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ARE PPI MEDICATIONS (NEXIUM, PRILOSEC, ETC) ASSOCIATED WITH HEART ATTACKS?

BMJ 2015;350:h3220

A study in London showed a 16% increase in heart attacks in people using these types of stomach acid blockers. There were no connections to heart disease with other acid blockers (Zantac, Pepcid, etc.) It is not known why although it is suspected that PPI medications interfere with vascular function. It should also be noted that this study did not prove that there was a direct causation with these drugs and heart disease, just an association. More testing needs to be done.

Until more information becomes available, long term PPI use should only be used with the consent of your physician. If you can switch to other types of acid medications and it works just as well, it might be worth trying. There are, however, many patients who only get relief with PPI’s. As with all treatment options, benefits versus risk should always be weighed.

 

NEW CHOLESTEROL MEDICINE

The FDA has given preliminary approval to a new class of cholesterol medication called PCSK9 inhibitors. These drugs, which work differently than statins, are indicated for lowering LDL cholesterol in patients with hypercholesterolemia, especially for patients with heterozygous familial hypercholesterolemia (HeFH). Other groups predicted to get special benefit include those at high cardiovascular risk or who don’t tolerate statins. This looks like it will be an injectable medication and  will have a good side effect profile.

There are a few problems:

1.       Many people do not want to inject a medicine as opposed to taking a pill.

2.       The are NO OUTCOME studies that show that this drug will actually prevent heart attacks.

3.       Most insurance companies will most likely NOT pay for this. (My guess is that it will initially cost at least $25,000/year!!)

The FDA is supposed to give final approval in July and there is already a second PCSK9 drug in the wings.

 

KIDNEY STONES

Kidney stones are among the most painful medical conditions that I treat. They are usually calcium based and about 50% of people who have a stone will get another within 5 years. The best way to prevent stones is to make dietary changes. Urologists recommend drinking 12-8 ounce glasses of water per day. It is also recommended to avoid soft drinks, especially colas. This is because they contain phosphoric acid which can increase the risk of getting stones. Calcium supplements have also come under fire recently. I have written about the risks of not only kidney stones, but also heart disease and macular degeneration with a lot of calcium supplements. However, DIETARY CALCIUM has never been associated with any side effects. Certain foods like black tea and chocolate can raise oxalates which also cause stones.

When dietary changes aren’t enough, we sometimes will add a diuretic which is cheap and decreases calcium excretion in the kidneys. (No calcium-no stones) Another product, potassium citrate will decrease the acidity of the urine, which will also decrease stone formation.

ARE TESTOSTERONE GELS SAFER THAN INJECTIBLE VERSIONS?

JAMA Internal Medicine

 

 

Researchers have evaluated 500,000 men in 3 different studies to see if there was a difference in topical gels versus injectable testosterone replacement. They found that some men get a large spike in testosterone levels right after an injection which caused a slightly higher risk of heart disease. There are risks in taking any medication, which is why I only prescribe testosterone in patients who are clearly symptomatic from “LOW T”. Testosterone DOES NOT cause prostate cancer and for every study that shows a relationship between testosterone and heart disease there a ten times as many that show a DECREASED risk.

The advantages of injectable testosterone is that it only has to be taken every 2 weeks and the patient is assured of absorbing it. It also costs about $4/injection and can be self-injected.

Topical testosterone gels are messy and absorption is variable. Once applied, you cannot come in contact with any women or children until you shower it off.

If you are lucky enough to have commercial insurance, there are coupon vouchers that cut the cost to $10/month. Medicare patients(and some commercial) are out of luck and if not covered could cost as much as $240/month.

NEW THOUGHTS ABOUT OBESITY

We usually think about obesity in terms of calories and exercise, but not every person who makes lifestyle changes are able to lose weight no matter what they do.

The latest thinking is that obesity is related to inflammation in the body as well as micronutrient deficiencies.

Many researchers are connecting the dots when it comes to MICROBIOME (bacteria in the gut) with inflammation and insulin resistance which can lead to increased bidy fat and weight. There are studies that are looking at the role of both prebiotics and probiotics in weight reduction.(there is also an association of heart disease and depression with abnormal bacteria in the intestines)

Also, deficiencies in Vitamin C, Zinc, Iron, Magnesium, CoQ10 and Calcium have been linked to weight gain.

So, yes, diet and exercise and even sometimes prescription medications can help you lose weight but when that doesn’t help, INFLAMMATION should be considered and treated

CAN YOUR YEARLY MAMMOGRAM PREVENT HEART DISEASE?

American Roentgen Ray Society (ARRS) 2015 Annual Meeting: Abstract 1226.

For years, we have used “cardiac calcium” scores to help predict and prevent heart disease. Our biggest obstacle has always been getting insurance companies to cover the test. (There a several radiology practices that will perform this for only $50- at one time it cost over $400).

Radiologists at the Mount Sinai School of Medicine in new York City have discovered that breast arterial calcium scoring done on routing digital screening mammograms were predictive of underlying coronary calcification in 69% of their patients! Even though the actual “calcium scores” were different they were able to correlate cardiac risk when comparing the mammogram to a standard CT scan of the chest.

Let’s hope that our local radiologists will incorporate this in their reports that are sent to the office.

 

 

TOO LATE TO QUIT SMOKING??

British Medical Journal

 Actually, it’s never too late to quit smoking. Even at age 60, those who stop smoking see their heart attack risks dramatically improve after just 5 years of being smoke free. We’ve known for years that it only takes 1 cigarette a day to cause fatal cardiac arrhythmias, so it’s not just a question of cutting back. The big problem is that smoking is very addictive and very hard to stop. Several prescription medications can be very effective, but I have found that you, the patient has to want to quit. It’s very hard to quit if you are motivated; almost impossible if you still enjoy smoking.

 

UPDATE OF SMOKING CESSATION PRODUCTS-ARE YOU STILL VAPING?

The hardest habit to change is quitting smoking. No matter what method is tried, most people will restart smoking within 1-2 years. The best products I have seen to date are Wellbutrin, an antidepressant medication that was discovered accidentally in the 1980’s and more recently Chantix.  More and more people are turning to e-cigarettes in spite of the lack of studies showing long term success. There have also been safety issues. The latest study is from the New England Journal of Medicine which shows that excessive levels or FORMALDEHYDE are produced, especially when the vapor devices are used at higher voltages. The cancer risk is estimated at 5-15 times greater when compared to tobacco! In Eastern Europe, a plant alkaloid called CYTISINE has been found to be more effective than placebo. After 1 month,  40% of those using cytisine were smoke free when compared to those using nicotine replacement products and persisted for the next 6 months. Side effects include nausea and sleep disturbances.

Of course non-medical approaches such as hypnosis, acupuncture and biofeedback can also be helpful.

 

OBESITY AND REDUCED LIFE EXPECTANCY

US National Health and Nutrition Examination Survey (NHANES)

 

A new study showed that obesity alone can reduce life expectance by up to 8 years. This may increase to 19 years if it also causes either diabetes or heart disease. The study showed that not only is life expectancy decreased but also quality of life. What is interesting is that this study evaluated Americans between 20-79 and made NO mention of any medications. It is important to know what your BMI is and to try to keep it in a healthy range. There are many ways to lose weight. For more information on losing weight in a physician supervised manner, please call our office

Chiropractic and stroke

This is a topic that I have known about dating back to my medical residency days in the 1970’s. That is manipulation of the neck can cause strokes! This was reported in the MAYO CLINIC JOURNAL in the mid 70’s and again in a recent article in the journal STROKE. Ruptured neck arteries can occur spontaneously or be associated with car accidents or sporting injuries. However, it is well documented that it is also associated with cervical spine manipulation therapy. The moral of the story is to be gentle with your neck. Try to avoid too much extension or rotation during therapy. And, if therapy is necessary, ask your physician to refer you to a licensed and experienced physical therapist.

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