Consider The Evidence: Med/Peds Journal Roundup

July 18, 2007

Food for thought: Chocolate to lower BP?

Filed under: cardiovascular, hypertension, JAMA — medblog @ 9:34 am

JAMA 7/4/07 –  Maybe some wizard medicine applies to muggles as well… An article in JAMA by Taubert et al. tests the theory that flavonols found in dark chocolate may lower blood pressure

 The study population consisted of 44 otherwise healthy subjects with upper-range prehypertension or stage 1 hypertension. Patients with any other major medical problems including CVD, diabetes, hyperlipidemia, etc were excluded. Study design was an RCT with investigators blinded, but subjects not – because they couldnt disguise the white and the dark chocolate. Patients were also counseled to abstain from any other cocoa products during the study.  Participants were instructed to take one 5.6(white) or 6.3(dark)  gram piece of chocolate per day.

At 6 weeks – no statistical difference between groups.
12 weeks: dark chocolate group BP was down 2.4/1.3 mmHg from baseline.
At 18 weeks the BP difference in the dark chocolate group was – 2.9/1.9 mmHg.
The white chocolate group: no change.
    
Looks like we have a winner.

For the basic science portion of the study, researchers measured plasma S-nitrosoglutathione. Basically they postulate that this compound is an intermediary between nitric oxide stores and active NO in the endothelium. They also measured 8-isoprostane, a measure of oxidative stress. Levels of S-nitrosoglutathione were significantly increased only in the dark chocolate group. 8-isoprostane levels were unchanged with intervention in both groups. Investigators concluded that the effect of dark chocolate was more likley from stimulation of endothelial NO production rather than changes in redox equilibrium between thiol and nitrosothiols. Big words aside – it seemed to work… at least in a healthy, homogenous, untreated population with mild HTN – although I dont seem to have alot of those in my practice….

July 6, 2007

Do SSRIs reduce bone density?

Filed under: Uncategorized — medblog @ 10:53 am

ArchivesIM 6/25 – The current issue contains a pair of articles that make a connection between SSRI use and bone mineral density (BMD). The pair of observational studies by Diem et al. and Haney et al. seperately studied a cohort of men and women respectively. The study involving women showed a greater yearly decrease in BMD when compared to nonusers as well as trazodone and TCA users. The study of men simply showed overall lower mean BMD associated with SSRIs as well with no effect seen from TCAs.  Obviously both studies suffer from the typical observational methodology pitfalls – but definitely merit further investigation. The main question to be answered is whether this effect translates into a greater clinical risk of fracture or other negative outcomes.  Given the large burden of both depression and osteopenia in the elderly, clearly the interaction needs further study.

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