Small Magnets Interfere with ICD, Pacemaker Functions
The small neodymium-iron-boron magnets (also known as "rare-earth magnets") that are often found in computer components, electronic equipment, and household devices can interfere with the functioning of cardiac pacemakers and implantable cardioverter-defibrillators. Researchers examined the electromagnetic effects of 4 small neodymium-iron-boron magnets in 41 ambulatory patients with cardiac pacemakers and 29 patients with implantable cardioverter-defibrillators. All patients experienced magnetic interference. The maximum skin-to-magnet distance at which interference occurred with the magnetic switch of a device was 3 cm. No association was seen between the potential for interference and the device manufacturer or type. The researchers recommend cautioning patients with cardiac pacemakers or implantable cardioverter-defibrillators about the possibility of device malfunction when they are in close proximity to rare-earth magnets.

Long-Term PPI Therapy Increases Hip Fracture Risk
Patients who take proton pump inhibitors (PPIs) may be at increased risk of hip fracture, according to a large British study of patients older than 50 years that included 13,556 who had sustained a hip fracture and 135,386 controls (mean age for both groups, 77 years). Treatment with PPIs for more than 1 year increased the risk of hip fracture by 44%. The association between PPI therapy and the adjusted odds ratio for hip fracture strengthened with increasing duration of PPI use. The adjusted odds ratios at 1, 2, 3, and 4 years of PPI therapy were 1.22, 1.41, 1.54, and 1.59, respectively. In patients receiving long-term, high-dose PPI therapy, the adjusted odds ratio for hip fracture was 2.65.

Metabolic Syndrome Marker for Diabetic Complications
The metabolic syndrome is an independent clinical indicator of the macro- and microvascular complications of diabetes, according to a study of 7859 patients (mean age, 65 years) with type 2 diabetes and 638 patients (mean age, 48 years) with type 1 diabetes. Two definitions of the metabolic syndrome were used, which included parameters for abdominal obesity, atherogenic dyslipidemia, hypertension, and elevated blood glucose level. Both definitions were equally and independently associated with the presence of nephropathy and neuropathy in patients with type 1 diabetes, and with all complications, including cardiovascular disease and retinopathy, in patients with type 2 diabetes.

Diabetes Linked to Cerebral Infarction in Elderly
Diabetes is associated with an increased risk of cerebral infarction, but not with Alzheimer's disease pathology, according to a study of 223 older adults (mean age, 86 years) who underwent annual evaluations, neuropsychologic testing (in 5 cognitive domains), and brain autopsy at the time of death. Some 15% of patients had diabetes. Pathology consistent with Alzheimer's disease was related to all 5 cognitive domains, and cerebral infarctions were related to perceptual speed. The risk for cerebral infarct was increased among patients with diabetes (odds ratio, 2.47). But diabetes was not related to Alzheimer's disease pathology or to other specific histologic features of Alzheimer's disease.

Use OGTT in Patients with CAD
The oral glucose tolerance test (OGTT) is the most appropriate method for assessing glucometabolic status, and thus the risk of future cardiovascular events, in patients with coronary artery disease (CAD). The study included 3362 patients with CAD and no known glucose abnormalities who were referred for glucose metabolism assessment; 1867 had a fasting plasma glucose measurement and OGTT. The use of OGTT per World Health Organization criteria showed that 47% of the patients had normal glucose regulation, 5% had impaired fasting glucose, 32% had impaired glucose tolerance, and 17% had diabetes. Had the American Diabetes Association criteria for fasting plasma glucose been used instead, 41% of the patients would have been misclassified. OGTT was not done in 1495 eligible patients; these were more often female and older and had a higher waist circumference (ie, more likely to have abnormal glucose regulation than those who were tested). Using a model based on clinical and laboratory variables (eg, age, FPG, and glycated hemoglobin A1c) misclassified 44% of the patients, providing further support for the use of OGTT in this population.

Panic Attacks Interfere with Glycemic Control
Patients with diabetes who have repeated panic attacks are less likely to have good glycemic control and more likely to have diabetic complications and poor quality of life, a new study has found. Responses to a survey mailed to 4385 patients with diabetes showed that 193 (4.4%) patients reported having panic episodes that caused a definite change in behavior. Of these 193 patients, 54.5% also met the criteria for major depression. After adjusting for the effects of depression, average hemoglobin A1c levels were 8.1% in patients with panic attacks and 7.7% in those without panic attacks. In addition, those with panic episodes had almost twice as many diabetes symptoms (average, 4.2 vs 2.4 in those without panic attacks).

Antiepileptic Drugs Can Interfere with Balance
A meta-analysis of 16 studies that included more than 6000 patients (age range, 13-77 years) has shown that standard-dose therapy with all second-generation antiepileptic drugs, except for gabapentin (Neurontin) and levetiracetam (Keppra), increases the risk for imbalance and ataxia. A pooled analysis of all such agents showed an increased risk for balance problems at any dose, including the lowest dose. Evaluation of individual agents showed that oxcarbazepine (Trileptal) and topiramate (Topamax) increased imbalance risk at all doses, but gabapentin and levetiracetam had no effects on balance at any dose. A dose-response effect was found for most of the second-generation antiepileptic drugs.

SSRIs Associated with Fractures
Daily use of selective serotonin reuptake inhibitors (SSRIs) is associated with an increased risk of fracture in older persons, a population-based study of 5008 community-dwelling persons aged 50 years or older shows. Daily SSRI use was reported by 137 persons. After adjusting for potential covariates, daily SSRI use was associated with an increased risk of incident clinical fragility fracture (hazard rate, 2.1) and an increased risk of falling (odds ratio, 2.2). Daily use of SSRI was also associated with decreased bone mineral density (BMD) at the hip and a trend toward decreased BMD at the spine. These adverse effects were dose dependent and unrelated to the duration of treatment.

HRT and Colon Cancer Survival
Using hormone replacement therapy (HRT) containing estrogen before being diagnosed with colorectal cancer significantly decreases mortality. The study included 834 women from the Nurses' Health Study. Compared with no previous HRT use, use of HRT before colorectal cancer diagnosis was associated with a 36% decrease in cancer-specific mortality and a 26% decrease in overall mortality. The inverse association between HRT and mortality was greatest in women who initiated HRT within 5 years of being diagnosed with cancer.

High Levels of Vitamin D Lower Risk for Multiple Sclerosis
Higher serum vitamin D concentrations were associated with a lower risk of multiple sclerosis in the first large-scale, prospective study to investigate this relationship. More than 7 million individuals whose serum samples were analyzed for 25-hydroxyvitamin D, were divided into 5 groups of equal size according to their average levels. Because vitamin D levels are strongly influenced by skin color, separate analyses were conducted for whites, blacks, and Hispanics. Among whites, the risk for multiple sclerosis was 62% lower among those in the top quintile of vitamin D concentration (>100 nmol/L) than among those in the bottom quintile (<63.3 nmol/L). The association was strongest among those who were at most 20 years of age when they first entered the study.