ACE Inhibitors Reduce Albuminuria Better Than ARBs in Patients With Type 2 Diabetes

June 7, 2011 -- Angiotensin-converting enzyme (ACE) inhibitors reduce albuminuria better than angiotensin receptor blockers (ARBs) in patients with type 2 diabetes, researchers said here on June 5 at the 93rd Annual Meeting of the Endocrine Society (ENDO)

Previous studies have shown that ACE inhibitors and ARBs improve the surrogate markers for and reduce cardiovascular disease, renal disease, and stroke. In fact, most of the studies have shown no major difference between the 2 treatments in reducing cardiovascular and renal end points.

However, no study has directly compared ACE inhibitors with ARBs as a class effect in patients with type 2 diabetes with respect to overall mortality and morbidity.

Nasreen A. Al-Sayed, MD, Department of Endocrinology and Metabolism, Cleveland Clinic Foundation, Cleveland, Ohio, and colleagues reviewed electronic medical records from the Cleveland Clinic Health System (1998-2006) and identified 12,353 patients on ACE inhibitors and 4,138 patients on ARBs. All patients were aged 18 years and older with type 2 diabetes.

There were no significant differences in overall survival rates between patients taking ACE inhibitors and those taking ARBs (P =.12) and no significant differences in coronary artery disease events (P =.991).

When the 2 groups were compared for renal events, the model was divided into creatinine doubling and albuminuria. Concerning creatinine doubling, ARBs increased the risk compared with ACE inhibitors, but the difference was only marginally significant (P =.097). Patients who received ARBs had a higher rate of albuminuria than patients who received ACE inhibitors -- a statistically significant difference (P =.012).

“This is a striking finding,” said Dr. Al-Sayed. “Our study is one of the first that has compared these agents as a class in type 2 diabetics, and suggests that ACE inhibitors may be better to prevent renal disease than ARBs in these patients.”

“This study also shows that these agents may be effective in preventing renal disease early in the course of the disease -- prior to the development of any clinically significant albuminuria,” he said.

[Presentation title: ACE Inhibitors Reduce Albuminuria More Than ARBS in Type 2 Diabetics. Abstract 616]

France Suspends Use of Medicines Containing Pioglitazone

SAINT DENIS, France -- June 9, 2011 --

The French Health Products Safety Agency (Afssaps) has today decided to suspend the use of medicines containing pioglitazone (Actos and Competact), on the advice of the Committee of Authorisation Market and the National Commission Pharmacovigilance.

The decision was based on a review of preclinical, clinical, epidemiological, and pharmacovigilance data showing a potential increased risk of bladder cancer among patients with diabetes who were treated with pioglitazone.

The review included 155,535 patients aged 40 to 79 years with diabetes who were exposed to medicines containing pioglitazone and 1,335,525 patients with diabetes who were not exposed to pioglitazone-containing medicines.

The Afssaps recommends that patients currently taking medicines containing pioglitazone consult their physician to adjust their diabetes treatment.

Physicians should not prescribe more medicines containing pioglitazone.

The French Agency recommends that any serious and/or unexpected adverse events should be reported to the regional centres of pharmacovigilance.

The European Medicines Agency’s (EMA) Committee for Medicinal Products for Human Use (CHMP) started a European review of pioglitazone-containing medicines in March 2011 to investigate the signal of a possible increased risk of bladder cancer with pioglitazone.

The CHMP is currently reviewing all relevant data, including data from pharmacoepidemiological studies, non-clinical and clinical data, post-marketing reports of bladder cancer, and published data to assess their impact on the balance of benefits and risks of these medicines.

The Committee will now also assess the results of the French study and its potential impact on the use of these medicines across the whole EU. The CHMP will discuss this issue at their next meeting on June 20 and recommend appropriate actions as necessary. While this review is ongoing the CHMP is not recommending any changes to the use of pioglitazone-containing medicines.

SOURCE: French Health Products Safety Agency and European Medicines Agency

Estudios “Pequeños”: ¿Cuál es la Importancia del Tamaño en los Estudios Clínicos?

Medwave. Año XI, No. 6, Junio 2011Autor: Miguel Araujo Alonso
Filiación: Hospital de Los Andes, Medwave
Correspondencia: miguel.araujo@medwave.cl
Fecha de Aceptación: 26 de mayo, 2011
Citación: Araujo M. Estudios “Pequeños”: ¿Cuál es la Importancia del Tamaño en los Estudios Clínicos? Medwave 2011;11(06)

Los estudios con bajo número de pacientes suelen ser tratados con desdén por los médicos clínicos. Muchas veces son los propios investigadores los que adoptan esta actitud, y se desisten de enviarlos a publicación, por considerar que su escaso tamaño muestral les resta importancia e interés. En Medwave hemos sostenido que daremos cabida a estudios pequeños, y para fundamentarlo proponemos aquí a los lectores una mirada más integral del tema, que responda a la pregunta que sirve de título a la editorial.

Artículo completo: http://www.mednet.cl/link.cgi/Medwave/Perspectivas/Editorial/5060

El Uso de Probióticos en Algunas Enfermedades Gastrointestinales

Artículo de Revisión ClínicaMedwave. Año XI, No. 6, Junio 2011.


Autor: Daniel Cisternas
Filiación: Pontificia Universidad Catolica de Chile
Fecha de Aceptación: 25 de abril, 2011
Citación: Cisternas D. El Uso de Probióticos en Algunas Enfermedades Gastrointestinales. Medwave 2011;11(06).
Resumen [+]

Resumen

Los probióticos incluyen bacterias muy distintas entre sí: algunas son Gram(+) y otras Gram(-); algunas se adhieren a la mucosa y otras habitan en el lumen. Por esta razón, sus acciones son muy distintas y no es posible extrapolar el beneficio de una cepa en particular a otra. Existen múltiples probióticos disponibles. Sin embargo, son pocos los que verdaderamente han demostrado un beneficio claro en la salud humana. En este artículo se describen las dificultades y posibilidades de los estudios realizados acerca de los efectos de los probióticos en diversas afecciones gastrointestinales, analizando la posibilidad de indicación de estos productos en ellas.

Artículo completo: http://www.mednet.cl/link.cgi/Medwave/Revisiones/RevisionClinica/5051

A cuidar los pies...

Una persona promedio camina el equivalente a darle 4 vueltas a la Tierra durante su vida...

Increíble !!!

Urgente !!!!

Alguien tiene un link para bajar el libro: Clínica y Terapéutica en la Nutrición del Adulto. Daniel De Girolami y Carlos González Infantino ????



Gracias

Salt Study Discounts Link to Hypertension

By Michael Smith, North American Correspondent, MedPage Today

Published: May 03, 2011
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner


In a study that seems likely to re-energize the debate over dietary salt, European researchers found that the changes in the amount of sodium excreted in the urine were related to changes in systolic blood pressure.

But they were not linked to diastolic pressure or the risk of developing hypertension, according to Jan Staessen, MD, PhD, of the University of Leuven in Leuven, Belgium, and colleagues.

And levels of urinary sodium excretion were inversely related to the risk of dying of cardiovascular causes, Staessen and colleagues reported in the May 4 issue of the Journal of the American Medical Association

Artículo completo:  http://www.medpagetoday.com/Cardiology/Hypertension/26258