Evaluating the Incremental Benefits of Raising HDL-Cholesterol Levels During Lipid Therapy After Adjustment for the Reductions in Other Blood Lipid Levels

Penelitian ini menilai pengaruh HDL-C sebagai target terapi terhadap kejadian kardiovaskuler.

Subyek diambil dari studi Framingham dari tahun 1975 sampai 2003.

Hasil penelitian menunjukkan bahwa HDL-C merupakan faktor risiko independen yang kuat terhadap kejadian kardiovaskuler (hazard ratio 0,79 setiap kenaikan 5mg/dL ; 95% confidence interval, 0.67-0.93). 

Kesimpulan terapi untuk peningkatan HDL-C  adalah hal yang penting untuk mencegah kejadian kardiovaskuler.

Abstract.

Arch Intern Med 169(19):1775-1780, 26 October 2009. © 2009 to the Amercian Medical Association
Evaluating the Incremental Benefits of Raising High-Density Lipoprotein Cholesterol Levels During Lipid Therapy After Adjustment for the Reductions in Other Blood Lipid Levels. Steven A. Grover, Mohammed Kaouache, Lawrence Joseph, Philip Barter, Jean Davignon. 

Background  The role of high-density lipoprotein cholesterol (HDL-C) as a therapeutic target to prevent cardiovascular (CV) events remains unclear. We examined data from the Framingham Offspring Study from 1975 through 2003 to determine whether increases in HDL-C levels after lipid therapy was started were independently associated with a reduction in CV events.

Methods  Using Cox proportional-hazards regression, we evaluated the risk of a CV event associated with changes in blood lipid levels among individuals who started lipid therapy. The independent effect of HDL-C levels on future CV risk (averagefollow-up, 8 years) was estimated after adjustment for changes in low-density lipoprotein cholesterol, plasma triglycerides,and pretreatment blood lipid levels. Potential confounders (eg, smoking status, weight, and the use of β-blockers) werethen added to the model. Interactions between blood lipid levels were also explored.

Results  The change in HDL-C level was a strong independent risk factor for CV events (hazard ratio, 0.79 per 5-mg/dL increase; 95% confidence interval, 0.67-0.93) after adjustment for the other lipid changes associated with treatment. This relationship remained stable across a wide range of patient subgroups and did not appear to be associated with a specific drug class. An important interaction was observed: the lower the pretreatment low-density lipoprotein cholesterol level, the greater the impact of raising the HDL-C.

Conclusions  Raising HDL-C levels with commonly used lipid medications appears to be an important determinant of the benefits associated with lipid therapy. These results support the further evaluation of therapies to raise HDL-C levels to prevent CV events.

Association of the Mediterranean Dietary Pattern With the Incidence of Depression

Diet mediterrania dapat mengurangi risiko depresi karena  diduga berhubungan dengan reaksi inflamasi, vaskuler dan metabolisme.

 

Peneliti dari Spanyol melakukan desain kohort terhadap >10.000 orang dewasa sehat sejak tahun 1999 sampai sekarang.

Setelah median follow-up selama 4,4 tahun ternyata mereka yang paling patuh mengikuti pola diet mediterrania mempunyai risiko lebih rendah untuk terjadinya depresi secara signifikan.

Bahan makanan yang paling berpengaruh adalah buah, kacang2an, rasio MUFA:SAFA, dan polong2an

 

Disimpulkan bahwa diet mediterrania mempunyai fungsi protektif terhadap depresi

 

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Arch Gen Psychiatry 66(10):1090-1098, October 2009 © 2009 to the American Medical Association
Association of the Mediterranean Dietary Pattern With the Incidence of Depression-The Seguimiento Universidad de Navarra/University of Navarra Follow-up (SUN) Cohort. Almudena Sanchez-Villegas, Miguel Delgado-Rodriguez, Alvaro Alonso, et al.

 

Context  Adherence to the Mediterranean dietary pattern (MDP) is thought to reduce inflammatory, vascular, and metabolic processes that may be involved in the risk of clinical depression.

Objective  To assess the association between adherence to the MDP and the incidence of clinical depression.

Design  Prospective study that uses a validated 136-item food frequency questionnaire to assess adherence to the MDP. The MDP score positively weighted the consumption of vegetables, fruit and nuts, cereal, legumes, and fish; the monounsaturated- to saturated-fatty-acids ratio; and moderate alcohol consumption, whereas meat or meat products and whole-fat dairy were negatively weighted.

Setting  A dynamic cohort of university graduates (Seguimiento Universidad de Navarra/University of Navarra Follow-up [SUN] Project).

Participants  A total of 10 094 initially healthy Spanish participants from the SUN Project participated in the study. Recruitment began on December 21, 1999, and is ongoing.

Main Outcome Measure  Participants were classified as having incident depression if they were free of depression and antidepressant medication at baseline and reported a physician-made diagnosis of clinical depression and/or antidepressant medication use during follow-up.

Results  After a median follow-up of 4.4 years, 480 new cases of depression were identified. The multiple adjusted hazard ratios (95% confidence intervals) of depression for the 4 upper successive categories of adherence to the MDP (taking the category of lowest adherence as reference) were 0.74 (0.57-0.98), 0.66 (0.50-0.86), 0.49 (0.36-0.67), and 0.58 (0.44-0.77) (P for trend <.001). Inverse dose-response relationships were found for fruit and nuts, the monounsaturated- to saturated-fatty-acids ratio, and legumes.

Conclusions  Our results suggest a potential protective role of the MDP with regard to the prevention of depressive disorders; additional longitudinal studies and trials are needed to confirm these findings.

Physical Activity, Function, and Longevity Among the Very Old

Penelitian kohort terhadap 1.861 manula berusia >70 tahun membuktikan bahwa melanjutkan atau bahkan memulai aktifitas fisik pada usia lanjut sekalipun akan bermanfaat meningkatkan angka survival dan status fungsional.

 

Arch Intern Med 169(16):1476-1483, 14 September 2009 © 2009 to the American Medical Association
Physical Activity, Function, and Longevity Among the Very Old. Jochanan Stessman, Robert Hammerman-Rozenberg, Aaron Cohen, Eliana Ein- Mor, Jeremy M. Jacobs.

 

Background  Recommendations encouraging physical activity (PA) set no upper age limit, yet evidence supporting the benefits of PA among the very old is sparse. We examined the effects of continuing, increasing, or decreasing PA levels on survival, function, and health status among the very old.

Methods  Mortality data from ages 70 to 88 years and health, comorbidity, and functional status at ages 70, 78, and 85 years were assessed through the Jerusalem Longitudinal Cohort Study (1990-2008). A representative sample of 1861 people born in 1920 and 1921 enrolled in this prospective study, resulting in 17 109 person-years of follow-up for all-cause mortality.

Results  Among physically active vs sedentary participants, respectively, at age 70, the 8-year mortality was 15.2% vs 27.2% (P < .001); at age 78, the 8-year mortality was 26.1% vs 40.8% (P <.001); and at age 85 years, the 3-year mortality was 6.8% vs 24.4% (P < .001). In Cox proportional-hazards models adjusting for mortality risk factors, lower mortality was associated with PA level at ages 70 (hazard ratio, 0.61; 95% confidence interval, 0.38-0.96), 78 (0.69; 0.48-0.98), and 85 (0.42; 0.25-0.68). A significant survival benefit was associated with initiating PA between ages 70 and 78 years (P = .04) and ages 78 and 85 years (P < .001). Participation in higher levels of PA, compared with being sedentary, did not show a dose-dependent association with mortality. The PA level at age 78 was associated with remaining independent while performing activities of daily living at age 85 (odds ratio, 1.92; 95% confidence interval, 1.11-3.33).

Conclusions  Among the very old, not only continuing but also initiating PA was associated with better survival and function. This finding supports the encouragement of PA into advanced old age.