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FOR THE PRESS

16 June 2009 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians on the first and third Tuesday of every month. These highlights are not intended to substitute for articles as sources of information. For a copy of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656, or visit www.annals.org. Past highlights are accessible as well.

1. Calcium Supplementation Has No Weight-loss Benefit for Obese Patients

One in three American adults is overweight or obese, with a body mass index (BMI) of 25 or greater. As the obesity rate continues to rise, researchers seek an approach that can prevent weight gain or promote weight loss. Some studies suggest that people who eat more dairy products weigh less. Dairy products are a good source of calcium. Researchers studied 340 overweight and obese patients to determine whether calcium supplementation might prevent weight gain or promote weight loss. The investigators weighed each participant and then randomly assigned half of them to take calcium pills (1500 mg/d) and the other half to placebo. After two years, researchers found no difference in body weight, BMI, or body fat mass between the two groups. The researchers conclude that while calcium supplementation has health benefits, it is unlikely to prevent weight gain in overweight or obese patients.

2. Red Yeast Rice Capsules Reduce Cholesterol Levels in Statin-Intolerant Patients

High levels of low-density lipoprotein (LDL) cholesterol put people at risk for heart attack and stroke. Statins are considered the standard of care for lowering LDL cholesterol levels. While generally well-tolerated, some patients cannot take statins due to adverse events such as muscle pain and weakness. Some studies have shown that red yeast rice pills can lower LDL cholesterol levels. Researchers studied patients with statin-associated muscle pain to determine if red yeast rice supplementation could improve cholesterol levels without causing muscle pain. Sixty-two patients with abnormal LDL cholesterol levels and a history of statin intolerance were randomly assigned to either 1800 mg a day of red yeast rice supplementation or placebo. Patients in both groups were enrolled in a therapeutic lifestyle change program that included weekly 3.5 hour meetings and education on cardiovascular disease, nutrition, exercise, and relaxation techniques. The researchers checked LDL and total cholesterol levels in both groups at 12 and 24 weeks. They found that both cholesterol levels improved more in the red yeast rice group than in the placebo group. Pain, creatinine phosphokinase, and liver enzyme levels did not differ between the groups.

3. Study Raises Questions About Establishing an Upper Age Limit for Colonoscopy

The four types of colorectal cancer screening tests are fecal occult blood testing (FOBT), sigmoidoscopy, double-contrast barium enema, and colonoscopy. Of the four tests, colonoscopy is considered the best, but is also the most invasive and has the greatest risk for complications. Medicare covers colonoscopy for beneficiaries after the age of 50. While use of colonoscopy by elderly Medicare patients has increased, colonoscopy-related adverse events in this population have not been studied. Researchers looked at a random sample of 53,220 Medicare beneficiaries between the ages of 66 and 95 who underwent outpatient colonoscopy. Individuals in this sample were matched with individuals who did not have colonoscopy and then assessed at 30 days to determine the rate of cardiac and gastrointestinal events. Rates of adverse events following colonoscopy were low, but were greater in patients who had polyps removed, or had specific, common comorbid conditions. Adverse events also increased with age, another reason for establishing an upper age limit for colonoscopy.

4. Stents Ineffective, Potentially Dangerous for Patients with Renal Artery Stenosis and Impaired Renal Function

Renal stents are commonly used to treat atherosclerotic renal artery stenosis (ARAS). However, few data support the efficacy and safety of this practice. Researchers studied 140 patients with ARAS and impaired renal function to determine if stenting could help. They randomly assigned patients to medical treatment plus stenting or medical treatment only and followed them over a two-year period. Medical treatment consisted of antihypertensive treatment, a statin, and aspirin. The researchers found that stent placement with medical treatment had no clear effect on progression of impaired renal function but led to a small number of significant procedure-related complications, including two deaths. The researchers conclude that stenting is not a safe or effective treatment for patients with ARAS and impaired renal funcion. They suggest that physicians treat these patients using a conservative therapeutic approach that focuses on managing cardiovascular risk factors.


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