New and Noteworthy Information—April 2016
Carotid endarterectomy is superior to carotid artery stenting in patients age 70 and older with symptomatic carotid stenosis, according to a study published online ahead of print February 12 in the Lancet. Researchers analyzed individual patient data from four randomized controlled trials. In all, 4,754 patients were randomly assigned to carotid endarterectomy or carotid artery stenting. For patients assigned to carotid artery stenting, the periprocedural hazard ratio for stroke and death in patients age 65 to 69, compared with patients younger than 60, was 2.16. The hazard ratio was about 4.0 for patients age 70 or older. There was no evidence of an increased periprocedural risk by age group with carotid endarterectomy. Age was not associated with the postprocedural stroke risk either within treatment group or between treatment groups.
Having a history of major surgery is associated with a negligibly lower level of cognitive functioning, according to a study published in the February issue of Anesthesiology. Using linear regression adjusted for sex and age, investigators compared results from five cognitive tests between twins who had major, minor, hip, knee replacement, or other surgery, and a reference group of twins without surgery. Genetic and shared environmental confounding was addressed in intrapair analysis of 87 monozygotic and 124 dizygotic same-sex twin pairs in whom one had a history of major surgery and the other did not. Compared with the reference group, twins with at least one major surgery had a composite cognitive score that was one tenth of one standard deviation lower.
Alcohol consumption immediately raises cardiovascular risk, but risk remains high only following heavy alcohol consumption, according to a study published March 8 in Circulation. Researchers identified 23 studies including 29,457 participants that assessed the association between alcohol intake and cardiovascular events in the subsequent hours and days. They calculated pooled relative risks for the association between alcohol intake and myocardial infarction, ischemic stroke, and hemorrhagic stroke. Their analysis was based on DerSimonian and Laird random-effects models. Moderate alcohol consumption was associated with a higher cardiovascular risk that was attenuated after 24 hours. Moderate alcohol consumption also was protective against myocardial infarction, hemorrhagic stroke, and ischemic stroke within one week. Heavy alcohol consumption was associated with higher cardiovascular risk during the following day and week.
Hostile attitudes and effortful coping in young adulthood are associated with worse cognition in midlife, according to a study published online ahead of print March 2 in Neurology. Investigators used linear regression to examine the association of these two characteristics at baseline with subsequent cognitive ability in 3,126 black and white people. Baseline hostility and effortful coping were prospectively associated with lower cognitive function 25 years later, controlling for age, sex, race, education, long-term exposure to depression, discrimination, negative life events, and baseline cognitive ability. Compared with the lowest quartile, those in the highest quartile of hostility performed 0.21 standard deviation units lower on cognitive tasks. Those in the highest quartile of effortful coping performed 0.30 standard deviation units lower on cognitive tasks, compared with those in the lowest quartile.
Insufficient amounts of vitamin D during pregnancy may increase the risk of multiple sclerosis (MS) in offspring, according to a study published online ahead of print March 7 in JAMA Neurology. Researchers identified 193 people who received a diagnosis of MS before December 31, 2009, and matched 176 cases with 326 controls. Maternal serum vitamin D levels were measured using a chemiluminescence assay. Mean maternal vitamin D levels were in the insufficient range, but were higher in controls than in cases. Maternal vitamin D deficiency during early pregnancy was associated with a nearly twofold increased risk of MS in the offspring, compared with maternal vitamin D sufficiency. The researchers found no statistically significant association between the risk of MS and increasing serum vitamin D levels.
Comorbidity is more common than expected in multiple sclerosis (MS), even around the time of diagnosis, according to a study published online ahead of print March 9 in Neurology. Using population-based administrative health data, researchers identified 23,382 incident MS cases and 116,638 age-, sex-, and geographically matched controls. Investigators estimated the prevalence of hypertension, diabetes, hyperlipidemia, heart disease, chronic lung disease, epilepsy, fibromyalgia, inflammatory bowel disease, depression, anxiety, bipolar disorder, and schizophrenia at MS diagnosis using validated case definitions. Compared with the matched population, all comorbidities except hyperlipidemia were more common in the MS population. The prevalence of hypertension was 16% higher for women with MS and 48% higher for men with MS, compared with controls. Diabetes, epilepsy, depression, and anxiety were more prevalent among men with MS than women with MS.
