Bisher AKIL, MD

Archive for April 13th, 2009|Daily archive page


It is never too late to start.

In General Health on April 13, 2009 at 2:46 pm

Does increasing physical activity in middle age lead to longer life?
In this prospective population-based study, Swedish investigators examined the effects of changes in physical activity and of smoking cessation among 2205 men (age, 50 at study enrollment in 1970–1973).
After 35 years of follow-up, absolute mortality rates for men with low (sedentary), medium, and high (3 hours of active recreational sports or heavy gardening weekly) levels of physical activity were 27.1, 23.6, and 18.4 per 1000 person-years, respectively. During the first 10 years of follow-up, men who boosted their physical activity from low or medium levels to high levels exhibited significantly higher mortality than did men who sustained high baseline levels of physical activity (hazard ratio, 1.70). However, after 10 years of follow-up, men who increased their physical activity to high levels showed the same mortality rate as men who sustained high levels of activity. Furthermore, mortality was halved in sedentary men who increased their physical activity to high levels compared with rates in men who remained sedentary (HR, 0.51). Similar results were found for men who increased their physical activity from medium to high levels. These rate reductions were comparable to those observed with smoking cessation (HR, 0.64). Ref: Byberg L et al. Total mortality after changes in leisure time physical activity in 50 year old men: 35 year follow-up of population based cohort. BMJ 2009 Mar 5; 338:b688. FROM JOURNAL WATCH. Comments: Smoking remains the most crucial modifier of longevity, but exercise is up there _ BA


How much Aleve is safe?

In General Health on April 13, 2009 at 2:37 pm

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed but carry both gastrointestinal (GI) and cardiovascular (CV) risks. Multiple guidelines offer recommendations for mitigating the GI risks associated with NSAIDs (e.g., bleeding), but strategies for simultaneously dealing with the GI and CV risks of these drugs have not been published. To bridge this gap, the Canadian Association of Gastroenterology convened a panel of 21 physician-experts to develop evidence-based recommendations for long-term (>4 weeks) NSAID use.
After considering the strength of relevant evidence in the literature, the panel voted on a series of questions regarding NSAID use. Their answers were used to develop an algorithm to guide the use of NSAIDs in different GI and CV risks. Patients with high CV risk were assumed to be taking low-dose aspirin. The panel’s consensus document included the following recommendations:
1. Patients with low GI and low CV risks should receive a traditional NSAID.
2. Patients with low GI and high CV risks should receive naproxen (Aleve).
3. Patients with high GI and low CV risks should receive a cyclooxygenase-2 inhibitor (Celebrex) plus a proton-pump inhibitor (such as Prilosec, Prevacid, or Protonix).
4. Patients with high GI and high CV risks should receive a careful assessment to prioritize risks.
NSAIDs should be prescribed at the lowest effective dose and for the shortest possible duration. Ref:Rostom A et al. Canadian consensus guidelines on long-term nonsteroidal anti-inflammatory drug therapy and the need for gastroprotection: Benefits versus risks. Aliment Pharmacol Ther 2009 Mar 1; 29:481. FROM JOURNAL WATCH.
Comments: Studies are still needed to validate these guidelines that are mainly based on personal experience more than clinical data; but this is a start _BA