Common blood pressure drug linked to severe gastrointestinal problems

ScienceDaily (June 21, 2012) — Mayo Clinic researchers have discovered an association between a commonly prescribed blood pressure drug, Olmesartan, and severe gastrointestinal issues such as nausea, vomiting, diarrhea, weight loss and electrolyte abnormalities -- symptoms common among those who have celiac disease. The findings are published online June 21 in the medical journal Mayo Clinic Proceedings.

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From 2008-11, Mayo Clinic physicians treated 22 patients with symptoms similar to celiac disease, including intestinal inflammation and abnormalities. Patients came from 17 states, and some had been diagnosed with celiac disease. They had chronic diarrhea and weight loss; the median weight loss was 39 pounds, and one patient lost 125 pounds. Fourteen of the 22 were hospitalized because of the severity of their symptoms. When given a blood test, however, these patients didn't come back with results typical of celiac disease. They also didn't respond to treatments such as gluten-free diets.

After examining their medications, Mayo Clinic gastroenterologist Joseph Murray, M.D., pulled several of the patients off Olmesartan. Their symptoms dramatically improved. Eventually, all 22 were taken off the drug, and all showed improvement. Eighteen of the 22 patients had intestinal biopsies after stopping the medication and showed improvement.

"We thought these cases were celiac disease initially because their biopsies showed features very like celiac disease, such as inflammation," says Dr. Murray, the lead author. "What made them different was they didn't have the antibodies in their blood that are typical for celiac disease."

Olmesartan -- prescribed for the treatment of hypertension, or high blood pressure -- works by blocking substances that tighten blood vessels, allowing blood to flow more smoothly and the heart to pump more efficiently, according to the U.S. National Library on Medicine.

"It's really an awareness issue. We want doctors to be aware of this issue, so if they see a patient who is having this type of syndrome -- they think about medications as a possible association," Dr. Murray says. "We've reported an association. What needs to be known next is the science to understand why there is such an association."

The investigators were supported in part by the National Institutes of Health, the American College of Gastroenterology Junior Faculty Development Award, the Swedish Society of Medicine, the Swedish Research Council and the Fulbright Commission.

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Regional Systems to Treat Severe Heart Attack Increasing

HealthDay – 32 mins ago WEDNESDAY, May 23 (HealthDay News) -- The number of regional care systems able to quickly identify, transfer if necessary, and treat patients experiencing the most severe form of heart attack is increasing, new research finds.

ST-segment elevation myocardial infarction, or STEMI, is a deadly form of heart attack that affects nearly 300,000 people in the United States per year. It occurs when a blood clot completely blocks an artery to the heart. Quickly restoring blood flow is needed in order to prevent death.

In a regional STEMI-care system, emergency medical services have the equipment on their ambulances to diagnose the heart attack on the way to the hospital, and hospitals cooperate to make sure that patients are delivered to a facility that can quickly activate a team able to treat the heart attack. That treatment is often the artery-opening procedure called percutaneous coronary intervention, commonly known as angioplasty.

Between April 2008 and January 2010, the American Heart Association conducted a survey of 381 regional STEMI-care systems that included nearly 900 hospitals in 47 states. Each system included at least one hospital that performs angioplasty, and one emergency medical service provider.

The survey found that 67 percent of the systems were in urban areas and most followed standard procedures and policies, such as:

Admitting STEMI patients even when a hospital bed was not readily available (97 percent).Requiring a single phone call to activate the catheterization lab for angioplasty (92 percent).Permitting emergency department doctors to activate the catheterization lab without consulting a cardiologist (87 percent) and allowing the lab to be activated without a cardiology consultation before the patient arrives at the hospital (78 percent).Being part of a data collection registry (84 percent).

Competition among hospitals and cardiology groups was the most common barrier to implementing STEMI care systems. The researchers also found that about one-quarter of the systems have difficulties with emergency medical services' transport and finances.

The study appears in the journal Circulation: Cardiovascular Quality and Outcomes.

"It's essential to get competing hospitals and separate

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Gene that leads to severe weight gain with antipsychotic treatment discovered

ScienceDaily (May 7, 2012) — Antipsychotic medications are increasingly prescribed in the US, but they can cause serious side effects including rapid weight gain, especially in children. In the first study of its kind, researchers at Zucker Hillside Hospital and the Feinstein Institute for Medical Research identified a gene that increases weight gain in those treated with commonly-used antipsychotic drugs.

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These findings were published in the May issue of Archives of General Psychiatry.

Second-generation antipsychotics (SGAs) were used as the treatment in this study. SGAs are commonly used to treat many psychotic and nonpsychotic disorders. However, it is important to note that these SGAs are associated with substantial weight gain, including the development of obesity and other cardiovascular risk factors. The weight gain side effect of SGAs is significant because it often results in a reduced life expectancy of up to 30 years in those who suffer from chronic and severe mental illnesses. The weight gain also prompts some to stop taking the medication, adversely impacting their quality of life.

In this genome-wide association study (GWAS), researchers first evaluated a group of pediatric patients in the US being treated for the first time with antipsychotics. They then replicated the result in three independent groups of patients who were in psychiatric hospitals in the United States and Germany or participating in European antipsychotic drug trials. The gene that was identified to increase weight gain, MC4R or melanocortin 4 receptor, has been previously identified as being linked to obesity and type 2 diabetes. In the new study, it was found that patients gained up to 20 pounds when on treatment.

"This study offers the prospect of being able to identify individuals who are at greatest risk for severe weight gain following antipsychotic treatment," said Anil Malhotra, MD, investigator at the Zucker Hillside Hospital Department of Psychiatry Research and Feinstein Institute for Medical Research. "We hope that those who are at risk could receive more intensive or alternative treatment that would reduce the potential for weight gain and we are currently conducting studies to identify such treatment."

Additional Details About the Study

Researchers conducted the first GWAS of SGA-induced weight gain in patients carefully monitored for medication adherence who were undergoing initial treatment with SGAs. To confirm results, they next assessed three independent replication cohorts: 1) a cohort of adult subjects undergoing their first treatment with a single SGA (clozapine), 2) a cohort of adult subjects treated with the same SGAs as in our discovery sample, and 3) a cohort of adult subjects in the first episode of schizophrenia and enrolled in a randomized clinical trial of antipsychotic drugs. The discovery cohort consisted of 139 pediatric patients undergoing first exposure to SGAs. The 3 additional cohorts consisted of 73, 40, and 92 subjects. Patients in the discovery cohort were treated with SGAs for 12 weeks. Additional cohorts were treated for 6 and 12 weeks.

This GWAS yielded 20 single-nucleotide polymorphisms at a single locus exceeding a statistical threshold of P10-5. This locus, near the melanocortin 4 receptor (MC4R) gene, overlaps a region previously identified by large-scale GWAS of obesity in the general population. Effects were recessive, with minor allele homozygotes gaining extreme amounts of weight during the 12-week trial. These results were replicated in 3 additional cohorts, with rs489693 demonstrating consistent recessive effects; meta-analysis revealed a genome-wide significant effect. Moreover, consistent effects on related metabolic indices, including triglyceride, leptin, and insulin levels were observed.

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