Top Medical Bulletin 26/May/2022

Here are the top medical stories for today:

Lifestyle changes effective to prevent/ delay Type 2 diabetes             

A lifestyle intervention program of increased physical activity, healthy eating and aiming for weight loss of 7% or more, or taking the medication that is metformin were effective long-term to either delay or prevent Type 2 diabetes in adults with prediabetes. Neither approach, however, reduced the risk of cardiovascular disease for study participants over 21 years of the study. The study here is published in the American Heart Association's Circulation journal.

The study included 3,234 adults who participated in the original, 3-year Diabetes Prevention Program (DPP) trial. The analysis of the study focused on determining whether the medication metformin or lifestyle intervention might reduce the risk of cardiovascular disease or the rate of major cardiac events such as heart attack, stroke or death due to cardiovascular disease.

There was no significant differences in the incidence of heart attacks, stroke or cardiovascular death among the intervention groups. Specifically, the analysis found that there was a continued reduction or delay in the development of type 2 diabetes for up to 15 years. The number of non-fatal heart attacks across each group was similar: 35 heart attacks occurred in the lifestyle intervention group; 46 in the metformin group; and 43 in the placebo group. Similarities were also found in the number of non-fatal strokes: 39 incidences of stroke in the lifestyle intervention group; 16 in the metformin-only group; and 28 in the placebo group. The number of deaths due to cardiovascular occurrences were low: 37 deaths among the lifestyle intervention participants; 39 in the metformin group; and 27 in the participants who took the placebo during the original trial.

The fact that neither a lifestyle intervention program nor metformin led to a decrease in cardiovascular disease among people with prediabetes may mean that these interventions have limited or no effectiveness in preventing cardiovascular disease, even though they are highly effective in preventing or delaying the development of Type 2 diabetes.

 Alcohol found to be more risky to the heart  

Levels of alcohol consumption currently considered safe by some countries are linked with development of heart failure. As per a research presented at Heart Failure 2022.

This was a secondary analysis of the STOP-HF trial that is the St Vincent's Screening TO Prevent Heart Failure. The STOP-HF provides an excellent model to the global community on how to integrate primary care simple screening with secondary and tertiary level targeted diagnostic and therapeutic system. 

The study included 744 adults over 40 years of age either at risk of developing heart failure due to risk factors or with pre-heart failure. Participants were categorised according to their weekly alcohol intake into none; low, moderate and high.

A total of 27% patients reported no alcohol usage, while 48% were low users and 25% had moderate or high intake. In the pre-heart failure group, compared with no alcohol use, moderate or high intake was associated with a 4.5-fold increased risk of worsening heart health.

The study suggests that drinking more than 70 g of alcohol per week is associated with worsening pre- heart failure or progression to symptomatic heart failure. Hence, their results indicate that countries should advocate lower limits of safe alcohol intake in pre-heart failure patients.

Preterm Births and Lung Function Deficits- Linked in Middle Age?       

A recent study in Respiratory Medicine investigated the effect of prematurity on lung function into middle-age. Study found that very-to-moderate prematurity is associated with obstructive lung function deficits including chronic obstructive pulmonary disease well into the sixth decade of life and that this effect is advanced by personal smoking.

Data were analysed from 1445 participants where the lung function was measured at 53 years of age. Gestational ages were very preterm, moderate preterm, late preterm and term.

Of 3565, 41% participants were included in this study. Compared with term birth, very to moderate preterm birth was significantly associated with an increased risk of chronic obstructive pulmonary disease. The association between very-to-moderate preterm birth and forced vital capacity ratio was only significant among smokers. Compared with term birth, late preterm birth was not associated with lower forced vital capacity ratio or chronic obstructive pulmonary disease.

Therefore, the researchers concluded that very-to-moderate prematurity is associated with obstructive lung function deficits including COPD well into the sixth decade of life and that this effect is compounded by personal smoking.

Herbal remedies benefit chronic pruritus patients   

A new review cited in the Journal of Cosmetic Dermatology conveys that herbal remedies and complementary medicine may have a good therapeutic response in the treatment of chronic pruritus and that conventional medication may not always be helpful. So some investigators and patients use herbal and complementary remedies for treatment. However, limited data exists regarding the effectiveness of these treatments.

For the present study, researchers reviewed clinical trials where herbal and complementary medicine were used for the treatment of chronic pruritus. Herbal remedies include turmeric, Fumaria parviflora, Avena sativa, capsaicin, sweet almond oil, peppermint oil, violet oil, and vinegar, as well as manual therapies including aromatherapy, auricular acupressure, and acupuncture, were some that were significantly effective in the treatment of chronic pruritus.

Some studies showed deduction in pruritus in both the control and placebo groups and that the effect of complementary and alternative remedies were more effective. Hence, practitioners can consider the usage of herbal medications for the treatment of chronic pruritus.