Clear evidence that long-term obesity can lead to heart disease

Researchers have tracked thousands of people in the three decades since the mid-1980s to see what effect getting obese might have on their heart risks. They say this is one of the few studies that can give proof of the consequences of long-term obesity.

Follow-up of the 3,275 adults - who were not obese at the start of the research in 1985-1986 - found that those who became obese were more likely to have coronary artery calcification (hardening of the arteries supplying the heart), a problem that can lead to a heart attack.

Of the people who became obese, the earlier they did - and the longer they stayed overweight - the more likely they were to be at risk of coronary artery disease. This risk was decided by computed tomography (CT), a form of X-ray scan that was used to pick up artery calcification.

The research participants were aged between 18 and 30 years at the beginning of the study, which has just been published in the Journal of the American Medical Association. They were almost equal in numbers of men and women, and in proportion of white and black people.

Study examined both "overall" and "abdominal" obesity

Two measures of obesity were made at specific points during the long-term study. Overall obesity was worked out by measuring body-mass index (BMI), and abdominal obesity was measured by waist circumference. These checks were done at 2, 5, 7, 10, 15, 20, and 25 years after baseline.

Being obese was defined as:
- Having overall obesity with a BMI of at least 30
- Having abdominal obesity with a waist circumference of more than 40.2 inches (102cm) in men, 34.6 inches (88cm) in women.

During follow-up, 40% and 41% of the subjects developed overall and abdominal obesity, respectively. The average duration of each type of obesity was 13 years and 12 years, respectively. The CT scans to check for hardening of the coronary artery were done at 15 years (in 2000-2001), 20 years (2005-2006), and 25 years (2010-2011).

There was an almost double chance of finding hardened coronary arteries in the people who were obese for 20 years or more, compared with the people who had never become obese.

The researchers - Jared Reis of the National Heart, Lung, and Blood Institute, Bethesda, MD, and colleagues - give percentage values for these results: "Approximately 38.2% and 39.3% of participants with more than 20 years of overall and abdominal obesity, respectively, had coronary artery calcification, compared with 24.9% and 24.7% of those who never developed overall or abdominal obesity."

Not only was the presence of artery hardening more likely in the obese people, but the longer people were too big, the greater the extent to which calcification got worse (disease "progression").

The authors conclude:

"These findings suggest that the longer duration of exposure to excess adiposity as a result of the obesity epidemic, and an earlier age at onset, will have important implications on the future burden of coronary atherosclerosis and potentially on the rates of clinical cardiovascular disease in the United States."

The study has been given the name CARDIA - Coronary Artery Risk Development in Young Adults. It is a large, multi-center, community-based study published in a world-renowned medical journal.

The design of the study, which set out to track future changes over time, means that the association between obesity and heart disease risk is a reliable one. This is because it was a "prospective" study as opposed to a "retrospective" one in which links are drawn from past data.

Source

Harvard Scientists Urge You to Stop Drinking Milk

Vegans may have had it right all along; while raw, organic milk offers numerous health benefits, a Harvard

researcher and pediatrician argues that conventional milk and dairy products alike are a detriment to your health – thanks to added health-compromising sweeteners.

As David Ludwig mentioned in his research, which was published in the Journal of the American Medical Association Pediatrics, there have been countless pieces of research concluding the ill effects of sugar-sweetened beverages. The over-consumption of sugar has been tied to obesity, diabetes, inflammatory-related pain, and much more. And because of sugar’s negative effects on our health, even the United States Department of Agriculture, the American Academy of Pediatrics, and other organizations are recommending against consuming calories from sugary drinks.

The one calorie-containing beverage they still heavily promote, however, is reduced-fat milk, where the organization recommends drinking 3 cups daily. This is where Ludwig questions the scientific rationale for such recommendations.

“This recommendation to drink three cups a day of milk – it’s perhaps the most prevailing advice given to the American public about diet in the last half century. As a result, Americans are consuming billions of gallons of milk a year, presumably under the assumption that their bones would crumble without them,” says David Ludwig.

As far as Ludwig is concerned, if the USDA is recommending to drink reduced-fat milk, it is also inadvertently encouraging the consumption of added sugars – a piece of advice that goes against all the research saying not to consume sugar and sugar-sweetened beverages. The idea of consuming low-fat milk or chocolate milk cancels out the whole reasoning for the recommendation in the first place since the fats are simply being replaced with dangerous sugars.

“The worst possible situation is reduced-fat chocolate milk: you take out the fat, it’s less tasty. So to get kids to drink 3 cups a day, you get this sugar-sweetened beverage,” Ludwig says. ”…we can get plenty of calcium from a whole range of foods. On a gram for gram basis, cooked kale has more calcium than milk. Sardines, nuts seeds beans, green leafy vegetables are all sources of calcium.”

The Case Against Low-Fat Dairy, and Other Dangers of Milk

Harvard researcher David Ludwig certainly has a point in analyzing and ultimately criticizing the USDA’s recommendations, but there is much more to the full-fat vs reduced-fat argument for milk and dairy products.

There are plenty of reasons to avoid certain fats such as trans-fats and refined polyunsaturated fats in vegetable oils (like corn, soy, sunflower, and canola), but the evidence for moderate consumption of saturated fat, which is found in milk, coconut oil, and grass-fed land animals, is coming to the surface. While saturated fat was villainized for decades, a 2010 analysis published in the American Journal of Clinical Nutrition concluded that “there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of [coronary heart disease or cardiovascular disease].”

Further, there are numerous benefits to drinking full-fat dairy products. In it’s most pure state (raw, organic, and coming from grass-fed cows), full-fat dairy has been found in research to potentially promote heart health, control diabetes, aid in vitamin absorption, lower bowel cancer risk, and even aid in weight loss. But while pure dairy could promote your health, conventional dairy may prove damaging.

Before you consume more conventional dairy, please educate yourself as to what’s in your dairy. You’d be surprised that there could be 20+ painkillers, antibiotics, and much more lurking in your milk.

Source

Los huevos no elevan el colesterol en la adolescencia

La ingesta de huevo no conlleva riesgos de enfermedades cardiovasculares. Expertos sugieren una revisión de las recomendaciones alimentarias.

Un estudio de la Universidad de Granada concluye que comer más huevos no se relaciona con un mayor colesterol plasmático en adolescentes ni con un peor perfil cardiovascular, independientemente de su nivel de actividad física. El trabajo ha analizado la asociación entre la ingesta de huevo en adolescentes y los principales factores de riesgo de desarrollar enfermedades cardiovasculares. Pese a que se ha tendido a restringir la ingesta de huevos por asociarlos con un aumento en el colesterol, las investigaciones más recientes afirman que el incremento del colesterol plasmático parece estar más influido por la ingesta de grasas saturadas y grasas trans que por el colesterol de la dieta.

Uno al día

Los resultados del trabajo, perteneciente al estudio europeo Helena y con nueve países implicados, se publican en Nutrición Hospitalaria y "concuerdan con estudios recientes en adultos sanos que sugieren que una ingesta de hasta siete huevos por semana no está asociada con un mayor riesgo de enfermedades cardiovasculares", explica Alberto Soriano Maldonado, autor del trabajo.

Los autores sugieren una revisión de las recomendaciones para la alimentación de los adolescentes, si bien sostienen que sería conveniente replicar la investigación en una población en la que la ingesta de huevo fuese superior.

Fuente

Swedish Study Suggests Bipolar Disorder Associated With Premature Mortality

Bipolar disorder was associated with premature mortality in a large study of Swedish adults by Casey Crump, M.D., Ph.D., of Stanford University, California, and colleagues.

The study used outpatient and inpatient data from more than 6.5 million Swedish adults, including 6,618 with bipolar disorder, to examine the physical health effects associated with bipolar disorder. Bipolar disorder is a chronic mental illness and a leading cause of disability worldwide.

According to the results, women and men with bipolar disorder died nine and 8.5 years earlier on average, respectively, than the rest of the population. All-cause mortality was increased two-fold among women and men with bipolar disorder compared to the rest of the population. Patients with bipolar disorder also had increased mortality from cardiovascular disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD), influenza or pneumonia, unintentional injuries and suicide for both women and men, and cancer for women only.

"Timely medical diagnosis appeared to improve chronic disease mortality among bipolar disorder patients to approach that of the general population. More effective provision of primary, preventive medical care is needed to reduce early mortality among persons with bipolar disorder," the study concludes.

Source

Harvard Scientists Urge You to Stop Drinking Sweetened-Milk

Vegans may have had it right all along; while raw, organic milk offers numerous health benefits, a Harvard researcher and pediatrician argues that conventional milk and dairy products alike are a detriment to your health – thanks to added health-compromising sweeteners.

As David Ludwig mentioned in his research, which was published in the Journal of the American Medical Association Pediatrics, there have been countless pieces of research concluding the ill effects of sugar-sweetened beverages. The over-consumption of sugar has been tied to obesity, diabetes, inflammatory-related pain, and much more. And because of sugar’s negative effects on our health, even the United States Department of Agriculture, the American Academy of Pediatrics, and other organizations are recommending against consuming calories from sugary drinks.

The one calorie-containing beverage they still heavily promote, however, is reduced-fat milk, where the organization recommends drinking 3 cups daily. This is where Ludwig questions the scientific rationale for such recommendations.

“This recommendation to drink three cups a day of milk – it’s perhaps the most prevailing advice given to the American public about diet in the last half century. As a result, Americans are consuming billions of gallons of milk a year, presumably under the assumption that their bones would crumble without them,” says David Ludwig.

As far as Ludwig is concerned, if the USDA is recommending to drink reduced-fat milk, it is also inadvertently encouraging the consumption of added sugars – a piece of advice that goes against all the research saying not to consume sugar and sugar-sweetened beverages. The idea of consuming low-fat milk or chocolate milk cancels out the whole reasoning for the recommendation in the first place since the fats are simply being replaced with dangerous sugars.

“The worst possible situation is reduced-fat chocolate milk: you take out the fat, it’s less tasty. So to get kids to drink 3 cups a day, you get this sugar-sweetened beverage,” Ludwig says. ”…we can get plenty of calcium from a whole range of foods. On a gram for gram basis, cooked kale has more calcium than milk. Sardines, nuts seeds beans, green leafy vegetables are all sources of calcium.”

The Case Against Low-Fat Dairy, and Other Dangers of Milk

Harvard researcher David Ludwig certainly has a point in analyzing and ultimately criticizing the USDA’s recommendations, but there is much more to the full-fat vs reduced-fat argument for milk and dairy products.

There are plenty of reasons to avoid certain fats such as trans-fats and refined polyunsaturated fats in vegetable oils (like corn, soy, sunflower, and canola), but the evidence for moderate consumption of saturated fat, which is found in milk, coconut oil, and grass-fed land animals, is coming to the surface. While saturated fat was villainized for decades, a 2010 analysis published in the American Journal of Clinical Nutrition concluded that “there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of [coronary heart disease or cardiovascular disease].”

Further, there are numerous benefits to drinking full-fat dairy products. In it’s most pure state (raw, organic, and coming from grass-fed cows), full-fat dairy has been found in research to potentially promote heart health, control diabetes, aid in vitamin absorption, lower bowel cancer risk, and even aid in weight loss. But while pure dairy could promote your health, conventional dairy may prove damaging.

Before you consume more conventional dairy, please educate yourself as to what’s in your dairy. You’d be surprised that there could be 20+ painkillers, antibiotics, and much more lurking in your milk.

Source

El té verde: mucho más que antioxidantes

Además de ser un maravilloso antioxidante, esta infusión alivia problemas recurrentes de salud, de manera rápida y natural. Algunos de sus principales beneficios son:

Disminuye el riesgo de cáncer: las catequinas del té contienen sustancias anticancerígenas, gracias a los polifenoles. Según un estudio del Instituto Nacional del Cáncer de los Estados Unidos y también el Instituto del Cáncer de China, reveló que quienes bebían, al menos una taza de esta infusión a la semana, tuvieron el 57% menos de riesgo de padecer cáncer de esófago y en las mujeres, aumento a un 60%.

Quema grasas: al ser un agente de termogénesis, ayuda de manera natural a gastar más energías, conllevando un descenso de peso. Acelera el metabolismo mediante los polifenoles (sustancias antioxidantes), aceleran el metabolismo, ayudando a las enzimas digestivas a que trabajen mejor, logrando un efecto adelgazante. Y también, es diurético, es decir colabora el proceso de diuresis, depurando el organismo de toxinas acumuladas.

Reduce el estrés: ciertos compuestos de este té disminuyen la formación y la actividad de radicales libres, reduciendo el estrés. Asimismo, posee un aminoácido llamado L-teanina, cuyo efecto principal es la relajación, sin somnolencia y aumenta los niveles de hormona llamada dopamina que mejora el estado de ánimo.

Sin embargo, esas no son todas sus bondades, sino que sólo unas pocas. El té verde también reduce el riesgo de cáncer, previene enfermedades cardiovasculares, combate el envejecimiento, previene las arrugas, reduce el riesgo de artritis, fortalece los huesos, ayuda a bajar el colesterol, previene la obesidad, es bueno para la diabetes, fortalece la memoria, protege contra el mal de Parkinson, es hepatoprotector, previene la hipertensión, protege de intoxicaciones alimentarias, reduce los niveles de glucosa en la sangre, estimula la inmunidad, evita gripes y resfriados, alivia el asma, combate infecciones en los oídos, contribuye en el tratamiento contra el herpes, previene caries, reduce el estrés y alivia las alergias.

¿Cómo consumirlo?

Según la Escuela de Medicina de Harvard, se debe tomar una taza de té tres veces al día. La hierba debe permanecer en agua caliente de tres a cinco minutos y es mejor si se consume recién macerado.

El mejor momento para beberlo es entre comidas, ya que puede impedir la absorción de hierro de las frutas y vegetales. Y si prefieres tomarlo en el desayuno o durante la comida, el problema se soluciona añadiéndole limón o leche.

Por último, los médicos recomienda beberlo al menos, dos horas antes de dormir, para prevenir el insomnio.

Fuente

How High-Fat Extra Virgin Olive Oil is good for your immune system

One tablespoon of high-fat extra virgin olive oil can provide numerous benefits to the immune system.

Skip the butter and stick margarine in the kitchen and use oil — extra virgin olive — to improve your immune system. The consumption of this oil has increased dramatically in recent years with a United States purchase of 292,925 metric tons (MT) in 2011, reports the U.S. Department of Agriculture (USDA) Foreign Agricultural Service (FAS). This high-fat oil contains 73 grams of monounsaturated fatty acids (MUFAs) and is popularly used as for frying and baking as a healthier replacement for vegetable oil. It can also serve as a dressing for salads. Its health benefits derive from its nutritional content of high MUFAs that are considered to be a healthy dietary fat. MUFAs have been linked to lower cholesterol and control the insulin levels in the body as they replace the saturated fats or trans fats that can increase LDL cholesterol levels and the risk of cardiovascular disease.

Extra virgin olive oil is a good source of antioxidants with vitamins E and K that can protect the body from oxygen-free radicals and promote healthy cognitive function, says the USDA. Implementing olive oil in cooking provides numerous health benefits if used correctly. The nutritional value of olive oil is affected by heat, light, and air. For storage, Mayo Clinic recommends to keep the oil in a dark, room-temperature cupboard or in the refrigerator to preserve the healthy fats and the taste that can wither over a long period of time.

Combats Inflammation

The phenolic compound — oleocanthal — found in olive oil has anti-inflammatory properties. A study from the Monell chemical Senses Center in Philadelphia, Pa. examined the effects of daily intake of teaspoons of extra virgin olive oil on pain. Researchers found that four teaspoons of this high-fat oil per day for 12 weeks acted as an anti-inflammatory drug, such as ibuprofen, to reduce pain. While extra virgin oil and ibuprofen have the same effect on treating inflammation, they have different effects on the body. According to Science Daily, ibuprofen can increase bleeding and gastrointestinal damage whereas olive oil has no such effect on the body.

Tip: The amount of oleocanthal differs in olive oils. To see how strong the oleocanthal content is in an olive oil, you can take a sip and see how it stings the back of your throat. The stronger the sting, the more oleocanthal it has, says Arthritis Today.

Combats Diabetes

Diabetics are often told to limit their daily intake of dietary fat because they are at high risk of developing cardiovascular disease. In a landmark government study, it was determined that foods with high MUFAs does not cause weight gain in diabetics and can even reduce the risk of developing type 2 diabetes by approximately 60 percent. MUFAs help diabetics regulate their insulin levels and blood sugar, especially for those who have type 2 diabetes.

Combats Cancer

The consumption of olive oil has been linked to a decrease in tumors of colon, prostate, and breast cancer. Before recent studies, researchers concluded that higher incidences of breast cancer are linked to a high saturated fat diet. In a study published in Annals of Oncology, researchers found that oleic acid — the main MUFA in olive oil — can weaken a cancer gene found in 25 to 30 percent of all breast cancers. What's more, with oleic acid, the effective of the breast cancer drug Herceptin improved dramatically.

Reduces Risk of Cardiovascular Disease

MUFAs in olive oil have been shown to reduce heart problems and rate of heart disease deaths. In a study published in the New England Journal of Medicine, researchers conducted a randomized trial of the Mediterranean diet pattern and its prevention of cardiovascular disease. In Spain, participants who were at high risk of cardiovascular disease but did not develop it yet were assigned to a Mediterranean diet with extra virgin oil, a Mediterranean diet with the addition of mixed nuts, or a control diet with advice on how to reduce dietary fat. Researchers found that a Mediterranean diet with either extra virgin olive oil or mixed nuts can significantly reduce the incidence of cardiovascular disease.

Promotes Healthy Fetal Development

Pregnant women are often advised to include olive oil in their diet due to its high content of omega-3 fatty acids. This heart healthy oil has the ability to improve brain function and learning capacities in young children. The consumption of extra virgin olive oil has been linked to a positive effect on a child's height, weight, and cognitive and behavioral development. In a study published in the Journal of Physiology and Biochemistry, researchers tested the effects of consuming olive oil in relation to body weight gain and foot efficiency as well as placental and fetal development. The results of the study showed that a pregnant rat's consumption of olive oil as the only dietary fat source did not have any detrimental effects on the expectant mother's weight gain or placental and fetal development.

Source 

Nine foods you should never eat again

With so much misinformation out there about food and how it affects human health, making healthy food choices for you and your family can be difficult and confusing. There are a number of scientific foods; however, that you will want to avoid in almost every circumstance because they provide virtually no health benefits while posing plenty of heath risks:

1. White bread, refined flours: the body doesn't know how to properly digest and assimiliate these so-called foods, which can lead to health problems. Refined white flour has also been cleached with chlorine and brominated with bromide, two poisonous chemicals that have been linked to causing thyroid and organ damage.
2. Conventional frozen meals: Most conventionally-prepared frozen meals are loaded with preservatives, processed salt, hydrogenated oils and other artificial ingredients, not to mention the fact that most frozen meals have been heavily pre-cooked, rendering their nutrient content minimal at best (especially after getting microwaved again at home). Most frozen meals are little more than disease in a box, so avoid them in favor of fresh foods.
3. White rice: Like white bread, white rice has been stripped of most of its nutrients, and separated from the bran and germ, two natural components that make up rice in its brown form. Even so-called "fortified" white rice is nutritionally deficient, as the body still processes this refined food much differently than brown rice, which is absorbed more slowly and does not cause the same spike in blood sugar that white rice does.
4. Microwaveable popcorn. This processed food is a favorite among moviegoers and regular snackers alike, but it is one of the unhealthiest foods you can eat. Practically every component of microwaveable popcorn, from the genetically-modified (GM) corn kernels to the processed salt and preservative chemicals used to enhance its flavor, is unhealthy and disease-promoting. On top of this, microwaveable popcorn contains a chemical known as diacetyl that can actually destroy your lungs. If you love popcorn, stick with organic kernels that you can pop yourself in a kettle and douse with healthy ingredients like coconut oil, grass-fed butter, and Himalayan pink salt.
5. Cured meat products with nitrates, nitrites: Deli meats, summer sausage, hot dogs, bacon, and many other meats sold at the grocery store are often loaded with sodium nitrite and other chemical preservatives that have been linked to causing heart disease and cancer. If you eat meat, stick with uncured, nitrite and nitrate-free varieties, and preferably those that come from organic, grass-fed animals.
6. Most conventional protein, energy bars: By the way they are often marketed, it might seem as though protein and energy bars are a strong addition to a healthy diet. But more often than not, these meal replacements contain processed soy protein, refined sugar, hydrogenated fat, and other harmful additives that contribute to chronic illness. Not all protein and energy bars are bad, of course all make healthy protein and energy bars. Just be sure to read the ingredient labels and know what you are buying.
7. Margarine: Hidden in all sorts of processed foods, margarine, a hydrogenated trans-fat oil, is something you will want to avoid at all costs for your health. Contrary to popular belief, butter and saturated fats in general are not unhealthy, especially when they are derived from pastured animals that feed on grass rather than corn and soy. And if animal-based fats are not for you, stick with extra-virgin coconut oil or olive oil rather than margarine.
8. Soy milk and soy-based meat substitutes: One of the biggest health frauds of modern times, the soy craze is a fad that you will want to skip. Besides the fact that nearly all non-organic soy ingredients are of GM origin, most soy additives are processed using a toxic chemical known as hexane, which is linked to causing birth defects, reproductive problems, and cancer. Soy that has not been fermented is also highly estrogenic, which can throw your natural hormone balance out of whack.
9. "Diet" anything: Many so-called "diet" products on the market today contains artificial sweeteners like aspartame (Equal) and sucralose (Splenda), both of which are linked to causing neurological damage, gastrointestinal problems, and endocrine disruption. Many diet products also contain added chemical flavoring agents to take the place of fat and other natural components that have been removed to artificially reduce calorie content. Instead, stick with whole foods that are as close to nature as possible, including high-fat foods grown the way nature intended, and your body will respond surprisingly well. 

Source

Gwen Olsen: Pharma Not in Business of Health, Healing, Cures, Wellness

Highlights

"Pharmaceutical industry are not in the business to cure cancer, to cure Alzheimer, to

cure heart disease because if they were, they will be onthe business putting themselves:

OUT  OF BUSINESS"

"Pharmaceutical industry doesn't want to cure people"

"Psychiatric drugs: these drugs encourage people to

remain customers of the pharmaceutical industry"

"Cholesterol drugs are lowering cholesterol excessively and causing other diseases states as a consequence"

"The drugs are always trailed against the placebo and clinical trials. Placebo is a sugar pill.

In fact, many drugs are not found to be much more efficaces than a sugar pill"

"Antidepressants are not more effective than placebo as per clinical study"

"Pharmaceutical industry makes 5 to 6 times the amount of

money as any of the others companies in United States of America"

Plavix No Help in Kids' Cyanotic Heart Disease

Children with cyanotic congenital heart disease derived no benefit from prophylactic clopidogrel (Plavix) for shunt thrombosis, a large, randomized trial showed.

The composite endpoint of death plus three types of clinical events occurred in 19.1% of clopidogrel-treated patients and 20.5% of the placebo group. Separate analyses of each component of the endpoint also showed no significant differences between treatment groups.

Subgroup analysis failed to identify any patients who benefited more or less from clopidogrel, as reported in the June 20 issue of the New England Journal of Medicine.

"We found no benefit of clopidogrel, as compared with placebo, in reducing the rate of death for any cause or shunt-related morbidity, particularly shunt thrombosis, among infants with congenital heart disease palliated with a systemic-to-pulmonary-artery shunt," David L. Wessel, MD, of Children's National Medical Center in Washington, and co-authors concluded.

Placement of a systemic-to-pulmonary-artery shunt for palliation increases the risk of shunt thrombosis and death among infants with congenital heart disease. Prophylactic anti-thrombotic therapy had not been evaluated in a randomized trial, but data from a prospective registry showed a significant reduction in the risk of death and shunt thrombosis among infants treated with aspirin, the authors noted.

As an approved medication for adults, clopidogrel use has spread into pediatric populations, absent sound evidence of efficacy. Retrospective, single-center reviews have suggested clopidogrel is safe and effective in infants.

Wessel and collaborators at 134 sites in Europe, Asia, North America, South America, and Africa prospectively evaluated the safety and efficacy of prophylactic clopidogrel in a randomized trial involving children with congenital heart disease. Eligible patients were 92 days or younger at randomization and had received a palliative systemic-to-pulmonary-artery shunt. Patients with active bleeding or with an increased risk of bleeding were excluded.

Patients were randomized to weight-based clopidogrel or matching placebo and were followed by telephone or clinic visits at weeks 4, 12, 24, and 36. A final visit occurred on a patient's first birthday, the common study end date, or first occurrence of a qualifying event for termination: shunt thrombosis, elective surgery to correct the congenital heart defect, or death.

The primary endpoint was the composite of death, heart transplantation, shunt thrombosis requiring intervention, or a cardiac procedure performed before 120 days of age because of thrombotic event. The final analysis included 906 patients, 88% of whom were receiving aspirin in addition to the study drug.

The trial had a median duration of follow-up of 5.8 months. Administration of study drug was stopped temporarily (for median of 8 days) in 53.6% of patients, and study drug was permanently discontinued in significantly more patients in the clopidogrel group (24.0% versus 18.2%, P=0.03). Median time to permanent discontinuation was 96 days, and reasons for discontinuation did not differ significantly between groups.

A primary-endpoint event occurred in 89 patients in the clopidogrel group and 90 patients in the placebo group. The combination of death and heart transplantation occurred slightly less often in the clopidogrel group (11.8% versus 13.9%, NS); death accounted for all but one of the events. Causes of death did not differ significantly between groups, nor did the remaining components of the composite endpoint.

A post-hoc analysis showed that patients receiving concomitant aspirin had a significantly lower rate of the composite endpoint when treated with clopidogrel (18.6% versus 28.2%, P=0.009).

Adverse events occurred more often with clopidogrel than with placebo, whether assessed in all randomized patients (76.1% versus 71.1%, P=0.09) or per protocol (73.9% versus 66.9%, P=0.04). Bleeding occurred in 18.8% of clopidogrel patients and 20.2% of the placebo group and severe bleeding in 4.1% and 3.4%, respectively, neither of which achieved statistical significance.

The study was supported by sanofi-aventis and Bristol-Myers Squibb.

Wessel disclosed a relationship with sanofi-aventis. One or more co-authors disclosed relationships with AGA, Actelion, Pfizer, sanofi-aventis, Daiichi Sankyo, Bristol-Myers Squibb, and Merck. Investigators included current or former employees of sanofi-aventis and Bristol-Myers Squibb.

Source

What about Overweight and Obesity in United States?

According to the first CLINICAL GUIDELINE ON THE IDENTIFICATION, EVALUATION, AND TREATMENT OF OVERWEIGHT AND OBESITY IN ADULTS based on evidence from approximately 394 randomized controlled trials (RCTs) found in MEDLINE from January 1980 to September 1997:

Highlights

1. According to the latest statistics from the third National Health and Nutrition Examination Survey, 97 million Americans are overweight or obese.
2. Excess weight is often accompanied by hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea and respiratory problems, and endometrial, breast, prostate, and colon cancers.
3. The total costs attributable to obesity-related disease approach $100 billion annually in the United States.
4. Overweight is here defined as a body mass index (BMI) of 25 to 29.9 kg/m2 and obesity as a BMI
   of 30 kg/m2.
5. A variety of effective options exist for the management of overweight and obese patients, including
   dietary therapy approaches such as low-calorie diets and lower-fat diets; altering physical activity patterns; behavior therapy techniques; pharmacotherapy*; surgery; and combinations of these technique.
6. *As of September 1997, the Food and Drug Administration (FDA) requested the voluntary withdrawal from the market of dexfenfluramine and fenfluramine due to a reported association between valvular heart disease and the use of dexfenfluramine or fenfluramine alone or combined with phentermine. The use of these drugs for weight reduction, therefore, is not recommended in this report. Sibutramine is approved by FDA for long-term use. It has limited but definite effects on
   weight loss and can facilitate weight loss maintenance.
7. Weight loss drugs that have been approved by the FDA for long-term use can be useful adjuncts to dietary therapy and physical activity for some patients with a BMI of 30 with no concomitant risk factors or diseases, and for patients with a BMI of 27 with concomitant risk factors or diseases. 
8. Weight loss surgery is one option for weight reduction in a limited number of patients with clinically severe obesity, i.e., BMIs 40 or 35 with comorbid conditions. Weight loss surgery should be
   reserved for patients in whom efforts at medical therapy have failed and who are suffering from the complications of extreme obesity.
9. Randomized trials suggest that weight loss at the rate of 1 to 2 lb/week (calorie deficit of 500 to
   1,000 kcal/day) commonly occurs for up to 6 months.
10. A review of 44 pharmacotherapy RCT articles provides strong evidence that pharmacological therapy (which has generally been studied along with lifestyle modification, including diet and physical activity) using dexfenfluramine, sibutramine, orlistat, or phentermine/fenfluramine results in weight loss in obese adults when used for 6 months to 1 year. Strong evidence also indicates that appropriate weight loss drugs can augment diet, physical activity, and behavior therapy in weight loss. Adverse side effects from the use of weight loss drugs have been observed in patients. As a result of the observed association of valvular heart disease in patients taking fenfluramine and dexfenfluramine alone or in combination, these drugs have been withdrawn from the market. Weight loss drugs approved by the FDA for long-term use may be useful as an adjunct to diet and physical activity for patients with a BMI of 30 with no concomitant obesity-related risk factors or diseases, as well as for patients with a BMI of 27 with concomitant risk factors or diseases; moreover, using weight loss drugs singly (not in combination) and starting with the lowest effective doses can decrease the likelihood of adverse effects.
11. Women in the United States with low incomes or low education are more likely to be obese than those of higher socioeconomic status.
12. In the majority of epidemiologic studies, mortality begins to increase with BMIs above 25 kg/m2.
13. The environment is a major determinant of overweight and obesity. Environmental influences on overweight and obesity are primarily related to food intake and physical activity behaviors. In countries like the United States, there is an overall abundance of palatable, calorie-dense food. In addition, aggressive and sophisticated food marketing in the mass media, supermarkets, and restaurants, and the large portions of food served outside the home, promote high calorie consumption.
14. Since 1995, the use of the prescription drugs fenfluramine or dexfenfluramine for weight loss had increased greatly to 14 million prescriptions in 1'5 years. The increased interest in drug treatment of obesity derives from the poor long-term results often obtained with behavior therapy, including diet and physical activity, as noted earlier in this report. The rationale for the addition of drugs to these regimens is that a more successful weight loss and maintenance may ensue. However, as of September 1997, the FDA requested the voluntary withdrawal of fenfluramine and dexfenfluramine from the market, due to a reported association between valvular heart disease with the drugs dexfenfluramine and fenfluramine, alone or combined with phentermine. In November 1997, the FDA provided clearance for marketing the drug sibutramine hydrochloride monohydrate for the management of obesity, including weight loss and maintenance of weight loss when used in conjunction with a reduced-calorie diet.