, Gilbert JF, et al. Effects of changes in fat, fish, and fibre intakes on Death and Myocardial Reinfarction Trial (DART) . Lancet. 1989;2:757-761.Crossref 71. Buchwald H, Varco RL, Matts JP, et al. Effect of partial ileal bypass surgery on mortality and morbidity from coronary heart disease in patient with hypercholesterolemia: report of the Program on the Surgical Control of the Hyperlipidemias (POSCH) . N Engl J Med. 1990;323:946-955.Crossref 72. Buchwald H, Matts JP, Fitch LL, et al. Program on the Surgical Control of the Hyperlipidemias (POSCH): design and methodology . J Clin Epidemiol. 1989; 42:1111-1127.Crossref 73. Buchwald H, Matts JP, Hansen BJ, Long JM, Fitch LL, and the POSCH Group. Program on Surgical Control of the Hyperlipidemias (POSCH): recruitment experience . Control Clin Trials. 1987;8:94S-104S.Crossref 74. Buchwald H, Matts JP, Fitch LL, et al. Changes in sequential coronary arteriograms and subsequent coronary events . JAMA. 1992;268:1429-1433.Crossref 75. Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? the Lifestyle Heart Trial . Lancet. 1990;336:129-133.Crossref 76. Brown G, Albers JJ, Fisher LD, et al. Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B. N Engl J Med. 1990;323:1289-1298. 77. Kane JP, Malloy MJ, Ports TA, Phillips NR, Diehl JC, Havel RJ. Regression of coronary atherosclerosis during treatment of familial hypercholesterolemia with combined drug regimens . JAMA. 1990;264:3007-3012.Crossref 78. Sahni R, Maniet AR, Voci G, Banka VS. Prevention of restenosis by lovastatin after successful coronary angioplasty . Am Heart J. 1991;121:1600-1608.Crossref 79. Fail PS, Sahni RC, Maniet AR, Voci G, Banka VS. The long-term clinical efficacy of lovastatin therapy following successful coronary angioplasty . Clin Res. 1992;40:400. Abstract. 80. Singh RB, Rastogi SS, Verma R, Bolaki L, Singh R. An Indian experiment with nutritional modulation in acute myocardial infarction . Am J Cardiol. 1992; 69:879-885.Crossref 81. Singh RB, Rastogi SS, Verma R, et al. Randomised controlled trial of cardioprotective diet in patients with recent acute myocardial infarction: results of one year follow up . BMJ. 1992;304:1015-1019.Crossref 82. Watts GF, Lewis B, Brunt JNH, et al. Effects on coronary artery disease of lipid-lowering diet, or diet plus cholestyramine, in the St Thomas' Atherosclerosis Regression Study (STARS) . Lancet. 1992;339:563-569.Crossref 83. Frick MH, Heinonen OP, Huttunen JK, Koskinen P, Mänttäri M, Manninen V. Efficacy of gemfibrozil in dyslipidaemic subjects with suspected heart disease: an ancillary study in the Helsinki heart study frame population . Ann Med. 1993;25:41-45.Crossref 84. Blankenhorn DH, Azen SP, Kramsch DM, et al. Coronary angiographic changes with lovastatin therapy: the Monitored Atherosclerosis Regression Study (MARS) . Ann Intern Med. 1993;119:969-976.Crossref 85. Hodia HN, Mack WJ, Azen SP, et al. Triglyceride- and cholesterol-rich lipoproteins have a different effect on mild/moderate and severe lesion progression as assessed by quantitative coronary angiography in a controlled trial of lovastatin . Circulation. 1994;90:42-49.Crossref 86. MAAS Investigators. Effect of simvastatin on coronary atheroma: the Multi-centre Anti-Atheroma Study . Lancet. 1994;344:633-638.Crossref 87. de Lorgeril M, Renaud S, Mamelle N, et al. Mediterranean alpha-linoleic acidrich diet in secondary prevention of coronary heart disease . Lancet. 1994; 343:1454-1459.Crossref 88. Waters D, Higginson L, Gladstone P, et al. Effects of monotherapy with an HMG-CoA reductase inhibitor on the progression of coronary artherosclerosis as assessed by serial quantitative ateriography: the Canadian Coronary Atherosclerosis Intervention trial . Circulation. 1994;89:959-968.Crossref 89. Sacks FM, Pasternack RC, Gibson CM, Rosner B, Stone PH, for the Harvard Atherosclerosis Reversibility Project (HARP) Group. Effect on coronary atherosclerosis of decrease in plasma cholesterol concentration in normocholesterolaemic patients . Lancet. 1994;344:1182-1186.Crossref 90. The Scandinavian Simvastatin Survival Study Group. Design and baseline results of the Scandinavian Simvastatin Survival Study of patients with stable angina and/or previous myocardial infarction . Am J Cardiol. 1993;71:393-400.Crossref 91. Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S) . Lancet. 1994;344:1383-1389. 92. Weintraub WS, Boccuzzi SJ, Klein L, et al. Lack of effect of lovastatin on restenosis after coronary angioplasty . N Engl J Med. 1994;331:1331-1337.Crossref 93. Pitt B, Ellis SG, Mancini J, Rosman HS, McGovern ME, for the PLAC I Investigators. Design and recruitment in the United States of a multicenter quantitative angiographic trial of Pravastatin to Limit Atherosclerosis in the Coronary Arteries (PLAC I) . Am J Cardiol. 1993;72:31-35.Crossref 94. Pitt B, Mancini J, Ellis SG, Rosman HS, McGovern ME, for the PLAC I Investigators. Pravastatin Limitation of Atherosclerosis in the Coronary Arteries (PLAC I) . J Am Coll Cardiol. 1994;A739-A742. 95. Furberg CD, Pitt B, Byington RP, Park J-S, McGovern ME, for the PLAC I and II Investigators. Reduction in coronary events during treatment with prevastatin . Am J Cardiol. 1995;76:60C-63C.Crossref 96. Crouse JR, Byington RP, Bond MG, et al. Pravastatin, lipids, and atherosclerosis in the carotid arteries: design features of a clinical trial with carotid atherosclerosis outcome . Control Clin Trials. 1992;13:495-506.Crossref 97. Furberg CD, Byington RP, Crouse JR, Espeland MA. Pravastatin, lipids, and major coronary events . Am J Cardiol. 1994;73:1133-1134.Crossref 98. Furberg CD, Crouse JR, Byington RP, Bond MG, Espeland MA. PLAC-2: effects of pravastatin on progression of carotid atherosclerosis and clinical events . J Am Coll Cardiol. 1993;21:71. Abstract 716-5. 99. Jukema WJ, Bruschke AVG, van Boven AJ, et al. Effect of lipid-lowering by pravastatin of coronary artery disease in symptomatic men with normal to moderately elevated serum cholesterol levels: the Regression Growth Evaluation Statin Study (REGRESS) . Circulation. 1995;91:2528-2540.Crossref 100. Yusuf S, Peto R, Lewis J, Collins R, Sleight P. Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis. 1985;27:335-371. 101. Berlin JA, Laird NM, Sacks HS, Chalmers TC. A comparison of statistical methods for combining event rates from clinical trials . Stat Med. 1989;8:141-151.Crossref 102. Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Treatment of Early Breast Cancer: Worldwide Evidence 1985-1990. New York, NY: Oxford University Press Inc; 1990;1. 103. DerSimonian R, Laird N. Meta-analysis in clinical trials . Control Clin Trials. 1986;7:177-188.Crossref 104. Laupacis A, Naylor CD, Sackett DL. How should the results of clinical trials be presented to clinicians? Ann Intern Med. 1992;116( (suppl 3) ):A12-A14. 105. Tognoni G, Bonati M. Second-generation clinical pharmacology . Lancet. 1986; 2:1028-1029.Crossref 106. Scandinavian Simvastatin Survival Study Group. Baseline serum cholesterol and treatment effect in the Scandinavian Simvastatin Survival Study (4S) . Lancet. 1995;345:1274-1275.Crossref 107. Schmidt EB, Dyerberg J. Omega-3 fatty acids: current status in cardiovascular medicine . Drugs. 1994;47:405-424.Crossref 108. Steinberg D. Antioxidants in the prevention of human atherosclerosis: summary of the proceedings of a National Heart, Lung, and Blood Institute workshop: September 5-6, 1991, Bethesda , Maryland. Circulation. 1992;85:2337-2344.Crossref 109. Levine GN, Keaney JF, Vita JA. Cholesterol reduction in cardiovascular disease: clinical benefits and possible mechanisms . N Engl J Med. 1994;332:512-521.Crossref 110. Meredith IT, Yeung AC, Weidinger FF, et al. Role of impaired endothelium-dependent vasodilation in ischemic manifestations of coronary heart disease . Circulation. 1993;87( (suppl) ):56-66. 111. Vita JA, Treasure CB, Yeung AC, et al. Patients with evidence of coronary endothelial dysfunction as assessed by acetylcholine infusion demonstrate marked increase is sensitivity to constrictor effects of catecholamines . Circulation. 1992;85:1390-1397.Crossref 112. Quyyumi AA, Cannon RO III, Panza JA, Diodati JG, Epstein SE. Endothelial dysfunction in patients with chest pain and normal coronary arteries . Circulation. 1992;86:1864-1871.Crossref 113. Falk E. Why do plaques rupture? Circulation. 1992;86( (suppl 3) ):30-42. 114. Fuster V, Badimon L, Chesebro JH. The pathogenesis of coronary artery disease and the acute coronary syndromes . N Engl J Med. 1992;326:310-318.Crossref 115. Seiler C, Hess OM, Buechi M, Suter TM, Krayenbuehl HP. Influence of serum cholesterol and other risk factors on vasomotion of angiographically normal coronary arteries . Circulation. 1993;88:2139-2148.Crossref 116. Treasure CB, Klein L, Weintraub WS, et al. Beneficial effects of cholesterol-lowering therapy on the coronary endothelium in patients with coronary artery disease . N Engl J Med. 1995;332:481-487.Crossref 117. Creager MA, Cooke JP, Mendelsohn ME, et al. Impaired vasodilation of forearm resistance vessels in hypercholesterolemic humans . J Clin Invest. 1990; 86:228-234.Crossref 118. Leung W-H, Lau C-P, Wong C-K. Beneficial effect of cholesterol-lowering therapy on coronary endothelium-dependent relaxation in hypercholesterolaemic patients . Lancet. 1993;341:1496-1500.Crossref 119. Egashira K, Hirooka Y, Kai H, et al. Reduction in serum cholesterol with pravastatin improves endothelium-dependent coronary vasomotion in patients with hypercholesterolemia . Circulation. 1994;89:2519-2524.Crossref 120. Chowienczyk PJ, Watts GF, Cockcroft JR, Ritter JM. Impaired endothelium-dependent vasodilation of forearm resistance vessels in hypercholesterolaemia . Lancet. 1992;340:1430-1432.Crossref 121. Sorensen KE, Celermajer DS, Georgakopoulos D, Hatcher G, Betteridge DJ, Deanfield JE. Impairment of endothelium-dependent dilation is an early event in children with familial hypercholesterolemia and is related to the lipoprotein(a) level . J Clin Invest. 1994;93:50-55.Crossref 122. Casino PR, Crescence MK. Cannon RO III, Quyyumi AA, Panza JA. Impaired endothelium-dependent vascular relaxation in patients with hypercholesterolemia extends beyond the muscarinic receptor . Am J Cardiol. 1995;75:40-44.Crossref 123. Gordon JB, Ganz P, Nabel EG, et al. Atherosclerosis influences the vasomotor response for epicardial coronary arteries to exercise . J Clin Invest. 1989; 83:1946-1952.Crossref 124. Gage JE, Hess OM, Murakami T, Grimm J, Krayenbuehl HP. Vasoconstriction of stenotic coronary arteries during dynamic exercise in patients with classic angina pectoris: reversibility by nitroglycerin . Circulation. 1986;73:865-876.Crossref 125. Nabel EG, Ganz P, Gordon JB, Alexander RW, Selwyn AP. Dilation of normal and constriction of atherosclerotic coronary arteries caused by the cold pressor test . Circulation. 1988;77:43-53.Crossref 126. Yeung AC, Vekshtein VI, Krantz DS, et al. The effect of atherosclerosis on the vasomotor response of coronary arteries to mental stress . N Engl J Med. 1991;325:1551-1556.Crossref 127. Okumura K, Yasue H, Matsuyama K, et al. Effect of acetylcholine on the highly stenotic coronary artery: difference between the constrictor response of the infarct-related coronary artery and that of the noninfarct-related artery . J Am Coll Cardiol. 1992;19:752-758.Crossref 128. Egashira K, Inou T, Hirooka Y, et al. Impaired coronary blood flow response to acetylcholine in patients with coronary risk factors and proximal atherosclerotic lesions . J Clin Invest. 1993;91:29-37.Crossref 129. Vita JA, Treasure CB, Nabel EG, et al. Coronary vasomotor response to acetylcholine relates to risk factors for coronary artery disease . Circulation. 1990; 81:491-497.Crossref 130. Harrison DG, Armstrong ML, Freiman PC, Heistad DD. Restoration of endothelium-dependent relaxation by dietary treatment of atherosclerosis . J Clin Invest. 1987;80:1808-1811.Crossref 131. Zeiher AM, Drexler H, Saurbier B, Just H. Endothelium-mediated coronary blood flow modulation in humans: effects of age, atherosclerosis, hypercholesterolemia, and hypertension . J Clin Invest. 1993;92:652-662.Crossref 132. Calver A, Collier J, Vallance P. Inhibition and stimulation of nitric oxide synthesis in the human forearm bed of patients with insulin-dependent diabetes . J Clin Invest. 1992;90:2548-2554.Crossref 133. Lyons TJ. Glycation and oxidation: a role in the pathogenesis of atherosclerosis . Am J Cardiol. 1993;71:26B-31B.Crossref 134. Simon BC, Cunningham LD, Cohen RA. Oxidized low density lipoproteins cause contraction and inhibit endothelium-dependent relaxation in the pig coronary artery . J Clin Invest. 1990;86:75-79.Crossref 135. Anderson TJ, Meredith IT, Yeung AC, Frei B, Selwyn AP, Ganz P. The effect of cholesterol-lowering and anti-oxidant therapy on endothelium-dependent coronary vasomotion . N Engl J Med. 1995;332:488-493.Crossref 136. Plane F, Jacobs M, McManus D, Bruckdorfer KR. Probucol and other antioxidants prevent the inhibition of endothelium-dependent relaxation by low density lipoproteins . Atherosclerosis. 1993;103:73-79.Crossref 137. Fleischhauer FJ, Yan W-D, Fischell TA. Fish oil improves endothelium-dependent coronary vasodilation in heart transplant recipients. J Am Coll Cardiol. 1993;21:982-989. 138. Kromhout D, Bosschieter EB, de Lezenne Coulander C. The inverse relation between fish consumption and 20-year mortality from coronary heart disease . N Engl J Med. 1985;312:1205-1209.Crossref 139. Kromhout D. n-3 Fatty acids and coronary heart disease: epidemiology from Eskimos to western populations . J Intern Med. 1989;225( (suppl 1) ):47-51.Crossref 140. Shekelle RB, Missell LV, Oglesby P, MacMillan-Shryock A, Stamler J. Fish consumption and mortality from coronary heart disease . N Engl J Med. 1985; 313:820.Crossref 141. Norell SE, Ahlbom A, Feychting M, Pedersen NL. Fish consumption and mortality from coronary heart disease . BMJ. 1986:293:426. 142. Dolecek TA, Grandits G. Dietary polyunsaturated fatty acids and mortality in the Multiple Risk Factor Intervention Trial (MRFIT) . World Rev Nutr Diet. 1991; 66:205-216. 143. Ascherio A, Rimm EB, Stampfer MJ, Giovannucci EL, Willett WC. Dietary intake of marine n-3 fatty acids, fish intake, and the risk of coronary disease among men. N Engl J Med. 1995;332:977-982. 144. Katan MB. Fish and heart disease . N Engl J Med. 1995;332:1024-1025Crossref 145. Gey KF, Puska P, Jordan P, Moser UK. Inverse correlation between plasma vitamin E and mortality from ischemic heart disease in cross-cultural epidemiology . Am J Clin Nutr. 1991;53:326S-334S. 146. Stampfer MJ, Hennekens CH, Manson JE, Colditz GA, Rosner B, Willett WC. Vitamin E consumption and the risk of coronary disease in women . N Engl J Med. 1993;328:1444-1449.Crossref 147. Rimm EB, Stampfer MJ, Ascherio A, Giovannucci E, Colditz GA, Willett WC. Vitamin E consumption and the risk of coronary heart disease in men . N Engl J Med. 1993;328:1450-1456.Crossref 148. Burr ML, Fehily AM, Gilbert JF, et al. Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: Diet and Reinfarction Trial (DART) . Lancet. 1989;2:757-761.Crossref 149. Singh RB, Rastogi SS, Verma R, et al. Randomised controlled trial of cardioprotective diet in patients with recent acute myocardial infarction: results of one year follow up . BMJ. 1992;304:1015-1019.Crossref 150. de Lorgeril M, Renaud S, Mamelle N, et al. Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease . Lancet. 1994; 343:1454-1459.Crossref 151. Trevisan M, Krogh V, Freudenheim J, et al. Consumption of olive oil, butter, and vegetable oils and coronary heart disease risk factors . JAMA. 1990;263:688-692.Crossref 152. Lau J, Antman EM, Jimenez-Silva J, Kupelnick B, Mosteller F, Chalmers TC. Cumulative meta-analysis of therapeutic trials for myocardial infarction . N Engl J Med. 1992;327:248-254.Crossref 153. Peto R, Collins R, Gray R. Large-scale randomized evidence: large simple trials and overview of trials . J Clin Epidemiol. 1995;48:23-40.Crossref 154. Shapiro S. Point/counterpoint: meta-analysis of observational studies: metaanalysis/shmeta-analysis . Am J Epidemiol. 1994;140:771-778. 155. Petitti DB. Of babies and bathwater . Am J Epidemiol. 1994;140:779-782. 156. Greenland S. Can meta-analysis be salvaged? Am J Epidemiol. 1994;140: 783-787. 156. Shapiro S. Is there is or is there ain't no baby?: Dr Shapiro replies to Drs Petitti and Greenland . Am J Epidemiol. 1994;140:788-791. 157. Spector TD, Thompson SG. The potential and limitations of meta-analysis . J Epidemiol Community Health. 1991;45:89-92.Crossref 158. Spitzer WO. Meta-meta-analysis: unanswered questions about aggregating data . J Clin Epidemiol. 1991;44:103-107.Crossref 159. Thompson SG, Pocock SJ. Can meta-analyses be trusted? Lancet 1991;338:1127-1130.Crossref 160. Rosendaal FR. The emergence of a new species: the professional meta-analyst . J Clin Epidemiol. 1994;47:1325-1326.Crossref 161. Cook DJ, Guyatt GH. The professional meta-analyst: an evolutionary advantage . J Clin Epidemiol. 1994;47:1327-1329.Crossref 162. Rosendaal FR. The professional meta-analyst: an evolutionary advantage (response) . J Clin Epidemiol. 1994;47:1331-1332.Crossref
Reid, Ian R.;Wattie, Diana J.;Evans, Margaret C.;Stapleton, Joanne P.
doi: 10.1001/archinte.1996.00440100065008pmid: N/A
Abstract Background: Treatment with glucocorticoid drugs is a valuable therapy, but the use of these drugs is associated with major side effects, including osteoporosis, muscle wasting, and obesity. In men who take glucocorticoids, circulating testosterone concentrations are reduced, and this might contribute to the changes in bone and soft-tissue mass. Objective: To assess the effect of testosterone replacement on these above-mentioned parameters in glucocorticoid-treated men. Methods: Fifteen asthmatic men who were receiving long-term glucocorticoid treatment were randomly allocated to receive therapy with testosterone esters (30 mg of proprionate, 60 mg of phenylprionate, 60 mg of isocaproate, and 100 mg of decanoate [Sustanon]) (250-mg/mo intramuscular depot injection) or to act as control subjects during 12 months. After a washout period for those men who were receiving testosterone, the groups were then crossed over and studied for a further 12 months. Bone density and body composition were assessed by dual-energy, x-ray absorptiometry. Paired or unpaired 2-tailed t tested were calculated. Unless otherwise stated, all values are given as mean±SEM. Results: Bone density in the lumbar spine increased 5.0%±1.4% (mean±SEM) (P=.005) during testosterone supplementation, but it did not change during the control period (between-groups difference, P=.05). These changes were accompanied by a decrease in the indexes of bone turnover. There was a gain in body fat mass (2.1±0.06 kg, P=.01) and a loss of lean body mass (1.4±0.5 kg, P=.02) during the control period, with both changes being reversed by testosterone treatment (P<.03). Conclusion: Testosterone treatment reverses the deleterious effects of glucocorticoid drugs on skeletal and soft tissues in men.(Arch Intern Med. 1996;156:1173-1177) References 1. Adinoff AD, Hollister JR. Steroid-induced fractures and bone loss in patients with asthma . N Engl J Med. 1983;309:265-268Crossref 2. Luengo M, Picado C, Del Rio L, Guanabens N, Montserrat JM, Setoain J. Vertebral fractures in steroid dependent asthma and involutional osteoporosis: a comparative study . Thorax. 1991;46:803-806.Crossref 3. Michel BA, Bloch DA, Fries JF. Predictors of fractures in early rheumatoid arthritis . J Rheumatol. 1991:18:804-808. 4. Reid IR. Pathogenesis and treatment of steroid osteoporosis . Clin Endocrinol (Oxf). 1989;30:83-103.Crossref 5. Reid IR, France JT, Pybus J, Ibbertson HK. Low plasma testosterone levels in glucocorticoid-treated male asthmatics . BMJ. 1985;291:574.Crossref 6. MacAdams MR, White RH, Cipps BE. Reduction of serum testosterone levels during chronic glucocorticoid therapy . Ann Intern Med. 1986;104:648-651.Crossref 7. Reid IR, Veale AG, France JT. Glucocorticoid osteoporosis . J Asthma. 1994;31:7-18.Crossref 8. Takeuchi M, Kakushi H, Tohkin M. Androgens directly stimulate mineralization and increase androgen receptors in human osteoblast-like osteosarcoma cells . Biochem Biophys Res Commun. 1994;204:905-911.Crossref 9. Murphy S, Khaw KT, Cassidy A, Compston JE. Sex hormones and bone mineral density in elderly men . Bone Miner. 1993;20:133-140.Crossref 10. Kubler A, Schulz G, Cordes U. Beyer J, Krause U. The influence of testosterone substitution on bone mineral density in patients with Klinefelter's syndrome . Exp Clin Endocrinol. 1992;100:129-132.Crossref 11. Devogelaer JP, Decooman S, Dedeuxchaisnes CN. Low bone mass in hypogonadal males—effect of testosterone substitution therapy: a densitometric study . Maturitas. 1992;15:17-23.Crossref 12. Isaia G, Mussetta M, Pecchio F, Sciolla A, Distefano M, Molinatti GM. Effect of testosterone on bone in hypogonadal males . Maturitas. 1992;15:47-51.Crossref 13. Finkelstein JS, Klibanski A, Nerr RM. Increases in bone density during treatment of men with idiopathic hypogonadotropic hypogonadism . J Clin Endocrinol Metab. 1989;69:776-783.Crossref 14. Young NR, Baker HWG, Liu GD, Seeman E. Body composition and muscle strength in healthy men receiving testosterone enanthate for contraception . J Clin Endocrinol Metab. 1993;77:1028-1032. 15. Tenover JS. Effects of testosterone supplementation in the aging male . J Clin Endocrinol Metab. 1992;75:1092-1098. 16. Forbes GB, Porta CR, Herr BE, Griggs RC. Sequence of changes in body composition induced by testosterone and reversal of changes after drug is stopped . JAMA. 1992;267:397-399.Crossref 17. Reid IR, Ames R, Evans MC, et al. Determinants of total body and regional bone mineral density in normal postmenopausal women—a key role for fat mass . J Clin Endocrinol Metab. 1992;75:45-51. 18. Grey AB, Stapleton JP, Evans MC, Reid IR. The effect of the anti-estrogen tamoxifen on cardiovascular risk factors in normal postmenopausal women . J Clin Endocrinol Metab. 1995;80:3191-3195. 19. Reid IR, King AR, Alexander CJ, Ibbertson HK. Prevention of steroid-induced osteoporosis with (3-amino-1-hydroxypropylidene)-1,1-bisphosphonate (APD) . Lancet. 1988;1:143-146.Crossref 20. Diamond T, McGuigan L, Barbagallo S, Bryant C. Cyclical etidronate plus ergocalciferol prevents glucocorticoid-induced bone loss in postmenopausal women . Am J Med. 1995;98:459-463.Crossref 21. Sambrook P, Birmingham J, Kelly P, et al. Prevention of corticosteroid osteoporosis—a comparison of calcium, calcitriol, and calcitonin . N Engl J Med. 1993;328:1747-1752.Crossref 22. Reid IR, Evans MC, Stapleton J. Lateral spine densitometry is a more sensitive indicator of glucocorticoid-induced bone loss . J Bone Miner Res. 1992;7:1221-1225.Crossref 23. Hobbs CJ, Plymate SR, Rosen CJ, Adler RA. Testosterone administration increases insulin-like growth factor-I levels in normal men . J Clin Endocrinol Metab. 1993;77:776-779. 24. Weissberger AJ, Ho KKY. Activation of the somatotropic axis by testosterone in adult males—evidence for the role of aromatization . J Clin Endocrinol Metab. 1993;76:1407-1412. 25. Arisaka O, Arisaka M, Nakayama Y, Fujiwara S, Yabuta K. Effect of testosterone on bone density and bone metabolism in adolescent male hypogonadism . Metabolism. 1995;44:419-423.Crossref 26. Bellido T, Jilka RL, Boyce BF, et al. Regulation of interleukin-6, osteoclastogenesis, and bone mass by androgens: the role of the androgen receptor . J Clin Invest. 1995;95:2886-2895.Crossref 27. Rebuffe-Scrive M, Marin P, Bjorntorp P. Effect of testosterone on abdominal adipose tissue in men . Int J Obes Relat Metab Disord. 1991;15:791-795. 28. Cigolini M, Smith U. Human adipose tissue in culture, VIII: studies on the insulin-antagonistic effect of glucocorticoids . Metabolism. 1979;28:502-510.Crossref 29. Behre HM, Bohmeyer J, Nieschlag E. Prostate volume in testosterone-treated and untreated hypogonadal men in comparison to age-matched normal controls . Clin Endocrinol (Oxf). 1994;40:341-349.Crossref
Wilt, Timothy J.;Rubins, Hanna Bloomfield;Collins, Dorothea;O'Connor, Theresa Z.;Rutan, Gale H.;Robins, Sander J.
doi: 10.1001/archinte.1996.00440100073009pmid: N/A
Abstract Background: Peripheral atherosclerosis is a strong and independent predictor of mortality even in patients with known coronary heart disease. However, the prevalence, correlates, and potential adverse effects on quality of life associated with combined coronary heart disease and clinically evident cerebrovascular or lower-extremity atherosclerosis are not known. Identification of patients with "diffuse atherosclerosis" may enhance treatment of modifiable risk factors and alter therapeutic strategies. Methods: We conducted a cross-sectional analysis of 2531 men younger than 73 years with coronary heart disease, low-density lipoprotein cholesterol levels of 3.62 mmol/L (140 mg/dL) or less, and high-density lipoprotein cholesterol level of 1.03 mmol/L (40 mg/dL) or less who were participating in Department of Veterans Affairs Cooperative Study 363 (the Veterans Affairs High-Density Lipoprotein Intervention Trial. Baseline demographic, medication, comorbidity, and atherosclerotic risk factor data were assessed by means of a standardized questionnaire. All plasma lipid levels were determined after a 12-hour fast by a central standardized lipid laboratory. Health status was determined by baseline reported symptoms, medical comorbidities, and the Psychological General Well-being Index. Clinically evident diffuse atherosclerosis was defined as a documented history of lower-extremity atherosclerosis or cerebrovascular disease. Results: The mean age of all participants was 63.5 years. The mean plasma lipid values were as follows: total cholesterol, 4,52 mmol/L (174.6 mg/dL); high-density lipoprotein cholesterol, 0.81 mmol/L (31.5 mg/dL); low-density lipoprotein cholesterol, 2.88 mmol/L (111.2 mg/ dL); and triglycerides, 1.81 mmol/L (160.6 mg/dL). Diffuse atherosclerosis was present in 525 (21%). Lower-extremity atherosclerosis was reported in 10%, while cerebrovascular disease was present in 13%. After controlling for other variables, the following factors were associated with the presence of diffuse atherosclerosis: increased age, being unmarried, being retired, having less than a high school education, increased alcohol use, hypertension, cigarette smoking, and diabetes. There was no association between lipid levels and the presence of diffuse atherosclerosis. After adjustment for age, race, and comorbidities, men with diffuse disease still had a reduced quality of life compared with men without diffuse atherosclerosis, as defined by having a greater number of clinical symptoms, lower psychological well-being scores, and more advanced or complicated coronary heart disease. Conclusions: Clinically evident diffuse atherosclerosis is common in men with coronary heart disease and low levels of high-density lipoprotein cholesterol. Because diffuse atherosclerosis is associated with a reduced quality of life and several modifiable risk factors, early detection and aggressive risk factor intervention appear justified.(Arch Intern Med. 1996;156:1181-1188) References 1. Eagle KA, Rihal CS, Foster ED, Mickerl MC, Gersh BJ, for the CASS Investigators. Long-term survival in patients with coronary artery disease: importance of peripheral vascular disease . J Am Coll Cardiol. 1994;23:1091-1095.Crossref 2. Criqui MH, Langer RD, Fronek A, et al. Mortality over a period of 10 years in patients with peripheral arterial disease . N Engl J Med. 1992;326:381-386.Crossref 3. Pardaens J, Lesaffre E, Willems JL, DeGeest H. Multivariant survival analysis for the assessment of prognostic factors and risk categories after recovery from acute myocardial infarction: the Belgian situation . Am J Epidemiol. 1985; 122:805-819. 4. Varnauskas E, the European Coronary Surgery Study Group. Survival, myocardial infarction, and employment status in a prospective randomized study of coronary bypass surgery . Circulation. 1985;72(suppl V):V-90-V-101. 5. Smith SD, Shipley MJ, Rose G. Intermittent claudication, heart disease risk factors and mortality: the Whitehall study . Circulation. 1990;82:1925-1931.Crossref 6. Newman AB, Siscovick DS, Manolio TA, et al. Ankle-arm index as a marker of atherosclerosis in the Cardiovascular Health Study . Circulation. 1993;88:837-845.Crossref 7. Vogt MT, Cauley JA, Newman AB, Kuller LH, Hulley SB. Decreased ankle/arm blood pressure index and mortality in elderly women . JAMA. 1993;270:465-469.Crossref 8. Rubins HB, Robins SJ, Iwane MK, et al. Rationale and design for the Department of Veterans Affairs Lipoprotein Cholesterol Intervention Trial (HIT) for secondary prevention of coronary artery disease in men with low high-density lipoprotein cholesterol and desirable low-density cholesterol . Am J Cardiol. 1993; 71:45-52.Crossref 9. Friedewald WT, Levy RI, Frederickson DS. Estimation of the concentrations of low-density lipoprotein cholesterol in plasma without use of the preparative ultracentrifuge . Clin Chem. 1972;18:499-508. 10. Dupuy HJ. The Psychological General Well-being (PGWB) Index . In: Wenger NK, Mattson ME, Furberg CD, Elinson CD, eds. Assessment of Quality of Life in Clinical Trials of Cardiovascular Therapies . United States:Le Jacq Publishing; 1984:170-183. 11. Ware JE, Johnston SA, Davies-Avery A, et al. Conceptualization and Measurement of Health for Adults in the Health Insurance Study, Vol 3: Mental Health . Santa Monica, Calif: RAND Corp; 1979. R-1987/3-HEW. 12. Wilt TJ, Davis BR, Meyers DG, Rouleau J-L, Sacks FM. Prevalence and correlates of symptomatic peripheral atherosclerosis in individuals with coronary heart disease and cholesterol levels less than 240 mg/dL: baseline results from the Cholesterol and Recurrent Events (CARE) Study. Angiology. In press. 13. Kuller L, Borhani N, Furberg C, et al. Prevalence of subclinical atherosclerosis and cardiovascular disease and association with risk factors in the Cardiovascular Health Study . Am J Epidemiol. 1994;139:1164-1179. 14. Tanaka H, Nishino M, Ishida M, Fukunaga R, Sueyoshi K. Progression of carotid atherosclerosis in Japanese patients with coronary artery disease . Stroke. 1992;23:946-951.Crossref 15. Rubens J, Espeland MA, Ryu J, et al. Individual variation in susceptibility to extracranial carotid atherosclerosis . Arteriosclerosis. 1988;9:389-397.Crossref 16. NASCET Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis . N Engl J Med. 1991;325:445-453.Crossref 17. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis . JAMA. 1995;273:1421-1428.Crossref 18. Hobson RW, Weiss DG, Fields WS, et al. Efficacy of carotid endarterectomy for asymptomatic carotid stenosis . N Engl Med. 1993;328:221-227.Crossref 19. PDAY Research Group. Relationship of atherosclerosis in young men to serum lipoprotein cholesterol concentrations and smoking: a preliminary report from the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group . JAMA. 1990;264:3018-3024.Crossref 20. Laustiola KE. Atherothrombotic mechanisms in smoking . J Intern Med. 1991; 230:469-470.Crossref 21. Tell GS, Howard G, McKinney WM. Risk factors for site specific extracranial carotid artery plaque distribution as measured by B-mode ultrasound . J Clin Epidemiol. 1989;42:551-559.Crossref 22. Ingall TJ, Homer D, Baker HL, Kottke BA, O'Fallon M, Whisnant JP. Predictors of intracranial carotid artery atherosclerosis: duration of cigarette smoking and hypertension are more powerful than serum lipid levels . Arch Neurol. 1991; 48:687-691.Crossref 23. Atkins D, Psaty BM, Koepsell TD, Longstreth WT, Larson EB. Cholesterol reduction and the risk for stroke in men: a meta-analysis of randomized, controlled trials . Ann Intern Med. 1993;110:136-145.Crossref 24. Hebert PR, Gaziano M, Hennekens CH. An overview of trials of cholesterol lowering and risk of stroke . Arch Intern Med. 1995;155:50-55.Crossref 25. Fowkes FGR, Housley E, Riemersma RA, et al. Smoking, lipids, glucose intolerance and blood pressure as risk factors for peripheral atherosclerosis compared with ischemic heart Edinburgh Artery Study . Am J Epidemiol. 1992;135:331-340. 26. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Summary of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II) . JAMA. 1993; 269:3015-3023.Crossref 27. Rubins HB, Schectman G, Wilt TJ, Iwane MK. Distribution of lipid phenotypes in community-living men with coronary artery disease: high prevalence of isolated low levels of high-density lipoprotein cholesterol . Arch Intern Med. 1992; 152:2412-2416.Crossref 28. Rubins HB, Robins SJ, Collins D, et al. Lipid profiles in 8,500 men with coronary artery disease . Am J Cardiol. 1995;75:1195-1201.Crossref 29. Coroni-Huntley J, LaCroiz AZ, Havkuj RJ. Race and sex differentials in the impact of hypertension in the United States: the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study . Arch Intern Med. 1989; 149:780-788Crossref
Abdelhamid, Saleh;Müller-Lobeck, Heinrich;Pahl, Stefan;Remberger, Klaus;Bönhof, Joerg-A.;Walb, Dieter;Röckel, Arnold
doi: 10.1001/archinte.1996.00440100086010pmid: N/A
Abstract Background: Primary aldosteronism (PA) is caused by an adrenal aldosterone-producing tumor (A-APT) or adrenal hyperplasia. An extra-adrenal APT (E-APT) as a cause of PA has been reported in 5 cases. Autopsy studies show a high incidence of ectopic adrenocortical tissue. We did a prospective study of the prevalence of A-APTs and E-APTs and the biochemical features of E-APTs in patients with PA. Methods: Hypertensive patients (N=3900) referred to our unit were screened for PA by measuring renin activity, urinary aldosterone-18-glucuronide, tetrahydroaldoster one, and 18-hydroxycorticosterone (18-OH-B). Primary aldosteronism was found in 257 cases. The differentiation between A-APTs and adrenal hyperplasia was based on the results of postural response of renin, plasma aldosterone, 18-OH-B, computed tomography, isotope scanning, or adrenal venous aldosterone. Ultrasound examination of the abdomen was used to screen for E-APT. Results: The cause of PA was bilateral adrenal hyperplasia in 101 cases, unilateral adrenal hyperplasia in 2, an A-APT in 146, and an E-APT in 1. The site of aldosterone production was uncertain in 7 patients who had normal adrenal glands on computed tomography but refused to undergo isotopic scanning and adrenal venous catheterization. Ultrasound examination disclosed normal retroperitoneum in 4 of the 7 cases but could not rule out E-APT in 3 cases. The biochemical features of the patient with the E-APT were similar to classic A-APT, with low renin, high aldosterone, and high 18-OH-B values without appropriate response to posture or to short-term volume expansion. The excision of the E-APT in the right kidney resulted in normalization of blood pressure and renin, aldosterone, and 18-OH-B levels. Conclusion: Although E-APT is rare, it should be considered in the interests of specific therapy for PA because aldosterone-secreting malignant ovarian tumors also have been reported.(Arch Intern Med. 1996;156:1190-1195) References 1. Conn JW. Primary aldosteronism, a new clinical syndrome . J Lab Clin Med. 1955;45:3-17. 2. Young WF Jr, Hogan MJ, Klee GG, Grant CS, van Heerden JA. Primary aldosteronism: diagnosis and treatment . Mayo Clin Proc. 1990;65:96-110.Crossref 3. Ehrlich EN, Dominguez OV, Samuels LT, Lynch D, Oberhelman H, Warner NE. Aldosteronism and precocious puberty due to an ovarian androblastoma (Sertolicell tumor) . J Clin Endocrinol Metab. 1963;23:358-367.Crossref 4. Todesco S, Terribile V, Borsatti A, Mantero F. Primary aldosteronism due to a malignant ovarian tumor . J Clin Endocrinol Metab. 1975;41:809-819.Crossref 5. Jackson B, Valentine R, Wagner G. Primary aldosteronism due to a malignant ovarian tumor . Aust N Z J Med. 1986;16:69-71.Crossref 6. Kulkarni JN, Mistry RC, Kamat MR, Chinoy R, Lotriuar RG. Case report: autonomous aldosterone-secreting ovarian tumor . Gynecol Oncol. 1990;37:284-289.Crossref 7. Flanagan MJ, McDonald JH. Heterotopic adrenocortical adenoma producing primary aldosteronism . J Urol. 1967;98:133-139. 8. Apitz K. Die Geschwülste und Gewebsmissbildungen der Nierenrinde, die intrarenalen Nebenniereninseln . Virchows Arch. 1944;311:285-305. 9. Graham LS. Celiac accessory adrenal glands . Cancer. 1953;6:149-152.Crossref 10. Dahl EV, Bahn RC. Aberrrant adrenal cortical tissue near the testis in human infants . Am J Pathol. 1982;40:587-598. 11. Whalen RK, Althausen AF, Daniels GH. Extra adrenal pheochromocytoma . J Urol. 1992;147:1-10. 12. Kirendall WM, Hammond JJ, Thomas JC, Overturf ML, Zama A. Prazosin and clonidine for moderately severe hypertension . JAMA. 1976;240:2553-2556.Crossref 13. Kem DC, Weinberger MH, Mayes DM, Nugent CA. Saline suppression of plasma aldosterone in hypertension . Arch Intern Med. 1971;128:380-386.Crossref 14. Connolly TM, Vecsei P, Haack D, Kohl KH, Abdelhamid S, Ammenti A. Aldosterone diagnosis in hypertension: comparative evaluation of radioimmunoassays for urinary aldosterone and 18-OH-corticosterone. Klin Wochenschr. 1978; 56( (suppl 1) ):173-181. 15. Kohl KH, Vecsei P, Abdelhamid S. Radioimmunoassay of tetrahydroaldosterone (Th-Ald) in human urine . Acta Endocrinol (Copenh). 1978;87:596-608. 16. Vecsei P, Abdelhamid S, Bubel P, et al. Radioimmunologic methods in aldosterone diagnosis . In: Kaufmann W, Wambach G, Helber A, Meurer KA, eds. Mineralocorticoids and Hypertension . New York, NY: Springer-Verlag NY Inc; 1983:62-77. 17. Gross MD, Shapiro B, Grekin RJ, et al. Scintigraphic localization of adrenal lesions in primary aldosteronism . Am J Med. 1984;77:839-844.Crossref 18. Schröder S , Niendorf A, Achilles E, et al. Immunocytochemical differential diagnosis of adrenocortical neoplasms using the monoclonal antibody D11. Virchows Arch. 1990;417:89-96. 19. Hedinger C. Beidseitige Hodentumoren und kongenitales adrenogenitales Syndrom: Leydig-Zellen oder Nebennierenrindengewebe? Schweiz Z Pathol. 1954; 17:743-750. 20. Glenn JF, Boyce WH. Adrenogenitalism with testicular adrenal rests simulating interstitial cell tumor . J Urol. 1963;89:456-463. 21. Hamwi GJ, Gwinup G, Mostow JH, Besch PK. Activation of testicular adrenal rest tissue by prolonged excessive ACTH production . J Clin Endocrinol Metab. 1963;23:861-869.Crossref 22. Poutasse EF, Higgins CHC. Surgery of the adrenal gland for Cushing's syndrome . J Urol. 1953;70:129-136. 23. Conn JW, Knopf RF, Nesbit RM. Clinical characteristics of primary aldosteronism from an analysis of 145 cases . Am J Surg. 1964;107:159-172.Crossref 24. Pardes JG, Auh YH, Kneeland JB, et al. The oblique coronal view in sonography of the retroperitoneum . AJR Am J Roentgenol. 1985;144:1241-1247.Crossref 25. Yeh HC. Adrenal gland and nonrenal retroperitoneum . Urol Radiol. 1987;9:127-140.Crossref 26. Jackson FI, Lalani Z. Ultrasound in the diagnosis of lymphoma: a review . J Clin Ultrasound. 1989;17:145-171.Crossref 27. Teilum G. Special Tumors of Ovary and Testis and Related Extragonadal Lesions . Copenhagen, Denmark: Munksgaard International Publishers Ltd; 1972: 79-105, 178-205. 28. Yamakita N, Yasuda K, Miura K. Ultrasonography in the diagnosis of aldosterone-producing adenoma: is it useful? Intern Med. 1992;31:589-592.Crossref 29. Yeh HC. Sonography of the adrenal glands: normal glands and small masses . AJR Am J Roentgenol. 1980;135:1167-1177.Crossref 30. Levine E, Huntrakoon M, Wetzel LH. Small renal neoplasms: clinical, pathological, and imaging features . AJR Am J Roentgenol. 1989;153:69-73.Crossref
Showing 1 to 10 of 17 Articles