Statin-associated muscle symptoms: impact on statin therapy-European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management.

Statin-associated muscle symptoms (SAMS) are one of the principal reasons for statin non-adherence and/or discontinuation, contributing to adverse cardiovascular outcomes. This European Atherosclerosis Society (EAS) Consensus Panel overviews current understanding of the pathophysiology of statin-associated myopathy, and provides guidance for diagnosis and management of SAMS. Statin-associated myopathy, with significant elevation of serum creatine kinase (CK), is a rare but serious side effect of statins, affecting 1 per 1000 to 1 per 10 000 people on standard statin doses. Statin-associated muscle symptoms cover a broader range of clinical presentations, usually with normal or minimally elevated CK levels, with a prevalence of 7-29% in registries and observational studies. Preclinical studies show that statins decrease mitochondrial function, attenuate energy production, and alter muscle protein degradation, thereby providing a potential link between statins and muscle symptoms; controlled mechanistic and genetic studies in humans are necessary to further understanding. The Panel proposes to identify SAMS by symptoms typical of statin myalgia (i.e. muscle pain or aching) and their temporal association with discontinuation and response to repetitive statin re-challenge. In people with SAMS, the Panel recommends the use of a maximally tolerated statin dose combined with non-statin lipid-lowering therapies to attain recommended low-density lipoprotein cholesterol targets. The Panel recommends a structured work-up to identify individuals with clinically relevant SAMS generally to at least three different statins, so that they can be offered therapeutic regimens to satisfactorily address their cardiovascular risk. Further research into the underlying pathophysiological mechanisms may offer future therapeutic potential.

ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS).

Cardiovascular disease (CVD) due to atherosclerosis of the arterial vessel wall and to thrombosis is the foremost cause of premature mortality and of disability-adjusted life years (DALYs) in Europe, and is also increasingly common in developing countries.1 In the European Union, the economic cost of CVD represents annually E192 billion1 in direct and indirect healthcare costs. The main clinical entities are coronary artery disease (CAD), ischaemic stroke, and peripheral arterial disease (PAD). The causes of these CVDs are multifactorial. Some of these factors relate to lifestyles, such as tobacco smoking, lack of physical activity, and dietary habits, and are thus modifiable. Other risk factors are also modifiable, such as elevated blood pressure, type 2 diabetes, and dyslipidaemias, or non-modifiable, such as age and male gender. These guidelines deal with the management of dyslipidaemias as an essential and integral part of CVD prevention. Prevention and treatment of dyslipidaemias should always be considered within the broader framework of CVD prevention, which is addressed in guidelines of the Joint European Societies' Task forces on CVD prevention in clinical practice.2 ­ 5 The latest version of these guidelines was published in 20075; an update will become available in 2012. These Joint ESC/European Atherosclerosis Society (EAS) guidelines on the management of dyslipidaemias are complementary to the guidelines on CVD prevention in clinical practice and address not only physicians [e.g. general practitioners (GPs) and cardiologists] interested in CVD prevention, but also specialists from lipid clinics or metabolic units who are dealing with dyslipidaemias that are more difficult to classify and treat.

High dietary supplement intakes among Flemish preschoolers.

The aim of this study was to determine the prevalence of dietary supplement use among Flemish preschoolers and to investigate associations between dietary supplement use and socio-economic variables of the parents. Parentally reported 3-day estimated dietary records (n=696) were used to calculate mean daily nutrient intakes, using Software for Intake Distribution Estimation (Cside). Socio-demographic information and frequency of dietary supplement use were collected via parental questionnaires, including a food frequency questionnaire (FFQ) (n=1847). The results from the FFQ revealed that more than 30% of the children used dietary supplements in the past month. Children of more highly educated parents and children of non-smokers were significantly more likely to use supplements than their counterparts. The types most frequently used were multi-vitamin/mineral supplements. Except for vitamin D, mean dietary intakes derived from foods alone was higher than the minimum recommendations for both supplement and non-supplement users. The youngest group of supplement users even exceeded the tolerable upper intake level for zinc (7 mg). However, for vitamin D, dietary supplements could help meet dietary recommendations for this micronutrient. In conclusion, the results indicated that dietary supplement use by healthy children who typically achieve their micronutrient requirements by foods alone could cause excessive intakes. Future studies should investigate potential harms and benefits of dietary supplementation use among preschoolers.

Determinants of ferritin and soluble transferrin receptors as iron status parameters in young adult women.

OBJECTIVE: To investigate associations between nutritional and non-nutritional variables and Fe status parameters, i.e. serum ferritin and soluble transferrin receptors (sTfR). DESIGN: Cross-sectional design. Fe status parameters were determined on a fasting venous blood sample. Nutritional variables were assessed using a 2 d food record and non-nutritional variables by a general questionnaire. A general linear model was used to investigate associations between the variables and Fe status parameters. SETTING: Region of Ghent, Dutch-speaking part of Belgium. SUBJECTS: Random sample of 788 women (aged 18-39 years). RESULTS: Median (interquartile range) ferritin and sTfR were 26.3 (15.9, 48.9) ng/ml and 1.11 (0.95, 1.30) mg/l, respectively. BMI and alcohol intake were positively associated and tea intake was negatively associated with serum ferritin. Women who used a non-hormonal intra-uterine device, who gave blood within the past year or who had been pregnant within the past year had lower serum ferritin values than their counterparts. Significant determinants of sTfR were smoking habit and pregnancy, with higher values for non-smokers and women who had been pregnant within the past year. CONCLUSIONS: The present study indicates that contraceptive use, time since last blood donation, time since last pregnancy, BMI, alcohol and tea intake are determinants of Fe stores, whereas smoking habit and time since last pregnancy are determinants of tissue Fe needs. When developing strategies to improve Fe status, special attention should be given to women who use a non-hormonal intra-uterine device, gave blood within the past year and had been pregnant within the past year.

Food intakes by preschool children in Flanders compared with dietary guidelines.

The objective of this study was to compare food group intakes among preschool children with food-based dietary guidelines (FBDG) and to determine the proportion of children meeting these guidelines. Food consumption of preschool children (2.5-6.5 years) living in Flanders (Belgium) were assessed in a cross-sectional study, using proxy reported 3d estimated dietary records (EDR) (n 696). Statistical modelling was used to account for within-individual variation in the 3d EDR. Mean daily intakes of most food groups (beverages, vegetables, fruit and milk) were below the minimum recommendations. Only 'grains and potatoes' and 'meat products' were in line with the recommendations and 'bread and cereals' showed borderline intakes. Mean intakes of energy-dense and low-nutritious foods, which are discouraged within a healthy diet (like snacks and sugared drinks), were high. Furthermore, the percentage of children complying with the different food-based dietary guidelines was for most food groups extremely low (ranging from approximately 4% for fluid and vegetable intakes up to 99% for potato intakes). Boys had in general higher mean intakes of the recommended food groups. In conclusion, preschool children in Flanders follow eating patterns that do not meet Flemish FBDG. Although the impact of these eating habits on preschooler's current and future health should be further investigated, it is clear that nutrition education and intervention are needed among preschool children and their parents in Flanders.

Dietary intakes and food sources of fatty acids for Belgian women, focused on n-6 and n-3 polyunsaturated fatty acids.

The intake of fat, saturated and monounsaturated FA (SFA and MUFA), and omega-6 and omega-3 PUFA has been estimated in 641 Belgian women (age 18-39 y). Their food intake was recorded using a 2-d food diary. The PUFA included were linoleic (LA), alpha-linolenic (LNA), arachidonic (AA), eicosapentaenoic (EPA), docosapentaenoic (DPA) and docosahexaenoic (DHA) acids. The mean total fat intake corresponded to 34.3% of total energy intake (E). The mean intake of the FA groups corresponded to 13.7%, 13.1%, and 6.0% of E, for SFA, MUFA, and PUFA, respectively. The mean intake of LA was 5.3% of E and of LNA was 0.6% of E, with a mean LA/LNA ratio of 8.7. The mean intake of AA was 0.03% of E. The mean intake of EPA, DPA, and DHA was 0.04%, 0.01%, and 0.06% of E, respectively. According to the Belgian recommendations, the total fat and SFA intake was too high for about three-quarters of the population. The mean LA and overall n-6 PUFA intake corresponded with the recommendation, with part of the population exceeding the upper level. Conversely, the population showed a large deficit for LNA and n-3 PUFA. The major food source for LA and LNA was fats and oils, followed by cereal products. The main sources of long-chain PUFA were fish and seafood, and meat, poultry, and eggs. From a public health perspective, it seems desirable to tackle the problem of low n-3 PUFA intake.

Epidemiological evidence for an association between habitual tea consumption and markers of chronic inflammation.

BACKGROUND: Tea consumption has been inversely related to the risk of cardiovascular disease, but the mechanism behind this cardioprotective role is not fully understood. In vitro and animal model studies suggest an anti-oxidative and/or anti-inflammatory role. We aimed at investigating the association between tea drinking and indicators of low-grade inflammation in humans. METHODS: We used observational data from 1031 healthy men participating in a larger cross-sectional study (BELSTRESS). Tea consumption was determined according to a semi-quantitative food frequency questionnaire. Blood samples were analysed for C-reactive protein (CRP), serum amyloid A (SAA), serum haptoglobin and plasma fibrinogen. RESULTS: Of all participants, 22% consumed tea regularly while 10% drank more than two cups per day. Tea drinkers were less obese, smoked less and drank less alcohol and coffee. CRP, SAA and haptoglobin were significantly associated with tea consumption, the effect being graded for SAA. Multivariate analysis did confirm the independence of the observed beneficial role of tea drinking. Fibrinogen levels were however not different between habitual tea consumers and non-consumers. Coffee drinking proved unrelated to chronic inflammation. CONCLUSION: Tea drinking might be of interest in reducing the inflammatory process underlying cardiovascular disease. In light of the fact that tea is the most consumed beverage in the world after water, our findings might be of importance from a public health perspective.