- Foundation for the Development of Internal Medicine in Europe
October 31, 2022
Statins are widely used all over the world since decades and are effective in lowering bloodcholesterol values and preventing atherosclerotic cardiovascular disease. Usually they are well tolerated, but disturbing reports about muscle pain, mainly in the first year of use and in a rather high percentage of patients, have appeared over the years. A recent meta-analysis, however, reports that more than 90 % of all muscle symptoms by patients taking statins were not due to the drug. Nineteen large long-term, randomized, double-blind trials of statin therapy involving 123,940 patients and four double-blind trials of a more intensive versus a less intensive statin regimen involving 30,724 patients were examined. Treatment duration was at least two years. In the placebo-controlled trials with an average follow-up of 4.3 years 16,835 (27.1 %) on a statin and 16,446 (26.6%) on a placebo reported muscle pain or weakness. In the first year of therapy statins were associated with a 7 % relative increase in muscle complaints, an absolute rate excess rate of 11 events per 1,000 person-years. It was concluded that only one in fifteen reports of muscle-related adverse effects allocated to statin use were actually caused by the statin. After the first year no […]
October 31, 2022
For many years it has been standard to test bloodlipid levels in the fasting state. However, since 2009 starting in Denmark the utility of nonfasting testing became the test of choice. It is good to realize that except for a few hours in the morning, most of the people spend the majority of their lives in the nonfasting state. Moreover, it is much more convenient for patients not to have to come back for fasting testing, healthcare delivery is more streamlined and evoked hypoglycemia in patients with diabetes is avoided. Several studies of fasting vs nonfasting lipid testing have shown that the differences between fasting and nonfasting lipidlevels are limited and that most of them do not change substantially after eating. It is good to realize that non-HDL cholesterol is now considered to be a better predictor of cardiovascular disease risk than LDL chlesterol. Even more important is that a large evidence-based review of published literature from over 300,000 individuals found equal lipid relationship for predicting incident CVD events using nonfasting lipids. Another trial reported high concordance of fasting and nonfasting lipid levels for classifying participants into appropiate ASCVD (atherosclerotic cardiovascular disease) risk categories (94.8 %). According to the authors, […]
October 31, 2022
From 9 to 11 June 2002 the 20th European Congress of Internal Medicine (ECIM) has been held in Malaga, Spain, originally meant to be held in March 2022, but postponed because of Covid 19. The slogan was “Internal Medicine in the Front Line of Health Care”. The Foundation for the Development of Internal Medicine in Europe (FDIME) was involved in both congress organization and performance. Several Board members did evaluate abstracts, chaired sessions and awarded prizes for the three best abstracts. A session together with EFIM was organized for the first time, during which the FDIME Secretary General gave an overview of Internists as informants and advisers of citizens, the case of Covid 19. It was explained what internists actually do, what the activities of the FDIME have been during the last two years, including the circulation of 14 newsletters (FAQs) on Covid 19. The role of the internist in Covid 19 care was explained and emphasized. During the session, chaired by the Presidents of EFIM and FDIME, also a presentation by Gilead on Patient perspective in COVID-19, education, care and clinical research was included and a talk by representatives of Spanish patient organizations. For the first time also there […]
September 27, 2022
A UK study was conducted among half a million people, all participants in a large cohort study called “UK Biobank” from 2006 and 2010. Dietary questionnaires were administered at enrollment and during follow-up of median 11.2 years about tea-drinking habits, specifically about the number of cups of tea and other drinks and also about drinking the tea very hot, hot or warm. Information on death and cause of death were also gathered from the participants. Eighty five percent of the participants reported tea drinking, 89 % of those who reported tea type drank black tea. When compared to non-tea drinkers, those who took 2 or more cups daily had 9 to 13 % lower risk for CVD and other mortality. Tea drinking had a beneficial effect on mortality regardless of whether they drank coffee or not. Adding milk or sugar to tea and altered (lowered) caffeine metabolism rate did nor affect the results. Unmeasured confounding factors could influence tea-drinking behavior and the risk of death, but probably did not attenuate the associations found. The findings of this study suggest that (black) tea drinking may be associated with modestly lower mortality. There is no definitive proof that tea drinking directly reduced […]
September 27, 2022
The current data on climate change and environmental degradation are dramatic. The consequences of these changes are already having a significant impact on people’s health. Physicians — as advocates of the patients, but also as citizens — have an ethical obligation to be involved in efforts to stop these changes. The European Federation of Internal Medicine (EFIM) strongly encourages the Internal Medicine societies and internists across Europe to play an active role in matters related to climate change and environmental degradation. At a national level, this includes advocating the adoption of measures that reduce greenhouse gas (GHG) emissions and environmental degradation and contributing to policy decisions related to these issues. At a hospital level and in clinical practice, supporting actions by the health sector to reduce its ecological footprint is vital. At the level of EFIM and its associated internal societies, promoting educational activities and developing a toolkit to prepare internists to better care for citizens who suffer from the consequences of climate change. In addition to advocating and implementing effective actions to reduce the ecological footprint of the health industry, recommending the introduction of these themes in scientific programs of Internal Medicine meetings and congresses and the pre- and […]
July 11, 2022
A big prospective, multicenter, cohort study, conducted in the UK and the USA with 14.478 CAD (cardiac artery disease) patients with a median follow-up of 6.7 (UK) to 8.9 (USA) years has shown that very high HDL-c paradoxically are associated with higher mortality in individuals with CAD. This was also the case with low HDL-c levels. Normally HDL-c is considered to have a protective role with concern to CAD in opposite to the “bad” LDL-c. A higher HDL-c thus is associated with a lower CAD risk. However, as it appears now a very high HDL-c shows a complete different picture and is a big risk for mortality in CAD patients. In a recent presentation at the European congress of Internal Medicine ( ECIM) from Spain a 10-year follow-up of 1.849.087 workers with a mean age of 36.7 years, 67.8 % men, was reported. It was investigated how low and high HDL-c were associated with the development of a malignant neoplasm. In this large group of working people the risk of neoplasia (fatal or not) in indivuals with extreme HDL-c appeared to be much higher (5 times) than in the group with average HDL-c. In the group with a low HDL-c […]
July 11, 2022
Demographic, clinical and lifestyle data were collected by the UK Biobank over the course of a year between 2009 and 2012. 171.616 adults without underlying heart disease or cancer at the start of the study did participate. Questions about the use of coffee were included. The data were analyzed and the patients were classified according to their usual coffee drinking habit. Participants (average age 55.6 years) were followed during up to 7 years. When compared to non-coffee drinkers, those who drank unsweetened coffee regularly in any amount were 16 to 21 % less likely to die. Adults who drank moderate amounts of coffee sweetened with sugar ( 1 teaspoon, 1,5 – 3,5 cups per day) were 29 to 31 % less likely to die. Results were inconclusive for those who added artificial sweeteners to their coffee. This was an observational study and may have missed important factors. Confounding variables such as differences in socioeconomic status, diet, and other lifestyle factors may impact findings. Coffee drinking patterns were from over a decade before in a country where many drink tea. So a comparison with other countries might not be easy. The average amount of daily sugar per cup of coffee is […]
July 11, 2022
Why do you need iodine in your food? Which food does contain iodine? What happens if you are iodine deficient? How much do you need? These are important questions because without sufficient amounts of iodine in the food your thyroid can not function normally and this has consequences. Both thyroid hormones thyroxin (T4) and triiodothyronin (T3) do contain iodine (iodide) 4 and 3 molecules respectively. Without iodine no thyroid hormone can be synthesised and consequently hypothyroidism and/or goitre may develop. In case of endemic iodine deficiency even cretinism can occur. The recommended daily intake is 150 µg for an adult and a child aged 13 years or older. During pregnancy and lactation more iodine intake is required: respectively 200-250 µg and 250- 290 µg daily. It is not easy to measure on an individual basis whether a person is taking enough iodine. Iodine used to be incorpated in table salt, but with decreasing intake of salt other ways have been sought to deliver iodine. In many countries iodine is added to the salt used in the production of bread (in some countries already since many decades). Other high-iodine content foods are: fish/seafood, eggs, milk and other dairy foods. Vegans and […]