Infants exposed to ACE inhibitors have significantly increased rates of major congenital malformations

This post includes a synopsis of a study published in the New England Journal of Medicine 2006; 354:2443-2451June 8, 2006 and a recipe for steak with piquant Italian salsa verde.

Study title and authors:
Major Congenital Malformations after First-Trimester Exposure to ACE Inhibitors
William O. Cooper, M.D., M.P.H., Sonia Hernandez-Diaz, M.D., Dr.P.H., Patrick G. Arbogast, Ph.D., Judith A. Dudley, B.S., Shannon Dyer, B.S., Patricia S. Gideon, R.N., Kathi Hall, B.S., and Wayne A. Ray, Ph.D.

This study can be accessed at: http://www.nejm.org/doi/full/10.1056/NEJMoa055202
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ACE inhibitors are used mainly in the treatment of hypertension (high blood pressure) and heart failure. They are also used in some people with diabetes, for some forms of kidney disease and after a heart attack to help to protect the heart. They include: •benazepril (Lotensin), •captopril (Capoten), •enalapril (Vasotec), •fosinopril (Monopril), •lisinopril (Prinivil, Zestril) •moexipril (Univasc), and •perindopril(Aceon), •quinapril (Accupril), •ramipril (Altace), •trandolapril (Mavik).

Infants with only first-trimester exposure to ACE inhibitors had a 2.71 increased risk of major congenital malformations as compared with infants who had no exposure to antihypertensive medications.

Infants exposed to ACE inhibitors had a 3.72  increased risk for malformations of the cardiovascular system.

Infants exposed to ACE inhibitors had a 4.39 increased risk for malformations of the central nervous system

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Recipe of the day

Steak with Piquant Italian Salsa Verde

                                                                                                                     Food Mall: Sirloin Steak

Ingredients:

- 1 sliced tomato
- 1/2 cup flat-leaf parsley leaves
- 1/2 cup basil leaves
- 2 cloves garlic
- 2 tablespoons capers, drained
- 1 anchovy fillet, cut into pieces
- 1 cup extra virgin olive oil
- 2 tablespoons fresh lime juice
- Sea salt, to taste
- Freshly ground pepper, to taste
- 1 1/2 pounds sirloin steak
- 5 cups baby field greens
- 1 sliced avocado optional

Method:
- In a food processor, purée parsley, basil, garlic, tomato, capers and anchovy fillet. Slowly add olive oil mixed well. Add lime juice and pepper blend until sauce is smooth. Season to taste. Set sauce aside.

- Season the steak to taste and grill or broil. Slice beef thinly and cover with salsa verde.

- Optional cover sauce with sliced avacodo.

Statin exposure causes birth abnormalities

This post includes a synopsis of a paper published in the New England Journal of Medicine 350, 1579-82 2004

Study title and authors:
Central Nervous System and Limb Anomalies in Case Reports of First-Trimester Statin Exposure
Robin J. Edison, M.D., M.P.H. Maximilian Muenke, M.D.
National Institutes of Health Bethesda, MD 20892-1852

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This paper can be accessed at: http://www.nejm.org/doi/pdf/10.1056/NEJM200404083501524

The paper reviewed 52 cases of first-trimester statin exposure reported to the Food and Drug Administration (FDA).

The review found:
(a) Among these cases, there were 20 reports of malformation, including 5 severe defects of the central nervous system (2 of which were holoprosencephaly) and 5 unilateral limb deficiencies.
(b) One patient had both of these malformations. The two simvastatin-exposed cases of limb deficiency were complex lower-limb anomalies including both long-bone shortening and aplasia or hypoplasia of the foot structures. The infant in one of these cases and a lovastatin-exposed infant also had rare forms of the VACTERL association (i.e., three or more of the following findings: vertebral, anal, cardiac, tracheal, esophageal, renal, and limb defects).
(c) It is thought that only a small proportion of statin adverse events are reported to the FDA.
(d) There would be no expected cases of most of the malformations listed in the paper; yet three rare anomalies are each observed twice.

Dr Edison concludes that these findings support the need for controlled studies evaluating the potential birth defects effects of statin drugs.
 

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