Bisher AKIL, MD

Archive for June, 2012|Monthly archive page

Elevated Serum Uric Acid Predicts Metabolic Syndrome in Adolescents

In General Health, Heart on June 20, 2012 at 8:59 pm

Elevated uric acid (UA) is one of a number of clinical abnormalities associated with the metabolic syndrome in adults and children. To examine this association in adolescents, researchers followed 613 randomly selected male adolescents (age range, 10–15 years) from a health screening center in Taiwan for a mean of 2.7 years. Baseline UA, waist circumference, blood pressure (BP), body-mass index (BMI), fasting plasma glucose, and cholesterol levels were measured at baseline and follow-up. Adolescents with metabolic syndrome, type 1 diabetes, hypertension, or hyperlipidemia at baseline were excluded. Adolescents were divided into quartiles according to UA levels, ranging from lowest (mean, 5.2 mg/dL) to highest (mean, 8.9 mg/dL). Nineteen adolescents (3.1%) developed metabolic syndrome as defined by the International Diabetes Federation consensus criteria (>3 of the following: abdominal obesity, triglycerides 150 mg/dL, high-density lipoprotein cholesterol <40 mg/dL, hypertension, and fasting plasma glucose 100 mg/dL). Age, waist circumference, BMI, BP, high-density lipoprotein cholesterol, and triglycerides were significantly associated with baseline UA. Risk for developing metabolic syndrome was significantly greater in adolescents in the highest UA quartile than in those in the lowest quartile (odds ratio, 6.39). The positive predictive value of a baseline UA value of 7.6 mg/dL for developing metabolic syndrome was 79% and the negative predictive value was 94%. Higher UA, waste circumference, and BP were independently predictive of metabolic syndrome at follow-up. Conclusion: Male adolescents with the highest uric acid levels at baseline were 6 times more likely to develop metabolic syndrome after 3 years

 Comments: small but interesting data. The positive predictive value is somewhat low but was strong. This is another marker in this disease _ BA


  1. Wang J-Y et al. Predictive value of serum uric acid levels for the diagnosis of metabolic syndrome in adolescents. J Pediatr 2012 May 11
  2. Journal Watch

Metabolic Syndrome: Metabolic syndrome is a name for a group of risk factors that occur together and increase the risk for coronary artery disease, stroke, and type 2 diabetes.

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low dose aspirin and risk of bleeding

In General Health, Heart on June 20, 2012 at 5:09 pm

Low-dose aspirin use lowers risk for recurrent adverse cardiovascular (CV) events in patients with known CV disease. Its benefit for primary prevention of CV events, especially in low-risk patients (those with 10-year risk <10%), is less clear given the risk for complications, particularly major bleeding. In this Italian study, researchers used a population-based database to identify 186,425 patients (mean age, 69) who took low-dose aspirin (81-83 mg) daily for at least 75 days and matched them to the same number of control patients who had the same bleeding propensity and did not use aspirin. During median follow-up of 5.7 years, 6907 episodes of major bleeding requiring hospitalization in aspirin and control patients occurred; about two thirds of bleeds were gastrointestinal, and one third were intracranial. The incidence rate was 5.58 events per 1000 person-years in aspirin users and 3.60 for nonusers, an excess of 2 per 1000 person-years.

Editorial: This is an observational study, and other factors could not be accounted for, these factors could change the outcome / conclusion of this study. Nevertheless, these are important data. An editorial that accompanied this study in JAMA,  puts these risks into perspective with the calculation that, for 10,000 patients without known cardiovascular (CV) disease followed for 1 year, aspirin would prevent about seven (7) major CV events and would cause four (4) major bleeding events. Not a big benefit! Other data have shown different results, , in 10,000 patients with known CV disease, aspirin use would prevent about 250 major CV events and would cause about 40 major bleeding events.

CITATION(S): 1. De Berardis G et al. Association of aspirin use with major bleeding in patients with and without diabetes. JAMA 2012 Jun 6; 307:2286.

2. Siller-Matula JM. Hemorrhagic complications associated with aspirin: An underestimated hazard in clinical practice? JAMA2012 Jun 6; 307:2318.

3. Journal Watch & Thomas L. Schwenk, MD


Let them eat choclate.

In General Health on June 1, 2012 at 6:28 pm

Dark chocolate may be a cost effective — and palatable — option to reduce cardiovascular risk in high-risk patients, according to a new study.
To construct their model, Australian researchers used data from meta-analyses that showed dark chocolate consumption reduced systolic blood pressure by 3.2 mm Hg and LDL cholesterol by 0.15 mmol/L (roughly 6 mg/dL). The model included 2000 people with hypertension and metabolic syndrome who were free of cardiovascular disease.They calculated that over a decade, regular dark chocolate consumption could prevent 70 nonfatal cardiovascular events and 15 cardiovascular-related deaths per 10,000 population treated. The strategy would be cost effective if $42 was spent per person per year on a dark chocolate prevention strategy (e.g., advertising, educational campaigns, or chocolate subsidies). The strategy would still be cost effective with only 80% compliance. The authors conclude: “Chocolate benefits from being by and large a pleasant, and hence sustainable, treatment option. Evidence to date suggests that the chocolate would need to be dark and of at least 60-70% cocoa, or formulated to be enriched with polyphenols.” This paper published in British Medical Journal (  BMJ 2012;344:e3657   ) comes after another study showing the benefit of dark chocolate in blood pressure control. In a randomized, investigator-blinded trial, German researchers evaluated whether low doses of polyphenol-rich dark chocolate offer benefits. Forty-four adults (mean age, 64) with untreated pre- or stage 1 hypertension (mean blood pressure [BP], 147/87) received daily supplements of either dark chocolate (6.3 g — about the weight of 1.5 Hershey’s Kisses) or polyphenol-free white chocolate. Participants had no other cardiovascular or metabolic disease and maintained their usual diet and physical activity. At 18 weeks, mean systolic BP declined by 2.9 mm Hg and diastolic BP by 1.9 mm Hg in the intervention subjects, with no change in control subjects. The BP reductions were associated with a significant increase in S-nitrosoglutathione, a marker of nitric oxide activity. No significant changes were noted in weight, cholesterol profile, or other metabolic parameters.( Taubert D et al. Effects of low habitual cocoa intake on blood pressure and bioactive nitric oxide: A randomized controlled trial. JAMA 2007 Jul 4; 298:49-60.)

Comments: these remain small studies and large trials might be needed; in the meantime a little dark chocolate might be healthy treat_BA

Appeared in Physician’s First Watch