Review of the Recent Medical Literature

NSAIDs Increase Risk of First MI
Use of nonsteroidal antiinflammatory drugs (NSAIDs) is associated with an increased risk for myocardial infarction (MI), according to a population-based study of 33,309 persons in Finland with a first-time MI and 138,949 controls. The adjusted odds ratio for first MI was 1.40 in current NSAID users. The risk of first MI was similar, whether individuals used conventional nonselective, semiselective, or cyclooxygenase (COX)-2 selective NSAIDs. The risk of first MI was greater among those who used conventional NSAIDs for up to 180 days or a COX-2 selective NSAID for 31 to 90 days. The association between NSAIDs and MI was not influenced by age.

Helin-Salmivaara A, et al. NSAID use and the risk of hospitalization for first myocardial infarction in the general population: a nationwide case-control study from Finland. Eur Heart J. 2006; 27:1657-1663.

Insulin Use Associated with Hypertension
Patients with type 2 diabetes who use insulin may be at increased risk for hypertension, according to a study of 87,850 patients with type 2 diabetes. Compared with insulin nonusers, insulin users tended to be older and female and to have a longer duration of diabetes, lower body mass index, and greater prevalence of hypertension. The risk for hypertension increased with longer duration of insulin use. The adjusted odds ratios for hypertension in patients using insulin for <5 years, 5 to 9 years, and ≥10 years were 1.14, 1.35, and 1.46, respectively, compared with nonusers of insulin.

Tseng CH. Exogenous insulin use and hypertension in adult patients with type 2 diabetes mellitus. Arch Intern Med. 2006; 166:1184-1189.

Lead Levels as Low as 2 µg/dL in Adults Increase Mortality Risk
This study examined mortality risk in persons with blood lead levels below the range currently associated with increased risk in adults (10 μg/dL). Blood lead levels were measured in 13,946 adults aged ≥17 years who were followed for up to 12 years. At baseline, mean serum lead concentration was 2.58 μg/dL. In this study, blood lead levels as low as 2 μg/dL were associated with significant increase in the risk for all-cause and cardiovascular mortality. Serum lead level also correlated significantly with myocardial infarction and stroke mortality but not with cancer mortality.

Menke A, et al. Blood lead below 0.48 μmol/L (10 μg/dL) and mortality among US adults. Circulation. 2006;114:1388-1394.

Sleep Apnea and Heart Disease
Effective treatment of obstructive sleep apnea (OSA) may help decrease the incidence of coronary artery disease (CAD), based on a study that included 308 snorers (mean age, 49 years). At 7-year follow-up, CAD was identified in 16.2% of the snorers with OSA compared with 5.4% of those without OSA. Among patients with OSA, CAD was confirmed in 24.6% of those who received incomplete treatment for OSA compared with only 3.9% of those who received efficient treatment.

Peker Y, et al. Increased incidence of coronary artery disease in sleep apnoea: a long-term follow-up. Eur Respir J. 2006; 28:596-602.

Signs of Myocardial Infarction Too Often Missed
An unexpectedly high proportion of the elderly have undiagnosed myocardial infarction (MI), according to a study of 259 randomly selected 70-year-olds. Cardiac magnetic resonance imaging revealed that 60 participants (24.2%) had late enhancement involving the subendocardial layer, which was considered to represent MI scars; of these, 49 persons (19.8%) were determined to have unrecognized MI. Unrecognized MIs were significantly smaller than recognized MIs. Compared with persons without MI scars, those with recognized MI (ie, hospital diagnosis of MI) or unrecognized MI had a greater frequency of chest pain and a significantly lower ejection fraction and larger left ventricular mass.

Barbier CE, et al. Myocardial scars more frequent than expected: magnetic resonance imaging detects potential risk group. J Am Coll Cardiol. 2006; 48: 765-771.

Whole-Grain Diet Can Lower Blood Pressure
Increasing intake of whole-grain foods, whether high in soluble or insoluble fiber, decreases systolic and diastolic blood pressure (BP). A group of 25 adults consumed a controlled Step I diet (ie, total fat ≤30% of total calories, saturated fat ≤10% of total calories, and cholesterol <300 mg/d) for 2 weeks. Thereafter, about 20% of the energy was replaced with whole wheat/brown rice, barley or half wheat-rice/half barley for 5 weeks each. Systolic BP dropped after the whole-grain and half-grain diets, while diastolic and mean arterial BP decreased with the whole-grain diet.

Behall KM, et al. Whole-grain diets reduce blood pressure in mildly hypercholesterolemic men and women. J Am Diet Assoc. 2006;106: 1445-1449.