Mengurangi konsumsi garam akan mencegah stroke dan serangan jantung

Mengurangi konsumsi garam akan mencegah stroke dan serangan jantung, sehingga dapat menurunkan biaya pemeliharaan kesehatan.

Annals of Internal Medicine, vol. 152 no. 8 481-7

Abstract

Background: Sodium consumption raises blood pressure, increasing the risk for heart attack and stroke. Several countries, including the United States, are considering strategies to decrease population sodium intake.

Objective: To assess the cost-effectiveness of 2 population strategies to reduce sodium intake: government collaboration with food manufacturers to voluntarily cut sodium in processed foods, modeled on the United Kingdom experience, and a sodium tax.

Design: A Markov model was constructed with 4 health states: well, acute myocardial infarction (MI), acute stroke, and history of MI or stroke.

Data Sources: Medical Panel Expenditure Survey (2006), Framingham Heart Study (1980 to 2003), Dietary Approaches to Stop Hypertension trial, and other published data.

Target Population: U.S. adults aged 40 to 85 years.

Time Horizon: Lifetime.

Perspective: Societal.

Outcome Measures: Incremental costs (2008 U.S. dollars), quality-adjusted life-years (QALYs), and MIs and strokes averted.

Results of Base-Case Analysis: Collaboration with industry that decreases mean population sodium intake by 9.5% averts 513 885 strokes and 480 358 MIs over the lifetime of adults aged 40 to 85 years who are alive today compared with the status quo, increasing QALYs by 2.1 million and saving $32.1 billion in medical costs. A tax on sodium that decreases population sodium intake by 6% increases QALYs by 1.3 million and saves $22.4 billion over the same period.

Results of Sensitivity Analysis: Results are sensitive to the assumption that consumers have no disutility with modest reductions in sodium intake.

Limitation: Efforts to reduce population sodium intake could result in other dietary changes that are difficult to predict.

Conclusion: Strategies to reduce sodium intake on a population level in the United States are likely to substantially reduce stroke and MI incidence, which would save billions of dollars in medical expenses.

Kombinasi terapi lipid tidak efektif

Penelitian ini membuktikan bahwa terapi dislipidemia dengan kombinasi statin dan fenofibrat tidak efektif

N Engl J Med 362(17):1563-1574, 29 April 2010 © 2010 to the Massachusetts Medical Society
Effects of Combination Lipid Therapy in Type 2 Diabetes Mellitus-The ACCORD Study Group. Henry N. Ginsberg, Marshall B. Elam, Laura C. Lovato, et al. 

ABSTRACT

Background We investigated whether combination therapy with a statin plus a fibrate, as compared with statin monotherapy, would reduce the risk of cardiovascular disease in patients with type 2 diabetes mellitus who were at high risk for cardiovascular disease.

Methods We randomly assigned 5518 patients with type 2 diabetes who were being treated with open-label simvastatin to receive either masked fenofibrate or placebo. The primary outcome was the first occurrence of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. The mean follow-up was 4.7 years.

Results The annual rate of the primary outcome was 2.2% in the fenofibrate group and 2.4% in the placebo group (hazard ratio in the fenofibrate group, 0.92; 95% confidence interval [CI], 0.79 to 1.08; P=0.32). There were also no significant differences between the two study groups with respect to any secondary outcome.Annual rates of death were 1.5% in the fenofibrate group and 1.6% in the placebo group (hazard ratio, 0.91; 95% CI, 0.75 to 1.10; P=0.33). Prespecified subgroup analyses suggested heterogeneity in treatment effect according to sex, with a benefit for men and possible harm for women (P=0.01 for interaction), and a possible interaction according to lipid subgroup, with a possible benefit for patients with both a high baseline triglyceridelevel and a low baseline level of high-density lipoprotein cholesterol (P=0.057 for interaction).

Conclusions The combination of fenofibrate and simvastatin did not reduce the rate of fatal cardiovascular events, nonfatal myocardial infarction, or nonfatal stroke, as compared with simvastatin alone. These results do not support the routine use of combination therapy with fenofibrate and simvastatin to reduce cardiovascular risk in the majority of high-risk patients with type 2 diabetes.

Gula menyebabkan dislipidemia

Asupan karbohidrat diketahui berhubungan dengan dislipidemia. Dislipidemia akan meningkatkan risiko kardiovaskuler.

Penambahan gula dalam makanan atau minuman juga berhubungan dengan dislipidemia.

Abstrak

JAMA 303(15):1490-1497, 21 April 2010 © 2010 American Medical Association Caloric Sweetener Consumption and Dyslipidemia Among US Adults. Jean A. Welsh, Andrea Sharma, Jerome L. Abramson, Viola Vaccarino, Cathleen Gillespie, Miriam B. Vos.

Context Dietary carbohydrates have been associated with dyslipidemia, a lipid profile known to increase cardiovasculardisease risk. Added sugars (caloric sweeteners used as ingredients in processed or prepared foods) are an increasing and potentially modifiable component in the US diet. No known studies have examined the association between the consumption of added sugars and lipid measures.

Objective To assess the association between consumption of added sugars and blood lipid levels in US adults.

Design, Setting, and Participants Cross-sectional study among US adults (n = 6113) from the National Health and Nutrition Examination Survey (NHANES) 1999-2006. Respondents were grouped by intake of added sugars using limits specified in dietary recommendations (<> 5%-<10%, src="http://jama.ama-assn.org/math/ge.gif" alt="≥" border="0">25% of total calories). Linear regression was used to estimate adjusted mean lipid levels. Logistic regression was used to determine adjusted odds ratios of dyslipidemia. Interactions between added sugars and sex were evaluated.

Main Outcome Measures Adjusted mean high-density lipoprotein cholesterol (HDL-C), geometric mean triglycerides, and mean low-density lipoprotein cholesterol (LDL-C) levels and adjusted odds ratios of dyslipidemia, including low HDL-C levels (<40 mg/dL for men; <50> (150 mg/dL), high LDL-C levels (130 mg/dL), or high ratio of triglycerides to HDL-C (>3.8). Results were weighted to be representative of the US population.

Results A mean of 15.8% of consumed calories was from added sugars. Among participants consuming less than 5%, 5% to less than 10%, 10% to less than 17.5%, 17.5% to less than 25%, and 25% or greater of total energy as added sugars, adjusted mean HDL-C levels were, respectively, 58.7, 57.5, 53.7, 51.0, and 47.7 mg/dL (P < .001 for linear trend), geometric mean triglyceride levels were 105, 102, 111, 113, and 114 mg/dL (P < .001 for linear trend), and LDL-C levels modified by sex were 116, 115, 118, 121, and 123 mg/dL among women (P = .047 for linear trend). There were no significant trends in LDL-C levels among men. Among higher consumers (10% added sugars) the odds of low HDL-C levels were 50% to more than 300% greatercompared with the reference group (<5%>

Conclusion In this study, there was a statistically significant correlation between dietary added sugars and blood lipid levels among US adults.