By Sarah A LoBisco, ND
Can you believe its July already!
Today, I was just about to sit down and write a blog on the scientific union between biochemistry, quantum physics, epigenetics, integrative medicine, and mind-body medicine. I was tuning in and thinking of how serendipitous it was that I had just completed a course on the epigenetics of methylation. To think how this single nucleotide polymorphisms (SNPs) could be the connection point in relation to a new video series I received and this blog!
Whew!…
First, let me explain the above in English!
These SNPs are individual genetic variances in certain enzymes. Enzymes are molecules that are used to produce signaling molecules throughout our whole body. These differences don’t necessarily cause a mutation or genetic disease, but they can create havoc in certain individuals who have these less optimal functioning enzymes in their biochemical genome. (So, yes you can literally have genomic envy for those born with the SNPs to carbohydrate burning and stay slim on bread!)
(Thank you Institute of Functional Medicine and Genomic Testing for my geek out)!
Remember, I wrote about SNPs in regards to cleansing a few years back?:
Genetic differences in enzyme detoxification pathways, including methylation and sulfation pathways, can cause some individuals to be more susceptible to environmental exposures than others. For example, someone who has a SNP, or single nucleotide polymorphism, in MTHFR (methylenetetrahydrofolate reductase), MS (methionine synthase), COMT (catechol-O-methyltransferase), Methyl-transferases, STM1, GSTP1 (glutathione transferases), Apo E 4 (apolipoprotein E 4), and/or Impaired Metallothionein function can create imbalances in clearance and a retention in toxins. These SNPs are actually quite common in the general population and their lucky owners usually diagnosed with “psychosomatic illnesses.” The good news is that, with the new science of nutrigenomics, various nutrients in therapeutic doses can help to remedy the body’s slow detoxification capacity.
Back to my realization:
All of a sudden realized, “I didn’t do my Top Reads this month!”
No worries, the June 2013 Top Holistic Health Reads is here!
(And, the blog mentioned above on the link of the science of holistic, integrative, and “energy” medicine will be coming soon :)).
I hope you enjoy reading my humble compilation of summaries from the top wellness and medical news in June.
Here are some Highlights from the below articles:
Nutrigenomics
1. How Fish Oil Boosts Immune Function
2. The Power of the Gut in Immune Function & a Highlight on Probiotics and MRSA
3. Diet: Sugars, Fats, Heart Health, & Sugar Addiction (Carnitine also makes a comeback)
Health:
1. Policy: Obesity is now classified as a disease & the money waste in USA healthcare
2. GMOs and Food Updates
3. Environmental Connections to Brain Health (Aluminum, Wheat, & Meditation)
To be posted in my upcoming blog at Saratoga.com (check in later this week)
4. The Effects of Yoga on Your Genes!
4. Essential Oils Highlight:
Essential Oils with Massage Helps Menstrual Pain (Compared to massage with placebo)
See my new BREAKFREE MEDICINE Facebook Page in the works (and like me while you’re there please :)):
Drug Updates:
1. NSAIDs and Health Risks
The non-steroidal anti-inflammatory drugs such as Ibuprofen, various cox-2 inhibitors (coxibs), and Diclofenac all are linked to cardiovascular and gastrointestinal complications. However, which has got the worse safety profile?
2. More Safety Concerns Hit Headlines with Statin Medications
3. Safety Concerns with Proton Pump Inhibitors
4. Two New Drugs hit the FDA Warning List
Nutrigenomics
How Fish Oil Helps Immune Function
Summary: It could boost immune function with a specific immune cell pathway
DHA is a n-3 LCPUFA in fish oil that generally suppresses T lymphocyte function. However, the effect of fish oil on B cell function remains relatively understudied. Given the important role of B cells in gut immunity and increasing human fish oil supplementation, we sought to determine whether DFO leads to enhanced B cell activation in the SMAD?/? colitis-prone mouse model, similar to that observed with C57BL/6 mice. This study tested the hypothesis that DHA from fish oil is incorporated into the B cell membrane to alter lipid microdomain clustering and enhance B cell function. Purified, splenic B cells from DFO-fed mice displayed increased DHA levels and diminished GM1 microdomain clustering. DFO enhanced LPS-induced B cell secretion of IL-6 and TNF-? and increased CD40 expression ex vivo compared with CON. Despite increased MHCII expression in the unstimulated ex vivo B cells from DFO-fed mice, we observed no difference in ex vivo OVA-FITC uptake in B cells from DFO or CON mice. In vivo, DFO increased lymphoid tissue B cell populations and surface markers of activation compared with CON. Finally, we investigated whether these ex vivo and in vivo observations were consistent with systemic changes. Indeed, DFO-fed mice had significantly higher plasma IL-5, IL-13, and IL-9 (Th2-biasing cytokines) and cecal IgA compared with CON. These results support the hypothesis and an emerging concept that fish oil enhances B cell function in vivo.
Gurzell, E, Teague, H, Harris, M, Clinthorne, J, Shaikh, Saame Raza, & Fenton, J. DHA-enriched fish oil targets B cell lipid microdomains and enhances ex vivo and in vivo B cell function (abstract). Journal of Leukocyte Biology vol. 93 no. 4 463-470. April 2013. http://www.jleukbio.org/content/93/4/463.abstract
The Power of the Gut on Overall Health
Probiotics and Immune Health, A Possible Protection from MRSA?
One of the central mechanisms of Propionibacterium acnes’ ability to inhibit MRSA was through a biochemical called propionic acid. The researchers isolated the propionic acid from the skin probiotic and found that propionic acid in itself significantly inhibited the colonization of MRSA.
Propionic acid is normally present on the skin of healthy persons.
The researchers then tested the ability of Propionibacterium acnes bacteria to prevent infection on the skin of mice. The Propionibacterium acnes bacteria cultures significantly inhibited MRSA infections – at even greater degrees than within the laboratory. The researchers also found that the Propionibacterium acnes bacteria tended to colonize into and around any wounds on the skin of the mice – thereby preventing MRSA infection into the wound.
Adams, C. Skin Probiotics Offer Best Defense Against MRSA Infections. GreenMedInfo.com. May 2, 2013. http://www.greenmedinfo.com/blog/skin-probiotics-offer-best-defense-against-mrsa-infections?utm_source=GreenMedInfo+Weekly&utm_campaign=2c0691525a-Greenmedinfo&utm_medium=email&utm_term=0_62bb7ef31e-2c0691525a-86825417
Gut Microbome Related to Fatty Liver
Further evidence that the gut microflora plays a major role in the pathogenesis of nonalcoholic steatohepatitis (NASH) was presented in a separate study.[8] These investigators found elevated bacterial metabolic products in liver tissue from patients with NASH, supporting the hypothesis that gram-positive cell wall components arising from the gastrointestinal tract exert a direct effect on hepatocytes, causing increased oxidative stress and contributing to tissue injury. These observations offer a possibility that administration of antibiotics or probiotics may be of benefit in the treatment of steatohepatitis.
William F. Balistreri, MD. Fatty Liver Takes Center Stage. Medscape Gastroenterology. Jun 04, 2013. http://www.medscape.com/viewarticle/805102_3
Gut Microbome Permanently Altered by Antibiotics
Emerging research shows that the harmful effects of antibiotics go much further than the development of drug resistant diseases. The beneficial bacteria lost to antibiotics, along with disease-inducing bacteria, do not fully recover. Worse, flora lost by a mother is also lost to her babies. The missing beneficial gut bacteria are likely a major factor behind much of the chronic disease experienced today. The continuous use of antibiotics is resulting in each generation experiencing worse health than their parents.
Martin Blaser, the author of a report in the prestigious journal Nature writes:
Antibiotics kill the bacteria we do want, as well as those we don’t. These long-term changes to the beneficial bacteria within people’s bodies may even increase our susceptibility to infections and disease. Overuse of antibiotics could be fuelling the dramatic increase in conditions such as obesity, type 1 diabetes, inflammatory bowel disease, allergies and asthma, which have more than doubled in many populations.
Stevenson, H. Gut Biota Never Recover from Antibiotics: Damages Future Generations. GreenMedInfo.com. (Originally published on Gaia Health). June 5, 2013. http://www.greenmedinfo.com/blog/gut-biota-never-recover-antibiotics-damages-future-generations?utm_source=GreenMedInfo+Weekly&utm_campaign=270dfd42aa-Greenmedinfo&utm_medium=email&utm_term=0_62bb7ef31e-270dfd42aa-86825417
Study Shows Probiotics Help when on Antibiotics
(In hospitals, when you give the good bugs to the gut, people get better faster!)
Patients in hospital who are on antibiotics may benefit from taking probiotics, according to researchers at St. Michael’s Hospital.
Dr. Reena Pattani led a literature review that looked at the effectiveness of probiotics, live bacteria that can take up residence in digestive tracts, in treating common side effects of antibiotics, such as antibiotic-associated diarrhea and life-threatening side effects such as Clostridium difficile infection.
Taylor, K. Study finds taking probiotics has benefits for patients in hospitals.St. Michael’s Hospital. Newsroom: Our Stories. June 4, 2013. http://www.stmichaelshospital.com/media/detail.php?source=hospital_news/2013/20130604_hn
Test the Gut Bugs, Treat the Baby
(Testing what’s in the gut means potential benefits in treatment!)
Researchers are in the process of sequencing entire microbial communities in samples taken from defined body sites to describe the human microbiome. The potential contribution of metagenomics, as this technology is called, is significant. “Children with a high fever who present to the emergency department are treated with various diagnostics. For a fraction of these children, the infecting organism cannot be identified because the causative organisms are not being tested with current diagnostics,” Dr. Weinstock explained.
In a study of febrile children, Dr. Weinstock and colleagues Gregory Storch, MD, and Kristine Wylie, PhD, were able to demonstrate that children with fever were more likely to harbor a wide range of viruses, detected with nasopharyngeal swabs and in plasma, than children without fever. “By taking a nasal or blood sample, doing DNA sequencing, and analyzing these sequences, there is the potential to detect organisms that you could not detect with current standard diagnostics,” Dr. Weinstock said.
This could spare children inappropriate treatment, especially young children in whom antibiotics should be avoided, he noted. The direct application of microbiome therapy to various clinical scenarios is also in its infancy. One potential application is “fecal transplant,” which is given to patients with recurrent Clostridium difficile infections to reestablish a healthy microbiome. In a recent study (N Engl J Med. 2013;368:407-415), the infusion of feces from a donor into recipients suffering from recurrent C difficile infection significantly outperformed conventional antibiotics
Harrison, P. Medscape. Future of Genomic Medicine (FoGM) VI. Medscape Medical News. April 3, 2013. http://www.medscape.com/viewarticle/781916?src=wnl_edit_cwu&uac=146852BY
Dietary Choices
Good Fat for Heart
Objective. To evaluate the effectiveness of replacing dietary saturated fat with omega 6 linoleic acid, for the secondary prevention of coronary heart disease and death.
Conclusions. Advice to substitute polyunsaturated fats for saturated fats is a key component of worldwide dietary guidelines for coronary heart disease risk reduction. However, clinical benefits of the most abundant polyunsaturated fatty acid, omega 6 linoleic acid, have not been established. In this cohort, substituting dietary linoleic acid in place of saturated fats increased the rates of death from all causes, coronary heart disease, and cardiovascular disease. An updated meta-analysis of linoleic acid intervention trials showed no evidence of cardiovascular benefit. These findings could have important implications for worldwide dietary advice to substitute omega 6 linoleic acid, or polyunsaturated fats in general, for saturated fats.
Christopher E Ramsden, Daisy Zamora, Boonseng Leelarthaepin, Sharon F Majchrzak-Hong, Keturah R Faurot, Chirayath M Suchindran, Amit Ringel, John M Davis, Joseph R Hibbeln. Use of Dietary Linoleic Acid for Secondary Prevention of Coronary Heart Disease and Death: Evaluation of Recovered Data From the Sydney Diet Heart Study and Updated Meta-Analysis. BMJ>Medscape Special Report. 6/5/13. http://www.medscape.com/viewarticle/779083?src=wnl_edit_specol&uac=146852BY
The Undeserved Bad Rep of Saturated Fats
Still, Lawrence describes:
· The role of lipid peroxidation in promoting atherogenesis, arguing that its effects are more pronounced on PUFA than on SFAs or monosaturated fatty acids.
· An arguably protective effect of omega-3 PUFAs against proinflammatory effects of omega-6 and other PUFAs.
· Evidence that potentially carcinogenic preservatives in processed meats as well as high-heat cooking methods have influenced perceptions that red meat per se has adverse health effects.
· How “the preparation and cooking methods used for foods that are traditionally classified as saturated fat foods may be producing substances from PUFAs and carbohydrates in those foods that are promoting disease.”
· Studies suggesting positive health effects from dairy fat and tropical oils, both high in SFAs and therefore discredited as unhealthy. The hazards of diets with increased carbohydrates as a result of being lower in fat, in low-fat diets followed to improve health, especially cardiovascular health.
Stiles, St. Dietary Saturated Fat Has Undeserved Bad Reputation, Says Review. Medscape: Heartwire. May 17, 2013.
L-Carnitine is the Good Guy
Methods
A systematic review and meta-analysis of 13 controlled trials (N=3629) was conducted to determine the effects of L-carnitine vs placebo or control on mortality, ventricular arrhythmias (VAs), angina, heart failure, and reinfarction. These trials were identified via searches of the Ovid MEDLINE, PubMed, and Excerpta Medica (Embase) databases between May 1, 2012, and August 31, 2012.
Conclusion
Compared with placebo or control, L-carnitine is associated with a 27% reduction in all-cause mortality, a 65% reduction in VAs, and a 40% reduction in anginal symptoms in patients experiencing an acute myocardial infarction. Further study with large randomized controlled trials of this inexpensive and safe therapy in the modern era is warranted.
James J. DiNicolantonio, Carl J. Lavie, Hassan Fares,Arthur R. Menezes, James H. O’Keefe. L-Carnitine in the Secondary Prevention of Cardiovascular Disease: Systematic Review and Meta-analysis. Mayo Clinic Proceedings. Volume 88, Issue 6 , Pages 544-551, June 2013
Sugar and Heart Health?
Addicted to sugar? A new study finds that eating too much sweet stuff will not only contribute to weight gain but can set people down a pathway to heart failure.
A single small molecule, the glucose metabolite glucose 6-phosphate (G6P) — which accumulates from eating too much starch or sugar — causes stress to the heart that changes the muscle proteins and induces poor pump function leading to heart failure, researchers from the University of Texas Health Science Center at Houston reported.
Daily News. Sugar stresses the heart, may contribute to heart failure:study. AFP RELAXNEWS. June 17, 2013. http://www.nydailynews.com/life-style/health/sugar-stresses-heart-contribute-heart-failure-study-article-1.1374771#ixzz2Wbw9XxNG
Sugar Addiction?
Abstract
Background: Qualitative aspects of diet influence eating behavior, but the physiologic mechanisms for these calorie-independent effects remain speculative.
Objective: We examined effects of the glycemic index (GI) on brain activity in the late postprandial period after a typical intermeal interval.
Design: With the use of a randomized, blinded, crossover design, 12 overweight or obese men aged 18–35 y consumed high- and low-GI meals controlled for calories, macronutrients, and palatability on 2 occasions. The primary outcome was cerebral blood flow as a measure of resting brain activity, which was assessed by using arterial spin-labeling functional magnetic resonance imaging 4 h after test meals. We hypothesized that brain activity would be greater after the high-GI meal in prespecified regions involved in eating behavior, reward, and craving.
Conclusions: Compared with an isocaloric low-GI meal, a high-GI meal decreased plasma glucose, increased hunger, and selectively stimulated brain regions associated with reward and craving in the late postprandial period, which is a time with special significance to eating.
Belinda S Lennerz, David C Alsop, Laura M Holsen, Emily Stern, Rafael Rojas, Cara B Ebbeling, Jill M Goldstein, & David S Ludwig. Effects of dietary glycemic index on brain regions related to reward and craving in men. doi: 10.3945/ajcn.113.064113 Am J Clin Nutr September 2013 ajcn.064113behavior at the next meal. This trial was registered at clinicaltrials.gov as NCT01064778.
Health Updates
National Health News in Policy
AMA: Obesity is Now Classified as a Disease
(Reuters) – In order to fight what it described as an “obesity epidemic,” the American Medical Association voted on Tuesday to recognize obesity as a disease and recommended a number of measures to fight it.
The association voted on the measure at its annual meeting in Chicago. The AMA noted that obesity rates in the United States have “doubled among adults in the last twenty years and tripled among children in a single generation” and that the World Health Organization, the U.S. Food and Drug Administration and Internal Revenue Service already recognize the condition as a disease.
Nick Carey. U.S. doctor group votes to recognize obesity as a disease. Reuters.com. Jun 19, 2013. http://www.reuters.com/article/2013/06/19/us-usa-doctors-obesity-idUSBRE95I1EW20130619
Russell Kridel, MD, incoming chair of the AMA Council on Science and Public Health (CSPH), told Medscape Medical News that there is no debate about the importance and urgency of addressing the problem, but he doesn’t believe it qualifies as a disease.
“It’s more like smoking. Smoking isn’t a disease. Smoking can cause disease such as lung cancer and emphysema in the same way that obesity can lead to diabetes and hypertension,” he explained. “We’re really talking nomenclature here, not philosophy.”
Marcia Frellick.AMA Declares Obesity a Disease. Medscape Medical News > Conference News. Jun 19, 2013. http://www.medscape.com/viewarticle/806566?src=wnl_edit_medn_wir&uac=146852BY&spon=34
Is Obesity a Disease?
Last week at the annual meeting of the American Medical Association in Chicago, the organization’s delegates voted for the first time to designate obesity a disease. How should the rest of us respond? When we meet obese people, should we cast them a knowing glance of concern and ask how they are doing? Should we send flowers and “get well soon” cards to obese family members and friends?
Should the U.S. declare war on obesity, as we once did on cancer?
If obesity truly is a disease, then over 78 million adults and 12 million children in America just got classified as sick. ..
Yet many sensible people, from physicians to philosophers, know that declaring obesity a disease is a mistake. Simply put, obesity is not a disease. To be sure, it is a risk factor for some diseases. But it would be as false to say that everyone who is obese is sick as to say that every normal-weight person is well. Hence the AMA’s vote raises some key questions. Why did it take this action? What is problematic about treating obesity as a disease? And how should sensible people think about obesity?
Gunderman, R. Is Obesity Really a Disease? The Atlantic (theatlantic.com).June 24, 2013.http://www.theatlantic.com/health/archive/2013/06/is-obesity-really-a-disease/277148/
USA-Spendthrift in HealthCare
The U.S. spends $200 billion each year — about 8 percent of the nation’s health care tab — on medical care stemming from improper or unnecessary use of prescription drugs, a new report out Wednesday says.
Much of those costs result from unneeded hospitalizations or doctor visits, according to the study by the IMS Health’s Institute for Healthcare Informatics, which provides data and other consulting services to the health care industry. Medical costs are driven up by patients who don’t get the right medications or fail to take their drugs, the misuse of antibiotics, medication errors and inadequate oversight when patients take multiple drugs.
Even though the use of lower cost generic drugs is high, further increases could shave $10 billion in costs, the report says.
Julie Appleby. Improper Use of Prescription Drugs Costs $200 Billion a Year, Report Finds. Medscape: Kaiser Health News. Jun 20, 2013. http://www.medscape.com/viewarticle/806673?src=wnl_edit_medn_wir&uac=146852BY&spon=34
More Waste in USA HealthCare
If doctors and patients used prescription drugs more wisely, they could save the U.S. health care system at least $213 billion a year, by reducing medication overuse, underuse and other flaws in care that cause complications and longer, more-expensive treatments, researchers conclude.
The new findings by the IMS Institute for Healthcare Informatics improve on numerous prior efforts to quantify the dollars wasted on health care.
….
Other areas of waste noted in the report include:
— Prescribing antibiotics inappropriately, as for patients with the flu or another viral infection, costing about $35 billion annually. This can contribute to bacteria becoming resistant to antibiotics, resulting in more expensive treatment and even hospitalization with a future infection.
— Medication errors, costing about $20 billion annually. Those include sloppy handwriting leading to the wrong drug or dose being dispensed and doctors not checking to see that the patient is getting better, meaning they’ve been getting the right medicine. Those errors are on the decline due to more doctors using electronic prescriptions and other changes.
— Not using generic drugs when they are available, costing about $12 billion annually. That’s a decreasing problem, as strategies of health plans and pharmacies encourage patients to choose generics by setting copayments for brand-name drugs a few times higher than for the generics. Without insurance, generics can cost 90 percent less than brand-name drugs. Today, when a generic is available, it’s dispensed about 95 percent of the time.
— Multiple medication confusion, costing about $1.3 billion annually. For elderly patients taking five or more medicines, it’s easy to mix up which pills should be taken when, and for those who are frail, those mistakes can cause serious harm. That problem likely will grow significantly with our aging population.
Johnson, L. Study: Wiser medication use could save US $213 billion a year in avoidable health care costs. StarTribune.com. June 19, 2013. http://www.startribune.com/lifestyle/health/212202901.html
FOODS & GMOs
GMO Corn Vs. Non-GMO
- A 2012 nutritional analysis of GMO versus non-GMO corn shows shocking differences in nutritional content. Non-GMO corn contains 437 times more calcium, 56 times more magnesium, and 7 times more manganese than GMO corn
- GMO corn was also found to contain 13 ppm of glyphosate, compared to zero in non-GMO corn. EPA “safe” level for glyphosate in American water supplies is 0.7 ppm, and organ damage in animals has occurred at levels as low as 0.1 ppm
- GMO corn contains extremely high levels of formaldehyde—about 200 times the amount found toxic to animals
- Research by a Texas teenager using fruit flies, which began when she was in middle school, shows that in virtually every health measure, including fertility, stress resistance and longevity, flies that fed on organic bananas and potatoes fared better than those who fed on conventionally raised produce. Her research was recently published in a respected science journal.
Mercola, J. Analysis Identifies Shocking Problems with Monsanto’s Genetically Engineered Corn Mercola.com. April 30, 2013. http://articles.mercola.com/sites/articles/archive/2013/04/30/monsanto-gmo-corn.aspx?e_cid=20130430_DNL_art_1&utm_source=dnl&utm_medium=email&utm_content=art1&utm_campaign=20130430
The “organic food” market is the fastest growing food sector, yet it is unclear whether organically raised food is nutritionally superior to conventionally grown food and whether consuming organic food bestows health benefits. In order to evaluate potential health benefits of organic foods, we used the well-characterized fruit fly Drosophila melanogaster as a model system. Fruit flies were raised on a diets consisting of extracts of either conventionally or organically raised produce (bananas, potatoes, raisins, soy beans). Flies were then subjected to a variety of tests designed to assess overall fly health. Flies raised on diets made from organically grown produce had greater fertility and longevity. On certain food sources, greater activity and greater stress resistance was additionally observed, suggesting that organic food bestows positive effects on fly health. Our data show that Drosophila can be used as a convenient model system to experimentally test potential health effects of dietary components. Using this system, we provide evidence that organically raised food may provide animals with tangible benefits to overall health.
Citation: Chhabra R, Kolli S, Bauer JH (2013) Organically Grown Food Provides Health Benefits to Drosophila melanogaster. PLoS ONE 8(1): e52988. doi:10.1371/journal.pone.0052988
“GMO Free Meat” Gets OK
The Agriculture Department has approved a label for meat and liquid egg products that includes a claim about the absence of genetically engineered products.
It is the first time that the department, which regulates meat and poultry processing, has approved a non-G.M.O. label claim, which attests that meat certified by the Non-GMO Project came from animals that never ate feed containing genetically engineered ingredients like corn, soy and alfalfa.
The U.S.D.A.’s Food Safety Inspection Service “allows companies to demonstrate on their labels that they meet a third-party certifying organization’s standards, provided that the third-party organization and the company can show that the claims are truthful, accurate and not misleading,” Cathy Cochran, a U.S.D.A. spokeswoman, said in a statement.
Ms. Cochran said the approval for labeling meats did not signal “any new policy regarding non-G.E. or non-G.M.O. products.”
Labeling foods to indicate the absence or presence of genetically engineered ingredients is one of the most contentious issues in the food business today, with about two dozen states mulling labeling requirements and the biotech industry fighting back with intense lobbying.
Strom, S. U.S. Approves a Label for Meat From Animals Fed a Diet Free of Gene-Modified Products. New York Times: Business Day. June 20, 2013. http://www.nytimes.com/2013/06/21/business/us-approves-a-label-for-meat-from-animals-fed-a-diet-free-of-gene-modified-products.html?_r=1&
DRUG UPDATES
Gastrointestinal vs. Cardiovascular Side Effects Relate to Your Choice in OTC Pain Control.
Study Abstract
The vascular and gastrointestinal effects of non-steroidal anti-inflammatory drugs (NSAIDs), including selective COX-2 inhibitors (coxibs) and traditional non-steroidal anti-inflammatory drugs (tNSAIDs), are not well characterised, particularly in patients at increased risk of vascular disease. We aimed to provide such information through meta-analyses of randomised trials.
We undertook meta-analyses of 280 trials of NSAIDs versus placebo (124 513 participants, 68 342 person-years) and 474 trials of one NSAID versus another NSAID (229 296 participants, 165 456 person-years). The main outcomes were major vascular events (non-fatal myocardial infarction, non-fatal stroke, or vascular death); major coronary events (non-fatal myocardial infarction or coronary death); stroke; mortality; heart failure; and upper gastrointestinal complications (perforation, obstruction, or bleed).
Interpretation: The vascular risks of high-dose diclofenac, and possibly ibuprofen, are comparable to coxibs, whereas high-dose naproxen is associated with less vascular risk than other NSAIDs. Although NSAIDs increase vascular and gastrointestinal risks, the size of these risks can be predicted, which could help guide clinical decision making.
Coxib and traditional NSAID Trialists’ (CNT) Collaboration. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials (abstract). The Lancet, Early Online Publication, 30 May 2013. doi:10.1016/S0140-6736(13)60900-9
The Risk of Proton Pump Inhibitors
The reported associations for harm relative to PPI use have received considerable attention across a broad range of adverse effects. Clearly, the literature does show that some of these are related, albeit quite rare and more typically idiosyncratic (eg, hypomagnesemia and interstitial nephritis). As such, these potential adverse effects should be not dismissed but put in perspective relative to the vast universe of patients receiving this class of therapy. The evolving data on C difficile should be monitored carefully. The clinical risk/benefit of any medical intervention or therapy always should be evaluated for each patient and appropriate use of therapy should be directed accordingly. Because PPIs are overprescribed in many patients, in particular for continued long-term use, the clinical effects always should be reviewed and attempts should be justified to stop any therapy that may not be needed.
David A. Johnson, Edward C. Oldfield IV. Reported Side Effects and Complications of Long-term Proton Pump Inhibitor Use: Dissecting the Evidence. Clin Gastroenterol Hepatol. 2013;11(5):458-464.Clinical Gastroenterology and Hepatology. Medscape. http://www.medscape.com/viewarticle/804146_5
Antibiotic and Statin Toxicity
Coprescription of clarithromycin or erythromycin with a statin that is metabolized by cytochrome P450 isoenzyme 3A4 (CYP3A4) increases the risk for statin toxicity in older adults, according to, a population-based cohort study.
Amit M. Patel, MD, from the London Kidney Clinical Research Unit, London Health Sciences Centre, Ontario, Canada, and colleagues published their results in an article online June 17 in the Annals of Internal Medicine.
Barclay, L. Concurrent Macrolide Antibiotic May Increase Statin Toxicity. Medscape Medical News. June 17 2013. http://www.medscape.com/viewarticle/806436?src=wnl_edit_medn_wir&uac=146852BY&spon=34
Statins and Diabetes
TORONTO, ON — The debate about the potential risks of new-onset diabetes in statin-treated patients is addressed in two separate studies published by Canadian researchers looking at patients treated with the LDL-lowering drugs[1,2]. While one study is reassuring for older patients treated with statins, with researchers finding no evidence of an increased risk of diabetes in acute coronary syndrome (ACS) patients, the other suggests that the more potent statins, such as rosuvastatin (Crestor, AstraZeneca), atorvastatin, and simvastatin, do pose an increased risk compared with pravastatin.
In a study published online May 14, 2013 in Circulation: Cardiovascular Quality and Outcomes, Dr Dennis Ko (Sunnybrook Health Sciences Center, Toronto, ON) and colleagues explain that while clinical-practice guidelines for ACS patients advocate for the use of intensive-dose statin therapy, the data suggesting an increased risk of diabetes with the drugs have raised some concerns.
Michael O’Riordan.Two Studies Address Diabetes Risks With Statins–One Good News, One So-So. Medscape: Heartwire. May 24, 2013.http://www.medscape.com/viewarticle/804716?src=wnl_edit_medn_wir&uac=146852BY&spon=34
Statins and Muscle Injury Risk
In the propensity-matched analysis, treatment with a statin was associated with a 19% increased risk of any type of musculoskeletal injury (p<0.001), a 13% increased risk of dislocations, strains, and sprains (p=0.001), and a 9% increased risk of musculoskeletal pain (p=0.02). There was a trend toward a 7% higher risk of osteoarthritis/arthropathies, but the association was not statistically significant in the propensity-matched analysis. There was an increased risk of osteoarthritis/arthropathies in two analyses that first adjusted for and then excluded patients with comorbidities at baseline.
O’Riordan, M. Statins Linked With Risk of Musculoskeletal Injury. Heartwire. Medscape. June 5, 2013. http://www.medscape.com/viewarticle/805369?src=wnl_edit_medn_wir&spon=34
FDA Watches Two Drugs (Ondansteron and Metoprolol)
The US Food and Drug Administration (FDA) has put a class of antiemetic drugs, including ondansetron (Zofran, GlaxoSmithKline, and Zuplenz, Par Pharmaceutical), on its latest quarterly list of products to monitor because of potential signals of an increased risk for serotonin syndrome.
The beta blocker metoprolol succinate (Toprol-XL, AstraZeneca) also landed on the list, posted on the FDA Web site last month, because of reports that suggested therapeutic ineffectiveness.
The agency received reports of possible adverse events for these products in the FDA Adverse Event Reporting System (FAERS) database during the first 3 months of 2013. The FDA cautions that an appearance on the watch list does not mean that the agency has concluded that the drug poses the health risk reported through FAERS. What it does mean is that the FDA will investigate whether there is a causal connection. If there is one, the agency would consider a regulatory action such as collecting more data to better characterize the risk, revising the drug’s label, or requiring a risk evaluation and mitigation strategy.
Lowes, R. FDA Adds Antinausea, Cardiac Drugs to Watch List. News Alerts > Medscape Medical News. Jun 25, 2013. http://www.medscape.com/viewarticle/806890?src=wnl_edit_medn_wir&uac=146852BY&spon=34
