Risk of major cardiac malformations associated with paroxetine use during the first trimester of pregnancy

Posted on January 15, 2016 by Maurice Preter MD

The risk of major cardiac malformations associated with paroxetine use during the first trimester of pregnancy: A systematic review and meta-analysis

 

 

http://onlinelibrary.wiley.com/doi/10.1111/bcp.12849/abstract

  1. Anick Bérard1,2,*,
  2. Noha Iessa1,2,
  3. Sonia Chaabane1,2,
  4. Flory T. Muanda1,2,
  5. Takoua Boukhris1,2 and
  6. Jin-Ping Zhao1,2

DOI: 10.1111/bcp.12849

Article has an altmetric score of 190

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Author InformationPublication History

  1. This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/bcp.12849.

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Keywords:

  • Paroxetine;
  • pregnancy;
  • major malformations;
  • cardiac malformations;
  • meta-analysis

Aims

The aim of this study was to perform an up-to-date meta-analysis on the risk of cardiac malformations associated with gestational exposure to paroxetine, taking into account indication, study design, and reference category.

Method

A systematic review of studies published between 1966 and November 2015 was conducted using EMBASE and MEDLINE. Studies reporting major malformations with first trimester exposure to paroxetine were included. Potentially relevant articles were assessed and relevant data extracted to calculate risk estimates. Outcomes included any major malformations, and major cardiac malformations. Pooled odds ratios and 95% confidence intervals were calculated using random-effects models.

Results

Twenty-three studies were included. Compared to non-exposure to paroxetine, first trimester use of paroxetine was associated with an increased risk of any major congenital malformations combined (pooled OR 1.23, 95% CI 1.10, 1.38; n=15 studies); major cardiac malformations (pooled OR 1.28, 95% CI 1.11, 1.47; n=18 studies), specifically bulbus cordis anomalies and anomalies of cardiac septal closure (pooled OR 1.42, 95% CI 1.07, 1.89; n=8 studies), atrial septal defects (pooled OR 2.38, 95% CI 1.14, 4.97; n=4 studies), and right ventricular outflow track defect (pooled OR 2.29, 95% CI 1.06, 4.93; n=4 studies). Although the estimates varied depending on the comparator group, study design and malformation detection period, a trend towards increased risk was observed.

Conclusions

Paroxetine use during the first trimester of pregnancy is associated with an increased risk of any major congenital malformations and cardiac malformations. The increase in risk is not dependent on the study method or population.

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Stress resilience and subsequent risk of type 2 diabetes in 1.5 million young men

Posted on January 15, 2016 by Maurice Preter MD

 

 

http://link.springer.com/article/10.1007/s00125-015-3846-7

  • Casey Crump 
  • , Jan Sundquist
  • , Marilyn A. Winkleby
  • , Kristina Sundquist

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Abstract

Aims/hypothesis

Psychosocial stress in adulthood is associated with a higher risk of type 2 diabetes, possibly mediated by behavioural and physiological factors. However, it is unknown whether low stress resilience earlier in life is related to subsequent development of type 2 diabetes. We examined whether low stress resilience in late adolescence is associated with an increased risk of type 2 diabetes in adulthood.

Methods

We conducted a national cohort study of all 1,534,425 military conscripts in Sweden during 1969–1997 (97–98% of all 18-year-old men nationwide each year) without prior diagnosis of diabetes, who underwent standardised psychological assessment for stress resilience (on a scale of 1–9) and were followed up for type 2 diabetes identified from outpatient and inpatient diagnoses during 1987–2012 (maximum attained age 62 years).

Results

There were 34,008 men diagnosed with type 2 diabetes in 39.4 million person-years of follow-up. Low stress resilience was associated with an increased risk of developing type 2 diabetes after adjusting for BMI, family history of diabetes, and individual and neighbourhood socioeconomic factors (HR for lowest vs highest quintile: 1.51; 95% CI 1.46, 1.57; p < 0.0001), including a strong linear trend across the full range of stress resilience (p trend < 0.0001). This association did not vary by BMI level, family history of diabetes or socioeconomic factors.

Conclusions/interpretation

These findings suggest that low stress resilience may play an important long-term role in aetiological pathways for type 2 diabetes. Further elucidation of the underlying causal factors may help inform more effective preventive interventions across the lifespan.

Keywords

Psychological resilience Psychological stress Type 2 diabetes mellitus

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Cognitive effects of intentional weight loss in elderly obese individuals with mild cognitive impairment

Posted on January 15, 2016 by Maurice Preter MD

 

 

http://press.endocrine.org/doi/abs/10.1210/jc.2015-2315

Cognitive effects of intentional weight loss in elderly obese individuals with mild cognitive impairment

Address all correspondence and requests for reprints to: Dr.Nidia Celeste Horie Ph.D. nidiachorie@yahoo.com.br

Faculdade de Medicina da Universidade de São Paulo – Endocrinology R Dr Ené as de Carvalho Aguiar, 155 8andar, Endocrinologia Sao Paulo SP BRAZIL 05403–000 55–011–99640 6475

.

Received: May 17, 2015
Accepted: December 11, 2015
First Published Online: December 29, 2015

Abstract

Context:

Obesity in midlife is a risk factor for dementia, but it is unknown if caloric restriction-induced weight loss could prevent cognitive decline and therefore dementia in elderly patients with cognitive impairment.

Objective:

To evaluate the cognitive effect of intentional weight loss in obese elderly patients with mild cognitive impairment (MCI), considering the influence of age, apolipoprotein E genotype (APOE), physical activity, biochemical markers and diet.

Design:

Single-center, prospective controlled trial.

Setting:

Academic medical center

Participants:

Eighty obese patients with MCI, aged 60 or older (68.1±4.9 years, body mass index (BMI) 35.5±4.4kg/m2, 83.7% women, 26.3% APOE4 carriers).

Intervention:

Random allocation to conventional medical care alone (n=40) or together with nutritional counselling (n=40) in group meetings aiming to promote weight loss through caloric restriction for 12 months.

Outcome:

Measurements: Clinical data, body composition, neuropsychological tests (main outcome), serum biomarkers, APOE genotype, physical performance, dietary recalls.

Results:

Seventy-five patients completed the follow-up. BMI, on average, decreased 1.7 ±1.8kg/m2 (p=0.021), and most of the cognitive tests improved, without difference between the groups. In analysis with linear generalized models, the BMI decrease was associated with improvements in verbal memory, verbal fluency, executive function and global cognition, after adjustment for education, gender, physical activity and baseline tests: this association was strongest in younger seniors (for memory and fluency) and in APOE4 carriers (for executive function). Changes in HOMA-IR, C-reactive protein, leptin and intake of energy, carbohydrates and fats were associated with improvement in cognitive tests.

Conclusions:

Intentional weight loss through diet was associated with cognitive improvement in patients with MCI.

Affiliations
  • 1Obesity and Metabolic Syndrome Group- Sao Paulo University, School of Medicine;
  • 2Psychology Division- Hospital das Clínicas, Sao Paulo University;
  • 3Institute of Psychiatry – Sao Paulo University, School of Medicine;
  • 4Nutrition Division- Clinical Hospital – Sao Paulo University, School of Medicine;
  • 5Discipline of Geriatrics – Sao Paulo University, School of Medicine;
  • 6Division of Clinical Immunology and Allergy- Sao Paulo University, School of Medicine

– See more at: http://press.endocrine.org/doi/abs/10.1210/jc.2015-2315#sthash.JzKKeyZO.dpuf

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Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease

Posted on January 15, 2016 by Maurice Preter MD

Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease

http://archinte.jamanetwork.com/article.aspx?articleid=2481157

Benjamin Lazarus, MBBS1,2; Yuan Chen, MS1; Francis P. Wilson, MD, MS3; Yingying Sang, MS1; Alex R. Chang, MD, MS4; Josef Coresh, MD, PhD1,5; Morgan E. Grams, MD, PhD1,5
JAMA Intern Med. Published online January 11, 2016. doi:10.1001/jamainternmed.2015.7193
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Importance  Proton pump inhibitors (PPIs) are among the most commonly used drugs worldwide and have been linked to acute interstitial nephritis. Less is known about the association between PPI use and chronic kidney disease (CKD).

Objective  To quantify the association between PPI use and incident CKD in a population-based cohort.

Design, Setting, and Participants  In total, 10 482 participants in the Atherosclerosis Risk in Communities study with an estimated glomerular filtration rate of at least 60 mL/min/1.73 m2 were followed from a baseline visit between February 1, 1996, and January 30, 1999, to December 31, 2011. The data was analyzed from May 2015 to October 2015. The findings were replicated in an administrative cohort of 248 751 patients with an estimated glomerular filtration rate of at least 60 mL/min/1.73 m2 from the Geisinger Health System.

Exposures  Self-reported PPI use in the Atherosclerosis Risk in Communities study or an outpatient PPI prescription in the Geisinger Health System replication cohort. Histamine2 (H2) receptor antagonist use was considered a negative control and active comparator.

Main Outcomes and Measures  Incident CKD was defined using diagnostic codes at hospital discharge or death in the Atherosclerosis Risk in Communities Study, and by a sustained outpatient estimated glomerular filtration rate of less than 60 mL/min/1.73 m2 in the Geisinger Health System replication cohort.

Results  Among 10 482 participants in the Atherosclerosis Risk in Communities study, the mean (SD) age was 63.0 (5.6) years, and 43.9% were male. Compared with nonusers, PPI users were more often of white race, obese, and taking antihypertensive medication. Proton pump inhibitor use was associated with incident CKD in unadjusted analysis (hazard ratio [HR], 1.45; 95% CI, 1.11-1.90); in analysis adjusted for demographic, socioeconomic, and clinical variables (HR, 1.50; 95% CI, 1.14-1.96); and in analysis with PPI ever use modeled as a time-varying variable (adjusted HR, 1.35; 95% CI, 1.17-1.55). The association persisted when baseline PPI users were compared directly with H2 receptor antagonist users (adjusted HR, 1.39; 95% CI, 1.01-1.91) and with propensity score–matched nonusers (HR, 1.76; 95% CI, 1.13-2.74). In the Geisinger Health System replication cohort, PPI use was associated with CKD in all analyses, including a time-varying new-user design (adjusted HR, 1.24; 95% CI, 1.20-1.28). Twice-daily PPI dosing (adjusted HR, 1.46; 95% CI, 1.28-1.67) was associated with a higher risk than once-daily dosing (adjusted HR, 1.15; 95% CI, 1.09-1.21).

Conclusions and Relevance  Proton pump inhibitor use is associated with a higher risk of incident CKD. Future research should evaluate whether limiting PPI use reduces the incidence of CKD.

 

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Erectile dysfunction? – Eat berries!

Posted on January 15, 2016 by Maurice Preter MD

http://ajcn.nutrition.org/content/early/2016/01/06/ajcn.115.122010.abstract

Dietary flavonoid intake and incidence of erectile dysfunction1

  1. Aedín Cassidy2,
  2. Mary Franz3, and
  3. Eric B Rimm3–6*

+Author Affiliations


  1. 2Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, United Kingdom;

  2. 3Departments of Nutrition and

  3. 4Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; and

  4. 5Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital; and

  5. 6Harvard Medical School, Boston, MA

+Author Notes

  • ↵1 Supported by research grants CA55075, HL35464, and UM1 CA167552 from the NIH and the Biotechnology and Biological Sciences Research Council, United Kingdom (reference BB/J004545/1); AC is a Royal Society Wolfson Research Merit Award Holder. This is an open access article distributed under the CC-BY license (http://creativecommons.org/licenses/by/3.0/).

  1. ↵*To whom correspondence should be addressed. E-mail: erimm@hsph.harvard.edu.

Abstract

Background: The predominant etiology for erectile dysfunction (ED) is vascular, but limited data are available on the role of diet. A higher intake of several flavonoids reduces diabetes and cardiovascular disease risk, but no studies have examined associations between flavonoids and erectile function.

Objective: This study examined the relation between habitual flavonoid subclass intakes and incidence of ED.

Design: We conducted a prospective study among 25,096 men from the Health Professionals Follow-Up Study. Total flavonoid and subclass intakes were calculated from food-frequency questionnaires collected every 4 y. Participants rated their erectile function in 2000 (with historical reporting from 1986) and again in 2004 and 2008.

Results: During 10 y of follow-up, 35.6% reported incident ED. After multivariate adjustment, including classic cardiovascular disease risk factors, several subclasses were associated with reduced ED incidence, specifically flavones (RR = 0.91; 95% CI: 0.85, 0.97; P-trend = 0.006), flavanones (RR = 0.89; 95% CI: 0.83, 0.95; P-trend = 0.0009), and anthocyanins (RR = 0.91; 95% CI: 0.85, 0.98; P-trend = 0.002) comparing extreme intakes. The results remained statistically significant after additional adjustment for a composite dietary intake score. In analyses stratified by age, a higher intake of flavanones, anthocyanins, and flavones was significantly associated with a reduction in risk of ED only in men <70 y old and not older men (11–16% reduction in risk; P-interaction = 0.002, 0.03, and 0.007 for flavones, flavanones, and anthocyanins, respectively). In food-based analysis, higher total intake of fruit, a major source of anthocyanins and flavanones, was associated with a 14% reduction in risk of ED (RR = 0.86; 95% CI: 0.79, 0.92; P = 0.002).

Conclusions: These data suggest that a higher habitual intake of specific flavonoid-rich foods is associated with reduced ED incidence. Intervention trials are needed to further examine the impact of increasing intakes of commonly consumed flavonoid-rich foods on men’s health.

 

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