Clinical Care

Risk of coronary heart disease progressively increased as the number of years of exposure to high cholesterol increased in a new study of 1478 adults. At 15 years after early adulthood, individuals with 11 to 20 years of hyperlipidemia had an overall risk of 16.5%, compared with 8.1% for adults with 1 to 10 years of hyperlipidemia and 4.4% for those without hyperlipidemia. The unadjusted risk of coronary heart disease doubled for every 10 years of exposure to hyperlipidemia; a 1.5-fold increased risk was seen after adjusting for standard risk factors.

In a recent study, people with chronic insomnia who took longer than 14 minutes to fall asleep had >3 times the likelihood of having hypertension compared with normal sleepers. Insomniacs who took longer than 17 minutes to fall asleep had a >4 times increased risk. The Hypertension study included 219 individuals with chronic insomnia, defined as difficulty sleeping for >6 months, and 96 normal sleepers.

Researchers who followed 5583 girls who were aged 9 to 14 years between 1996 and 2001 found that those who drank >1.5 servings of sugary drinks per day had their first period 2.7 months earlier than those who consumed ≤2 such drinks per week. The effect was independent of BMI, height, total food intake, and lifestyle factors such as physical activity, according to the Human Reproduction study.

Schizophrenia was associated with a 25% increased risk of developing CKD within 3 years in a population-based retrospective cohort study conducted in Taiwan. The study included 2338 patients with schizophrenia and 7014 controls without schizophrenia; 6.97% of patients developed CKD, compared with 5.20% of controls. The 25% increased risk in patients vs. controls was determined after adjusting for gender, age group, hypertension, diabetes, hyperlipidemia, heart disease, and use of non-steroidal anti-inflammatory drugs.

A study of men in the Health Professionals Follow-Up Study who were free of nephrolithiasis at blood draw revealed higher plasma 1,25-dihydroxyvitamin D, even in ranges considered normal, was associated with higher risk of symptomatic kidney stones over 12 years. After adjusting for BMI, diet, plasma factors, and other covariates, men in the highest quartile of plasma 1,25-dihydroxyvitamin D had a 73% increased risk of incident symptomatic kidney stones compared with men in the lowest quartile. Higher fibroblast growth factor 23 was also associated with increased risk.

In a recent study of data from 142,069 hemodialysis patients in Japan, an increase in serum phosphate levels over 1 year elevated the risk of cardiovascular mortality in patients with low serum magnesium levels (<2.7 mg/dL) as well as in those with intermediate serum levels (2.7 to 3.0 mg/dL). However, no significant risk was observed in patients with magnesium levels ≥3.1 mg/dL. Among patients with serum phosphate levels ≥6.0 mg/dL, the cardiovascular mortality risk significantly decreased with increasing serum magnesium levels.

In a nationally representative cohort of 461,607 patients with moderate-to-severe CKD, there was an inverse association between eGFR and risk of hypothyroidism. For every 10 mL/min/1.73 m2 lower eGFR, there was an 18% higher risk of hypothyroidism. In secondary analyses, a 10 mL/min/1.73 m2 lower eGFR was associated with a 0.11 mIU/L higher serum thyroid-stimulating hormone.

Diabetics may become less adherent to diabetes medications following a cancer diagnosis, a new study shows. There was a 6.3% drop in patients’ Medication Possession Ratio (MPR) (an indicator for medication adherence) at the time of cancer diagnosis, plus an ongoing monthly decline in MPR of 0.20% after diagnosis. The largest drops in MPR at the time of cancer diagnosis were seen among patients with stage IV cancer and gastrointestinal or pulmonary cancers.

A retrospective study of 47,351 diabetic adults found metformin use was not associated with overall lower lung cancer risk. However, the risk over 15 years was 43% lower among patients who took metformin and had never smoked, and the risk appeared to decrease with longer metformin use. The Cancer Prevention Research findings suggest that metformin use may affect lung cancer risk in specific subpopulations, such as nonsmokers.

In a new study, people with kidney stones had more calcification in the abdominal aorta, which might explain their increased risk for heart disease compared with non–stone formers. The bones of stone formers were also less dense compared with the bones of individuals who did not develop kidney stones. Previous research has shown that vascular calcification often occurs alongside bone loss, suggesting a relationship between osteoporosis and atherosclerosis.

Among 131,430 hospitalizations for heart failure at 346 hospitals from 2009 to 2010, 11% were for patients treated with IV fluids during the first 2 days. Patients treated with IV fluids had higher rates of subsequent critical care admission (5.7% vs. 3.8%), intubation (1.4% vs. 1.0%), renal replacement therapy (0.6% vs. 0.3%), and hospital death (3.3% vs. 1.8%) compared with those who received only diuretics. The median volume of administered fluid was 1000 mL, and the most commonly used fluid was normal saline (80%).

The cost of managing diabetes has more than doubled since the 1980s, according to a new analysis. Investigators who compared National Medical Expenditure Survey data from 1987, 2000–2001, and 2010–2011 found that diabetics in 1987 spent $2588 per person more on health care than people without diabetes. In 2000 and 2010, the extra spending by diabetics rose to $4205 and $5378, respectively. Factors contributing to the increase between 1987 and 2011 included prescription medications (55%), inpatient visits (24%), outpatient visits (15%), and ER visits and other medical spending (6%).

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