生活型態改變可以減輕基因導致的冠心症危險性

The “nature versus nurture”, which is more important?

美國心臟醫學會上的Breaking News，這篇文章真是令人覺得勵志，因為可以經由後天的生活形態改變，減輕因為基因導致的冠心症危險性。

對象是來自三個不同的大型研究（Women's Genome Health Study，Atherosclerosis Risk in Communities，Malmö Diet and Cancer Study），共51,425 個病人，找出和CAD有相關性的危險基因（polygenic scores of single nucleotide polymorphisms associated with CAD)

那一些生活形態呢？1) no current smoking 2) no obesity 3) regular physical activity 4) healthy diet.

結果發現，有較高冠心症危險基因者，若是有3個以上「好」的生活習慣，比有一個「壞」的習慣，下降了接近一半(46%)冠心症的風險。

For individuals at high genetic risk, unhealthy and healthy lifestyles were associated with the following standardized 10-year incidences of coronary events:

Women's Genome Health Study, 4.6% and 2.0%

Atherosclerosis Risk in Communities, 10.7% and 5.1%

Malmö Diet and Cancer Study, 8.2% and 5.3%

所以作者的結論是：
We need to get the message to our patients: A healthy lifestyle can mitigate one's inherited cardiac risk.

Ref.
Khera AV et al. Genetic risk, adherence to a healthy lifestyle, and coronary disease. N Engl J Med 2016 Nov 13; [e-pub]. (http://dx.doi.org/10.1056/NEJMoa1605086)

病風患者之降尿酸治療藥是不是一定要吃一輩子？

2016有新的gout guidelines出來，和大家分享。

是不是一旦開始了痛風患者的降尿酸藥物治療後(例如：allopurinol/febuxostat），就一定要吃一輩子？如果這患者這一輩子只發作那一次，也要吃藥一輩子嗎？或是一輩子痛風發作沒幾次？這就讓我想起以前在神經內科學習時，老師問的：dilantin是不是在有seizure發作過的患者，一定要吃一輩子的藥？

根據這2016新的準則，反對在只單一次發作或是不常發作的痛風患者，給予長期的降尿酸治療。也不再建議一定要把患者的尿酸值降至目標 6 mg/dl以下。

New ACP Gout Guidelines Exclude Treat-to-Target Recommendation
http://annals.org/aim/article/2578528/management-acute-recurrent-gout-clinical-practice-guideline-from-american-college

CLINICAL GUIDELINES |1 NOVEMBER 2016

Recommendation 1:

ACP recommends that clinicians choose corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine to treat patients with acute gout. (Grade: strong recommendation, high-quality evidence)

Recommendation 2:

ACP recommends that clinicians use low-dose colchicine when using colchicine to treat acute gout. (Grade: strong recommendation, moderate-quality evidence)

Recommendation 3:

ACP recommends against initiating long-term urate–lowering therapy in most patients after a first gout attack or in patients with infrequent attacks. (Grade: strong recommendation, moderate-quality evidence)

Recommendation 4:

ACP recommends that clinicians discuss benefits, harms, costs, and individual preferences with patients before initiating urate–lowering therapy, including concomitant prophylaxis, in patients with recurrent gout attacks. (Grade: strong recommendation, moderate-quality evidence)

New gout guidelines from the American College of Physicians notably don't include a recommendation to lower serum uric acid levels below 357 µmol/L (6 mg/dL), in contrast with the American College of Rheumatology's 2012 guidelines.