Lee
S. Levin, M.D.
Internal and Anti-Aging Medicine
2212 Brothers
Road
Santa Fe, New Mexico 87505
(505)
983-9460 office
(505) 983-0568 fax
|
Monday, January 4, 2010
Dr. Lee S. Levin Dr. Lee Levin: Anti-Aging Internal Medicine
Santa Fe, New Mexico
A
Word from Dr. Lee Levin on Anti-Aging Internal Medicine
Anti-aging medicine is a new field that focuses on the detection and prevention
of diseases associated with aging before they become severe. Dr. Lee S. Levin, a successful practicing physician for the past
28 years, employs the techniques of anti-aging internal medicine by incorporating a preventive focus on diet, exercise, vitamins,
supplements and herbs, combined, as necessary, with traditional medical treatment. He further treats age-related hormonal
deficiencies with the latest in bioequivalent hormone replacement if this is medically needed.
This combination of alternative and traditional
therapies results in patients feeling younger, more energetic, and stronger. It is evidenced in improved test results demonstrating
decreased inflammation, improved cholesterol and lipid levels, stronger bones, better endurance, less diabetes, and numerous
other benefits.
We
all age. The question is, how well will we age? Medical knowledge is remarkably doubling every three to four years. As
a result, we now have many new approaches to markedly enhance an individual’s quality of life and slow the progression
of age-related disease. Dr. Levin devotes a great portion of his time and energy to the review and study of the latest in
these medical advances, providing his patients with the highest quality anti-aging expertise possible.
FREQUENTLY ASKED QUESTIONS
1) What is anti-aging medicine?
Anti-aging medicine focuses on the prevention, early detection and treatment of age-related dysfunction and disease. Scientific
advancements in recent years have demonstrated that many of the disabilities traditionally associated with the aging process
can be addressed by modern, informed medical treatment. The body’s biological processes can be revitalized and the quality,
and perhaps quantity, of the human life span enhanced. Physicians who are trained in anti-aging medicine focus on preventing
a long list of ailments through the use of diet and exercise, hormonal and metabolic analysis and treatment, and supplementation
with vitamins and other dietary supplements. Anti-aging medicine has been called “the most important new model for health
care for this millennium”
(“The New Anti-Aging Revolution,” p. 3, by Dr. Ronald Klatz, President of the American Academy
of Anti-Aging Medicine and Dr. Robert Goldman, President of the National Academy of Sports Medicine).
2) How does Dr. Levin’s personal philosophy and approach to anti-aging medicine help to define his
practice?
Dr. Levin has been in practice in Internal Medicine since 1979 and continues to meet the needs of
a large, diverse population at his office in Santa Fe, New Mexico. Active in mountain climbing, skiing, kayaking, running, and other outdoor activities, Dr. Levin began in recent years to explore the ways in which modern
medicine could enable him, and by extension his patients as well, to remain active and strong and to continue to perform at
an optimal level in all areas of life. He blends expertise in both traditional Internal Medicine with the newest discoveries
in anti-aging to actively delay, and in many cases prevent, the diseases and dysfunctions of the aging process.
3) What can I do to prevent breast cancer?
Science now understands that a healthy,
anti-inflammatory diet rich in omega-3 oils, fresh fruits and vegetables, along with regular exercise and weight control greatly
decreases one’s risk of breast cancer. Supplements such as calcium, vitamin D, fish oil, and Indole-3-Carbinol have
demonstrated great preventative qualities. Regular mammograms remain extremely important in early detection.
4) Does estrogen cause breast cancer as has been suggested in recent popular-press accounts?
The answer to this depends upon many factors rather than it being a simple “open and shut” case. Some studies
suggest that after ten to twenty years of estrogen supplementation (much of which has occurred a form of oral estrogen/progestin;
Premarin and Provera), there may be a slight increase rate of breast cancer. Other studies say there is no increased risk.
As with anything, what is important are the ages and health circumstances of individual patients, the form and amount of estrogen
supplemented, and the knowledge of the practitioner.
Women must consider that the advantages
of early (at menopause) bioequivalent
estrogen replacement include stronger bones, less colon cancer, less heart disease, increased libido, younger skin, and better
mood and memory. These advantages, resulting from natural estrogen supplementation in an informed, medically overseen way
(complemented by the significant preventative advantages of undertaking a healthy diet, exercise, and lifestyle), can strongly
outweigh the much smaller, possible increased risk of breast cancer.
5) Is testosterone
replacement just for sexual problems?
The benefits of appropriate testosterone replacement are numerous. They
include improved sexual function, improved mood and strength, decreased inflammation, prevention of coronary artery disease,
improved bone strength, and prevention of diabetes. Testosterone supplementation can positively affect almost every system
in the body.
6)
Does testosterone supplementation cause prostate cancer?
Numerous studies say “no.”
However, testosterone replacement can adversely affect an already pre-existing presence of cancerous cells in the prostate.
Individuals must be checked for prostate cancer with a prostate exam and PSA blood test prior to starting testosterone therapy,
and then monitored twice yearly with the appropriate exams and blood testing.
7) Is Human Growth Hormone (HGH) a dangerous steroid?
Human Growth Hormone is a complex protein and not a steroid. Some adults are deficient in growth hormone, a condition that leads to obesity, coronary
artery disease, fatigue, increased risk of infections, osteoporosis, and many other adverse effects. Replacement of growth
hormone in these patients will improve the physical and mental aspects of their lives.
8)
Will I live longer with anti-aging medicine?
This is not known, but we do know that you will feel better, have more energy, and have improved mood and zest for life with
the appropriate therapy. If you are feeling better, eating better, exercising more, and have improved lab tests, you will
have a greatly improved quality of life and could quite possibly increase your longevity.
9) Will my insurance company cover an anti-aging program?
Some
insurances cover the cost of many of the protocols prescribed by anti-aging physicians. Unfortunately others, including Medicare,
do not. Of course, lifestyle changes, much of what is involved in anti-aging medicine, simply require that you, the patient,
make the decision to begin taking the actions that will better the quality of your own life.
|
| Choosing a health-care provider is one of the most important decisions you can make. You want someone
who is caring, knowledgeable, and accessible. Someone willing to take the time to go over all of your options and treat you
as a person, not just a patient.At our practice, we pride ourselves on our patient service. We offer
a knowledgeable staff, safe and proven procedures, and the latest in medical technology.
We've created this web site for both new and current patients. It includes
specific information on our practice, together with general wellness information.
Lee S. Levin, M.D.
Anti-Aging Internal Medicine
Diplomate of the American Board of Anti-Aging Medicine
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Practice Philosophy
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The early prevention and treatment
of disease before it becomes severe and disabling is the focus of my practice of medicine. To achieve this goal, I use a variety
of medical techniques including traditional Internal Medicine, the latest in nutritional supplements and dietary research,
proper exercise, and stress reduction. I blend these techniques with a comprehensive metabolic and hormonal evaluation to
strive toward optimal health. My patients have found marked improvement in energy and quality of life following my wellness
program.
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Experience
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1979-1990
Physician, voluntary faculty at Kaiser Permanente, Santa Clara, California; a teaching affiliate of
Stanford University School of Medicine
1990-1993 Chief of Internal Medicine,
Lovelace Medical Group, Santa Fe, New Mexico
1993-2000 Medical
Director, La Residencia Nursing Home, Santa Fe, New Mexico
2003-present Medical Director, All-Care Physical Therapy, Santa Fe, New Mexico
2005 Voluntary faculty, New Mexico State University, Las Cruces
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1993-present Physician in
private practice, Santa Fe, New Mexico
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Professional
Organizations
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New Mexico Medical Society
American Academy of Anti-Aging Medicine
Life
Extension Foundation
International Hormone Society
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Education
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1968-1972 Case
Western Reserve University, Cleveland,
Ohio
1972-1976 University of Illinois School of Medicine, Chicago, Illinois
1976-1979 Residency, Yale Program at St. Vincent’s
Hospital,
Bridgeport, Connecticut
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Interests
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Mountaineering (Dr. Lee Levin was the official physician on a Mount Everest service trek--click here for photos and acknowledgment), skiing, hiking, mountain biking, weight training, kayaking, long distance running
Environmental advocacy
Longevity and optimal wellness
Married: four children,
one grandchild
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Lee S. Levin, M.D.
Internal and Anti-Aging Medicine
2212
Brothers Road
Santa Fe, New Mexico 87505
(505)
983-9460 office
(505) 983-0568 fax
You may schedule an appointment by contacting
Dr. Levin at the above telephone number. He also offers brief, no-charge telephone introductions
to anti-aging medicine.
Having an elevation of 7,500 feet, Santa Fe, New Mexico is located at the base of the Rocky Mountains.
A thriving arts colony for nearly a century, Santa Fe’s natural beauty and outdoor activities also contribute to its
being placed on lists of most-visited North American cities year after year.
Visiting Santa Fe; Anti-Aging News if (window['tickAboveFold']) {window['tickAboveFold'](document.getElementById("latency-5694099906562393935"));
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  The Historic El Rey Motor Inn in Santa Fe, New Mexico
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} Anti-Aging News Independent Association of Low Serum 25-Hydroxyvitamin
D and 1,25-Dihydroxyvitamin D Levels With All-Cause and Cardiovascular Mortality
Harald Dobnig, MD; Stefan
Pilz, MD; Hubert Scharnagl, PhD; Wilfried Renner, PhD; Ursula Seelhorst, MA; Britta Wellnitz, LLD; Jürgen Kinkeldei,
DEng; Bernhard O. Boehm, MD; Gisela Weihrauch, MSc; Winfried Maerz, MD
Arch Intern Med.
2008;168(12):1340-1349.
Background In cross-sectional studies, low serum levels of 25-hydroxyvitamin
D are associated with higher prevalence of cardiovascular risk factors and disease. This study aimed to determine whether
endogenous 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels are related to all-cause and cardiovascular mortality. Methods
Prospective cohort study of 3258 consecutive male and female patients (mean [SD] age, 62 [10] years) scheduled for coronary
angiography at a single tertiary center. We formed quartiles according to 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D
levels within each month of blood drawings. The main outcome measures were all-cause and cardiovascular deaths. Results
During a median follow-up period of 7.7 years, 737 patients (22.6%) died, including 463 deaths from cardiovascular causes.
Multivariate-adjusted hazard ratios (HRs) for patients in the lower two 25-hydroxyvitamin D quartiles (median, 7.6 and 13.3
ng/mL [to convert 25-hydroxyvitamin D levels to nanomoles per liter, multiply by 2.496]) were higher for all-cause mortality
(HR, 2.08; 95% confidence interval [CI], 1.60-2.70; and HR, 1.53; 95% CI, 1.17-2.01; respectively) and for cardiovascular
mortality (HR, 2.22; 95% CI, 1.57-3.13; and HR, 1.82; 95% CI, 1.29-2.58; respectively) compared with patients in the highest
25-hydroxyvitamin D quartile (median, 28.4 ng/mL). Similar results were obtained for patients in the lowest 1,25-dihydroxyvitamin
D quartile. These effects were independent of coronary artery disease, physical activity level, Charlson Comorbidity Index,
variables of mineral metabolism, and New York Heart Association functional class. Low 25-hydroxyvitamin D levels were significantly
correlated with variables of inflammation (C-reactive protein and interleukin 6 levels), oxidative burden (serum phospholipid
and glutathione levels), and cell adhesion (vascular cell adhesion molecule 1 and intercellular adhesion molecule 1 levels). Conclusions Low 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels are independently associated
with all-cause and cardiovascular mortality. A causal relationship has yet to be proved by intervention trials using vitamin
D.
Author Affiliations: Division of Endocrinology and Nuclear Medicine, Department of Internal
Medicine (Dr Dobnig), and Clinical Institute of Medical and Chemical Laboratory Diagnostics (Drs Scharnagl, Renner, and Maerz
and Ms Weihrauch), Medical University of Graz, Graz, Austria; and Department of Public Health, Social and Preventive Medicine,
Mannheim Medical Faculty, University of Heidelberg, Heidelberg (Dr Pilz), LURIC Study Nonprofit LLC, Freiburg (Ms Seelhorst
and Dr Wellnitz), Synlab Center of Laboratory Diagnostics Stuttgart, Leinfelden-Echterdingen (Dr Kinkeldei), Division of Endocrinology
and Diabetes, Department of Internal Medicine, University of Ulm, Ulm (Dr Boehm), and Synlab Center of Laboratory Diagnostics
Heidelberg, Eppelheim (Dr Maerz), Germany. Men Face Rising Osteoporosis Risk Though it’s much more common in women, osteoporosis can strike men
too, often with debilitating consequences. Until recently, male-oriented research into the disease lagged far behind that
devoted to women. But with more men living longer, and with their rates of osteoporosis climbing as a result, studies of male
risk have become more common. In research presented at the IOF World Congress on Osteoporosis in Toronto, Canada, Dr. Jane
Cauley from the University of Pittsburgh, showed that rates of hip bone loss increase with age among both white and non-white
men, particularly those 75 years or older. The study cohort of 5,995 individuals reflects the diversity of the male US population,
Cauley says.
As with women, Cauley explained, osteoporosis in men results in part from declining levels of estrogen,
which normally keep bone-depleting inflammatory compounds called cytokines in check. Without sufficient estrogen, cytokines
strip away at bone layers through a process called resorption. Over time, weakening bones develop the hallmarks of osteoporosis,
becoming brittle and fracture-prone. Rates of hip fracture were especially pronounced among Hispanic men, for unknown reasons,
Cauley said. “The increase may be due to inadequate vitamin D, but really we don’t yet know why Hispanic men are
more vulnerable.”
Cauley emphasized the study reinforces a basic message: namely that men over the age of 70 should
consider a bone density check. “If bone density is good, you may not need to repeat the test, but if it’s low,
you may need to retest within a few years and maybe start thinking about treatment,” she said. In a further study, Dr.
John Wong from Tufts University and his colleagues estimated the number of male fractures and associated costs from 2005 to
2025. Using a computer model that simulates costs, morbidity, and mortality for different age and racial/ethnic groups of
men in the United States, Wong and colleagues predicted a 56% increase in the incidence of male osteoporotic fractures, from
a total of 595,000 to 925,000.
The model also predicted a commensurate rise in related costs, from a baseline of US
$4.1 billion to US $6.7 billion. The increase in male fracture incidence, Wong said, can be attributed to rising numbers of
elderly people in the US population, which is steadily aging.
The Economic Impact of Osteoporosis in Men
A large portion of the total cost of treating fragility fractures in the United States goes to treating men, a new study
revealed. “People are not really aware that this disease also occurs in men as well as women, as a result, they don’t
really understand the economic consequences of osteoporosis in men,” said Dr. Rick Adachi, professor of medicine at
McMaster University, Hamilton, Ontario, Canada, and lead author on the study. But Adachi and colleagues found that 30 percent
of the total cost of treating fragility fractures goes towards treating men. “This was higher than anticipated and contradicts
the view that women alone are at risk for fragility fractures and the costs and consequences associated with them,”
Adachi said. Together with colleagues at St. Joseph’s Hospital, Hamilton, Ontario, and Proctor and Gamble Pharmaceuticals,
Mason, Ohio, Adachi examined data from approximately 45 different public and private healthcare plans. The researchers tallied
medical claims for treatment of vertebral and non-vertebral fractures in men and women aged 50-89 years. Nearly two million
claims were analyzed and fragility fracture rates determined for the wrist, leg, arm, hip, pelvis, shoulder and spine. In
addition to the higher than anticipated costs related to treating fractures in men, the study came up with another surprising
finding—over 90 percent of the cost of treating fractures in men goes towards treating non-vertebral fractures. “While
vertebral fractures are important and do reflect fragility in men, the real cost in men turns out to be these non-vertebral
fractures, said Adachi. These include fracture of the hip, wrist, and shoulder. Though osteoporosis affects more women than
men, about 1 in 5 men over age 50—more than will get prostate cancer—will, at sometime, suffer an osteoporotic
or fragility fracture, according to previous research. In fact, estimates suggest that by 2025 the number of hip fractures
in men, worldwide, will have more than doubled. Adachi’s findings suggest that adjusted for inflation, the cost of treating
osteoporosis in men will rise by at least that much, in real terms. “If we want to help reduce costs, then we really
need to focus on new approaches for the early identification of osteoporosis in men and we need to find medications that are
proven to help prevent both vertebral and non-vertebral fractures,” said Adachi. Note: This story has been adapted from
a news release issued by International Osteoporosis Foundation.
CANCER PREVENTION
Green Tea Extract Stops Progression to Prostate
Cancer
An extract of the catechins found in green tea appears to be effective in preventing the progression
of high-grade prostatic intraepithelial neoplasia to invasive prostate cancer, Saverio Bettuzzi, Ph.D., reported at the annual
meeting of the American Association for Cancer Research.In the placebo-controlled, double-blind study, 30 men with prostatic
intraepithelial neoplasia (PIN) took 200 mg of green tea catechins (GTCs) three times daily for 6 months. Another 30 men with
PIN took a placebo. Catechins are antioxidants, and they belong to a class of polyphenols called flavanols. Epigallocatechin-3-gallate
(EGCG) is the major catechin in green tea, and in tissue culture EGCG has been shown to induce apoptosis in cancer cells,
but not normal cells. At 12 months, nine (30%) of the men who took placebo had progressed to prostate cancer. In contrast,
only one (3.3%) of the men who took GTC had progression of PIN to invasive cancer, for an apparent efficacy rate of 90%. The
difference between the two groups was statistically significant.
By Robert Finn, excerpted from Internal
Medical News,August 1, 2005.
Exercise Cuts Breast Cancer Risk 10% After Menopause
In postmenopausal women, an active lifestyle
provided about 10% reduction in the risk of developing breast cancer over a 17-year period in over 36,000 women, according
to a prospective cohort study presented at the annual meeting of the American Society of Clinical Oncology.Dr. Aditya Bardia
and colleagues from the Iowa Women’s Health Study mailed questionnaires addressing leisure time physical activity and
breast cancer risk factors to postmenopausal women living in Iowa in 1986; a total of 41,837 women (43%) responded. A high
level of physical activity was associated with a 13% reduction in the risk of developing ER (estrogen responsive)-positive
breast cancer and an 8% reduction in ER-negative breast cancer, compared with low physical activity. The risk reduction for
PR-positive and PR-negative breast cancer was 5% and 27% respectively. Excerpted from Internal Medicine News
I3C and DIM: Natural, Dual-Action Protection Against Deadly Cancers With the increasing toxicity of our natural environment, guarding against cancer is an essential
part of the quest for a longer, healthier life. Despite the expenditure of hundreds of billions of research dollars, the war
on cancer has yet to produce a significant cure for most forms of this deadly disease. As a result, health-conscious adults
are advised to adopt an aggressive strategy of cancer prevention. Fortunately, scientists have identified and isolated remarkable
chemicals in cruciferous vegetables such as broccoli, cabbage, and watercress that can protect against cellular changes that
lead to colon, breast, thyroid, and other cancers. Many studies have demonstrated that specific compounds isolated from these
vegetables—including diindolylmethane (DIM) and its precursor, indole-3-carinol (I3C)—have unique cancer-fighting
benefits. These compounds have been found to alter estrogen metabolism in both men and women, thus protecting against hormone-dependent
cancers such as those of the breast, cervix, and prostate. One of the most important applications of I3C and DIM may be in
protecting against hormone-induced breast cancer. Epidemiological, laboratory, and animal studies indicate that dietary intake
of I3C prevents the development of estrogen-enhanced cancers, including breast, endometrial, and cervical cancers. I3C has
been found to cause growth arrest and increased apoptosis (programmed cell death). -Excerpted from Life Extension Journal,
January 2006
Diet and Nutrition
 Coffee for Heath
When the Ink Spots sang “I love the java
jive and it loves me” in 1940, they could not have known how right they were.Coffee drinkers are about 60% less likely
to develop type-2 diabetes, even in those with early signs of diabetes, vs. those who abstain from the beverage. The University
of California, San Diego, studied 910 people, ages 50 and older with no diabetes, and found the protective effect wasn’t
caffeine, since decaffeinated coffee also helped.
Investors Business Daily, November ‘06 Coffee Is a Top Source of Healthy Antioxidants Coffee not only helps clear the mind and perk up the energy,
it also provides more healthful antioxidants than any other food or beverage in the American diet, according to a study released
earlier this year. Of course, too much coffee can make people jittery and even raise cholesterol levels, so food experts stressed
moderation. Chemistry professor, Joe A. Vinson, of the University of Scranton, Pennsylvania, analyzed the anti-oxidant content
of more than 100 different food items, including vegetables, fruits, nuts, spices, oils, and common beverages. They then used
Agriculture Department data on typical food consumption patterns to calculate how much antioxidant each food contributes to
a person’s diet. They concluded that the average adult consumes 1,299 milligrams of antioxidants daily from coffee.
The closest competitor was tea at 294 milligrams. “Unfortunately, consumers are still not eating enough fruits and vegetables,
which are better for you from an overall nutritional point of view due to their higher content of vitamins, minerals and fiber,”
Vinson said. In February, a team of Japanese researchers reported in the Journal of the National Cancer Institute
that people who drank coffee daily, or nearly every day, had half the liver cancer risk of those who never drank it. The protective
effect occurred in people who drank one to two cups a day and increased at three to four cups. Last year, researchers at the
Harvard School of Public Health found that drinking coffee cut the risk of developing the most common form of diabetes. Men
who drank more than six 8-ounce cups of caffeinated coffee per day lowered their risk of type-2 diabetes by about half, and
women reduced their risk by nearly 30 percent, compared with people who did not drink coffee, according to the study in Annals
of Internal Medicine. -Excerpted from an article by Randolph E. Schmid, The Associated
Press Mediterranean Diet Prolongs
Life in Elderly Adherence to a Mediterranean diet decreases mortality in the elderly by more than 50%. In a study of dietary patterns
and lifestyle factors in 2,339 apparently healthy men and women aged 70 to 90 years conducted in 11 European countries, the
hazard ratio (HR) for all-cause mortality at 10 years was 0.77 for adhering to a Mediterranean diet, 0.78 for moderate alcohol
use, 0.63 for physical activity, and 0.65 for nonsmoking. Similar effects were seen regarding mortality from coronary heart
disease, cardiovascular diseases, and cancer. The combination of 4 low-risk factors lowered the HR for all-cause mortality
to 0.35 (Journal of the American Medical Association 2004; 292:1433-1439)
Olive oil added to a regular diet
may help reduce oxidative damage to cells that can eventually lead to cancer. Oil contains phenols, which are antioxidants
that prevent cell damage. The Copenhagen University Hospital’s study of 182 European men, aged 20-60, found that a quarter
cup of olive oil throughout a day reduced oxidative damage by 13%.  The Mediterranean Diet Pyramid
 Vitamin D Can Help
TESTOSTERONE
About half of randomized controlled trials of testosterone therapy in older men have shown positive effects on cognitive
function, particularly spatial cognition, Dr. Camille Vaughan said at the annual meeting of the American Geriatrics Society.
Dr. Vaughan presented data from a study in which 70 healthy men, ages 65-83 years, with low levels of testosterone (less than
350 ng/ dL) and normal performance on the Mini-Mental State Examination (MMSE) were randomly assigned to receive one of three
regimens. There was a trend in the active treatment groups toward improved performance in the Benton Visual Retention Test
in visuospatial skills on the Visual Patterns Test. ~~Exerpted from Internal Medicine News, June 15, 2006
Testosterone, DHEA Increased Physical Performance In Older Men
Data from the Massachusetts Male Aging Study showed that
elevated levels of endogenous total testosterone, bioavailable testosterone, dehydroepiandrosterone and dehydroepiandrosterone
sulfate are associated with increases in physical performance in older men.The average age of subjects was 68 years. All participants
completed a physical performance test as well as a grip strength and chair stand test. Researchers determined that up to certain
critical concentrations, hormones conferred benefit. ~~Excerpted from Endocrine Today
PREVENTING HEART DISEASE 
Erythropoietin is an entirely different modality of treatment for HF that is going to be a very exciting area in the
future. It doesn’t interfere with any of the other drugs currently used in treatment.”~~Reynolds M. Delgado III,
M.D. Anemia Therapy in Heart-Failure Patients
Increases Survival, Decreases Hospitalizations Erythropoietin therapy improves renal function and decreases the need for hospitalization
in anemic patients with heart failure (HF), according to results of an observational study presented at the annual meeting
of the Heart Failure Society of America. Anemia is diagnosed in up to 55% of patients with chronic HF, depending on the disease
severity and the definition of anemia applied. In patients with moderate-to-severe chronic HF, anemia has been associated
with worsening symptoms, impaired exercise capacity, and reduced cardiac functional status as measured by New York Heart Association
(NYHA) class. Several studies have shown that anemia in chronic HF is an independent predictor of cardiovascular death and
is associated with an increased risk of hospitalization. In the analysis, the charts of 467 patients treated for chronic HF
were reviewed. Anemia…was present in 38%. Treatment with an erythropoiesis-stimulation protein was given to 81 eligible
patients…. Erythropoiesis-stimulating proteins (were supplemented with) oral iron if the serum iron level was below
normal. Although the treated patients had worse renal function at baseline than the controls, the survival rates were 83%
in the treated group and 68% in the control group. An Israeli outcomes study showed a similar favorable effect. ~~Excerpted
from Internal Medicine World Report, November 2004, p.12. Coronary Calcium Screening Backed for High-Risk Patients
Coronary calcium scanning followed
by myocardial perfusion imaging looks like it may be an effective approach to screening for coronary disease, John J. Mahmarian,
M.S., said at the annual meeting of the American Society of Nuclear Cardiology. The results from several studies have shown
that people with high coronary calcium scores have a markedly increased risk of having myocardial perfusion defects and significant
coronary disease. Therefore, he said, screening for coronary calcium makes sense for people with an intermediate or high risk
for coronary disease based on their risk factor profile. People with a (high) calcium score should be placed on an aggressive,
risk-factor reduction regimen and are potential candidates for further, non-invasive testing by myocardial perfusion imaging
using SPECT (single-photon emission computed tomography). Whether myocardial perfusion imaging is used on people in this category
or not should depend on the severity of their risk factors as well as their age and gender. These people should have follow-up
screening for coronary calcium every 1-2 years. Dr. Mahmarian said that about 15% of people screened could be in this category.
~~ Excerpted from Internal Medicine News, February 1, 2005  Disentangling the Roles of Disability and Morbidity in Survival to Exceptional Old Age Dellara F. Terry, MD, MPH; Paola Sebastiani, PhD; Stacy L. Andersen, BS; Thomas T. Perls, MD,
MPH Arch Intern Med. 2008;168(3):277-283. Background
Although it is commonly held that survival to age 100 years entails markedly delaying or escaping age-related
morbidities, nearly one-third of centenarians have age-related morbidities for 15 or more years. Yet, we
have previously observed that many centenarians compress disability toward the end of their lives. Therefore,
we hypothesize that for some centenarians, compression of disability rather than morbidity is a key feature
for survival to old age. Methods This cross-sectional,
nationwide study included 523 women and 216 men 97 years or older. The participants were stratified
by sex and age at onset (age <85 years [termed survivors] and age  85 years [termed delayers]) of chronic obstructive pulmonary disease, dementia, diabetes, heart disease,
hypertension, osteoporosis, Parkinson disease, and stroke. Dependent variables were the Barthel Activities
of Daily Living Index (Barthel Index) and the Information-Memory-Concentration test of the Blessed Dementia
Scale. Results Thirty-two percent of the participants were
survivors. For men with hypertension and/or heart disease for 15 or more years, the median Barthel Index
score was 90 (independence range, 80-100). For female survivors with hypertension, heart disease, and/or
osteoporosis, the median Barthel Index score was 65 (minimal assistance range, 60-79). Generally, men had better
function than women: 60% of male survivors had Barthel Index scores of 90 or higher compared with 18%
of female survivors (P < .001) and 50% of male delayers had Barthel Index scores of 90 or higher
compared with 27% of females delayers (P < .001). Conclusions
Whereas the compression of both morbidity and disability are essential features of survival to old age
for some centenarians, for others, the compression of disability alone may be the key prerequisite. Though
far fewer in number, male centenarians tend to have significantly better cognition and physical function
than their female counterparts.
Author Affiliations: New
England Centenarian Study, Geriatrics Section of the Department of Medicine, Boston University School of Medicine and Boston
Medical Center (Drs Terry and Perls and Ms Andersen), and Department of Biostatistics, Boston University School of Public
Health (Dr Sebastiani), Boston, Massachusetts.
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The Association Between Physical Activity in Leisure Time
and Leukocyte Telomere Length Lynn F. Cherkas, PhD; Janice L. Hunkin, BSc;
Bernet S. Kato, PhD; J. Brent Richards, MD; Jeffrey P. Gardner, PhD; Gabriela L. Surdulescu, MSc; Masayuki Kimura, MD, PhD;
Xiaobin Lu, MD; Tim D. Spector, MD, FRCP; Abraham Aviv, MD Arch Intern Med. 2008;168(2):154-158.
Background Physical inactivity is an important risk factor for many aging-related
diseases. Leukocyte telomere dynamics (telomere length and age-dependent attrition rate) are ostensibly a
biological indicator of human aging. We therefore tested the hypothesis that physical activity level in leisure
time (over the past 12 months) is associated with leukocyte telomere length (LTL) in normal healthy
volunteers. Methods We studied 2401 white twin volunteers,
comprising 2152 women and 249 men, with questionnaires on physical activity level, smoking status, and
socioeconomic status. Leukocyte telomere length was derived from the mean terminal restriction fragment length
and adjusted for age and other potential confounders. Results Leukocyte telomere
length was positively associated with increasing physical activity level in leisure time (P < .001);
this association remained significant after adjustment for age, sex, body mass index, smoking, socioeconomic
status, and physical activity at work. The LTLs of the most active subjects were 200 nucleotides longer
than those of the least active subjects (7.1 and 6.9 kilobases, respectively; P = .006). This finding
was confirmed in a small group of twin pairs discordant for physical activity level (on average, the LTL of more
active twins was 88 nucleotides longer than that of less active twins; P = .03). Conclusions A sedentary lifestyle (in addition to smoking, high body
mass index, and low socioeconomic status) has an effect on LTL and may accelerate the aging process. This provides
a powerful message that could be used by clinicians to promote the potentially antiaging effect of regular
exercise.
Author Affiliations: Twin Research and Genetic Epidemiology
Unit, King's College London, St Thomas' Hospital Campus, London, England (Drs Cherkas, Kato, Richards, and Spector and Mss
Hunkin and Surdulescu); and The Center of Human Development and Aging, University of Medicine and Dentistry of New Jersey,
New Jersey Medical School, Newark (Drs Gardner, Kimura, Lu, and Aviv).
RELATED ARTICLES Successful Aging: Is It in Our Future?
Jack M.
Guralnik
Arch Intern Med. 2008;168(2):131-132.
EXTRACT | FULL TEXT Cystatin C and Aging Success
Mark J. Sarnak, Ronit Katz, Linda F.
Fried, David Siscovick, Brian Kestenbaum, Stephen Seliger, Dena Rifkin, Russell Tracy, Anne B. Newman, Michael G. Shlipak,
and for the Cardiovascular Health Study
Arch Intern Med. 2008;168(2):147-153.
ABSTRACT | FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES Physical Activity and Leukocyte Telomere Length
JWatch General 2008;2008:2-2.
FULL TEXT Successful Aging: Is
It in Our Future?
Guralnik
Arch Intern Med 2008;168:131-132.
FULL TEXT 
The Benefits of Regular Exercise Regular exercise plays a role in health
and well-being. Frequent exercisers display reduced cardiovascular risk-factors, reduced cardio-vascular-related mortality
and morbidity.
Those who exercise with regularity have a lower risk of type 2 diabetes (diabetes mellitus), cancer,
hypertension, obesity, and the bone-destroying disease, osteoporosis, all of which are regarded as age-related dysfunctions.
A recent study concluded that inactivity also influences the aging process.
Original Investigation, Source: the Archives
of Internal Medicine, Vol. 168 (No. 2), Jan. 28th, 2008 Page 154 (abstract version with conclusion)
The Association
between Physical Activity in Leisure Time and Leukocyte Telomere Length
By Lynn F. Cherkas, PhD.; Janice L. Hunkin,
BSc; Bernet S. Kato, PhD.; J. Brent Richards, MD; Jeffrey P. Gardner, PhD.; Gabriela Surdulescu, MSc; Masayuki Kimura, MD,
PhD.; Xiaobin Lu, MD; Tim D. Spector, MD, FRCP; Abraham Aviv, MD
Background: Physical inactivity is an important risk-factor
for many aging-related diseases. Leukocyte telomere dynamics (telomere length and age-dependent attrition rate) are ostensibly
a biological indicator of human aging. We therefore tested the hypothesis that physical activity level in leisure time (over
the past twelve months) is associated with leukocyte telomere length (LTL) in normal, healthy volunteers.
Methods: We
studied 2401 white twin volunteers, comprising 2152 women and 249 men, with questionnaires on physical activity level, smoking
status, and socioeconomic status. Leukocyte telomere length was derived from the mean terminal restriction fragment length
and adjusted for age and other potential confounders.
Results: Leukocyte telomere length was positively associated with
increasing physical activity level in leisure time. (P< .001).; this association remained significant after adjustment
for age, sex, body-mass index, smoking, socioeconomic status, and physical activity at work. The LTLs of the most active subjects
were 200 nucleotides longer than those of the least active subjects (7.1 and 6.9 kilobases, respectively; P= .006). This finding
was confirmed in a small group of twin pairs discordant for physical activity (on average, the LTL of more active twins was
88 nucleotides longer than that of less active twins; P= .03).
Conclusions: A sedentary lifestyle (in addition to smoking,
high body- mass index, and low socioeconomic status) has an effect on LTL, and may accelerate the aging process. This provides
a powerful message that could be used by clinicians to promote the potentially anti-aging effect of regular exercise.
NEW
from the Archives of Internal Medicine:
The Joint Effects of Physical Activity and Body Mass Index on Coronary Heart
Disease Risk in Women
Arch Intern Med. 2008;168(8):884-890.
Background Physical activity and body mass
index (calculated as weight in kilograms divided by height in meters squared) independently alter the risk of coronary heart
disease (CHD); however, their combined effect on CHD is not established. Our objective was to study the combined association
of physical activity and body mass index on CHD.
Methods Prospective cohort study of 38 987 women free of cardiovascular
disease, cancer, and diabetes at baseline in the Women’s Health Study, with 10.9 mean years of follow-up. Weight, height,
and recreational activities were reported on entry. Body mass index was categorized as normal weight (<25), overweight
(25 to <30), and obese ( 30). Active was defined as 1000 kilocalories or more expended on recreational activities weekly.
Six joint body weight–physical activity categories were defined. The main outcome measure was the occurrence of incident
CHD during follow-up, defined as a cardiovascular event including nonfatal myocardial infarction, coronary artery bypass graft,
percutaneous transluminal coronary angioplasty, or CHD death.
Results A total of 948 cases of incident CHD occurred
during follow-up. Higher body mass index and physical inactivity were individual predictors of CHD. In joint analyses, compared
with active normal-weight individuals, the multivariate-adjusted hazard ratios (95% confidence intervals) were 1.54 (1.14-2.08)
for overweight-active; 1.87 (1.29-2.71) for obese-active; 1.08 (0.84-1.39) for normal weight–inactive; 1.88 (1.46-2.42)
for overweight-inactive; and 2.53 (1.94-3.30) for obese-inactive. Increasing levels of walking also resulted in significant
reductions in CHD risk for overweight and obese individuals.
Conclusions The risk of CHD associated with elevated body
mass index is considerably reduced by increased physical activity levels. However, the risk is not completely eliminated,
reinforcing the importance of being lean and physically active.
Author Affiliations: Division of General
Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (Dr Weinstein), Division of Preventive Medicine, Department
of Medicine, Brigham and Women’s Hospital (Drs Sesso, Lee, Rexrode, Cook, Manson, Buring, and Gaziano), and Department
of Epidemiology, Harvard School of Public Health (Drs Lee, Manson, and Buring), Boston, Massachusetts.
In
This Issue of Archives of Internal Medicine
Arch Intern Med. 2008;168(8):790.
Lee Levin, M.D. Doctor’s
Office Recommended Reading
Dr. Levin would like to bring to your attention some articles relevant to successful aging,
which were published in 2008.
From the Archives of Internal Medicine Volume 168 (No. 2), January 28th, 2008
Successful
Aging: Is It in Our Future?
By Jack M. Guralnik, M.D. PhD
Arch Intern Med. 2008;168(2):Pages 131-132.
Cystatin-C and Aging Success
Author Affiliations: Department of Medicine,
Tufts–New England Medical Center, Boston, Massachusetts (Drs Sarnak and Rifkin); Collaborative Health Studies Coordinating
Center, Seattle, Washington (Drs Katz and Siscovick); Departments of Biostatistics (Dr Katz), Medicine (Drs Siscovick and
Kestenbaum), and Epidemiology (Dr Siscovick), University of Washington, Seattle; Departments of Medicine (Drs Fried and Newman)
and Epidemiology (Dr Newman), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Medicine,
University of Maryland, Baltimore (Dr Seliger); Department of Pathology, University of Vermont College of Medicine, Burlington
(Dr Tracy); and Department of Medicine, San Francisco Veterans Administration and University of California, San Francisco
(Dr Shlipak).
Group Information: A list of participating Cardiovascular Health Study investigators and institutions
can be found at http://www.chs-nhlbi.org.
Methods We evaluated the relationship between cystatin C and aging success
during a 6-year follow-up in the Cardiovascular Health Study, a community-based cohort of older adults (aged 65 years). Successful
aging was defined as remaining free of cardiovascular disease, cancer, and chronic obstructive pulmonary disease and having
intact physical and cognitive functioning. In adjusted analysis, an accelerated failure time model was used to evaluate the
percentage reduction in successful years by level of cystatin C. A separate Cox proportional hazards model evaluated whether
cystatin C was related to incident physical and cognitive disability.
Results A total of 2140 participants
had cystatin C measured and were free of the previously mentioned conditions at baseline. Their mean age was 74 years. The
mean cystatin C level, creatinine level, and estimated glomerular filtration rate were 1.06 mg/L, 0.93 mg/dL, and 78 mL/min/1.73
m2, respectively (to convert cystatin C to nanomoles per liter, multiply by 75; and to convert creatinine to micromoles per
liter, multiply by 88.4). A total of 873 participants reached a first event in follow-up, 138 because of cognitive disability,
238 because of physical disability, 34 because of chronic obstructive pulmonary disease, 146 because of cancer, and 317 because
of cardiovascular disease. The adjusted percentage reduction in successful life years in the highest vs the lowest quartile
of cystatin C was 27% (95% confidence interval, 11%-39%). The highest vs lowest quartile of cystatin C also was independently
associated with incident cognitive or physical disability (hazard ratio, 1.39; 95% confidence interval, 1.00-1.98).
Conclusion
A higher cystatin C level, even within a range of relatively normal kidney function, was associated with unsuccessful aging.
More
Anti-Aging News
From Internal Medicine News
Volume 41, Issue 11, Pages 1-2
(1 June 2008)
Low Vitamin D Tied To Poor Prognosis In Breast Cancer:
Significant Differences
Seen at 10 Years
by SHARON WORCESTER (Southeast Bureau)
Vitamin D deficiency at the time of breast cancer
diagnosis is common and is associated with a significantly increased risk of metastasis and mortality, according to data from
a study of 512 women with newly diagnosed breast cancer.
The women were enrolled in the study at three University of
Toronto hospitals between 1989 and 1995 and followed for a median of 11.6 years. Only 24% had adequate levels of vitamin D
in the blood at diagnosis (greater than 72 nmol/L), 37.5% had insufficient levels (50–72 nmol/L), and 38.5% were vitamin
D deficient (less than 50 nmol/L).
Women deficient in vitamin D were more likely to have high-grade cancer and were
more likely to die from their breast cancer, Dr. Pamela Goodwin, lead study author, said during a teleconference about the
study findings, which were released in advance of formal presentation of the research at the annual meeting of the American
Society of Clinical Oncology.
After 10 years, 69% of those with vitamin D deficiency had metastases-free survival, compared
with 83% of those with adequate levels of vitamin D at diagnosis (hazard ratio of 1.94, P = .02), and 74% of those with a
deficiency were alive, compared with 85% of those with adequate levels (HR 1.73,P = .02), reported Dr. Goodwin of Mount Sinai
Hospital in Toronto.
The associations between vitamin D deficiency and distant disease-free survival were independent
of age, body mass index, insulin level, and tumor stage and grade, and were not significantly modified by estrogen receptor,
adjuvant chemotherapy, or tamoxifen use. The associations between vitamin D deficiency and overall survival were attenuated
by tumor grade and were absent in women with estrogen receptor-negative breast cancer, Dr. Goodwin said.
The women in
the study had a mean age of 50 years. Low levels of vitamin D were associated with premenopausal status, high body mass index,
high insulin levels, and low dietary intake of retinol, vitamin E, grains, and alcohol, she noted.
Additional studies
are required before any conclusions can be drawn about a causal relationship between vitamin D deficiency and breast cancer
development or prognosis. Should these findings be replicated in future studies, a randomized clinical trial examining the
effects of vitamin D supplementation on outcomes in women with breast cancer would be warranted, Dr. Goodwin said. The results
of an ongoing replication study are expected by the end of the year, she added.
Commenting on the current study findings,
Dr. Julie Gralow, chair of the ASCO Cancer Communications Committee, called the results “fascinating,” and noted
that this is the first study to suggest an association between vitamin D deficiency and outcomes following breast cancer diagnosis.
“As a clinician, I will be seeing breast cancer patients tomorrow … who will ask, ‘Should I correct
vitamin D deficiency if I have one?’” added Dr. Gralow, a breast cancer specialist at the Fred Hutchinson Cancer
Research Center at the University of Washington, Seattle.
At this time, it would be premature to recommend supplementation
in the hopes that it might improve outcomes, she said, reiterating Dr. Goodwin’s conclusion that additional research
is necessary before that can be said “with any degree of confidence,” Dr. Gralow said.
But other benefits
of vitamin D, such as for bone health, may be reason enough to support supplementation “even if we can’t tell
patients that it would have any benefit with respect to breast cancer,” she added.
In patients who desire such
supplementation, it is important to first measure serum 25-hydroxyvitamin D levels to ensure they are healthy, because although
the study wasn’t powered to determine statistical significance on this measure, it was observed that extremely high
levels of vitamin D also might be associated with adverse outcomes, Dr. Goodwin reported.
From
Internal Medicine News
Volume 41, Issue 7, Page 39 (1 April 2008)
Coronary Artery Calcium Predicts Cardiovascular
Events
by BRUCE JANCIN (Denver Bureau)
SNOWMASS, COLO. —The most intriguing potential application
for coronary artery calcium imaging is as a tool to track atherosclerosis progression over time in response to treatment,
Dr. Matthew J. Budoff said at a conference sponsored by the Society for Cardiovascular Angiography and Interventions.
“I’m not suggesting that this is a current application, but the data now emerging are pretty interesting,”
said Dr. Budoff, director of cardiac CT at Harbor-UCLA Medical Center, Torrance, Calif.
He cited an observational study
by Dr. Paolo Raggi of Tulane University, New Orleans, and coinvestigators, who measured the change in coronary artery calcium
(CAC) on serial electron-beam tomography scans in 495 statin-treated asymptomatic patients.
During up to 7 years of
follow-up, 41 subjects had an acute MI. The relative risk of an MI was increased 17-fold in those with at least a 15% per
year rise in CAC score. CAC progression provided incremental prognostic value beyond that associated with LDL cholesterol
level, which was a mean of 118 mg/dL in patients who had an MI and a similar 122 mg/dL in those with no MI (Arterioscler.
Thromb. Vasc. Biol. 2004;24:1272–7).
“This might be a way, in the future, of monitoring therapy. You’re
on a statin, your LDL is pretty good, but your CAC is increasing—maybe we should do something more,” Dr. Budoff
commented at the conference cosponsored by the American College of Cardiology.
He also described several current uses
for CAC imaging:
▸ Screening asymptomatic patients with an intermediate Framingham risk score. Of asymptomatic
adults, 40% fall into the Framingham intermediate-risk category, meaning they have an estimated 10%–20% risk of a coronary
event within the next 10 years. Most acute MIs occur in this mid-risk group. Dr. Budoff was coauthor of a 2007 ACC/American
Heart Association Clinical Expert Consensus Statement that endorsed CAC measurement as a means of identifing a higher-risk
subgroup in whom aggressive primary preventive measures are warranted (J. Am. Coll. Cardiol. 2007;49:378–402).
The Multi-Ethnic Study of Atherosclerosis (MESA), a National Institutes of Health-sponsored prospective study of 6,814 patients
followed for 3.5 years, was merely the most recent of several large studies showing that a CAC score of 100 or more was associated
with a 10-fold increased risk of incident coronary heart disease (CHD).
Prior to MESA, Dr. Budoff conducted an observational
study of 25,253 consecutive asymptomatic patients referred by their primary care physicians for CAC scanning. After adjustment
for traditional cardiovascular risk factors, a baseline CAC of 100 or greater was associated with a 10.4-fold increased rate
of all-cause mortality over the next 10 years, compared with a CAC of 0 (J. Am. Coll. Cardiol. 2007;49:1860–70).
And an NIH-sponsored prospective study of more than 10,700 asymptomatic individuals free of known CHD showed that a baseline
CAC of 97–409 was associated with an adjusted 9.7-fold greater risk of nonfatal MI or CHD death in the next 3.5 years,
compared with subjects with a CAC of 0 (Am. J. Epidemiol. 2005;162:421–9).
“A CAC greater than 100 is more
robust as a predictor of future events than Framingham risk factors, which are traditionally in the realm of two- to threefold
increased risk, and more robust than C-reactive protein or carotid intimal-medial thickness, where relative risks are in the
1.5–3 range,” said Dr. Budoff, who is on the speakers bureau for General Electric.
▸ Identification
of very-low-risk patients needing no further evaluation for coronary artery disease. Four studies totaling nearly 6,000 patients
indicate a CAC of 0 has a 95%–99% negative predictive value for obstructive coronary disease. A fifth study, by Dr.
Budoff and co-investigators, concluded that a CAC score of 0 has at least a 5-year warranty before a repeat scan is appropriate
because the likelihood of CAC progression during that period is so low (Int. J. Cardiol. 2007;117:227–31).
CLICK
HERE FOR FULL ARTICLE
Carnitine May Be Helpful for Fibromyalgia Patients
by Luke Curtis of The Human
Ecologist
Carnitine is an amino acid that transports fatty acids into the mitochondria cells, and plays a critical
role in many energy-producing and detoxification reactions. Several earlier studies have reported that supplemental carnitine
or acetyl-carnitine may be helpful to fibromyalgia and chronic-fatigue patients. An Italian study of 102 fibromyalgia patients
found that those patients given 1500 milligrams of supplemental acetyl-carnitine daily for 10 weeks had significantly less
pain and significantly less depression than the fibromyalgia patients given placebo.–Rossini, M. et al. Double-blind,
multicenter trial comparing l-carnitine with placebo in the treatment of fibromyalgia patients. Clinical and Experimental
Rheumatology, 25 (2): 182-8, March-April 2007
The Study
Double-blind, multicenter trial comparing acetyl l-carnitine
with placebo in the treatment of fibromyalgia patients.
M Rossini, O Di Munno, G Valentini, G Bianchi,
G Biasi, E Cacace, D Malesci, G La Montagna, O Viapiana, and S Adami
Clin Exp Rheumatol, March 1, 2007; 25(2): 182-8.
Authors and affiliation: Rossini M, Di Munno O, Valentini G, Bianchi G, Biasi G, Cacace E, Malesci D, La Montagna G, Viapiana
O, Adami S. Rheumatology Unit, University of Verona, Italy.
PMID: 17543140
Objective: Fibromyalgia (FMS) is a
chronic syndrome characterized by widespread pain, troubled sleep, disturbed mood, and fatigue.
Several analgesic strategies
have been evaluated but the results are moderate and inconsistent. Antidepressant agents are now considered the treatment
of choice in most patients.
It has been recently suggested that FMS may be associated with metabolic alterations including
a deficit of carnitine.
In this multicenter randomized clinical trial we evaluated the efficacy of acetyl L-carnitine
(LAC) in patients with overt FMS.
Methods: 102 patients meeting the American College of Rheumatology criteria for FMS
were randomized into the study. The treatment consisted of 2 capsules/day of 500 mg LAC or placebo plus one intramuscular
(i.m.) injection of either 500 mg LAC or placebo for 2 weeks. During the following 8 weeks the patients took 3 capsules daily
containing either 500 mg LAC or placebo. The patients were seen during treatment after 2 (visit 3), 6 (visit 4) and 10 weeks
(visit 5). The patients were also visited 4 weeks after treatment discontinuation (follow-up visit).
Outcome measures
included the number of positive tender points, the sum of pain threshold (kg/cm2 or “total myalgic score”), the
Short Form 36 (SF36), a 100 mm visual analog scale (VAS) for self-perceived stiffness, fatigue, tiredness on awakening, sleep,
work status, depression, and muscular-skeletal pain, and the Hamilton depression scale.
Results: The “total myalgic
score” and the number of positive tender points declined significantly and equally in both groups until the 6th week
of treatment. At the 10th week both parameters remained unchanged in the placebo group but they continued to improve in the
LAC group with a statistically significant between-group difference.
Most VAS scores significantly improved in both
groups.
A statistically significant between-group difference was observed for depression and musculo-skeletal pain.
Significantly larger improvements in SF36 questionnaire were observed in LAC than in placebo group for most parameters. Treatment
was well-tolerated.
Conclusion: Although this experience deserves further studies, these results indicate that LAC may
be of benefit in patients with FMS, providing improvement in pain as well as the general and mental health of these patients.
Independent Association of Low Serum 25-Hydroxyvitamin D and 1,25-Dihydroxyvitamin D Levels With All-Cause and Cardiovascular
Mortality Harald Dobnig, MD; Stefan Pilz, MD; Hubert Scharnagl, PhD; Wilfried Renner, PhD; Ursula Seelhorst, MA; Britta Wellnitz,
LLD; Jürgen Kinkeldei, DEng; Bernhard O. Boehm, MD; Gisela Weihrauch, MSc; Winfried Maerz, MD
Arch Intern Med.
2008;168(12):1340-1349.
Background In cross-sectional studies, low serum levels of 25-hydroxyvitamin D are associated
with higher prevalence of cardiovascular risk factors and disease. This study aimed to determine whether endogenous 25-hydroxyvitamin
D and 1,25-dihydroxyvitamin D levels are related to all-cause and cardiovascular mortality.
Methods Prospective cohort
study of 3258 consecutive male and female patients (mean [SD] age, 62 [10] years) scheduled for coronary angiography at a
single tertiary center. We formed quartiles according to 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels within each
month of blood drawings. The main outcome measures were all-cause and cardiovascular deaths.
Results During a median
follow-up period of 7.7 years, 737 patients (22.6%) died, including 463 deaths from cardiovascular causes. Multivariate-adjusted
hazard ratios (HRs) for patients in the lower two 25-hydroxyvitamin D quartiles (median, 7.6 and 13.3 ng/mL [to convert 25-hydroxyvitamin
D levels to nanomoles per liter, multiply by 2.496]) were higher for all-cause mortality (HR, 2.08; 95% confidence interval
[CI], 1.60-2.70; and HR, 1.53; 95% CI, 1.17-2.01; respectively) and for cardiovascular mortality (HR, 2.22; 95% CI, 1.57-3.13;
and HR, 1.82; 95% CI, 1.29-2.58; respectively) compared with patients in the highest 25-hydroxyvitamin D quartile (median,
28.4 ng/mL). Similar results were obtained for patients in the lowest 1,25-dihydroxyvitamin D quartile. These effects were
independent of coronary artery disease, physical activity level, Charlson Comorbidity Index, variables of mineral metabolism,
and New York Heart Association functional class. Low 25-hydroxyvitamin D levels were significantly correlated with variables
of inflammation (C-reactive protein and interleukin 6 levels), oxidative burden (serum phospholipid and glutathione levels),
and cell adhesion (vascular cell adhesion molecule 1 and intercellular adhesion molecule 1 levels).
Conclusions Low
25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels are independently associated with all-cause and cardiovascular mortality.
A causal relationship has yet to be proved by intervention trials using vitamin D.
Author Affiliations: Division of
Endocrinology and Nuclear Medicine, Department of Internal Medicine (Dr Dobnig), and Clinical Institute of Medical and Chemical
Laboratory Diagnostics (Drs Scharnagl, Renner, and Maerz and Ms Weihrauch), Medical University of Graz, Graz, Austria; and
Department of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, University of Heidelberg, Heidelberg
(Dr Pilz), LURIC Study Nonprofit LLC, Freiburg (Ms Seelhorst and Dr Wellnitz), Synlab Center of Laboratory Diagnostics Stuttgart,
Leinfelden-Echterdingen (Dr Kinkeldei), Division of Endocrinology and Diabetes, Department of Internal Medicine, University
of Ulm, Ulm (Dr Boehm), and Synlab Center of Laboratory Diagnostics Heidelberg, Eppelheim (Dr Maerz), Germany.
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