scholarly journals Association between increased serum thyrotropin concentration and the oldest old: what do we know?

2015 ◽  
Vol 13 (1) ◽  
pp. 117-121 ◽  
Author(s):  
Glaucia Cruzes Duarte ◽  
Maysa Seabra Cendoroglo ◽  
Lara Miguel Quirino Araújo ◽  
Clineu de Mello Almada Filho
Keyword(s):  
Cardiovascular Events ◽  
Oldest Old ◽  
Hormone Replacement ◽  
Elevated Serum ◽  
Total Mortality ◽  
Elderly Subjects ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Potential Benefits ◽  
Increase In Risk

To assess studies that evaluate the relation between serum thyrotropin concentration, very old subjects, and their events. We searched the PubMed, SciELO, and LILACS databases for articles published between 2004 and 2012. Our search was restricted to studies involving humans aged 65 years or older, and written in English, Spanish, or Portuguese. Studies that evaluated the association between elevated serum thyrotropin concentration among elderly subjects with subclinical hypothyroidism were chosen since at least in part they included a subpopulation of individuals aged 80 years and above. Thirteen studies were selected. No significant increase in risk of cardiovascular events, coronary heart disease, or total mortality was observed. Elevated thyrotropin concentration was associated with longevity. More randomized controlled trials are required to better define the potential benefits of elevated thyrotropin concentration in this oldest old population, hormone replacement, and longevity.

scholarly journals Risks and benefits of hormone replacement therapy in older men

2004 ◽  
Vol 59 (1) ◽  
pp. 32-38 ◽  
Author(s):  
Fábio Firmbach Pasqualotto ◽  
Antônio Marmo Lucon ◽  
Jorge Hallak ◽  
Eleonora Bedin Pasqualotto ◽  
Sami Arap
Keyword(s):  
Replacement Therapy ◽  
Hormone Replacement ◽  
Older Men ◽  
Controlled Trials ◽  
Clinical Effects ◽  
Androgen Replacement Therapy ◽  
Randomized Controlled ◽  
The Past ◽  
Risks And Benefits ◽  
Potential Benefits

The use of testosterone in older men, known as male hormonal replacement therapy or androgen replacement therapy, has become of increasing interest to both the medical and lay communities over the past decade. Even though the knowledge of the potential benefits and risks of male Androgen Replacement Therapy has increased dramatically, there is still much that needs to be determined. Although there are a number of potential benefits of male Androgen Replacement Therapy and data concerning clinical effects of such replacement have accumulated, as yet there have not been any large multicenter randomized controlled trials of this therapy. It is the purpose of this article to review what is currently known about the possible risks and benefits of male Androgen Replacement Therapy by discussing the clinical trials to date.

scholarly journals Evening anti-hypertensive dosing improves blood pressure control and reduce cardiovascular events in hypertensive: a meta-analysis of 40 trials in 44,167 patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.P Sunjaya ◽  
A.F Sunjaya
Keyword(s):  
Blood Pressure ◽  
Randomized Controlled Trials ◽  
Diastolic Blood Pressure ◽  
Blood Pressure Control ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
Pressure Control ◽  
Controlled Trials ◽  
Night Time ◽  
Randomized Controlled

Abstract Introduction Nocturnal blood pressure (BP) and early morning BP surge have consistently been found to be a better prognostic marker of cardiovascular outcome than daytime BP. Most anti-hypertensive show greater blood pressure-lowering effect in the first 12 hours compared to the next 12 hours. Several prospective studies have shown better BP regulation and improved cardiovascular risk when anti-hypertensive are ingested at bedtime versus at awakening. Purpose In patients with hypertension does evening dosing of anti-hypertensive compared to morning dosing led to better reduction in pressure, blood pressure control and reduced cardiovascular morbidity. Methods A meta-analysis was performed based on randomized controlled trials obtained from Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Medline and Medline ahead of print published between 2000 and 2020. Main outcome measures include mean 24 hour systolic and diastolic blood pressure, cardiovascular events as well as prevalence of blood pressure in control. Data synthesis and analysis was done using RevMan 5.3 using a random effects model. Results A total of 40 randomized controlled trials, representing 44,167 patients were included in this meta-analysis. Most studies evaluate the administration of mixed anti-hypertensive with ≥1 medication ingested at bedtime, calcium channel blockers (CCBs) or angiotensin receptor blockers (ARBs) with sample sizes ranging from 30 to 19,084 patients. Evening administration of anti-hypertensive was found to significantly lower 24-hour systolic blood pressure (Mean difference = −1.05, 95% CI: −2.01 to −0.10, p=0.03) and 24-hour diastolic blood pressure (Mean difference = −1.09, 95% CI: −1.68 to −0.50, p=0.0003). Prevalence of controlled blood pressure was found to significantly increase with evening dosing (RR=1.15, 95% CI: 1.03 to 1.28, p=0.01). Significant reduction in cardiovascular events were found in the evening dosing group (RR=0.48, 95% CI: 0.03 to 0.68, p=<0.00001). Discussion Reduction in night-time blood pressure especially among non-dippers as reported in previous studies and higher prevalence of controlled blood pressure may explain the greater than 50% reduction in cardiovascular events in the evening dosing group. This marked benefit from a simple and inexpensive strategy certainly has great potential to benefit patients in practice. Even so, few studies have reported the prevalence of blood pressure in control (9 studies) and cardiovascular events (6 studies). Few has also studied this in geriatric populations where night-time hypotension and hypoperfusion may bring the most impact. Conclusion For patients with hypertension, evening dosing significantly improves blood pressure control and reduces the risk for cardiovascular events. Careful selection of anti-hypertensive administration time in patients is recommended given the possible benefits. Anti Hypertensive Dosing Forest Plot Funding Acknowledgement Type of funding source: None

The Cardiovascular Events in Metabolic Surgery Compared to the New Classes of Glucose-Lowering Agents in Patients with T2DM

2021 ◽  
Author(s):  
Najla Shamsi
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Metabolic Surgery ◽  
Cardiovascular Events ◽  
Controlled Trials ◽  
Glucose Lowering ◽  
Randomized Controlled ◽  
History Of

Type 2 Diabetes Mellitus is a prevalent chronic disease with several macrovascular and microvascular complications. Cardiovascular diseases including coronary artery disease and stroke are common macrovascular complication that reduces the quality of life and lead to early mortality. Additionally, they pose enormous socioeconomic burden on the societies and the governments. Therefore, any intervention that reduces the cardiovascular events in patients with diabetes will have positive impact of the patients and the society. Thus, this systematic review aimed to evaluate the cardiovascular events after metabolic surgery in comparison with the new classes of glucose lowering agents in patients with type 2 diabetes mellitus. The review included 11 randomized controlled trials to both GLP-1 RA and SGLT-2 i groups. It also included 7 metabolic surgery studies, 2 of these are randomized controlled trials and the other 5 are observational studies. These studies were the most relevant studies to the research question. The results revealed different baseline demographic and clinical characteristics between the medication trials and metabolic surgery studies. Moreover, it revealed significant reduction in cardiovascular events in metabolic surgery studies when compared to medication trials. It also showed significant HbA1c and weight reduction in the metabolic surgery group. The remission of diabetes was very high in the metabolic surgery group while none of medication trials accomplished diabetes recovery. However, both medication and surgery groups had adverse events. In conclusion, the review is consistent with previous literature. It suggests that metabolic surgery is more effective than medical therapy in reducing cardiovascular events. Although this conclusion should be interpreted with caution due to the differences in baseline characteristics between studies. In general, the review recommends younger adult diabetic patients with obesity and history of established cardiovascular diseases to undergo metabolic surgery. Whereas, older patients with history of cardiovascular disease should be advised to take one of the medications that has been proved to reduce cardiovascular events. Future studies that compare metabolic surgery and the new classes of the glucose lowering agents is recommended to confirm the findings in this review.

scholarly journals MO577EXPANDING THE POTENTIAL BENEFITS OF FERRIC CITRATE FOR IMPROVING IRON-DEFICIENCY ANAEMIA AND MINERAL BONE DISORDER PARAMETERS IN NON-DIALYSIS-DEPENDENT CHRONIC KIDNEY DISEASE PATIENTS: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Boby Pratama Putra ◽  
Felix Nugraha Putra
Keyword(s):  
Chronic Kidney Disease ◽  
Iron Deficiency ◽  
Iron Deficiency Anaemia ◽  
Fibroblast Growth Factors ◽  
Ferric Citrate ◽  
Controlled Trials ◽  
Fibroblast Growth ◽  
Deficiency Anaemia ◽  
Randomized Controlled ◽  
Potential Benefits

Abstract Background and Aims Most of non-dialysis-dependent chronic kidney disease (NDD-CKD) patients will suffer from iron-deficiency anaemia (IDA) also mineral and bone disorders (CKD-MBD) as consequences of CKD progression. Ferric citrate (FC) is an iron-based phosphate binder that based on previous studies showed efficacies in improving IDA and CKD-MBD parameters although the results were still inconclusive. This study aims to establish the overall efficacies of FC in improving IDA and CKD-MBD parameters in NDD-CKD patients. Method We did comprehensive searching using predefined keywords in online databases of Pubmed, EMBASE, ScienceDirect, and The Cochrane Library, to include all relevant studies from 2000-2020. We included all randomized controlled trials (RCTs) accessing the efficacies of FC in improving IDA and CKD-MBD parameters compared with standard care (SC) in NDD-CKD patients. The CKD-MBD parameters analysed in this study are changes in serum phosphorus (P), serum calcium ions (Ca), alkaline phosphatase (ALP), intact fibroblast growth factors-23 (iFGF-23), C-terminal fibroblast growth factors-23 (cFGF-23), and intact parathyroid hormone (iPTH), while the IDA parameters analysed are changes of haemoglobin (Hb), serum iron (Fe), transferrin saturation (TSAT), and ferritin. Bias risk was accessed by using the revised Cochrane Risk-of-bias (RoB-2) tool. Analysis was performed to provide standard mean difference (SMD) with 95% confidence interval (CI) using random-effect heterogeneity test. Results We included six RCTs with total of 1,082 participants met our inclusion criteria. The FC significantly improve CKD-MBD parameters of P (SMD = -0.84. 95% CI = -1.21 to -0.07, p<0.00001, I2 = 74%), iFGF-23 (SMD = -0.43. 95% CI = -0.73 to -0.13, p = 0.005, I2 = 73%), cFGF-23 (SMD = -0.74. 95% CI = -1.12 to -0.35, p = 0.0002, I2 = 78%), and iPTH (SMD = -0.23. 95% CI = -0.40 to -0.06, p = 0.008, I2 = 0%), while the improvement of Ca (SMD = 0.16. 95% CI = -0.07 to 0.38, p = 0.17, I2 = 0%) and ALP (SMD = 0.03. 95% CI = -0.22 to 0.28, p = 0.81, I2 = 14%) are not statistically significant compared with the SC group. The FC also significantly improve IDA parameters of Hb (SMD = 1.10. 95% CI = 0.06 to 2.14, p = 0.04, I2 = 97%), TSAT (SMD = 1.18. 95% CI = 0.67 to 1.69, p<0.00001, I2 = 72%), and ferritin (SMD = 1.10. 95% CI = 0.34 to 1.86, p = 0.004, I2 = 87%) compared with the SC group, unless the improvement of Fe is not statistically significant (SMD = 1.34. 95% CI = -0.28 to 2.95, p = 0.11, I2 = 97%). Conclusion The ferric citrate shows potential benefits for improving iron-deficiency anaemia and CKD-MBD parameters in NDD-CKD patients. Nevertheless, further trials are needed to establish the efficacies.

scholarly journals Comparative Utility of Acupuncture and Western Medication in the Management of Perimenopausal Insomnia: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-16
Author(s):  
Fei-Yi Zhao ◽  
Qiang-Qiang Fu ◽  
Gerard A. Kennedy ◽  
Russell Conduit ◽  
Wen-Zhong Wu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Psychotropic Drugs ◽  
Quality Index ◽  
Pittsburgh Sleep Quality Index ◽  
Meta Analysis ◽  
Hormone Replacement ◽  
Controlled Trials ◽  
Limited Evidence ◽  
Randomized Controlled ◽  
Kupperman Index

Background. Many women with perimenopausal insomnia (PMI) have sought alternative therapies such as acupuncture because of concerns about risks associated with hormone replacement therapy (HRT) and/or psychotropic drugs. This systematic review aimed to clarify if acupuncture alone or combined with standard Western pharmacotherapy (HRT and/or psychotropic drugs) is more effective in ameliorating PMI in comparison to pharmacotherapy alone. Methods. Randomized controlled trials (RCTs) of PMI treatment via acupuncture alone or combined with Western pharmacotherapy versus Western pharmacotherapy were searched for from eleven databases from inception to March 2020. Cochrane criteria were followed. Results. Fifteen studies involving 1410 women were analyzed. Meta-analysis indicated that acupuncture significantly reduced the global scores of Pittsburgh Sleep Quality Index (PSQI) [MD = −2.38, 95% CI (−3.38, −1.37), p  < 0.01] and Kupperman Index [MD = −5.95, 95% CI (−10.68, −1.21), p  = 0.01], compared with hypnotics. Acupuncture combined with hypnotics was more effective than hypnotics alone in decreasing PSQI scores [MD = −3.13, 95% CI (−5.43, −0.83), p  < 0.01]. Too few RCTs were available to investigate the clinical efficacy differences between acupuncture and HRT/psychotropic drugs other than hypnotics. Conclusions. Despite limited evidence, in comparison to hypnotics, acupuncture was associated with significant improvements in PMI, and reductions of other menopausal symptoms. This finding suggests that acupuncture may be a useful addition to treatment for PMI.

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