In the last decades we’ve made major strides in heart attack prevention through the use of blood pressure medications, smoking cessation, and statins – a family of cholesterol-lowering medications that have been proven to prevent heart attacks and strokes. Despite these advances, heart attacks remain the leading cause of death in the US. New medications to further decrease heart attack risk are being eagerly sought.
Allow me a brief digression to explain three important fat molecules in your bl...
More
Sitting Won’t Kill You, Except on Train Tracks
In the last couple of weeks the media has published stories making it sound like your Ikea chair is a death trap waiting to assist your suicide through the dangerous activity of sitting down. Stories with sensational titles like “Is Sitting a Lethal Activity?” (see link below) make you think that you’re better off walking outside for a smoke. Let’s spend a few minutes sifting the solid science from the wacky conjecture. You might as well sit down for this.
The media interest in the idea that si...
More
New Study on Estrogen Yields Confusion but Same Recommendations
This week a study published in the Journal of the American Medical Association revealed new results about estrogen use and generated major media hubbub. (See the links below for some of the media coverage, the article and an accompanying editorial.) To understand the kerfuffle it helps to review how our understanding of estrogen replacement therapy has evolved.
A generation ago, based largely on intuition and on epidemiologic studies, we were convinced that long term estrogen replacement therap...
More
News Flash: Diabetes is Not Good
Type 2 diabetes mellitus has long been known to increase the risk of stroke, heart attack, kidney disease, and eye disease. In the US diabetes is the leading cause of kidney failure requiring dialysis and one of the leading causes of blindness. Diabetes is also increasing in prevalence as people become more overweight.
A study in this week’s New England Journal of Medicine attempted to quantify the risk of premature death associated with diabetes. The results were dramatic, and attracted much m...
More
This Isn’t Your Father’s Heart Disease
What’s the most common cause of death among American women? Breast cancer? Accidents? Suicide after watching too many Lifetime Channel specials? Nope. Heart attacks kill more women than any other cause—same as men. A generation ago heart disease was mistakenly thought of as an exclusively male disease, but patients and physicians have learned that preventing and treating heart disease is critical in women too.
This week the American Heart Association published their updated recommendations for ...
More
Animated about Aspirin
Aspirin was hailed as a wonder-drug in the 1800s when it was first purified – the first anti-inflammatory medication that did not have the severe side effects of steroids. More recently aspirin’s benefits in stroke and heart attack prevention have been proven. This week another possible benefit of aspirin has been uncovered.
An important study published in The Lancet attempted to find any effect of aspirin on cancer prevention. I’ve written frequently about the myriad substances that are fal...
More
Apathy about Anacetrapib
The new cholesterol medication generating hubbub this week is anacetrapib.
Why is the world holding its breath for another cholesterol medicine in an already crowded field? Well, the most successful family of cholesterol medications is statins. Statins have solid evidence for stroke and heart attack prevention. Statins lower LDL, the “bad cholesterol” that you hear about whenever your doctor discusses your cholesterol results. But another important risk factor for heart disease is low HDL. ...
More
Is There a Patient Educator in the House?
… or, An Angioplasty Also Won’t Make You Taller
Over a million coronary angioplasties are performed in the US each year. In this procedure a thin tube is threaded into a narrowed coronary artery. Through this tube a balloon is inflated to open the narrowed artery, and then a stent (a metal mesh tube) is placed to keep the newly expanded artery open.
Some large well-designed studies in the last few years have taught us that angioplasty is a life-saving procedure in the setting of an a...
More
Rethinking Calcium Supplements
This week I discovered how painful it can be to change a habit. Not because it means admitting I was doing the wrong thing, but because it means analyzing how feeble my reasons were for the habit in the first place.
Ever since I started practice I’ve been recommending calcium supplements to post-menopausal women. Why? Mostly out of habit. There’s not a shred of evidence that calcium supplements prevent fractures, but some suggestion that they may help bone density. But what’s the harm? Ca...
More
More Support for Hands-Only CPR
My regular readers are a sharp bunch, so you probably already know that cardiac arrest – the cessation of a pulse and of blood circulation – is very very bad for you. Most doctors don’t recommend it. Nevertheless, hundreds of thousands in the U.S. every year suffer cardiac arrest outside of a hospital, frequently due to a heart attack. Cardiopulmonary resuscitation (CPR) was developed 50 years ago for just such situations. Decades of data strongly support that the following two factors are k...
More