Primecuts – This Week In The Journals

February 6, 2012

By Chelsey Forbess, MS4

Faculty Peer Reviewed

While some people in this country have been following the Republican primary elections this past week, others trending the economy, and others observing the changing global weather patterns, I think it is safe to say that most people have been focused on Super Bowl XLVI. Whether you root for Eli, Tom, or Madonna, the Super Bowl unites all of America in the name of sports. (And television.) Unfortunately, watching football has also become synonymous with high-cholesterol foods like burgers and nachos and drinking copious quantities of beer. Perhaps a little more scientific evidence would serve as ammunition for patients to make important lifestyle changes and break some of these bad “American” habits. This brings us to this week’s edition of Primecuts!

On the topic of cholesterol, a new meta-analysis published in the Journal of the American College of Cardiology shows that statin therapy is equally effective in decreasing cardiovascular events in women as it is in men, contrary to previous reports.[1] In this study, 18 randomized clinical trials with sex-specific outcomes were analyzed (N= 141,235; 40,275 women; 21,468 cardiovascular events). Overall, the cardiovascular event rate was lower in the groups randomized to receive statin therapy than those randomized to a control group. These results were similar for both women and men (OR: 0.81, 95% CI: 0.75 to 0.89; p < 0.0001, and OR: 0.77, 95% CI: 0.71 to 0.83, p < 0.0001, respectively). Statins were also associated with a significant decrease in all-cause mortality for both women and men, further suggesting that these medications can be used without regard to sex in all appropriate cases.

Before prescribing statins, lifestyle changes should be encouraged to lower cholesterol. A recent nutritional study demonstrates what no one ever believed to be possible: beef may actually be good for your heart.[2] Hypercholesterolemic patients who followed the Beef in an Optimal Lean Diet (BOLD), or 113 grams of beef per day for five weeks, saw a decrease in total cholesterol and LDL cholesterol (p< 0.05) when compared with a typical healthy American diet (HAD). Participants who ate a total of 153 grams of beef per day as part of the Beef in an Optimal Lean Diet plus additional protein (BOLD+) diet, saw the greatest decrease in apolipoprotein B levels when compared to other diets. This study suggests that including lean beef in a “heart-healthy dietary pattern” may in fact decrease one’s cardiovascular risk factors.

It is typically not only a good diet, but a good diet combined with exercise that leads to the greatest health outcomes. A large study in BMJ this week highlights the health benefits, as well as improvement in quality of life, of exercise in cancer survivors.[3] In this meta-analysis of 34 randomized controlled trials, 22 of which focused on patients with breast cancer, physical activity was associated with improvements in body mass index, body weight, peak oxygen consumption, peak power output, distance walked in six minutes, right handgrip strength, and quality of life. For the studies that included breast cancer patients only, physical activity was associated with decreased fatigue and depression, and improved quality of life, among other outcomes.

For those who want to lose weight, but cannot seem to make it to the gym, a virtual coach might be the answer. A randomized controlled trial from this past week focused on internet-based programs as a way to promote physical activity in overweight and obese subjects.[4] In this study, an animated computer “coach” set goals for participants and provided them with personalized feedback. Participants wore pedometers and their activity level was assessed by the change in their step counts. On average over the 12-week period, those with access to the virtual coach maintained their step counts, while those of the control group declined.

Is there any proven health benefit to massage therapy after exercise? According to a study this week in Science Translational Medicine, massage therapy delivered to acutely damaged muscle through exercise reduces inflammation and promotes mitochondrial biogenesis.[5] Through muscle biopsies, scientists were able to conclude that massage therapy reduces the amount of inflammatory cytokine release from damaged muscle, specifically tumor necrosis factor–? (TNF-?) and interleukin-6 (IL-6), as well as the amount of heat shock protein 27 (HSP27) phosphorylation. Massage therapy thus reduces stress from myofiber injury.

When trying to figure out how best to kick those bad “American” habits, consider exercising, whether it is at the gym or virtually at home, eating lean beef, and rewarding yourself with an anti-inflammatory massage. The latter will likely be crucial after sustaining all of those muscle injuries from cheering on the Giants.

Chelsey Forbess is a 4th year medical student at NYU School of Medicine

Peer reviewed by Cara Litvin, MD, section editor, Clinical Correlations

Image courtesy of Wikimedia Commons

References:

1. Kostis WJ, Cheng JQ, Dobrzynski JM, Cabrera J, Kostis JB. Meta-analysis of statin effects in women versus men. J Am Coll Cardiol. 2012 Feb 7;59(6):572-82. http://content.onlinejacc.org/cgi/content/abstract/59/6/572

2. Roussell MA, Hill AM, Gaugler TL, West SG, Heuvel JP, Alaupovic P, Gillies PJ, Kris-Etherton PM. Beef in an Optimal Lean Diet study: effects on lipids, lipoproteins, and apolipoproteins. Am J Clin Nutr. 2012 Jan;95(1):9-16. http://www.ajcn.org/content/early/2011/12/13/ajcn.111.016261.full.pdf+html.

3. Fong DY, Ho JW, Hui BP, Lee AM, Macfarlane DJ, Leung SS, Cerin E, Chan WY, Leung IP, Lam SH, Taylor AJ, Cheng KK. Physical activity for cancer survivors: meta-analysis of randomised controlled trials. BMJ. 2012 Jan 30;344:e70. http://www.bmj.com/content/344/bmj.e70.

4. Watson A, Bickmore T, Cange A, Kulshreshtha A, Kvedar J. An internet-based virtual coach to promote physical activity adherence in overweight adults: randomized controlled trial. J Med Internet Res. 2012 Jan 26;14(1):e1. http://www.jmir.org/2012/1/e1/.

5. Crane JD, Ogborn DI, Cupido C, Melov S, Hubbard A, Bourgeois JM, Tarnopolsky MA. Massage therapy attenuates inflammatory signaling after exercise-induced muscle damage. Sci Transl Med. 2012 Feb 1;4(119):119ra13. http://stm.sciencemag.org/content/4/119/119ra13.abstract

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