People are asking about the latest US Public Health Service Taskforce on Prevention (USPSTF) recommendation about the use of aspirin to prevent heart disease. It has been a long-standing recommendation for people who already have heart disease. When I turned 50, I started taking a “baby” aspirin. That was their recommendation then. I stopped taking […]
A few years back I was taking 81mg aspirin AND fish oil. I stopped taking the fish oil because every nick, scratch and cut would not stop bleeding and took a long time to clot. Personally I plan on continuing my aspirin therapy at least until my next wellness exam. My physician wanted me to continue aspirin until age 70. We’ll see.
These findings show that the prevalence of food insecurity in the U.S. is highest among Americans for whom a healthy diet is especially critical—Medicaid enrollees with insulin-dependent diabetes and diabetes-related eye or kidney complications (over 40% were food insecure). The problem of co-occurring food insecurity and diabetes among the nation’s disadvantaged has likely worsened during the coronavirus disease 2019 pandemic.
The Prevalence of Food Insecurity Is Highest Among Americans for Whom Diet Is Most Critical to Health — Diabetes Care 2021 Jun; 44(6): e131-e132. https://doi.org/10.2337/dc20-3116
In patients with newly diagnosed T2DM, alcohol abstinence was associated with a low risk of AF development. Lifestyle modifications, such as alcohol abstinence, in patients newly diagnosed with T2DM should be recommended to reduce the risk of AF.
New research published in Diabetologia has shown that if people achieve and maintain substantial weight loss to manage their type 2 diabetes, many can also effectively control their high blood pressure and stop or cut down on their anti-hypertensive medication.
During Pandemic Year One I lost 25 pounds. My PCP was impressed but when I told her how my diet changed she put her “doctor face” on, looked me straight in the eyes and said,
“I can’t wait to see your blood test results.”
Due to my family history my risk of developing DM2 is approximately 25% higher than the average underwriter. When I asked a prominent Endocrinologist for some advice many years ago he too put on his “doctor face” looked me straight in the eyes and said,
“Stay as thin as you can as long as you can.”
Yesterday I went to see Kevin and got a fresh flattop. The first question he asked was,
“Did you lose more weight?”
No, I haven’t. But my face definitely looks thinner without a mask.
BTW my blood work was about the same as last year even with my change in diet.
Moderate alcohol intake – defined as no more than one alcoholic drink for women and two for men per day – may be associated with a lower risk of dying from cardiovascular disease when compared with individuals who abstain from drinking or partake in excessive drinking, according to a new study. Of the 53,064 participants, 7,905 (15%) experienced a major adverse cardiovascular event: 17% in the low alcohol intake group and 13% in the moderate alcohol intake group. People who reported moderate alcohol intake were found to have a 20% lower chance of having a major event compared to low alcohol intake (in adjusted analysis), and also had lower stress-related brain activity. Kenechukwu Mezue, MD, the study’s lead author, cautions that these findings should not encourage alcohol use, but that they could open doors to new therapeutics or prescribing stress-relieving activities like exercise or yoga to help minimize stress signals in the brain.
It was a pair of laboratory measurements, however, that had the largest subdistribution hazard ratios. “Interestingly, the magnitude of associations of abnormal N-terminal pro–B-type natriuretic peptide [sHR, 2.82] and high-sensitivity troponin T [sHR, 2.46] measured in a stable population were greater than clinical variables in the prediction of all causes of death,” Cavallari and associates said.
They examined the records of nearly 300,000 adults in the U.S. who had an initial atherosclerotic cardiovascular disease event between 2007 and 2016. These were divided into three groups: coronary heart disease, ischemic stroke or transient ischemic attack, or peripheral artery disease.
When people left the hospital or emergency department in 2007 following a first diagnosis in one of these categories, about half began taking statins within 30 days. By 2016, statin use increased to approximately 60%.
“Based on the guidelines, we hoped to see a much higher uptake among this entire group,” says Dr. Noseworthy. “Statin intolerance was only noted for 4%-5% of the patients, which means as many as 35% of patients are not receiving treatment according to the guidelines.”
Xiaoxi Yao, Nilay D. Shah, Bernard J. Gersh, Francisco Lopez-Jimenez, Peter A. Noseworthy. Assessment of Trends in Statin Therapy for Secondary Prevention of Atherosclerotic Cardiovascular Disease in US Adults From 2007 to 2016. JAMA Network Open, 2020; 3 (11): e2025505 DOI: 10.1001/jamanetworkopen.2020.25505
OBJECTIVE To assess the relation of type 2 diabetes occurring earlier (age <55 years) versus later in life to the risk of cardiovascular death and to diabetes in offspring.
RESEARCH DESIGN AND METHODS In the Framingham Heart Study, a community-based prospective cohort study, glycemic status was ascertained at serial examinations over six decades among 5,571 first- and second-generation participants with mortality data and 2,123 second-generation participants who initially did not have diabetes with data on parental diabetes status. We assessed cause of death in a case (cardiovascular death)–control (noncardiovascular death) design and incident diabetes in offspring in relation to parental early-onset diabetes.
RESULTS Among the participants in two generations (N = 5,571), there were 1,822 cardiovascular deaths (including 961 coronary deaths). The odds of cardiovascular versus noncardiovascular death increased with decreasing age of diabetes onset (P < 0.001 trend). Compared with never developing diabetes, early-onset diabetes conferred a 1.81-fold odds (95% CI 1.10–2.97, P = 0.02) of cardiovascular death and 1.75-fold odds (0.96–3.21, P = 0.07) of coronary death, whereas later-onset diabetes was not associated with greater risk for either (P = 0.09 for cardiovascular death; P = 0.51 for coronary death). In second-generation participants, having a parent with early-onset diabetes increased diabetes risk by 3.24-fold (1.73–6.07), whereas having one or both parents with late-onset diabetes increased diabetes risk by 2.19-fold (1.50–3.19).
CONCLUSIONS Our findings provide evidence for a diabetes subgroup with an early onset, a stronger association with cardiovascular death, and higher transgenerational transmission.
Previous research has shown that parents pass on health to their offspring through both genes and shared environment/lifestyle. This was the first study to examine whether parents’ heart health was associated with the age at which offspring develop cardiovascular disease. In addition, it investigated the influence of each parent separately.
The study was conducted in offspring-mother-father trios from the Framingham Heart Study — a total of 1,989 offspring, 1,989 mothers, and 1,989 fathers. Offspring were enrolled at an average age of 32 years and followed over 46 years (1971-2017) for the development of cardiovascular events. “Crucially, the study followed offspring into most of their adult life when heart attacks and strokes actually occur,” explained Dr. Muchira
Journal Reference: Muchira JM, Gona PN, Mogos MF, et al. Parental cardiovascular health predicts time to onset of cardiovascular disease in offspring. Eur J Prev Cardiol., 2020 DOI: 10.1093/eurjpc/zwaa072
Sex Differences in Coronary Artery Calcium and Mortality From Coronary Heart Disease, Cardiovascular Disease, and All Causes in Adults With Diabetes: The Coronary Calcium Consortium
RESULTS Among 4,503 adults with diabetes (32.5% women) aged 21–93 years, 61.2% of women and 80.4% of men had CAC >0. Total, CVD, and CHD mortality rates were directly related to CAC; women had higher total and CVD death rates than men when CAC >100. Age- and risk factor–adjusted hazard ratios (HRs) per log unit CAC were higher among women versus men for total mortality (1.28 vs. 1.18) (interaction P = 0.01) and CVD mortality (1.47 vs. 1.27) (interaction P = 0.04) but were similar for CHD mortality (1.48 and 1.48). For CVD mortality, HRs with CAC scores of 101–400 and >400 were 3.67 and 6.27, respectively, for women and 1.63 and 3.48, respectively, for men (interaction P = 0.04). For total mortality, HRs were 2.56 and 4.05 for women, respectively, and 1.88 and 2.66 for men, respectively (interaction P = 0.01).
CONCLUSIONS CAC predicts CHD, CVD, and all-cause mortality in patients with diabetes; however, greater CAC predicts CVD and total mortality more strongly in women.
Sex Differences in Coronary Artery Calcium and Mortality From Coronary Heart Disease, Cardiovascular Disease, and All Causes in Adults With Diabetes: The Coronary Calcium Consortium — Diabetes Care 2020 Oct; 43(10): 2597-2606. https://doi.org/10.2337/dc20-0166
Many widely used medications may cause or exacerbate a variety of arrhythmias. Numerous antiarrhythmic agents, antimicrobial drugs, psychotropic medications, and methadone, as well as a growing list of drugs from other therapeutic classes (neurological drugs, anticancer agents, and many others), can prolong the QT interval and provoke torsades de pointes. Perhaps less familiar to clinicians is the fact that drugs can also trigger other arrhythmias, including bradyarrhythmias, atrial fibrillation/atrial flutter, atrial tachycardia, atrioventricular nodal reentrant tachycardia, monomorphic ventricular tachycardia, and Brugada syndrome. Some drug-induced arrhythmias (bradyarrhythmias, atrial tachycardia, atrioventricular node reentrant tachycardia) are significant predominantly because of their symptoms; others (monomorphic ventricular tachycardia, Brugada syndrome, torsades de pointes) may result in serious consequences, including sudden cardiac death. Mechanisms of arrhythmias are well known for some medications but, in other instances, remain poorly understood. For some drug-induced arrhythmias, particularly torsades de pointes, risk factors are well defined. Modification of risk factors, when possible, is important for prevention and risk reduction. In patients with nonmodifiable risk factors who require a potentially arrhythmia-inducing drug, enhanced electrocardiographic and other monitoring strategies may be beneficial for early detection and treatment. Management of drug-induced arrhythmias includes discontinuation of the offending medication and following treatment guidelines for the specific arrhythmia. In overdose situations, targeted detoxification strategies may be needed. Awareness of drugs that may cause arrhythmias and knowledge of distinct arrhythmias that may be drug-induced are essential for clinicians. Consideration of the possibility that a patient’s arrythmia could be drug-induced is important.
Statins remain our safest and most effective drug for primary and secondary prevention of coronary artery disease. However, a cult of statin deniers has taken hold on the internet and their efforts often result in patients inappropriately stopping statins, an outcome which can have lethal consequences. Early in the pandemic a patient of mine in…
Note to my readers: I encourage you to follow the link and read the entire post and the comments to fully understand Dr. Pearson’s message. And if you’re a statin denier don’t bother reading the full post because we’re not here to engage in an argument or to change your opinion on this medication.