Nutritional recovery with a soybean flour diet improves the insulin response to a glucose load without modifying glucose homeostasis

Objective: We investigated the effect of nutritional recovery with a soybean flour diet on glucose tolerance, insulin response to a glucose load, and the action of insulin in adult rats exposed to a protein deficiency during intrauterine life and lactation. Methods: Male Wistar rats from dams fed a normal- or low-protein diet during pregnancy and lactation were maintained after weaning by feeding them normal-protein isoenergetic diets containing soybean flour or casein and low-protein casein diet. Results: Rats fed a soybean flour diet had a lower final body weight, epididymal fat pad, carcass fat content, and liver glycogen level. The serum glucose concentrations in the basal and fed states and the area under the glucose curves during the glucose tolerance test were not significantly different among the four groups. Their serum insulin levels during fasting were observed to be similar to those fed a casein diet. These rats also had a higher serum insulin levels in a fed state and total area under the insulin curves in response to a glucose load, but a lower ratio of area under the glucose/insulin curves during the glucose tolerance test than those fed a casein diet. Conclusion: These results indicate that nutritional recovery with a soybean flour diet improved the insulin response to a glucose load and decreased the sensitivity to insulin, at least in hepatic tissue. (C) 2008 Elsevier Inc. All rights reserved.241768

Rivaroxaban with or without aspirin in stable cardiovascular disease

BACKGROUND: We evaluated whether rivaroxaban alone or in combination with aspirin would be more effective than aspirin alone for secondary cardiovascular prevention. METHODS: In this double-blind trial, we randomly assigned 27,395 participants with stable atherosclerotic vascular disease to receive rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily), rivaroxaban (5 mg twice daily), or aspirin (100 mg once daily). The primary outcome was a composite of cardiovascular death, stroke, or myocardial infarction. The study was stopped for superiority of the rivaroxaban-plus-aspirin group after a mean follow-up of 23 months. RESULTS: The primary outcome occurred in fewer patients in the rivaroxaban-plus-aspirin group than in the aspirin-alone group (379 patients [4.1%] vs. 496 patients [5.4%]; hazard ratio, 0.76; 95% confidence interval [CI], 0.66 to 0.86; P<0.001; z=−4.126), but major bleeding events occurred in more patients in the rivaroxaban-plus-aspirin group (288 patients [3.1%] vs. 170 patients [1.9%]; hazard ratio, 1.70; 95% CI, 1.40 to 2.05; P<0.001). There was no significant difference in intracranial or fatal bleeding between these two groups. There were 313 deaths (3.4%) in the rivaroxaban-plus-aspirin group as compared with 378 (4.1%) in the aspirin-alone group (hazard ratio, 0.82; 95% CI, 0.71 to 0.96; P=0.01; threshold P value for significance, 0.0025). The primary outcome did not occur in significantly fewer patients in the rivaroxaban-alone group than in the aspirin-alone group, but major bleeding events occurred in more patients in the rivaroxaban-alone group. CONCLUSIONS: Among patients with stable atherosclerotic vascular disease, those assigned to rivaroxaban (2.5 mg twice daily) plus aspirin had better cardiovascular outcomes and more major bleeding events than those assigned to aspirin alone. Rivaroxaban (5 mg twice daily) alone did not result in better cardiovascular outcomes than aspirin alone and resulted in more major bleeding events