Heidi Splete

ATLANTA — Lupus patients were more than 2.5 times as likely as the general population to develop blood cancers, based on data from 13,492 adults with lupus.

The risk for hematologic cancers was significantly elevated among patients with lupus. Specifically, lupus patients were more than three times as likely as the general population to develop any type of lymphoma, and more than three times as likely to develop non-Hodgkin's lymphoma. In addition, lupus patients were 1.15 times more likely than the general population to develop any cancer, said Dr. Sasha R. Bernatsky of the divisions of clinical epidemiology and rheumatology at McGill University in Montreal.

Previous studies have shown an association between systemic lupus erythematosus (SLE) and cancer, due largely to the increased risk for lymphoma. In this study, Dr. Bernatsky and her colleagues aimed for a more precise estimate of cancer rates in lupus patients, as well as stratification by age. This global effort included researchers from the Systemic Lupus International Collaborating Clinics, the Canadian Network for Improved Outcomes in SLE, and other sites around the world.

Dr. Bernatsky and her colleagues reviewed data on patients from 24 centers worldwide for an average follow-up period of 9 years, and a total of 118,359 patient-years. They identified 632 cancers during the study period.

The researchers also found a significantly increased risk of lung cancer, vulvovaginal cancer, and hepatic cancer in lupus patients, compared with the general population.

However, there was a significant decrease in the risk of hormone-sensitive cancers, including breast cancer, endometrial cancer, and ovarian cancer.

Altered clearance of viruses such as human papillomavirus might be behind the increased risk for cervical and vulvovaginal cancers in lupus patients, suggested Dr. Bernatsky. Changes in estrogen metabolism might be behind the decreased risk for hormone-sensitive cancers, although more research is needed to study these possible associations.

When the results were stratified by age, patients in the youngest age group (younger than 40 years) were significantly (1.7 times) more likely to develop any cancer compared with the general population.

Despite the increase in risk, blood cancers remain rare in lupus patients, Dr. Bernatsky noted. But the study results highlight the overall risk of cancer in lupus patients. The findings remind clinicians to counsel smoking cessation to reduce the risk of lung cancer.

The decreased risk of certain cancers such as breast cancer is good news for women with SLE “and will be an area of keen research interest in the future,” Dr. Bernatsky said.

She disclosed that she has received funding from the National Institutes of Health and research grants from the Arthritis Society of Canada.

Lupus patients have significantly higher risks for blood, lung, vulvovaginal, and hepatic cancer, said Dr. Sasha R. Bernatsky.

Source Heidi Splete/Elsevier Global Medical News

ATLANTA — Lupus patients were more than 2.5 times as likely as the general population to develop blood cancers, based on data from 13,492 adults with lupus.

The risk for hematologic cancers was significantly elevated among patients with lupus. Specifically, lupus patients were more than three times as likely as the general population to develop any type of lymphoma, and more than three times as likely to develop non-Hodgkin's lymphoma. In addition, lupus patients were 1.15 times more likely than the general population to develop any cancer, said Dr. Sasha R. Bernatsky of the divisions of clinical epidemiology and rheumatology at McGill University in Montreal.

Previous studies have shown an association between systemic lupus erythematosus (SLE) and cancer, due largely to the increased risk for lymphoma. In this study, Dr. Bernatsky and her colleagues aimed for a more precise estimate of cancer rates in lupus patients, as well as stratification by age. This global effort included researchers from the Systemic Lupus International Collaborating Clinics, the Canadian Network for Improved Outcomes in SLE, and other sites around the world.

Dr. Bernatsky and her colleagues reviewed data on patients from 24 centers worldwide for an average follow-up period of 9 years, and a total of 118,359 patient-years. They identified 632 cancers during the study period.

The researchers also found a significantly increased risk of lung cancer, vulvovaginal cancer, and hepatic cancer in lupus patients, compared with the general population.

However, there was a significant decrease in the risk of hormone-sensitive cancers, including breast cancer, endometrial cancer, and ovarian cancer.

Altered clearance of viruses such as human papillomavirus might be behind the increased risk for cervical and vulvovaginal cancers in lupus patients, suggested Dr. Bernatsky. Changes in estrogen metabolism might be behind the decreased risk for hormone-sensitive cancers, although more research is needed to study these possible associations.

When the results were stratified by age, patients in the youngest age group (younger than 40 years) were significantly (1.7 times) more likely to develop any cancer compared with the general population.

Despite the increase in risk, blood cancers remain rare in lupus patients, Dr. Bernatsky noted. But the study results highlight the overall risk of cancer in lupus patients. The findings remind clinicians to counsel smoking cessation to reduce the risk of lung cancer.

The decreased risk of certain cancers such as breast cancer is good news for women with SLE “and will be an area of keen research interest in the future,” Dr. Bernatsky said.

She disclosed that she has received funding from the National Institutes of Health and research grants from the Arthritis Society of Canada.

Lupus patients have significantly higher risks for blood, lung, vulvovaginal, and hepatic cancer, said Dr. Sasha R. Bernatsky.

Source Heidi Splete/Elsevier Global Medical News

ATLANTA — Lupus patients were more than 2.5 times as likely as the general population to develop blood cancers, based on data from 13,492 adults with lupus.

The risk for hematologic cancers was significantly elevated among patients with lupus. Specifically, lupus patients were more than three times as likely as the general population to develop any type of lymphoma, and more than three times as likely to develop non-Hodgkin's lymphoma. In addition, lupus patients were 1.15 times more likely than the general population to develop any cancer, said Dr. Sasha R. Bernatsky of the divisions of clinical epidemiology and rheumatology at McGill University in Montreal.

Previous studies have shown an association between systemic lupus erythematosus (SLE) and cancer, due largely to the increased risk for lymphoma. In this study, Dr. Bernatsky and her colleagues aimed for a more precise estimate of cancer rates in lupus patients, as well as stratification by age. This global effort included researchers from the Systemic Lupus International Collaborating Clinics, the Canadian Network for Improved Outcomes in SLE, and other sites around the world.

Dr. Bernatsky and her colleagues reviewed data on patients from 24 centers worldwide for an average follow-up period of 9 years, and a total of 118,359 patient-years. They identified 632 cancers during the study period.

The researchers also found a significantly increased risk of lung cancer, vulvovaginal cancer, and hepatic cancer in lupus patients, compared with the general population.

However, there was a significant decrease in the risk of hormone-sensitive cancers, including breast cancer, endometrial cancer, and ovarian cancer.

Altered clearance of viruses such as human papillomavirus might be behind the increased risk for cervical and vulvovaginal cancers in lupus patients, suggested Dr. Bernatsky. Changes in estrogen metabolism might be behind the decreased risk for hormone-sensitive cancers, although more research is needed to study these possible associations.

When the results were stratified by age, patients in the youngest age group (younger than 40 years) were significantly (1.7 times) more likely to develop any cancer compared with the general population.

Despite the increase in risk, blood cancers remain rare in lupus patients, Dr. Bernatsky noted. But the study results highlight the overall risk of cancer in lupus patients. The findings remind clinicians to counsel smoking cessation to reduce the risk of lung cancer.

The decreased risk of certain cancers such as breast cancer is good news for women with SLE “and will be an area of keen research interest in the future,” Dr. Bernatsky said.

She disclosed that she has received funding from the National Institutes of Health and research grants from the Arthritis Society of Canada.

Lupus patients have significantly higher risks for blood, lung, vulvovaginal, and hepatic cancer, said Dr. Sasha R. Bernatsky.

Source Heidi Splete/Elsevier Global Medical News

ATLANTA — Atorvastatin did not prevent early atherosclerosis in children and adolescents with lupus, based on data from 221 patients aged 10–21 years.

“This is a landmark study in the pediatric rheumatology community,” said Dr. Laura Schanberg, co-chief of the division of pediatric rheumatology at Duke University Medical Center in Durham, N.C.

To assess the risk of cardiovascular problems, the researchers used an accepted surrogate marker: an ultrasound measurement of the thickening of the carotid arteries. The study participants underwent ultrasound examinations seven times during the 3-year study period.

Overall, progression of thickening in the arteries was not significantly different between the statin and placebo groups.

“This was a surprise to us,” Dr. Schanberg said. The researchers had expected significantly less carotid intima-media thickening (CIMT) in the statin group.

The data were trending toward a positive effect, but the findings did not show enough benefit to recommend routine statin treatment for most children and adolescents with lupus. The difference in CIMT was 0.0010 mm/year in the statin group, vs. 0.0024 mm/year in the placebo group (P =.24).

The statin group did achieve statistically significant reductions in high-sensitivity C-reactive protein levels, total cholesterol, and low-density lipoprotein. Changes in lupus disease activity and damage, quality of life measures, and measures of muscle, liver, and neurotoxicity were similar between the two groups.

Previous studies have shown that lupus is a strong risk factor for cardiovascular problems. Pediatric lupus patients are considered at increased risk because they typically live with the disease for a longer period of time. Statins have not previously been studied as a way to reduce cardiovascular risk in children with lupus, but some clinicians already prescribe statins to children with lupus at especially high risk from factors such as high cholesterol, Dr. Schanberg said.

“We wanted to see whether there was a way to decrease the long-term risk” of cardiovascular problems in children with lupus, she said. In this study, the researchers enrolled patients from 21 sites through the Childhood Arthritis and Rheumatology Research Alliance.

All the children received standard lupus care including aspirin, a multivitamin, hydroxychloroquine, and counseling about a low-cholesterol diet and other cardiovascular risk factors. They were randomized to receive atorvastatin or a placebo.

Of note, the study did not include children at especially high risk for cardiovascular problems, such as those with high cholesterol, she said. In fact, a subgroup analysis may reveal certain groups that would benefit from statin use in childhood and adolescence, she said.

Despite the lack of clinical significance, the results showed that atorvastatin was safe and well tolerated in the study population, and Dr. Schanberg advised clinicians to continue prescribing statins for pediatric lupus patients with abnormal cholesterol or lipid levels.

Dr. Schanberg has served on the advisory board for Bristol-Myers Squibb, and Pfizer provided the drugs used in the study.

Less carotid intima-media thickening was expected in the statin group, notes Dr. Laura Schanberg at

Source Heidi Splete/Elsevier Global Medical Newswww.rheumatologynews.com

ATLANTA — Atorvastatin did not prevent early atherosclerosis in children and adolescents with lupus, based on data from 221 patients aged 10–21 years.

“This is a landmark study in the pediatric rheumatology community,” said Dr. Laura Schanberg, co-chief of the division of pediatric rheumatology at Duke University Medical Center in Durham, N.C.

To assess the risk of cardiovascular problems, the researchers used an accepted surrogate marker: an ultrasound measurement of the thickening of the carotid arteries. The study participants underwent ultrasound examinations seven times during the 3-year study period.

Overall, progression of thickening in the arteries was not significantly different between the statin and placebo groups.

“This was a surprise to us,” Dr. Schanberg said. The researchers had expected significantly less carotid intima-media thickening (CIMT) in the statin group.

The data were trending toward a positive effect, but the findings did not show enough benefit to recommend routine statin treatment for most children and adolescents with lupus. The difference in CIMT was 0.0010 mm/year in the statin group, vs. 0.0024 mm/year in the placebo group (P =.24).

The statin group did achieve statistically significant reductions in high-sensitivity C-reactive protein levels, total cholesterol, and low-density lipoprotein. Changes in lupus disease activity and damage, quality of life measures, and measures of muscle, liver, and neurotoxicity were similar between the two groups.

Previous studies have shown that lupus is a strong risk factor for cardiovascular problems. Pediatric lupus patients are considered at increased risk because they typically live with the disease for a longer period of time. Statins have not previously been studied as a way to reduce cardiovascular risk in children with lupus, but some clinicians already prescribe statins to children with lupus at especially high risk from factors such as high cholesterol, Dr. Schanberg said.

“We wanted to see whether there was a way to decrease the long-term risk” of cardiovascular problems in children with lupus, she said. In this study, the researchers enrolled patients from 21 sites through the Childhood Arthritis and Rheumatology Research Alliance.

All the children received standard lupus care including aspirin, a multivitamin, hydroxychloroquine, and counseling about a low-cholesterol diet and other cardiovascular risk factors. They were randomized to receive atorvastatin or a placebo.

Of note, the study did not include children at especially high risk for cardiovascular problems, such as those with high cholesterol, she said. In fact, a subgroup analysis may reveal certain groups that would benefit from statin use in childhood and adolescence, she said.

Despite the lack of clinical significance, the results showed that atorvastatin was safe and well tolerated in the study population, and Dr. Schanberg advised clinicians to continue prescribing statins for pediatric lupus patients with abnormal cholesterol or lipid levels.

Dr. Schanberg has served on the advisory board for Bristol-Myers Squibb, and Pfizer provided the drugs used in the study.

Less carotid intima-media thickening was expected in the statin group, notes Dr. Laura Schanberg at

Source Heidi Splete/Elsevier Global Medical Newswww.rheumatologynews.com

ATLANTA — Atorvastatin did not prevent early atherosclerosis in children and adolescents with lupus, based on data from 221 patients aged 10–21 years.

“This is a landmark study in the pediatric rheumatology community,” said Dr. Laura Schanberg, co-chief of the division of pediatric rheumatology at Duke University Medical Center in Durham, N.C.

To assess the risk of cardiovascular problems, the researchers used an accepted surrogate marker: an ultrasound measurement of the thickening of the carotid arteries. The study participants underwent ultrasound examinations seven times during the 3-year study period.

Overall, progression of thickening in the arteries was not significantly different between the statin and placebo groups.

“This was a surprise to us,” Dr. Schanberg said. The researchers had expected significantly less carotid intima-media thickening (CIMT) in the statin group.

The data were trending toward a positive effect, but the findings did not show enough benefit to recommend routine statin treatment for most children and adolescents with lupus. The difference in CIMT was 0.0010 mm/year in the statin group, vs. 0.0024 mm/year in the placebo group (P =.24).

The statin group did achieve statistically significant reductions in high-sensitivity C-reactive protein levels, total cholesterol, and low-density lipoprotein. Changes in lupus disease activity and damage, quality of life measures, and measures of muscle, liver, and neurotoxicity were similar between the two groups.

Previous studies have shown that lupus is a strong risk factor for cardiovascular problems. Pediatric lupus patients are considered at increased risk because they typically live with the disease for a longer period of time. Statins have not previously been studied as a way to reduce cardiovascular risk in children with lupus, but some clinicians already prescribe statins to children with lupus at especially high risk from factors such as high cholesterol, Dr. Schanberg said.

“We wanted to see whether there was a way to decrease the long-term risk” of cardiovascular problems in children with lupus, she said. In this study, the researchers enrolled patients from 21 sites through the Childhood Arthritis and Rheumatology Research Alliance.

All the children received standard lupus care including aspirin, a multivitamin, hydroxychloroquine, and counseling about a low-cholesterol diet and other cardiovascular risk factors. They were randomized to receive atorvastatin or a placebo.

Of note, the study did not include children at especially high risk for cardiovascular problems, such as those with high cholesterol, she said. In fact, a subgroup analysis may reveal certain groups that would benefit from statin use in childhood and adolescence, she said.

Despite the lack of clinical significance, the results showed that atorvastatin was safe and well tolerated in the study population, and Dr. Schanberg advised clinicians to continue prescribing statins for pediatric lupus patients with abnormal cholesterol or lipid levels.

Dr. Schanberg has served on the advisory board for Bristol-Myers Squibb, and Pfizer provided the drugs used in the study.

Less carotid intima-media thickening was expected in the statin group, notes Dr. Laura Schanberg at

Source Heidi Splete/Elsevier Global Medical Newswww.rheumatologynews.com

ATLANTA — An estimated 32 million adults in the United States have hyperuricemia, which often precedes gout, based on data from the National Health and Nutrition Examination Survey.

The results were presented during a press conference at the annual meeting.

Previous studies have suggested that the prevalence of gout and hyperuricemia are on the rise in the United States, possibly because of factors including obesity, the metabolic syndrome, and hypertension, said Yanyan Zhu, Ph.D., of Boston University.

Dr. Zhu and colleagues reviewed National Health and Nutrition Examination Survey (NHANES) data from 1999 through 2008 on 24,693 individuals aged 20 years and older.

The group included 11,816 men and 12,877 women. The data were compared with U.S. population estimates from the U.S. Census Bureau.

Hyperuricemia was defined using the standard NHANES definition of serum urate levels greater than 7.0 mg/dL for men, and greater than 5.7 mg/dL for women.

The results suggest a substantial potential burden from gout, especially in older adults, said Dr. Zhu. The prevalence of hyperuricemia was 31% in adults aged 65 years and older, vs. 18% in those aged 20–64 years.

Overall, the prevalence of hyperuricemia increased with age, ranging from 16% in individuals aged 20–29 years to 37% among those aged 80 years and older.

The estimates for hyperuricemia were similar for men and women (16.1 million vs. 15.8 million, respectively).

Gout rates in U.S. adults are rising, based on data from a related study also presented at the meeting. Dr. Zhu and her colleagues used NHANES data to estimate 8.3 million cases of gout in U.S. adults aged 20 years and older during 2007–2008.

In this study, the researchers compared NHANES data from 1988 through 1994 with NHANES data from 2007 through 2008. They found a 1.2% increase in gout among U.S. adults, from 2.7% during 1988–1994 to 3.9% during 2007–2008.

The increase was largely due to the significant rise in gout among men and older adults, the researchers noted. The prevalence of gout in men increased from 3.8% to 5.9% between the two time periods, and the prevalence in adults aged 80 years and older increased from 5.9% to 12.6%.

The NHANES data in the second study included 18,825 individuals from 1988 through 1994 and 5,707 from 2007 through 2008.

These numbers also were compared with U.S. Census Bureau data.

Most physicians in the United States don't regularly check patients' uric acid levels, and fewer than 5% of adults with gout receive treatment, noted Dr. John Sundy of Duke University Medical Center, Durham, N.C. Dr. Sundy served as moderator when the study findings were presented at the press conference. More education is needed for doctors and patients so the available therapies can be used more effectively, he said.

Dr. Zhu said she had no financial conflicts to disclose. Her study coauthors are employed by or have received consulting fees from Takeda Pharmaceuticals International. Dr. Sundy has served as a consultant for multiple companies including Array Biopharma, Savient Pharmaceuticals, and Takeda Pharmaceuticals.

To watch an interview with Dr. Yanyan Zhu about the NHANES data, please visit

Source Heidi Splete/Elsevier Global Medical Newswww.rheumatologynews.com

ATLANTA — An estimated 32 million adults in the United States have hyperuricemia, which often precedes gout, based on data from the National Health and Nutrition Examination Survey.

The results were presented during a press conference at the annual meeting.

Previous studies have suggested that the prevalence of gout and hyperuricemia are on the rise in the United States, possibly because of factors including obesity, the metabolic syndrome, and hypertension, said Yanyan Zhu, Ph.D., of Boston University.

Dr. Zhu and colleagues reviewed National Health and Nutrition Examination Survey (NHANES) data from 1999 through 2008 on 24,693 individuals aged 20 years and older.

The group included 11,816 men and 12,877 women. The data were compared with U.S. population estimates from the U.S. Census Bureau.

Hyperuricemia was defined using the standard NHANES definition of serum urate levels greater than 7.0 mg/dL for men, and greater than 5.7 mg/dL for women.

The results suggest a substantial potential burden from gout, especially in older adults, said Dr. Zhu. The prevalence of hyperuricemia was 31% in adults aged 65 years and older, vs. 18% in those aged 20–64 years.

Overall, the prevalence of hyperuricemia increased with age, ranging from 16% in individuals aged 20–29 years to 37% among those aged 80 years and older.

The estimates for hyperuricemia were similar for men and women (16.1 million vs. 15.8 million, respectively).

Gout rates in U.S. adults are rising, based on data from a related study also presented at the meeting. Dr. Zhu and her colleagues used NHANES data to estimate 8.3 million cases of gout in U.S. adults aged 20 years and older during 2007–2008.

In this study, the researchers compared NHANES data from 1988 through 1994 with NHANES data from 2007 through 2008. They found a 1.2% increase in gout among U.S. adults, from 2.7% during 1988–1994 to 3.9% during 2007–2008.

The increase was largely due to the significant rise in gout among men and older adults, the researchers noted. The prevalence of gout in men increased from 3.8% to 5.9% between the two time periods, and the prevalence in adults aged 80 years and older increased from 5.9% to 12.6%.

The NHANES data in the second study included 18,825 individuals from 1988 through 1994 and 5,707 from 2007 through 2008.

These numbers also were compared with U.S. Census Bureau data.

Most physicians in the United States don't regularly check patients' uric acid levels, and fewer than 5% of adults with gout receive treatment, noted Dr. John Sundy of Duke University Medical Center, Durham, N.C. Dr. Sundy served as moderator when the study findings were presented at the press conference. More education is needed for doctors and patients so the available therapies can be used more effectively, he said.

Dr. Zhu said she had no financial conflicts to disclose. Her study coauthors are employed by or have received consulting fees from Takeda Pharmaceuticals International. Dr. Sundy has served as a consultant for multiple companies including Array Biopharma, Savient Pharmaceuticals, and Takeda Pharmaceuticals.

To watch an interview with Dr. Yanyan Zhu about the NHANES data, please visit

Source Heidi Splete/Elsevier Global Medical Newswww.rheumatologynews.com

ATLANTA — An estimated 32 million adults in the United States have hyperuricemia, which often precedes gout, based on data from the National Health and Nutrition Examination Survey.

The results were presented during a press conference at the annual meeting.

Previous studies have suggested that the prevalence of gout and hyperuricemia are on the rise in the United States, possibly because of factors including obesity, the metabolic syndrome, and hypertension, said Yanyan Zhu, Ph.D., of Boston University.

Dr. Zhu and colleagues reviewed National Health and Nutrition Examination Survey (NHANES) data from 1999 through 2008 on 24,693 individuals aged 20 years and older.

The group included 11,816 men and 12,877 women. The data were compared with U.S. population estimates from the U.S. Census Bureau.

Hyperuricemia was defined using the standard NHANES definition of serum urate levels greater than 7.0 mg/dL for men, and greater than 5.7 mg/dL for women.

The results suggest a substantial potential burden from gout, especially in older adults, said Dr. Zhu. The prevalence of hyperuricemia was 31% in adults aged 65 years and older, vs. 18% in those aged 20–64 years.

Overall, the prevalence of hyperuricemia increased with age, ranging from 16% in individuals aged 20–29 years to 37% among those aged 80 years and older.

The estimates for hyperuricemia were similar for men and women (16.1 million vs. 15.8 million, respectively).

Gout rates in U.S. adults are rising, based on data from a related study also presented at the meeting. Dr. Zhu and her colleagues used NHANES data to estimate 8.3 million cases of gout in U.S. adults aged 20 years and older during 2007–2008.

In this study, the researchers compared NHANES data from 1988 through 1994 with NHANES data from 2007 through 2008. They found a 1.2% increase in gout among U.S. adults, from 2.7% during 1988–1994 to 3.9% during 2007–2008.

The increase was largely due to the significant rise in gout among men and older adults, the researchers noted. The prevalence of gout in men increased from 3.8% to 5.9% between the two time periods, and the prevalence in adults aged 80 years and older increased from 5.9% to 12.6%.

The NHANES data in the second study included 18,825 individuals from 1988 through 1994 and 5,707 from 2007 through 2008.

These numbers also were compared with U.S. Census Bureau data.

Most physicians in the United States don't regularly check patients' uric acid levels, and fewer than 5% of adults with gout receive treatment, noted Dr. John Sundy of Duke University Medical Center, Durham, N.C. Dr. Sundy served as moderator when the study findings were presented at the press conference. More education is needed for doctors and patients so the available therapies can be used more effectively, he said.

Dr. Zhu said she had no financial conflicts to disclose. Her study coauthors are employed by or have received consulting fees from Takeda Pharmaceuticals International. Dr. Sundy has served as a consultant for multiple companies including Array Biopharma, Savient Pharmaceuticals, and Takeda Pharmaceuticals.

To watch an interview with Dr. Yanyan Zhu about the NHANES data, please visit

Source Heidi Splete/Elsevier Global Medical Newswww.rheumatologynews.com

WASHINGTON — Daily doses of 600 international units of vitamin D and between 700 and 1,300 mg of calcium are enough for most children and adults in the United States and Canada, according to a report on new dietary reference intakes issued by the Institute of Medicine.

These new dietary reference intakes for calcium and vitamin D should provide “greater assurance that widespread vitamin D deficiency is not a public health problem,” said Dr. Steven Clinton, a member of the IOM committee that issued the report. Committee members spoke at a Nov. 30 press briefing.

After reviewing national databases on blood levels from the United States and Canada, the committee determined that most people in both countries are currently meeting their needs for vitamin D. Adequate vitamin D was defined as blood levels of at least 20 ng/mL as measured in the United States (50 nmol/L as measured in Canada).

Dr. Clinton, a medical oncologist at Ohio State University, Columbus, predicted that physicians will become more comfortable using recommended dietary allowances to advise patients about calcium and vitamin D intake and noted that vitamin D screening “probably should not be part of routine medical care.”

Previous recommendations for vitamin D and calcium intake were defined in terms of adequate intake, which is not the same as recommended dietary allowance (RDA), noted committee member Patsy Brannon, Ph.D., a professor in the division of nutritional science at Cornell University, Ithaca, N.Y. Although the new values might not look much different, “You can't compare the two sets of numbers,” she said. The evidence used to determine the new RDAs for calcium and vitamin D was much more comprehensive, especially data from studies conducted within the past 2 years, she explained.

While calcium and vitamin D are important for health, more is not necessarily better, the reviewers said.

They cautioned against excessive vitamin D supplementation beyond the RDA, but said supplements can be used in combination with diet to meet the RDAs. “The data are not sufficient to conclude that intakes higher than the recommended values would be beneficial,” A. Catherine Ross, Ph.D., of Pennsylvania State University, University Park.

To reduce the risk of kidney stones, calcium supplements should be used with caution, Dr. Brannon advised.

The IOM reviewers examined approximately 1,000 published studies and scientific testimonies to determine the levels of calcium and vitamin D needed to maintain health.

Based on their findings, 700 mg/day of calcium is enough for most children aged 1-3 years, and 1,000 mg is appropriate for most children aged 4-8 years. Older children and teens aged 9-18 years need no more than 1,300 mg/day, and most adults aged 19-50 years and men through 71 years need no more than 1,000 mg daily. For women aged 51 years and older and men aged 71 years and older, 1,200 mg of calcium per day is recommended, but more than that is unnecessary, according to the report.

As for vitamin D, the IOM report states that 600 IU/day meets the needs of almost all children and adults aged 1 year through 70 years, including pregnant and lactating women. For men and women aged 71 years and older, the RDA increases to 800 IU/day to accommodate age-related physical and behavioral changes.

The IOM review committee acknowledged the challenges of fitting sun exposure into the equation when estimating dietary reference intake (DRI) values for vitamin D because of concerns about skin cancer risk. “At this time, the only solution is to proceed on the basis of the assumption of minimal sun exposure and set reference values assuming that all of the vitamin D comes from the diet,” the reviewers wrote.

The report lists an upper level for daily vitamin D intake of 1,000 IU for infants up to 6 months of age and 1,500 IU for infants aged 6 months to 12 months. The upper levels for children aged 1-3 years and 4-8 years are 2,500 IU and 3,000 IU, respectively. For all other life stages, the upper level is 4,000 IU.

Upper levels for calcium for adults were based on data related to the formation of kidney stones, and the upper levels for children take adolescent growth spurts into account. The upper level for daily calcium intake for infants aged 0-6 months and 6-12 months are 1,000 mg and 1,500 mg, respectively. For children aged 1-8 years and 9-18 years, the upper levels are 2,500 mg and 3,000 mg, respectively, for both boys and girls. Adults aged 19-50 years have an upper level of 2,500 mg that drops to 2,000 mg after age 50 years for both men and women. The upper levels of calcium for pregnant and lactating women aged 14-18 years, 19-30 years, and 31-50 years are 3,000 mg, 2,500 mg, and 2,500 mg, respectively.

The full report is available online at www.iom.edu/vitaminD

WASHINGTON — Daily doses of 600 international units of vitamin D and between 700 and 1,300 mg of calcium are enough for most children and adults in the United States and Canada, according to a report on new dietary reference intakes issued by the Institute of Medicine.

These new dietary reference intakes for calcium and vitamin D should provide “greater assurance that widespread vitamin D deficiency is not a public health problem,” said Dr. Steven Clinton, a member of the IOM committee that issued the report. Committee members spoke at a Nov. 30 press briefing.

After reviewing national databases on blood levels from the United States and Canada, the committee determined that most people in both countries are currently meeting their needs for vitamin D. Adequate vitamin D was defined as blood levels of at least 20 ng/mL as measured in the United States (50 nmol/L as measured in Canada).

Dr. Clinton, a medical oncologist at Ohio State University, Columbus, predicted that physicians will become more comfortable using recommended dietary allowances to advise patients about calcium and vitamin D intake and noted that vitamin D screening “probably should not be part of routine medical care.”

Previous recommendations for vitamin D and calcium intake were defined in terms of adequate intake, which is not the same as recommended dietary allowance (RDA), noted committee member Patsy Brannon, Ph.D., a professor in the division of nutritional science at Cornell University, Ithaca, N.Y. Although the new values might not look much different, “You can't compare the two sets of numbers,” she said. The evidence used to determine the new RDAs for calcium and vitamin D was much more comprehensive, especially data from studies conducted within the past 2 years, she explained.

While calcium and vitamin D are important for health, more is not necessarily better, the reviewers said.

They cautioned against excessive vitamin D supplementation beyond the RDA, but said supplements can be used in combination with diet to meet the RDAs. “The data are not sufficient to conclude that intakes higher than the recommended values would be beneficial,” A. Catherine Ross, Ph.D., of Pennsylvania State University, University Park.

To reduce the risk of kidney stones, calcium supplements should be used with caution, Dr. Brannon advised.

The IOM reviewers examined approximately 1,000 published studies and scientific testimonies to determine the levels of calcium and vitamin D needed to maintain health.

Based on their findings, 700 mg/day of calcium is enough for most children aged 1-3 years, and 1,000 mg is appropriate for most children aged 4-8 years. Older children and teens aged 9-18 years need no more than 1,300 mg/day, and most adults aged 19-50 years and men through 71 years need no more than 1,000 mg daily. For women aged 51 years and older and men aged 71 years and older, 1,200 mg of calcium per day is recommended, but more than that is unnecessary, according to the report.

As for vitamin D, the IOM report states that 600 IU/day meets the needs of almost all children and adults aged 1 year through 70 years, including pregnant and lactating women. For men and women aged 71 years and older, the RDA increases to 800 IU/day to accommodate age-related physical and behavioral changes.

The IOM review committee acknowledged the challenges of fitting sun exposure into the equation when estimating dietary reference intake (DRI) values for vitamin D because of concerns about skin cancer risk. “At this time, the only solution is to proceed on the basis of the assumption of minimal sun exposure and set reference values assuming that all of the vitamin D comes from the diet,” the reviewers wrote.

The report lists an upper level for daily vitamin D intake of 1,000 IU for infants up to 6 months of age and 1,500 IU for infants aged 6 months to 12 months. The upper levels for children aged 1-3 years and 4-8 years are 2,500 IU and 3,000 IU, respectively. For all other life stages, the upper level is 4,000 IU.

Upper levels for calcium for adults were based on data related to the formation of kidney stones, and the upper levels for children take adolescent growth spurts into account. The upper level for daily calcium intake for infants aged 0-6 months and 6-12 months are 1,000 mg and 1,500 mg, respectively. For children aged 1-8 years and 9-18 years, the upper levels are 2,500 mg and 3,000 mg, respectively, for both boys and girls. Adults aged 19-50 years have an upper level of 2,500 mg that drops to 2,000 mg after age 50 years for both men and women. The upper levels of calcium for pregnant and lactating women aged 14-18 years, 19-30 years, and 31-50 years are 3,000 mg, 2,500 mg, and 2,500 mg, respectively.

The full report is available online at www.iom.edu/vitaminD

WASHINGTON — Daily doses of 600 international units of vitamin D and between 700 and 1,300 mg of calcium are enough for most children and adults in the United States and Canada, according to a report on new dietary reference intakes issued by the Institute of Medicine.

These new dietary reference intakes for calcium and vitamin D should provide “greater assurance that widespread vitamin D deficiency is not a public health problem,” said Dr. Steven Clinton, a member of the IOM committee that issued the report. Committee members spoke at a Nov. 30 press briefing.

After reviewing national databases on blood levels from the United States and Canada, the committee determined that most people in both countries are currently meeting their needs for vitamin D. Adequate vitamin D was defined as blood levels of at least 20 ng/mL as measured in the United States (50 nmol/L as measured in Canada).

Dr. Clinton, a medical oncologist at Ohio State University, Columbus, predicted that physicians will become more comfortable using recommended dietary allowances to advise patients about calcium and vitamin D intake and noted that vitamin D screening “probably should not be part of routine medical care.”

Previous recommendations for vitamin D and calcium intake were defined in terms of adequate intake, which is not the same as recommended dietary allowance (RDA), noted committee member Patsy Brannon, Ph.D., a professor in the division of nutritional science at Cornell University, Ithaca, N.Y. Although the new values might not look much different, “You can't compare the two sets of numbers,” she said. The evidence used to determine the new RDAs for calcium and vitamin D was much more comprehensive, especially data from studies conducted within the past 2 years, she explained.

While calcium and vitamin D are important for health, more is not necessarily better, the reviewers said.

They cautioned against excessive vitamin D supplementation beyond the RDA, but said supplements can be used in combination with diet to meet the RDAs. “The data are not sufficient to conclude that intakes higher than the recommended values would be beneficial,” A. Catherine Ross, Ph.D., of Pennsylvania State University, University Park.

To reduce the risk of kidney stones, calcium supplements should be used with caution, Dr. Brannon advised.

The IOM reviewers examined approximately 1,000 published studies and scientific testimonies to determine the levels of calcium and vitamin D needed to maintain health.

Based on their findings, 700 mg/day of calcium is enough for most children aged 1-3 years, and 1,000 mg is appropriate for most children aged 4-8 years. Older children and teens aged 9-18 years need no more than 1,300 mg/day, and most adults aged 19-50 years and men through 71 years need no more than 1,000 mg daily. For women aged 51 years and older and men aged 71 years and older, 1,200 mg of calcium per day is recommended, but more than that is unnecessary, according to the report.

As for vitamin D, the IOM report states that 600 IU/day meets the needs of almost all children and adults aged 1 year through 70 years, including pregnant and lactating women. For men and women aged 71 years and older, the RDA increases to 800 IU/day to accommodate age-related physical and behavioral changes.

The IOM review committee acknowledged the challenges of fitting sun exposure into the equation when estimating dietary reference intake (DRI) values for vitamin D because of concerns about skin cancer risk. “At this time, the only solution is to proceed on the basis of the assumption of minimal sun exposure and set reference values assuming that all of the vitamin D comes from the diet,” the reviewers wrote.

The report lists an upper level for daily vitamin D intake of 1,000 IU for infants up to 6 months of age and 1,500 IU for infants aged 6 months to 12 months. The upper levels for children aged 1-3 years and 4-8 years are 2,500 IU and 3,000 IU, respectively. For all other life stages, the upper level is 4,000 IU.

Upper levels for calcium for adults were based on data related to the formation of kidney stones, and the upper levels for children take adolescent growth spurts into account. The upper level for daily calcium intake for infants aged 0-6 months and 6-12 months are 1,000 mg and 1,500 mg, respectively. For children aged 1-8 years and 9-18 years, the upper levels are 2,500 mg and 3,000 mg, respectively, for both boys and girls. Adults aged 19-50 years have an upper level of 2,500 mg that drops to 2,000 mg after age 50 years for both men and women. The upper levels of calcium for pregnant and lactating women aged 14-18 years, 19-30 years, and 31-50 years are 3,000 mg, 2,500 mg, and 2,500 mg, respectively.

The full report is available online at www.iom.edu/vitaminD

Major Finding: Use of proton pump inhibitors increased patient risk for diarrhea due to Clostridium difficile infection by 80%.

Data Source: A meta-analysis of 21 studies from 1990 to 2010 including 133,054 adults on PPIs.

Disclosures: Dr. Janarthanan reported having no financial conflicts of interest.

SAN ANTONIO — Proton pump inhibitor use was associated with an 80% increase in the risk of Clostridium difficile–associated diarrhea, based on data from a meta-analysis of 21 studies.

Proton pump inhibitors (PPIs) are generally considered safe, resulting in some degree of indiscriminate use, said Dr. Sailajah Janarthanan of Wayne State University in Detroit. PPIs have faced scrutiny for a possible association with C. difficile–associated diarrhea (CDAD), but results from previous studies have yielded mixed results, she said.

“Given the millions of individuals on PPIs, even a slight increase in the risk of CDAD conferred by these drugs will have major public health implications,” she emphasized.

Dr. Janarthanan and her colleagues looked at data from 21 peer-reviewed published studies (7 cohort, 14 case control).that included 133,054 individuals.

Overall, there was a significant increase in the risk of CDAD in patients taking PPIs (risk estimate, 1.80). The risk estimate was 1.55 in the case-control studies and 2.07 in the cohort studies.

Major Finding: Use of proton pump inhibitors increased patient risk for diarrhea due to Clostridium difficile infection by 80%.

Data Source: A meta-analysis of 21 studies from 1990 to 2010 including 133,054 adults on PPIs.

Disclosures: Dr. Janarthanan reported having no financial conflicts of interest.

SAN ANTONIO — Proton pump inhibitor use was associated with an 80% increase in the risk of Clostridium difficile–associated diarrhea, based on data from a meta-analysis of 21 studies.

Proton pump inhibitors (PPIs) are generally considered safe, resulting in some degree of indiscriminate use, said Dr. Sailajah Janarthanan of Wayne State University in Detroit. PPIs have faced scrutiny for a possible association with C. difficile–associated diarrhea (CDAD), but results from previous studies have yielded mixed results, she said.

“Given the millions of individuals on PPIs, even a slight increase in the risk of CDAD conferred by these drugs will have major public health implications,” she emphasized.

Dr. Janarthanan and her colleagues looked at data from 21 peer-reviewed published studies (7 cohort, 14 case control).that included 133,054 individuals.

Overall, there was a significant increase in the risk of CDAD in patients taking PPIs (risk estimate, 1.80). The risk estimate was 1.55 in the case-control studies and 2.07 in the cohort studies.

Major Finding: Use of proton pump inhibitors increased patient risk for diarrhea due to Clostridium difficile infection by 80%.

Data Source: A meta-analysis of 21 studies from 1990 to 2010 including 133,054 adults on PPIs.

Disclosures: Dr. Janarthanan reported having no financial conflicts of interest.

SAN ANTONIO — Proton pump inhibitor use was associated with an 80% increase in the risk of Clostridium difficile–associated diarrhea, based on data from a meta-analysis of 21 studies.

Proton pump inhibitors (PPIs) are generally considered safe, resulting in some degree of indiscriminate use, said Dr. Sailajah Janarthanan of Wayne State University in Detroit. PPIs have faced scrutiny for a possible association with C. difficile–associated diarrhea (CDAD), but results from previous studies have yielded mixed results, she said.

“Given the millions of individuals on PPIs, even a slight increase in the risk of CDAD conferred by these drugs will have major public health implications,” she emphasized.

Dr. Janarthanan and her colleagues looked at data from 21 peer-reviewed published studies (7 cohort, 14 case control).that included 133,054 individuals.

Overall, there was a significant increase in the risk of CDAD in patients taking PPIs (risk estimate, 1.80). The risk estimate was 1.55 in the case-control studies and 2.07 in the cohort studies.

Major Finding: In patients with primary sclerosing cholangitis and inflammatory bowel disease, the occurrence of colonic neoplasms per 100 patient-years of follow-up was 21.5 within 2 years, 20.5 at 2-4 years, 19.3 at 4-6 years, 16.8 at 6-8 years, and 20.4 at 8-10 years.

Data Source: A review of data from 54 patients seen at the Mayo Clinic, Rochester, Minn., for primary sclerosing cholangitis and inflammatory bowel disease and later diagnosed with colonic neoplasms.

Disclosures: Dr. Thackeray said that she had no financial conflicts to disclose.

SAN ANTONIO — Patients with primary sclerosing cholangitis and inflammatory bowel disease were as likely to develop colon cancer within 2 years of diagnosis as they were within 8-10 years of diagnosis, based on data from 54 patients.

Yearly colonoscopies are often recommended for patients with primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD), but the evidence to support early screening has been limited, said Dr. Erin Thackeray of the Mayo Clinic in Rochester, Minn.

In this study, Dr. Thackeray and her colleagues reviewed medical charts from 54 adults with PSC and IBD who were seen at the Mayo Clinic between 1995 and 2005 and were later diagnosed with colonic neoplasms. Average age at the time of colon cancer diagnosis was 51 years, and 70% of the patients were male.

The occurrence of colonic neoplasms per 100 patient-years of follow-up was 21.5 within 2 years, 20.5 at 2-4 years, 19.3 at 4-6 years, 16.8 at 6-8 years, and 20.4 at 8-10 years.

Fourteen patients had colon cancer: two in the cecum, five in the ascending colon, four in the transverse colon, and three in the rectosigmoid colon. The cancers included two at stage 1, four at stage IIA, four at stage IIIB, two at stage IIIC, and two at stage IV.

Another 7 had high-grade dysplasia, 3 had dysplasia-associated lesions or a mass, and 30 had low-grade dysplasia.

The study population included 37 patients with ulcerative colitis, 6 who had Crohn's disease with colonic involvement, and 11 with indeterminate colitis. A total of 38 patients had IBD diagnosed prior to PSC by a median of 10.8 years, while 9 patients had PSC diagnosed before IBD b y a median of 4 years, and 7 patients were diagnosed simultaneously with both conditions.

The study was limited by its small size, but the results “support early and aggressive screening for colon cancer” in this patient population, Dr. Thackeray said.

Major Finding: In patients with primary sclerosing cholangitis and inflammatory bowel disease, the occurrence of colonic neoplasms per 100 patient-years of follow-up was 21.5 within 2 years, 20.5 at 2-4 years, 19.3 at 4-6 years, 16.8 at 6-8 years, and 20.4 at 8-10 years.

Data Source: A review of data from 54 patients seen at the Mayo Clinic, Rochester, Minn., for primary sclerosing cholangitis and inflammatory bowel disease and later diagnosed with colonic neoplasms.

Disclosures: Dr. Thackeray said that she had no financial conflicts to disclose.

SAN ANTONIO — Patients with primary sclerosing cholangitis and inflammatory bowel disease were as likely to develop colon cancer within 2 years of diagnosis as they were within 8-10 years of diagnosis, based on data from 54 patients.

Yearly colonoscopies are often recommended for patients with primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD), but the evidence to support early screening has been limited, said Dr. Erin Thackeray of the Mayo Clinic in Rochester, Minn.

In this study, Dr. Thackeray and her colleagues reviewed medical charts from 54 adults with PSC and IBD who were seen at the Mayo Clinic between 1995 and 2005 and were later diagnosed with colonic neoplasms. Average age at the time of colon cancer diagnosis was 51 years, and 70% of the patients were male.

The occurrence of colonic neoplasms per 100 patient-years of follow-up was 21.5 within 2 years, 20.5 at 2-4 years, 19.3 at 4-6 years, 16.8 at 6-8 years, and 20.4 at 8-10 years.

Fourteen patients had colon cancer: two in the cecum, five in the ascending colon, four in the transverse colon, and three in the rectosigmoid colon. The cancers included two at stage 1, four at stage IIA, four at stage IIIB, two at stage IIIC, and two at stage IV.

Another 7 had high-grade dysplasia, 3 had dysplasia-associated lesions or a mass, and 30 had low-grade dysplasia.

The study population included 37 patients with ulcerative colitis, 6 who had Crohn's disease with colonic involvement, and 11 with indeterminate colitis. A total of 38 patients had IBD diagnosed prior to PSC by a median of 10.8 years, while 9 patients had PSC diagnosed before IBD b y a median of 4 years, and 7 patients were diagnosed simultaneously with both conditions.

The study was limited by its small size, but the results “support early and aggressive screening for colon cancer” in this patient population, Dr. Thackeray said.

Major Finding: In patients with primary sclerosing cholangitis and inflammatory bowel disease, the occurrence of colonic neoplasms per 100 patient-years of follow-up was 21.5 within 2 years, 20.5 at 2-4 years, 19.3 at 4-6 years, 16.8 at 6-8 years, and 20.4 at 8-10 years.

Data Source: A review of data from 54 patients seen at the Mayo Clinic, Rochester, Minn., for primary sclerosing cholangitis and inflammatory bowel disease and later diagnosed with colonic neoplasms.

Disclosures: Dr. Thackeray said that she had no financial conflicts to disclose.

SAN ANTONIO — Patients with primary sclerosing cholangitis and inflammatory bowel disease were as likely to develop colon cancer within 2 years of diagnosis as they were within 8-10 years of diagnosis, based on data from 54 patients.

Yearly colonoscopies are often recommended for patients with primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD), but the evidence to support early screening has been limited, said Dr. Erin Thackeray of the Mayo Clinic in Rochester, Minn.

In this study, Dr. Thackeray and her colleagues reviewed medical charts from 54 adults with PSC and IBD who were seen at the Mayo Clinic between 1995 and 2005 and were later diagnosed with colonic neoplasms. Average age at the time of colon cancer diagnosis was 51 years, and 70% of the patients were male.

The occurrence of colonic neoplasms per 100 patient-years of follow-up was 21.5 within 2 years, 20.5 at 2-4 years, 19.3 at 4-6 years, 16.8 at 6-8 years, and 20.4 at 8-10 years.

Fourteen patients had colon cancer: two in the cecum, five in the ascending colon, four in the transverse colon, and three in the rectosigmoid colon. The cancers included two at stage 1, four at stage IIA, four at stage IIIB, two at stage IIIC, and two at stage IV.

Another 7 had high-grade dysplasia, 3 had dysplasia-associated lesions or a mass, and 30 had low-grade dysplasia.

The study population included 37 patients with ulcerative colitis, 6 who had Crohn's disease with colonic involvement, and 11 with indeterminate colitis. A total of 38 patients had IBD diagnosed prior to PSC by a median of 10.8 years, while 9 patients had PSC diagnosed before IBD b y a median of 4 years, and 7 patients were diagnosed simultaneously with both conditions.

The study was limited by its small size, but the results “support early and aggressive screening for colon cancer” in this patient population, Dr. Thackeray said.

SAN ANTONIO — Men who took more than 14 aspirin per week were more than twice as likely to report upper gastrointestinal bleeding as were men who reported no aspirin use, but increased duration of use did not appear to raise the risk of GI bleeding, said Dr. Edward Huang.

Evidence regarding the impact of aspirin use on GI bleeding is conflicting because of the limitations of previous studies, said Dr. Huang of Massachusetts General Hospital in Boston.

To examine the long-term effects of aspirin dose and duration on GI bleeding, Dr. Huang and his colleagues conducted a prospective study of 32,989 participants in the Health Professionals Follow-up Study, a longitudinal study of male health professionals in the United States. In 2006 and 2008, participants were asked to report any past episodes of GI bleeding severe enough to require hospitalization or blood transfusion.

During a mean 14-year follow-up period, 707 men had an episode of major GI bleeding. After adjustment for risk factors including use of NSAIDs, age, smoking status, exercise, and body mass index, the risk ratios for upper GI bleeding were 1.05 for men who took 0.5-1.5 standard aspirin tablets (325 mg) per week, 1.31 for those who took 2-5 tablets per week, 1.63 for those who took 6-14 tablets per week, and 2.40 for those who took more than 14 tablets per week, compared with men who reported no aspirin use.

Short-term use was defined as less than 5 years; long-term use was defined as 5 years or longer. “The dose-response relationship is significant regardless of duration of use,” Dr. Huang noted.

Longer duration of use was not significantly associated with an increased risk of upper GI bleeding, but individuals who use aspirin the longest tend to use the highest dose, he added.

The average age of the men when they enrolled in the study was 60 years, and those with a history of peptic ulcer disease were excluded.

The results suggest that both short-term and long-term aspirin users can minimize the risk of upper GI bleeding by using the lowest effective dose, Dr. Huang said.

Dr. Huang had no financial conflicts to disclose.

Both short- and long-term aspirin users can minimize the risk by using the lowest effective dose.

Source DR. HUANG

SAN ANTONIO — Men who took more than 14 aspirin per week were more than twice as likely to report upper gastrointestinal bleeding as were men who reported no aspirin use, but increased duration of use did not appear to raise the risk of GI bleeding, said Dr. Edward Huang.

Evidence regarding the impact of aspirin use on GI bleeding is conflicting because of the limitations of previous studies, said Dr. Huang of Massachusetts General Hospital in Boston.

To examine the long-term effects of aspirin dose and duration on GI bleeding, Dr. Huang and his colleagues conducted a prospective study of 32,989 participants in the Health Professionals Follow-up Study, a longitudinal study of male health professionals in the United States. In 2006 and 2008, participants were asked to report any past episodes of GI bleeding severe enough to require hospitalization or blood transfusion.

During a mean 14-year follow-up period, 707 men had an episode of major GI bleeding. After adjustment for risk factors including use of NSAIDs, age, smoking status, exercise, and body mass index, the risk ratios for upper GI bleeding were 1.05 for men who took 0.5-1.5 standard aspirin tablets (325 mg) per week, 1.31 for those who took 2-5 tablets per week, 1.63 for those who took 6-14 tablets per week, and 2.40 for those who took more than 14 tablets per week, compared with men who reported no aspirin use.

Short-term use was defined as less than 5 years; long-term use was defined as 5 years or longer. “The dose-response relationship is significant regardless of duration of use,” Dr. Huang noted.

Longer duration of use was not significantly associated with an increased risk of upper GI bleeding, but individuals who use aspirin the longest tend to use the highest dose, he added.

The average age of the men when they enrolled in the study was 60 years, and those with a history of peptic ulcer disease were excluded.

The results suggest that both short-term and long-term aspirin users can minimize the risk of upper GI bleeding by using the lowest effective dose, Dr. Huang said.

Dr. Huang had no financial conflicts to disclose.

Both short- and long-term aspirin users can minimize the risk by using the lowest effective dose.

Source DR. HUANG

SAN ANTONIO — Men who took more than 14 aspirin per week were more than twice as likely to report upper gastrointestinal bleeding as were men who reported no aspirin use, but increased duration of use did not appear to raise the risk of GI bleeding, said Dr. Edward Huang.

Evidence regarding the impact of aspirin use on GI bleeding is conflicting because of the limitations of previous studies, said Dr. Huang of Massachusetts General Hospital in Boston.

To examine the long-term effects of aspirin dose and duration on GI bleeding, Dr. Huang and his colleagues conducted a prospective study of 32,989 participants in the Health Professionals Follow-up Study, a longitudinal study of male health professionals in the United States. In 2006 and 2008, participants were asked to report any past episodes of GI bleeding severe enough to require hospitalization or blood transfusion.

During a mean 14-year follow-up period, 707 men had an episode of major GI bleeding. After adjustment for risk factors including use of NSAIDs, age, smoking status, exercise, and body mass index, the risk ratios for upper GI bleeding were 1.05 for men who took 0.5-1.5 standard aspirin tablets (325 mg) per week, 1.31 for those who took 2-5 tablets per week, 1.63 for those who took 6-14 tablets per week, and 2.40 for those who took more than 14 tablets per week, compared with men who reported no aspirin use.

Short-term use was defined as less than 5 years; long-term use was defined as 5 years or longer. “The dose-response relationship is significant regardless of duration of use,” Dr. Huang noted.

Longer duration of use was not significantly associated with an increased risk of upper GI bleeding, but individuals who use aspirin the longest tend to use the highest dose, he added.

The average age of the men when they enrolled in the study was 60 years, and those with a history of peptic ulcer disease were excluded.

The results suggest that both short-term and long-term aspirin users can minimize the risk of upper GI bleeding by using the lowest effective dose, Dr. Huang said.

Dr. Huang had no financial conflicts to disclose.

Both short- and long-term aspirin users can minimize the risk by using the lowest effective dose.

Source DR. HUANG

Women with fibromyalgia who participated in an 8-week yoga program reported significant improvements on measures of fibromyalgia symptoms and function, based on data from a pilot study of 53 women.

The positive findings have become the basis of a grant proposal to the National Institutes of Health to fund a larger clinical trial, said lead investigator and lead study author James Carson, Ph.D.

Many fibromyalgia patients find standard medical care ineffective for reducing their symptoms, including pain and fatigue, Dr. Carson of Oregon Health and Science University in Portland said in an interview.

More effective treatments for fibromyalgia are needed, Dr. Carson said. “Exercise is often prescribed for fibromyalgia, but for many patients it is hard to find an exercise program that is tolerable for them. Yoga poses done in a gentle way may be a good option.”

Dr. Carson and colleagues randomized 53 women who met the American College of Rheumatology criteria for fibromyalgia in an 8-week Yoga Awareness program (25 women) or standard care (28 women). The program consisted of gentle yoga poses, modified as needed to accommodate conditions such as knee osteoarthritis or carpal tunnel syndrome (Pain 2010;151:530–9).

The primary outcome measure was the total score on the Fibromyalgia Impact Questionnaire Revised (FIQR). After 8 weeks, the mean FIQR total score dropped from 48.32 at baseline to 35.49 in the yoga group (a statistically significant difference), compared with a change from 49.26 at baseline to 48.69 in the control group. More than half (56%) of the yoga group had at least a 30% reduction in overall FIQR scores, which is slightly more than twice the 14% reduction that is recommended to show clinical significance, the researchers noted. In addition, 50% of patients in the yoga group had at least a 30% reduction in the pain subscale of the FIQR.

The Patient Global Impression of Change (PGIC) scale scores for overall improvement in fibromyalgia symptoms were significantly higher in the yoga group vs. the control group (5.05 vs. 3.69). The PGIC was measured only once, at the end of the study. As part of the PGIC, approximately 90% of the patients in the yoga group reported feeling “a little better,” “much better,” or “very much better,” compared with 19% of the controls.

The average age of the participants was 54 years, and 68% had been symptomatic for more than 10 years. Patients who were already engaged in a yoga practice, those who were too disabled for meaningful participation in the yoga program, and those who were scheduled for elective surgery were excluded from the study. “The most surprising finding for us was that most patients became so fully engaged in the home yoga practices they were assigned,” Dr. Carson said. On average, the patients spent 40 minutes practicing yoga at home, including about 19 minutes of postures, 13 minutes of seated meditation, and 8 minutes of breathing exercises. Those who practiced more had better results on several of the study outcomes, he noted.

“This finding suggests that yoga practices, if taught in a tailored, accessible manner, are not only well tolerated and effective; they are practiced with an unexpected degree of enthusiasm,” he said.

The results also showed that patients in the yoga group were more likely to use positive pain-management strategies such as problem solving, religion, acceptance, and relaxation, and less likely to resort to negative pain-management strategies such as self-isolation, disengagement, and catastrophizing.

Dr. Carson said he and his colleagues are preparing a grant proposal to the National Institutes of Health to fund a larger trial that will include comparison with another active treatment.

The researchers had no financial conflicts to disclose.

Women with fibromyalgia who participated in an 8-week yoga program reported significant improvements on measures of fibromyalgia symptoms and function, based on data from a pilot study of 53 women.

The positive findings have become the basis of a grant proposal to the National Institutes of Health to fund a larger clinical trial, said lead investigator and lead study author James Carson, Ph.D.

Many fibromyalgia patients find standard medical care ineffective for reducing their symptoms, including pain and fatigue, Dr. Carson of Oregon Health and Science University in Portland said in an interview.

More effective treatments for fibromyalgia are needed, Dr. Carson said. “Exercise is often prescribed for fibromyalgia, but for many patients it is hard to find an exercise program that is tolerable for them. Yoga poses done in a gentle way may be a good option.”

Dr. Carson and colleagues randomized 53 women who met the American College of Rheumatology criteria for fibromyalgia in an 8-week Yoga Awareness program (25 women) or standard care (28 women). The program consisted of gentle yoga poses, modified as needed to accommodate conditions such as knee osteoarthritis or carpal tunnel syndrome (Pain 2010;151:530–9).

The primary outcome measure was the total score on the Fibromyalgia Impact Questionnaire Revised (FIQR). After 8 weeks, the mean FIQR total score dropped from 48.32 at baseline to 35.49 in the yoga group (a statistically significant difference), compared with a change from 49.26 at baseline to 48.69 in the control group. More than half (56%) of the yoga group had at least a 30% reduction in overall FIQR scores, which is slightly more than twice the 14% reduction that is recommended to show clinical significance, the researchers noted. In addition, 50% of patients in the yoga group had at least a 30% reduction in the pain subscale of the FIQR.

The Patient Global Impression of Change (PGIC) scale scores for overall improvement in fibromyalgia symptoms were significantly higher in the yoga group vs. the control group (5.05 vs. 3.69). The PGIC was measured only once, at the end of the study. As part of the PGIC, approximately 90% of the patients in the yoga group reported feeling “a little better,” “much better,” or “very much better,” compared with 19% of the controls.

The average age of the participants was 54 years, and 68% had been symptomatic for more than 10 years. Patients who were already engaged in a yoga practice, those who were too disabled for meaningful participation in the yoga program, and those who were scheduled for elective surgery were excluded from the study. “The most surprising finding for us was that most patients became so fully engaged in the home yoga practices they were assigned,” Dr. Carson said. On average, the patients spent 40 minutes practicing yoga at home, including about 19 minutes of postures, 13 minutes of seated meditation, and 8 minutes of breathing exercises. Those who practiced more had better results on several of the study outcomes, he noted.

“This finding suggests that yoga practices, if taught in a tailored, accessible manner, are not only well tolerated and effective; they are practiced with an unexpected degree of enthusiasm,” he said.

The results also showed that patients in the yoga group were more likely to use positive pain-management strategies such as problem solving, religion, acceptance, and relaxation, and less likely to resort to negative pain-management strategies such as self-isolation, disengagement, and catastrophizing.

Dr. Carson said he and his colleagues are preparing a grant proposal to the National Institutes of Health to fund a larger trial that will include comparison with another active treatment.

The researchers had no financial conflicts to disclose.

Women with fibromyalgia who participated in an 8-week yoga program reported significant improvements on measures of fibromyalgia symptoms and function, based on data from a pilot study of 53 women.

The positive findings have become the basis of a grant proposal to the National Institutes of Health to fund a larger clinical trial, said lead investigator and lead study author James Carson, Ph.D.

Many fibromyalgia patients find standard medical care ineffective for reducing their symptoms, including pain and fatigue, Dr. Carson of Oregon Health and Science University in Portland said in an interview.

More effective treatments for fibromyalgia are needed, Dr. Carson said. “Exercise is often prescribed for fibromyalgia, but for many patients it is hard to find an exercise program that is tolerable for them. Yoga poses done in a gentle way may be a good option.”

Dr. Carson and colleagues randomized 53 women who met the American College of Rheumatology criteria for fibromyalgia in an 8-week Yoga Awareness program (25 women) or standard care (28 women). The program consisted of gentle yoga poses, modified as needed to accommodate conditions such as knee osteoarthritis or carpal tunnel syndrome (Pain 2010;151:530–9).

The primary outcome measure was the total score on the Fibromyalgia Impact Questionnaire Revised (FIQR). After 8 weeks, the mean FIQR total score dropped from 48.32 at baseline to 35.49 in the yoga group (a statistically significant difference), compared with a change from 49.26 at baseline to 48.69 in the control group. More than half (56%) of the yoga group had at least a 30% reduction in overall FIQR scores, which is slightly more than twice the 14% reduction that is recommended to show clinical significance, the researchers noted. In addition, 50% of patients in the yoga group had at least a 30% reduction in the pain subscale of the FIQR.

The Patient Global Impression of Change (PGIC) scale scores for overall improvement in fibromyalgia symptoms were significantly higher in the yoga group vs. the control group (5.05 vs. 3.69). The PGIC was measured only once, at the end of the study. As part of the PGIC, approximately 90% of the patients in the yoga group reported feeling “a little better,” “much better,” or “very much better,” compared with 19% of the controls.

The average age of the participants was 54 years, and 68% had been symptomatic for more than 10 years. Patients who were already engaged in a yoga practice, those who were too disabled for meaningful participation in the yoga program, and those who were scheduled for elective surgery were excluded from the study. “The most surprising finding for us was that most patients became so fully engaged in the home yoga practices they were assigned,” Dr. Carson said. On average, the patients spent 40 minutes practicing yoga at home, including about 19 minutes of postures, 13 minutes of seated meditation, and 8 minutes of breathing exercises. Those who practiced more had better results on several of the study outcomes, he noted.

“This finding suggests that yoga practices, if taught in a tailored, accessible manner, are not only well tolerated and effective; they are practiced with an unexpected degree of enthusiasm,” he said.

The results also showed that patients in the yoga group were more likely to use positive pain-management strategies such as problem solving, religion, acceptance, and relaxation, and less likely to resort to negative pain-management strategies such as self-isolation, disengagement, and catastrophizing.

Dr. Carson said he and his colleagues are preparing a grant proposal to the National Institutes of Health to fund a larger trial that will include comparison with another active treatment.

The researchers had no financial conflicts to disclose.

WASHINGTON – Daily doses of 600 international units of vitamin D and between 700 and 1,300 mg of calcium are enough for most children and adults in the United States and Canada, according to a report on new dietary reference intakes issued by the Institute of Medicine.

These new dietary reference intakes for calcium and vitamin D should provide "greater assurance that widespread vitamin D deficiency is not a public health problem," Dr. Steven Clinton, a member of the IOM committee that issued the report. Committee members spoke at a Nov. 30 press briefing.

After reviewing national databases on blood levels from the United States and Canada, the committee determined that most people in both countries are currently meeting their needs for vitamin D. Adequate vitamin D was defined as blood levels of at least 20 ng/mL as measured in the United States (50 nmol/L as measured in Canada).

Dr. Clinton, a medical oncologist at Ohio State University, Columbus, predicted that physicians will become more comfortable using recommended dietary allowances to advise patients about calcium and vitamin D intake and noted that vitamin D screening "probably should not be part of routine medical care."

Previous recommendations for vitamin D and calcium intake were defined in terms of adequate intake, which is not the same as recommended dietary allowance (RDA), noted committee member Patsy Brannon, Ph.D., a professor in the division of nutritional science at Cornell University, Ithaca, N.Y. Although the new values might not look much different, "You can't compare the two sets of numbers," she said. The evidence used to determine the new RDAs for calcium and vitamin D was much more comprehensive, especially data from studies conducted within the past 2 years, she explained.

While calcium and vitamin D are important for health, more is not necessarily better, the reviewers said.

They cautioned against excessive vitamin D supplementation beyond the RDA, but said supplements can be used in combination with diet to meet the RDAs. "The data are not sufficient to conclude that intakes higher than the recommended values would be beneficial," A. Catherine Ross, Ph.D., of Pennsylvania State University, University Park.

To reduce the risk of kidney stones, calcium supplements should be used with caution, Dr. Brannon advised.

The IOM reviewers examined approximately 1,000 published studies and scientific testimonies to determine the levels of calcium and vitamin D needed to maintain health.

Based on their findings, 700 mg/day of calcium is enough for most children aged 1-3 years, and 1,000 mg is appropriate for most children aged 4-8 years. Older children and teens aged 9-18 years need no more than 1,300 mg/day, and most adults aged 19-50 years and men through 71 years need no more than 1,000 mg daily. For women aged 51 years and older and men aged 71 years and older, 1,200 mg of calcium per day is recommended, but more than that is unnecessary, according to the report.

As for vitamin D, the IOM report states that 600 IU/day meets the needs of almost all children and adults aged 1 year through 70 years, including pregnant and lactating women. For men and women aged 71 years and older, the RDA increases to 800 IU/day to accommodate age-related physical and behavioral changes.

The IOM review committee acknowledged the challenges of fitting sun exposure into the equation when estimating dietary reference intake values for vitamin D because of concerns about skin cancer risk. "At this time, the only solution is to proceed on the basis of the assumption of minimal sun exposure and set reference values assuming that all of the vitamin D comes from the diet," the reviewers wrote.

The report lists an upper level for daily vitamin D intake of 1,000 IU for infants up to 6 months of age and 1,500 IU for infants aged 6 months to 12 months. The upper levels for children aged 1-3 years and 4-8 years are 2,500 IU and 3,000 IU, respectively. For all other life stages, the upper level is 4,000 IU.

Upper levels for calcium for adults were based on data related to the formation of kidney stones, and the upper levels for children take adolescent growth spurts into account. The upper level for daily calcium intake for infants aged 0 to 6 months and 6-12 months are 1,000 mg and 1,500 mg, respectively. For children aged 1-8 years and 9-18 years, the upper levels are 2,500 mg and 3,000 mg, respectively, for both boys and girls. Adults aged 19-50 years have an upper level of 2,500 mg that drops to 2,000 mg after age 50 years for both men and women. The upper levels of calcium for pregnant and lactating women aged 14-18 years, 19-30 years, and 31-50 years are 3,000 mg, 2,500 mg, and 2,500 mg, respectively.

"What we have concluded may be surprising to some," Dr. Ross said. "I was surprised to find that vitamin D requirements don't vary much by age."

Dr. Ross noted that the report is not necessarily the last word on the subject, but "we are going to need to do a tremendous amount of research" before drawing any conclusions on additional benefits of vitamin D and calcium.

The study was sponsored by the federal governments of the United States and Canad

WASHINGTON – Daily doses of 600 international units of vitamin D and between 700 and 1,300 mg of calcium are enough for most children and adults in the United States and Canada, according to a report on new dietary reference intakes issued by the Institute of Medicine.

These new dietary reference intakes for calcium and vitamin D should provide "greater assurance that widespread vitamin D deficiency is not a public health problem," Dr. Steven Clinton, a member of the IOM committee that issued the report. Committee members spoke at a Nov. 30 press briefing.

After reviewing national databases on blood levels from the United States and Canada, the committee determined that most people in both countries are currently meeting their needs for vitamin D. Adequate vitamin D was defined as blood levels of at least 20 ng/mL as measured in the United States (50 nmol/L as measured in Canada).

Dr. Clinton, a medical oncologist at Ohio State University, Columbus, predicted that physicians will become more comfortable using recommended dietary allowances to advise patients about calcium and vitamin D intake and noted that vitamin D screening "probably should not be part of routine medical care."

Previous recommendations for vitamin D and calcium intake were defined in terms of adequate intake, which is not the same as recommended dietary allowance (RDA), noted committee member Patsy Brannon, Ph.D., a professor in the division of nutritional science at Cornell University, Ithaca, N.Y. Although the new values might not look much different, "You can't compare the two sets of numbers," she said. The evidence used to determine the new RDAs for calcium and vitamin D was much more comprehensive, especially data from studies conducted within the past 2 years, she explained.

While calcium and vitamin D are important for health, more is not necessarily better, the reviewers said.

They cautioned against excessive vitamin D supplementation beyond the RDA, but said supplements can be used in combination with diet to meet the RDAs. "The data are not sufficient to conclude that intakes higher than the recommended values would be beneficial," A. Catherine Ross, Ph.D., of Pennsylvania State University, University Park.

To reduce the risk of kidney stones, calcium supplements should be used with caution, Dr. Brannon advised.

The IOM reviewers examined approximately 1,000 published studies and scientific testimonies to determine the levels of calcium and vitamin D needed to maintain health.

Based on their findings, 700 mg/day of calcium is enough for most children aged 1-3 years, and 1,000 mg is appropriate for most children aged 4-8 years. Older children and teens aged 9-18 years need no more than 1,300 mg/day, and most adults aged 19-50 years and men through 71 years need no more than 1,000 mg daily. For women aged 51 years and older and men aged 71 years and older, 1,200 mg of calcium per day is recommended, but more than that is unnecessary, according to the report.

As for vitamin D, the IOM report states that 600 IU/day meets the needs of almost all children and adults aged 1 year through 70 years, including pregnant and lactating women. For men and women aged 71 years and older, the RDA increases to 800 IU/day to accommodate age-related physical and behavioral changes.

The IOM review committee acknowledged the challenges of fitting sun exposure into the equation when estimating dietary reference intake values for vitamin D because of concerns about skin cancer risk. "At this time, the only solution is to proceed on the basis of the assumption of minimal sun exposure and set reference values assuming that all of the vitamin D comes from the diet," the reviewers wrote.

The report lists an upper level for daily vitamin D intake of 1,000 IU for infants up to 6 months of age and 1,500 IU for infants aged 6 months to 12 months. The upper levels for children aged 1-3 years and 4-8 years are 2,500 IU and 3,000 IU, respectively. For all other life stages, the upper level is 4,000 IU.

Upper levels for calcium for adults were based on data related to the formation of kidney stones, and the upper levels for children take adolescent growth spurts into account. The upper level for daily calcium intake for infants aged 0 to 6 months and 6-12 months are 1,000 mg and 1,500 mg, respectively. For children aged 1-8 years and 9-18 years, the upper levels are 2,500 mg and 3,000 mg, respectively, for both boys and girls. Adults aged 19-50 years have an upper level of 2,500 mg that drops to 2,000 mg after age 50 years for both men and women. The upper levels of calcium for pregnant and lactating women aged 14-18 years, 19-30 years, and 31-50 years are 3,000 mg, 2,500 mg, and 2,500 mg, respectively.

"What we have concluded may be surprising to some," Dr. Ross said. "I was surprised to find that vitamin D requirements don't vary much by age."

Dr. Ross noted that the report is not necessarily the last word on the subject, but "we are going to need to do a tremendous amount of research" before drawing any conclusions on additional benefits of vitamin D and calcium.

The study was sponsored by the federal governments of the United States and Canad

WASHINGTON – Daily doses of 600 international units of vitamin D and between 700 and 1,300 mg of calcium are enough for most children and adults in the United States and Canada, according to a report on new dietary reference intakes issued by the Institute of Medicine.

These new dietary reference intakes for calcium and vitamin D should provide "greater assurance that widespread vitamin D deficiency is not a public health problem," Dr. Steven Clinton, a member of the IOM committee that issued the report. Committee members spoke at a Nov. 30 press briefing.

After reviewing national databases on blood levels from the United States and Canada, the committee determined that most people in both countries are currently meeting their needs for vitamin D. Adequate vitamin D was defined as blood levels of at least 20 ng/mL as measured in the United States (50 nmol/L as measured in Canada).

Dr. Clinton, a medical oncologist at Ohio State University, Columbus, predicted that physicians will become more comfortable using recommended dietary allowances to advise patients about calcium and vitamin D intake and noted that vitamin D screening "probably should not be part of routine medical care."

Previous recommendations for vitamin D and calcium intake were defined in terms of adequate intake, which is not the same as recommended dietary allowance (RDA), noted committee member Patsy Brannon, Ph.D., a professor in the division of nutritional science at Cornell University, Ithaca, N.Y. Although the new values might not look much different, "You can't compare the two sets of numbers," she said. The evidence used to determine the new RDAs for calcium and vitamin D was much more comprehensive, especially data from studies conducted within the past 2 years, she explained.

While calcium and vitamin D are important for health, more is not necessarily better, the reviewers said.

They cautioned against excessive vitamin D supplementation beyond the RDA, but said supplements can be used in combination with diet to meet the RDAs. "The data are not sufficient to conclude that intakes higher than the recommended values would be beneficial," A. Catherine Ross, Ph.D., of Pennsylvania State University, University Park.

To reduce the risk of kidney stones, calcium supplements should be used with caution, Dr. Brannon advised.

The IOM reviewers examined approximately 1,000 published studies and scientific testimonies to determine the levels of calcium and vitamin D needed to maintain health.

Based on their findings, 700 mg/day of calcium is enough for most children aged 1-3 years, and 1,000 mg is appropriate for most children aged 4-8 years. Older children and teens aged 9-18 years need no more than 1,300 mg/day, and most adults aged 19-50 years and men through 71 years need no more than 1,000 mg daily. For women aged 51 years and older and men aged 71 years and older, 1,200 mg of calcium per day is recommended, but more than that is unnecessary, according to the report.

As for vitamin D, the IOM report states that 600 IU/day meets the needs of almost all children and adults aged 1 year through 70 years, including pregnant and lactating women. For men and women aged 71 years and older, the RDA increases to 800 IU/day to accommodate age-related physical and behavioral changes.

The IOM review committee acknowledged the challenges of fitting sun exposure into the equation when estimating dietary reference intake values for vitamin D because of concerns about skin cancer risk. "At this time, the only solution is to proceed on the basis of the assumption of minimal sun exposure and set reference values assuming that all of the vitamin D comes from the diet," the reviewers wrote.

The report lists an upper level for daily vitamin D intake of 1,000 IU for infants up to 6 months of age and 1,500 IU for infants aged 6 months to 12 months. The upper levels for children aged 1-3 years and 4-8 years are 2,500 IU and 3,000 IU, respectively. For all other life stages, the upper level is 4,000 IU.

Upper levels for calcium for adults were based on data related to the formation of kidney stones, and the upper levels for children take adolescent growth spurts into account. The upper level for daily calcium intake for infants aged 0 to 6 months and 6-12 months are 1,000 mg and 1,500 mg, respectively. For children aged 1-8 years and 9-18 years, the upper levels are 2,500 mg and 3,000 mg, respectively, for both boys and girls. Adults aged 19-50 years have an upper level of 2,500 mg that drops to 2,000 mg after age 50 years for both men and women. The upper levels of calcium for pregnant and lactating women aged 14-18 years, 19-30 years, and 31-50 years are 3,000 mg, 2,500 mg, and 2,500 mg, respectively.

"What we have concluded may be surprising to some," Dr. Ross said. "I was surprised to find that vitamin D requirements don't vary much by age."

Dr. Ross noted that the report is not necessarily the last word on the subject, but "we are going to need to do a tremendous amount of research" before drawing any conclusions on additional benefits of vitamin D and calcium.

The study was sponsored by the federal governments of the United States and Canad

ATLANTA – Patients with rheumatoid arthritis showed significant arterial thickening over a 3-year period, but tumor necrosis factor inhibitor use slowed the progression, based on data from 158 patients. The findings were presented at the annual scientific meeting of the American College of Rheumatology.

"We know that many of our patients with autoimmune disease have higher risk for cardiovascular disease," said Dr. Joan M. Bathon, professor of medicine and director of the Johns Hopkins Arthritis Center at the Johns Hopkins University in Baltimore. But few studies have examined what drives the plaque buildup in these patients.

Dr. Bathon and her colleagues examined a subgroup of patients enrolled in a larger study of cardiovascular disease and RA. They used ultrasound to measure the thickness of the walls of the common carotid artery (CCA) and internal carotid artery (ICA) and compared data on each patient at two visits approximately 3 years apart. The average age of the patients was 60 years, 36% were male, and the average duration of RA at baseline was 8.5 years.

Thickening of the CCA occurred in 82% of the patients over 3 years, with a median yearly increase of 16 mcm. Thickening of the ICA occurred in 70% of the patients, with median yearly increase of 25 mcm.

However, patients who used a tumor necrosis factor inhibitor (TNFi) agents at baseline had a 37% lower rate of CCA thickening compared to those who did not use a TNFi agent (14 mcm/year vs. 22 mcm/year), after controlling for demographic variables, cardiovascular risk factors, and baseline arterial thickening.

"We found that progression in the common carotid was much more pronounced in patients with early disease than in later disease," said Dr. Bathon. "There seems to be a particular risk when the disease first starts."

Thickening of the ICA was independently associated with prednisone use, but progression was significantly lower in patients who were taking statins at baseline, Dr. Bathon said.

A total of 68 patients showed at least some plaque development, and 14% of patients developed new plaque during the study period. Patients who developed plaque over time had higher average swollen joint counts and higher average C-reactive protein levels than those who did not show atherosclerosis progression, Dr. Bathon noted.

"The data need to be confirmed in other studies," Dr. Bathon said, "but they suggest that prednisone promotes atherosclerosis in RA, even in the tiny doses that we use." But the findings also support the protective value of statins and TNFi agents against atherosclerosis in RA patients, she said.

The study was supported in part by the American College of Rheumatology Research and Education Foundation. Dr. Bathon said she had no financial conflicts to disclose.

ATLANTA – Patients with rheumatoid arthritis showed significant arterial thickening over a 3-year period, but tumor necrosis factor inhibitor use slowed the progression, based on data from 158 patients. The findings were presented at the annual scientific meeting of the American College of Rheumatology.

"We know that many of our patients with autoimmune disease have higher risk for cardiovascular disease," said Dr. Joan M. Bathon, professor of medicine and director of the Johns Hopkins Arthritis Center at the Johns Hopkins University in Baltimore. But few studies have examined what drives the plaque buildup in these patients.

Dr. Bathon and her colleagues examined a subgroup of patients enrolled in a larger study of cardiovascular disease and RA. They used ultrasound to measure the thickness of the walls of the common carotid artery (CCA) and internal carotid artery (ICA) and compared data on each patient at two visits approximately 3 years apart. The average age of the patients was 60 years, 36% were male, and the average duration of RA at baseline was 8.5 years.

Thickening of the CCA occurred in 82% of the patients over 3 years, with a median yearly increase of 16 mcm. Thickening of the ICA occurred in 70% of the patients, with median yearly increase of 25 mcm.

However, patients who used a tumor necrosis factor inhibitor (TNFi) agents at baseline had a 37% lower rate of CCA thickening compared to those who did not use a TNFi agent (14 mcm/year vs. 22 mcm/year), after controlling for demographic variables, cardiovascular risk factors, and baseline arterial thickening.

"We found that progression in the common carotid was much more pronounced in patients with early disease than in later disease," said Dr. Bathon. "There seems to be a particular risk when the disease first starts."

Thickening of the ICA was independently associated with prednisone use, but progression was significantly lower in patients who were taking statins at baseline, Dr. Bathon said.

A total of 68 patients showed at least some plaque development, and 14% of patients developed new plaque during the study period. Patients who developed plaque over time had higher average swollen joint counts and higher average C-reactive protein levels than those who did not show atherosclerosis progression, Dr. Bathon noted.

"The data need to be confirmed in other studies," Dr. Bathon said, "but they suggest that prednisone promotes atherosclerosis in RA, even in the tiny doses that we use." But the findings also support the protective value of statins and TNFi agents against atherosclerosis in RA patients, she said.

The study was supported in part by the American College of Rheumatology Research and Education Foundation. Dr. Bathon said she had no financial conflicts to disclose.

ATLANTA – Patients with rheumatoid arthritis showed significant arterial thickening over a 3-year period, but tumor necrosis factor inhibitor use slowed the progression, based on data from 158 patients. The findings were presented at the annual scientific meeting of the American College of Rheumatology.

"We know that many of our patients with autoimmune disease have higher risk for cardiovascular disease," said Dr. Joan M. Bathon, professor of medicine and director of the Johns Hopkins Arthritis Center at the Johns Hopkins University in Baltimore. But few studies have examined what drives the plaque buildup in these patients.

Dr. Bathon and her colleagues examined a subgroup of patients enrolled in a larger study of cardiovascular disease and RA. They used ultrasound to measure the thickness of the walls of the common carotid artery (CCA) and internal carotid artery (ICA) and compared data on each patient at two visits approximately 3 years apart. The average age of the patients was 60 years, 36% were male, and the average duration of RA at baseline was 8.5 years.

Thickening of the CCA occurred in 82% of the patients over 3 years, with a median yearly increase of 16 mcm. Thickening of the ICA occurred in 70% of the patients, with median yearly increase of 25 mcm.

However, patients who used a tumor necrosis factor inhibitor (TNFi) agents at baseline had a 37% lower rate of CCA thickening compared to those who did not use a TNFi agent (14 mcm/year vs. 22 mcm/year), after controlling for demographic variables, cardiovascular risk factors, and baseline arterial thickening.

"We found that progression in the common carotid was much more pronounced in patients with early disease than in later disease," said Dr. Bathon. "There seems to be a particular risk when the disease first starts."

Thickening of the ICA was independently associated with prednisone use, but progression was significantly lower in patients who were taking statins at baseline, Dr. Bathon said.

A total of 68 patients showed at least some plaque development, and 14% of patients developed new plaque during the study period. Patients who developed plaque over time had higher average swollen joint counts and higher average C-reactive protein levels than those who did not show atherosclerosis progression, Dr. Bathon noted.

"The data need to be confirmed in other studies," Dr. Bathon said, "but they suggest that prednisone promotes atherosclerosis in RA, even in the tiny doses that we use." But the findings also support the protective value of statins and TNFi agents against atherosclerosis in RA patients, she said.

The study was supported in part by the American College of Rheumatology Research and Education Foundation. Dr. Bathon said she had no financial conflicts to disclose.