With polypille less heart attacks and strokes

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Doctors newspaper online, 23.08.2019

    

        
        
        

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Prevention

The polypil seems to reduce the risk of cardiovascular disease. In the largest randomized study to date, the combination drug significantly reduced the number of cardiovascular events.

By Philipp Grätzel von Grätz

34 percent was the risk reduction for cardiovascular events in the lifestyle counseling plus polypil group compared to lifestyle counseling alone.

© FotografiaBasica / Getty Images

TEHERAN. The concept of the polypilla was born more than 15 years ago. One polypil combines ASA, one statin, and two antihypertensives, usually a RAAS inhibitor and a diuretic, at a low dose in a single tablet.

Thus, the medical cardiovascular prevention should be both cost-effective, and – thanks to better compliance, – be effective.

Polypillen are primarily regarded as a means of broad-based prevention in emerging countries where cardiovascular disease is currently on the increase.

PolyIran Study Published

Now, the results of the PolyIran study have been published, in which 6838 people, ages 50+, participated in rural Iran ( Lancet 2019; online August 23 ).

Mostly these were people without (diagnosed) cardiovascular disease. Cardiovascular disease was known in about one in ten subjects, and three out of four in this subgroup received medical treatment.

The PolyIran study was a simple lifestyle intervention consisting of repeated counseling sessions on diet, exercise, and other cardiovascular risk factors compared to lifestyle interventions plus polypil.

The polypilla contained 81 mg ASA, 12.5 mg HCT, 20 mg atorvastatin and 5 mg enalapril. Those who developed a dry cough, was switched to an analogous polypilla with 40 mg valsartan instead of enalapril. Other medications continued as normal.

The study's primary endpoint was severe cardiovascular events, broadly defined as fatal or non-fatal myocardial infarction or stroke, sudden death from any cause, hospitalization for heart failure, or revascularization of a coronary vessel. Randomization was not based on individuals, but as cluster randomization based on entire villages.

Study lasted five years

In addition to the high number of participants, the study duration is remarkable: it was five years. Over this period, 8.8 percent of subjects in the lifestyle counseling group suffered a cardiovascular event.

In the additional polyp group, it was 5.9 percent, a 34 percent relative risk reduction, and 34 percent Numberneeded-to-treat (NNT) over five years.

When only study participants with known cardiovascular disease were evaluated, the relative risk reduction was 20 percent, in absolute numbers 21 percent in the control group and 17 percent in the polypil group. In the primary prevention subgroup, which provided the vast majority of study participants, the relative risk reduction was 40 percent.

The effects were somewhat smaller after adjustment for other cardiovascular drugs but remained statistically significant.

Correlation Compliance and Effect

The scientists around Professor Reza Malekzadeh, University of Tehran, also found a clear link between polypole compliance and the effect size: those who had taken more than 70 percent of their tablets correctly, in which the relative risk reduction compared to the control group was 57 percent, in absolute frequencies 4 percent versus 9 percent. That's equivalent to an NNT of twenty over five years.

All this was not associated with significantly lower mortality, but the study was not designed for mortality.

5.9 percent of patients died in the study group and 6.5 percent in the control group in the 5-year study group. There were no differences in various adverse events, including intracranial haemorrhage, peptic ulcer, and upper gastrointestinal bleeding.

Overall, the polypole is therefore a very promising approach to improve the cardiovascular health at the population level, also in view of their low cost, said co-author. Nizal Sarrafzadegan from the University of Isfahan.

All the more so since more than three-quarters of people with cardiovascular disease lived in low- and middle-income countries.

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Avoid strong blood sugar fluctuations | Diabetes Guide

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. 3 Diseases

Also, a thyroid malfunction that produces too little or too much thyroid hormone may affect blood glucose levels. Therefore it makes sense to have the TSH value in the blood measured once a year by the doctor. This reveals whether the small organ in the neck works normally. In rare cases, a Cushing syndrome is behind the puzzling sugar fluctuations. Then there is too much cortisone in the blood and drives up the sugar. The reason is usually the regular intake of a cortisone drug, sometimes an overproduction of cortisone by the adrenal glands. Important: If you need cortisone because of an illness, such as rheumatism, you must not stop it or reduce the dose without talking to the doctor.

. 4 Gewebsverhärtungen

In diabetic patients who inject insulin, tissue hardening under the skin is one of the most common causes of fluctuating blood glucose levels. They arise when injecting insulin again and again in the same place. Then it does not get evenly into the blood. Diabetologist Kröger inspects the injection sites once a quarter for all insulin patients and advises them to check them regularly for changes. To prevent it, you should change the puncture site and the needle for each injection.

. 5 Hormones

Adolescence is a troubled time, as far as diabetes is concerned. This is not only because adolescents often neglect their diabetes at this stage. But also on hormones that counteract insulin. For example, this can cause the sugar to rise sharply in the morning hours. In this case, it can make sense to switch from the pen to the pump. Bellies can set their device to deliver more insulin early in the morning. In some women, the values ​​vary mainly on the days before the period, which is probably also due to hormones. This can be changed only with a flexible adjustment of the insulin dose.

. 6 Insulin or drugs

Sometimes the diabetes medications are to blame when the sugar roller coaster drives. For example, tablets from the group of sulfonylureas are more likely to cause hypoglycaemia than other diabetes medicines. People who take a sulphonylurea drug and often have too low levels should talk to the doctor about switching to tablets that do not increase the risk of low blood sugar.

If you inject normal insulin with food and then always have too high values, switching to a fast-acting analog insulin might help. "Sometimes it's enough to wait a few minutes after insulin administration before you start eating," says diabetic Kröger. Under no circumstances should one make the mistake of injecting insulin again, because of a higher value after eating. Because the insulin injected before eating is also still in the blood, it can lead to hypoglycaemia.

If the morning values ​​are always too high, you should temporarily check your blood sugar at night, for example, between two and four o'clock. Anyone carrying a system for continuous sugar measurement (CGM or FGM) will be able to track down nocturnal sugar derailments. Sometimes you have a hypo in your sleep, without realizing it. Then the body releases blood sugar-raising hormones – with the result that the value is increased afterwards. If the blood sugar rises from about four o'clock in the morning, it may also mean that the dose of the insulin sprayed on the previous evening or the diabetes tablets is no longer sufficient at this time.

In any case, it is advisable to check the dose of the drug or insulin taken in the evening with the doctor. Those who inject conventional delay insulin (NPH insulin) at night and have consistently high morning values ​​can benefit from the switch to a long-acting analog insulin. Sometimes it is enough to inject the NPH insulin later (about 11 pm). For the effect to last as long as possible: Always inject NPH insulin into the thigh.

. 7 Movement

Physical activity improves insulin action and lowers blood sugar. In itself a good thing. But anyone who injects insulin or takes a sulphonylurea drug and does not adjust the dose beforehand risks hypoglycaemia. Because many hours after strenuous exercise more sugar is channeled into the muscles, it can also come to "late" hypoglycemia. Therefore, it is particularly important to control sugar more often after intense exercise and go to bed at a slightly higher rate to prevent nocturnal sugar lows.

Strong fluctuations: checklist for sugar detectives

What is behind fluctuating values? The checklist helps to find out.

• Values ​​that are too low due to tablets? Sulfonylurea preparations increase the risk of hypoglycaemia by eating little carbohydrates or by omitting meals.
• Insulin spatter error? If you always inject in the same spot, it will change to cause insulin to enter the blood unevenly.
• Carbohydrates correctly estimated? Those who inject insulin and misjudge their carbohydrate content have too high or too low values.
• Need Refreshment? Perhaps a targeted training helps to improve diabetes management in everyday life and to prevent fluctuations. Talk to your doctor about it!
• Guilty thyroid? Thyroid dysfunction is more common in diabetes and can confound sugar levels.
• Diabetes Diary: Document your values ​​and anything that could influence them – this helps to get to the bottom of fluctuations.

Nutritional labeling: Edeka Group begins practical test

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Doctors newspaper online, 21.08.2019

    

        
        
        

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nutrition labeling

From the end of August Edeka sells products labeled with nutritional value models to test the systems for their suitability for daily use.

One of the models used: the much-discussed Nutri-Score.

© Christophe Gateau / dpa / picture alliance

HAMBURG. Political decision-making on a uniform nutrition labeling of processed foods continues. Meanwhile, the Edeka group has now announced that it will test three different nutrition labeling models for their practical suitability in its markets from the end of August.

In this way, the Verbund wants consumers in the current debate around
    incorporate suitable labeling models. Edeka and Netto Marken-Discount, the
    Subsidiary of the company, bring according to own data in each case 16
    Selected own-brand items from different categories on the shelves.

3 Models

On the front these will be provided with one of the three
    most publicly discussed models:
     the Nutri-Score, the model of the Max Rubner Institute and the model of the Food Association of Germany .

The Nutri score, for example, features pepper chips, lasagne, tuna pizza, chicken fricassee or pasta casserole. The model of MRI as well as of the food association Germany can be found among other things on boiled ham, tagliatelle, Tilsiter, butter toast, multigrain rolls, chocolate rolls or pralines.

In July, the Federal Ministry of Food and Agriculture had launched an official consumer survey the results of which, according to the responsible minister Julia Klöckner (CDU), were decisive for the political decision of the Federal Ministry. In addition, the consumer survey forms the legal basis for the introduction of a uniform model. First results are expected in the fall.

The discussion leads, according to the Edeka association, nevertheless past the consumers. In order to realistically evaluate the potential benefits and the acceptance of the various systems, authentic empirical values ​​would have to be included. The three-month practical test of the full range and its discount subsidiary should take this into account.

Sugar free as a trend

Not only the Edeka Association is committed to a "balanced diet of consumers". The major retail chains from Aldi to Rewe have long been reducing the sugar and salt content in their own brands – also because consumers demand it: "Free from sugar" is currently considered by market researchers to be one of the most important nutritional trends.

Already in June, the world's largest food company Nestlé had spoken out in favor of the introduction of Nutri-Score and announced that it intends to start immediately with the introduction of the logo in Germany as soon as the legal requirements be created . (mu)

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