February 10, 2012

Blood clot guidelines challenge economy class risk

CHICAGO (AP) ? Good news for budget-minded travelers: There’s no proof that flying economy-class increases your chances of dangerous blood clots, according to new guidelines from medical specialists.

Travelers’ blood clots have been nicknamed “economy class syndrome” but the new advice suggests this is a misnomer.

The real risk is not getting up and moving during long flights, whether flying coach or first-class. Sitting by the window seems to play a role, because it makes people less likely to leave their seats, the guidelines say.

Still, even on long flights, lasting at least four hours, the risk for most people is extremely low and not something to be alarmed about, said Dr. Gordon Guyatt, chairman of an American College of Chest Physicians’ committee that wrote the new guidelines.

The group, based in Northbrook, Ill., represents more than 18,000 physicians whose specialties include lung disease and critical care. The guidelines were released online Tuesday in the group’s journal, Chest. They’re based on a review of recent research and other medical evidence on deep vein thrombosis, blood clots that form deep in leg veins.

Flights lasting at least eight hours are riskiest, the guidelines say.

Muscles in the lower legs help push blood in the legs and feet back to the heart. Sitting still for extended periods of time without using these muscles puts pressure on leg veins and blood “tends to sit there,” which can increase chance for clots to form, said Guyatt, a researcher at McMaster University in Hamilton, Ontario. These clots can cause leg pain, swelling and redness, and can be life-threatening if they travel to the lungs. They can be treated with blood-thinning drugs, but may cause permanent damage to leg veins.

Most people who develop these clots have risk factors, including obesity, older age, recent surgery, a history of previous blood clots or use of birth control pills.

The average risk for a deep vein blood clot in the general population is about 1 per 1,000 each year. Long-haul travel doubles the chance, but still, the small risk should reassure healthy travelers that they’re unlikely to develop clots, said Dr. Susan Kahn, a co-author of the new guidelines and a professor of medicine at McGill University in Montreal.

Traveling by bus, train and car may also increase the risks, the guidelines say.

Besides taking a stroll down the aisle during flights, doing calf exercises including flexing and extending the ankles while seated can help prevent clots, Kahn said.

The guidelines recommend these precautions and use of special compression stockings only for people at increased risk for clots. They advise long-distance travelers against using aspirin or other blood thinners to prevent blood clots.

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Online:

American College of Chest Physicians’ journal: http://www.chestjournal.org

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/bbd825583c8542898e6fa7d440b9febc/Article_2012-02-07-US-MED-Travelers’-Blood-Clots/id-5d4bb0ab00924a0b8c01137acbb365c3

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December 14, 2011

Study finds no increased risk of serious cardiovascular events among adults who use ADHD medications

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Study finds no increased risk of serious cardiovascular events among adults who use ADHD medications

Monday, December 12, 2011

Although there have been cardiovascular safety concerns about attention-deficit/hyperactivity disorder (ADHD) medications because of their ability to increase heart rate and blood pressure levels, an analysis that included more than 150,000 ADHD users found no evidence of an increased risk of heart attack, stroke or sudden cardiac death associated with current use compared with nonuse or rare use among young and middle-aged adults, according to a study appearing in JAMA. The study is being released early online because of its public health importance.

“Between 2001 and 2010, use of medications labeled for treatment of ADHD increased even more rapidly in adults than in children. According to a 2006 U.S. Food and Drug Administration (FDA) advisory committee briefing on the safety of ADHD medications, more than 1.5 million U.S. adults were taking stimulants in 2005, and adults received approximately 32 percent of all issued prescriptions,” according to background information in the article. “Placebo-controlled studies in children and adults indicate that stimulants and atomoxetine [a medication used to treat ADHD] elevate systolic blood pressure levels by approximately 2 to 5 mm Hg and diastolic blood pressure levels by 1 to 3 mm Hg and also lead to increases in heart rate. Although these effects would be expected to slightly increase risk for myocardial infarction [MI; heart attack], sudden cardiac death (SCD), and stroke, clinical trials have not been large enough to assess risk of these events.”

Laurel A. Habel, Ph.D., of Kaiser Permanente Northern California, Oakland, and colleagues examined whether medications used primarily to treat ADHD are associated with an increased risk of heart attack, SCD, or stroke in adults. The researchers used computerized health records from 4 study sites, starting in 1986 at 1 site and ending in 2005 at all sites, with an additional assessment using 2007 survey data. Participants were adults 25 through 64 years of age with dispensed prescriptions for methylphenidate, amphetamine, or atomoxetine. Each medication user (n = 150,359) was matched to two nonusers on study site, birth year, sex, and calendar year (total users and nonusers = 443,198).

During follow-up, there were 1,357 cases of heart attacks, 296 cases of sudden cardiac death, and 575 cases of stroke. After analyses of the data, the researchers found that current or new use of ADHD medications, compared with nonuse or remote use, was not associated with an increased risk of serious cardiovascular events, such as heart attack, sudden cardiac death, or stroke. “We also found little support for an increased risk for any specific medication or with longer duration of current use. Results were similar when users were restricted to new users. Rate ratios did not appear to be influenced by prior cardiovascular disease or by prior non-ADHD psychiatric conditions. They also were similar across age groups. As expected, event rates were substantially higher in the Medicaid population; however, the rate ratio for current use was similar to that in other sites,” the authors write.

The researchers also found that among ever users of ADHD medications, the adjusted rate ratio of serious cardiovascular events was nearly the same during periods of current use as during follow-up periods more than 1 year after use ended. Cardiovascular diseases were similar or slightly more prevalent in new users than nonusers.

The authors note that a modestly elevated risk of serious cardiovascular events cannot be ruled out, given limited power of the study and a lack of complete information on some potentially important risk factors and other factors related to use of these medications.

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Article: DOI:10.1001/JAMA.2001.1830

JAMA and Archives Journals: http://www.jamamedia.org

Thanks to JAMA and Archives Journals for this article.

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Source: http://www.labspaces.net/115925/Study_finds_no_increased_risk_of_serious_cardiovascular_events_among_adults_who_use_ADHD_medications

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