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Author: Centrum Pharmacy

  • Cardiovascular Disease Research in Women: Underrepresented and Underdiagnosed

    Cardiovascular disease (CVD) stands as the primary global cause of death, accounting for approximately 17.9 million fatalities in 2019. In Canada, it ranks as the second leading cause of death for both men and women, with heart disease and stroke emerging as the top culprits for premature female mortality. Notably, the manifestation of heart disease differs between genders; women commonly exhibit microvascular disease in smaller vessels, while men tend to experience macrovascular disease in larger vessels. Consequently, the symptoms presented by women may vary from those observed in men. Hormone-related changes, specific medical conditions, and medications unique to women can also influence CVD development. Unfortunately, research studies have not consistently included women, resulting in unequal representation and potentially disparate treatments upon diagnosis. Addressing this gap requires further studies and enhanced educational efforts tailored to women, recognizing their distinct experiences with CVD, characterized by smaller vessel involvement and specific risk factors. Here is a breakdown:

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  • Tai Chi and its Effects on the Brain, particularly for the Elderly

    I have long advocated tai chi as a form of exercise, especially for the elderly and for individuals with physical challenges that make conventional aerobic exercises difficult to perform. If you’ve never done tai chi, which is a martial art that incorporates a series of movements, known as forms, with a focus on controlled breathing. It may look like nothing much is happening, but that’s a misconception. In fact, you are actually working very hard, and the physical benefits are pronounced. Many studies have shown that practicing tai chi can also help prevent falls and improve balance in older adults, and the benefit is greatest for people who keep up a regular practice over time.

    There has always been a suggestion that Tai Chi also has a beneficial effect on the brain and for maintaining mental acuity. Finally, there is a controlled study that seems to back up those claims:

    Tai chi is not just a physical exercise; it’s a mental workout too! A recent study shows that practicing tai chi can significantly slow cognitive decline and protect against dementia, especially for older adults.

    The study involved approximately 300 older adults, with an average age in their mid-70s, who reported experiencing a decline in their memory. All participants took a cognitive function test called the Montreal Cognitive Assessment, where a normal score ranges from 26-30. The average score at the beginning of the study was 25, indicating mild impairment.

    The findings revealed that those who practiced a simplified form of tai chi called Tai Ji Quan twice a week for six months improved their cognitive test scores by 1.5 points. While it may seem like a modest increase, study author Dr. Elizabeth Eckstrom emphasizes that it’s akin to giving oneself three extra years of staving off cognitive decline.

    For those engaged in a more rigorous type of tai chi, known as Cognitively Enhanced Tai Ji Quan, which involves additional challenges like spelling words backward and forward during tai chi moves, the improvement was about 3 points. This translates to giving individuals an extra six years of cognitive function.

    The study suggests that the memorization of tai chi movements, combined with fluid mind-body coordination, contributes to its effectiveness in preserving cognitive function. This combination of physical activity and memory engagement appears to be a winning formula.

    Dr. Joseph Quinn, a neurologist not involved in the study, finds the results impressive, even though he admits not fully understanding why tai chi works so well. He speculates that the meditative component and stress reduction effect could be contributing factors.

    Participants in the study expressed the meditative nature of tai chi, describing it as a practice that helps them feel grounded, release stress, and improve concentration. Beyond the cognitive benefits, tai chi has long been recognized for its impact on balance and fall prevention in older adults.

    While the study predominantly involved non-Hispanic white participants with college degrees, researchers acknowledge the need for efforts to make tai chi more accessible to a broader population, especially considering the disproportionate burden of cognitive impairment among certain demographic groups.

    In essence, tai chi isn’t just a series of graceful movements—it’s a dance for the mind and body, providing not only physical benefits but also a powerful defense against cognitive decline.

  • Obesity and Breast Cancer Recurrence

    Obesity has been found to elevate the risk of breast cancer recurrence in postmenopausal patients with hormone receptor–positive (HR+) early-stage breast cancer who are undergoing treatment with aromatase inhibitors, according to a comprehensive study conducted over an 18-year period using data from the Danish Breast Cancer Group.

    Clinical studies have consistently highlighted obesity as a risk factor for recurrence in postmenopausal women with HR+ breast cancer. Notably, evidence suggests that women with obesity may not experience the same protective effects from aromatase inhibitors as those with a healthy weight, although limited data exist on this subject.

    The cohort study, involving postmenopausal women diagnosed with stage I to III HR+ breast cancer receiving adjuvant endocrine therapy with aromatase inhibitors, categorized patients based on their body mass index (BMI). The BMI categories included healthy weight (18.5–24.9), overweight (25–29.9), obesity (30–34.9), and severe obesity (≥ 35), with patients of a healthy weight serving as the reference group for statistical analyses.

    Key findings from the study include:

    1. Patient Enrollment and Follow-Up:
      • A total of 13,230 patients with BMI information participated, with a median age at diagnosis of 64.4 years.
      • Throughout a median follow-up of 6.2 years, 1,587 recurrences were observed.
    2. Recurrence Hazards:
      • Multivariable analyses revealed increased recurrence hazards associated with obesity (adjusted HR, 1.18 [95% CI, 1.01–1.37]) and severe obesity (adjusted HR, 1.32 [95% CI, 1.08–1.62]) compared to patients with a healthy weight.
      • Patients with overweight also exhibited a greater risk of recurrence, but the results did not reach statistical significance (adjusted HR, 1.10 [95% CI, 0.97–1.24]).

    The study’s conclusion underscores the link between obesity and an elevated risk of breast cancer recurrence in postmenopausal patients with HR+ early-stage breast cancer undergoing aromatase inhibitor therapy. This large, population-based cohort study aligns with prior research, indicating that patients with obesity may derive less benefit from adjuvant endocrine therapy than those with a healthy weight.

    The authors advocate for further exploration into whether alternative endocrine therapies, such as tamoxifen, should be considered for postmenopausal women with obesity and early-stage HR+ breast cancer to enhance their prognosis, challenging the current recommendation of aromatase inhibitors for this patient population. However, one thing is certain, weight loss is clearly indicated for postmenopausal women with obesity and early-stage HR+ breast cancer to enhance their prognosis and enhance their general health. 

    The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information does not substitute for professional diagnosis and treatment. Please do not initiate, modify, or discontinue any treatment, medication, or supplement solely based on this information. Always seek the advice of your health care provider first. Full Disclaimer 

  • Intermittent Fasting

    Time-Restricted Eating (TRE), also known as intermittent fasting, which involves confining food intake to an 8-hour window each day without the need for calorie counting, has proven to be more effective in promoting weight loss in individuals with type 2 diabetes and obesity compared to traditional calorie restriction. Furthermore, both approaches resulted in a notable reduction in A1c levels compared to those who received no intervention.

    In a six-month clinical trial involving 75 adult participants with type 2 diabetes and obesity, individuals were randomly assigned to one of three groups: the 8-hour TRE approach (eating only from noon to 8 PM without calorie counting), a 25% daily calorie restriction, or a control group. The findings of the study demonstrate that Time-Restricted Eating is a safe and viable option for individuals managing type 2 diabetes, whether they are relying solely on dietary modifications or combining them with medication. However, it’s important to note that for those taking sulfonylureas and/or insulin, adopting a TRE regimen will necessitate adjustments in their medication regimen and regular monitoring, especially during the initial stages of implementing this dietary approach.

    Disclaimer: The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information does not substitute for professional diagnosis and treatment. Please do not initiate, modify, or discontinue any treatment, medication, or supplement solely based on this information. Always seek the advice of your health care provider first. Full Disclaimer 

  • This Halloween let’s discuss something genuinely frightening: Premature Death

    Death is an inevitable part of the human experience. What’s truly terrifying is premature death, the abrupt cessation of life before one’s time, leading to disability, pain, human suffering, and the agonizing prolongation of dying.

    The risk of experiencing premature death is deeply intertwined with the accessibility and availability of both beneficial and harmful products and services. Geography and economic factors play a significant role, often resulting in disparities that are both diverse and inherently unfair. Human behavior is remarkably malleable, influenced by the environment we inhabit. The availability of care and the presence of both advantageous and detrimental products further shape our fate.

    Consider that the average life expectancy at birth in North America is approximately 74.5 years for men and 80.2 years for women. The median age at death, when we remove gender, geography, race, or ethnicity as dividers, stands at 73.7 years. The World Health Organization (WHO) designates death before the age of 70 as “premature.” So, let’s uncover the common culprits responsible for prematurely ending North Americans’ lives, and at what age they typically strike:

    1. Gunshot wounds: Median age at death, Striking at 28 years.
    2. Fentanyl: A devastating 35 years.
    3. Vehicular accidents: Crashing lives at 40 years.
    4. Overdose not otherwise specified (NOS): A chilling 46 years.
    5. Alcoholism: A sobering 57 years.
    6. Tobacco addiction: Snuffing out lives at a mere at 66 years.
    7. Cirrhosis: A grim 67 years.
    8. Diabetes: Cutting lives short at 67 years.
    9. Chronic kidney disease: Claiming victims at 68 years.
    10. Lung cancer: A tragic 71 years.
    11. Cancer NOS: A cruel end at 73 years.
    12. Stroke: Taking lives too early at 73 years.
    13. Myocardial infarction (heart attack): time stops ticking prematurely at 73 years.

    All other significant causes of death, with median ages above 73.7, fall outside the “premature” category. These include Alzheimer’s disease, Parkinson’s disease, influenza, pneumonia, and sepsis.

    Premature death, typically defined as occurring before the age of 70, is closely linked to factors like behavior control, addiction, and the presence of harmful agents. These agents encompass street drugs, alcohol, tobacco, unhealthy foods, and even firearms.

    The accessibility of these harmful agents, including sugar-laden foods, ultra-processed junk, illicit drugs, and firearms, contributes to a wide array of health problems, from obesity and diabetes to addiction and violence. While society derives certain benefits from these substances and tools, it is imperative to weigh the risks they pose to our health.

    Conversely, the availability of beneficial elements, such as quality education, gainful employment, safe living environments, and nourishing foods, can serve as a shield against premature death.

    Addressing this alarming issue demands a multifaceted strategy, focusing on interventions that shape demand, harm reduction tactics, and the provision of support to encourage healthier choices. Despite the formidable challenges, it’s vital to strive for a society that prioritizes longevity and well-being.

    Ultimately, it all boils down to choices—individual, family, societal, and governmental choices, whether wise or reckless. Life, along with its timing, is a calculable risk. So, why not choose a longer life and work towards making it better? Happy Halloween!

  • New Guidelines for streamlined lipid management approach focusing on cardiovascular disease prevention

    These guidelines encompass both nonpharmacologic and pharmacologic interventions. Here’s a breakdown of the key recommendations:

    1. Physical Activity: The guidelines emphasize the importance of encouraging patients to engage in physical activity. Adherence to a regular exercise routine is considered more crucial than specifying a particular type, duration, or intensity of exercise.
    2. Mediterranean Diet: The Mediterranean diet is strongly recommended to reduce the risk of cardiovascular disease, highlighting the significant role of dietary choices in heart health.
    3. Primary Prevention with Statins: Healthcare professionals are advised to discuss the initiation of statins, preferably high-intensity statins, with patients who have a 10-year cardiovascular disease risk of 20% or higher for primary prevention.
    4. Primary Prevention with Statins (Moderate-Intensity): For patients with a 10-year cardiovascular disease risk falling in the 10%-19% range, clinicians are suggested to consider the initiation of statins, preferably of moderate intensity, for primary prevention.
    5. Lipid Level Re-testing: It is recommended to re-test lipid levels no earlier than five years and preferably in ten years for patients with a 10-year cardiovascular disease risk of less than 10% when estimating risk for primary prevention.
    6. Non-Statin Lipid-Lowering Drugs: The guidelines advise against the use of non-statin lipid-lowering medications either as monotherapy or in combination with statins for primary prevention.
    7. Secondary Prevention with High-Intensity Statins: For secondary prevention, healthcare providers are recommended to encourage the initiation of high-intensity statin therapy while discussing the potential risks and benefits with patients.
    8. Additional Risk Reduction: In cases where additional cardiovascular risk reduction is desired beyond maximizing statin therapy for secondary prevention, healthcare professionals are advised to discuss the potential use of ezetimibe or PCSK9 inhibitors with the patient.
    9. Icosapent Consideration: The guidelines suggest considering the addition of Icosapent to statins only after considering the potential adverse effects, such as atrial fibrillation and bleeding, following a discussion about the use of ezetimibe or PCSK9 inhibitors.

    These updated guidelines provide a comprehensive framework for managing lipid levels and reducing the risk of cardiovascular disease, with a focus on tailoring interventions to individual patient risk profiles.

    Disclaimer: The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information does not substitute for professional diagnosis and treatment. Please do not initiate, modify, or discontinue any treatment, medication, or supplement solely based on this information. Always seek the advice of your health care provider first. Full Disclaimer 

  • Statin Intolerance

    Many patients come to the pharmacy and tell me that they cannot tolerate Statins (Atorvastatin, Rosuvastatin, Simvastatin, etc.). I tell then that using Statins is extremely important to preventing heart disease, heart attacks, and premature death. Statins as a group of heart medications are responsible for preventing premature death in thousands upon thousands of individuals since 1987. 

    Here are the latest guidelines for dealing with Statin Intolerance. The guidelines provide the following recommendations:

    1. Non-Severe Muscle Adverse Effects (most common): When patients experience non-severe muscle adverse effects with a specific statin regimen, the guidelines suggest the following:
      • Prefer the use of any statin intensity over non-statin lipid therapy.
      • This can involve continuing with the same statin, switching to a different statin, adjusting the statin dose, or considering alternate daily dosing. The choice should be made through shared decision-making between the patient and the healthcare provider.
    2. Primary Prevention in Patients Unable to Tolerate Statin (extremely rare): For patients who cannot tolerate any statin and are undergoing primary prevention, the guidelines recommend against the use of non-statin pharmacologic therapies. In this case, non-pharmacologic interventions and lifestyle modifications should be emphasized.
    3. Secondary Prevention in Patients Unable to Tolerate Statin(patients who have already had a previous heart attack): When patients are unable to tolerate any statin and are undergoing secondary prevention, the guidelines advise considering the following options:
      • A discussion about the use of ezetimibe, fibrates, or PCSK9 inhibitors. These can be explored as alternative pharmacologic therapies.
      • Icosapent should be considered only after other options have been thoroughly evaluated. It’s important to note that the use of icosapent should be approached cautiously due to its potential adverse events, such as atrial fibrillation and bleeding.

    These guidelines aim to provide healthcare providers with a structured approach for managing patients who experience statin intolerance, ensuring that individualized decisions are made while considering the patient’s specific circumstances and risk factors.

    Disclaimer: The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information does not substitute for professional diagnosis and treatment. Please do not initiate, modify, or discontinue any treatment, medication, or supplement solely based on this information. Always seek the advice of your health care provider first. Full Disclaimer 

  • A New Survey Reveals Gaps in Understanding “Bad Cholesterol” and Its Impact

    LDL cholesterol, often referred to as “bad cholesterol,” silently poses a grave threat to cardiovascular health. However, a recent survey conducted in 2023 by the American Heart Association (AHA) in collaboration with the Harris Poll has unveiled a concerning lack of awareness, especially among heart attack and stroke survivors. Astonishingly, 70% of these survivors were found to be unfamiliar with the term “bad cholesterol” and its implications, indicating a significant knowledge gap and an urgent need for widespread education and proactive health management.

    Cholesterol is a waxy substance produced by the liver and introduced to the body through certain foods, primarily animal sources like meat and full-fat dairy products. Cholesterol travels through the bloodstream, attached to lipoproteins. The two main types of lipoproteins are high-density lipoproteins (HDL), often referred to as “good” cholesterol, and low-density lipoproteins (LDL), known as “bad” cholesterol. Together with triglycerides, these components make up your total cholesterol level.

    The pervasive lack of public awareness about “bad cholesterol” and its impact on cardiovascular health is a cause for concern. Since elevated LDL cholesterol typically exhibits no symptoms, many individuals may be unaware of their risk and how to mitigate it. Elevated LDL cholesterol can lead to the formation of fatty deposits, or plaques, in the arteries, significantly increasing the risk of heart attacks and strokes. The AHA survey found that, while 75% of heart attack and stroke survivors reported having high cholesterol, but only 49% recognized the importance of lowering it. Furthermore, 47% of survivors were unaware of their LDL cholesterol levels, despite its crucial role in preventing additional cardiovascular events.

    To address this issue, the AHA recommends that all adults aged 20 or older have their cholesterol checked every four to six years, provided their risk remains low. After the age of 40, healthcare professionals should use a specific calculation to assess an individual’s 10-year risk of experiencing a heart attack or stroke. Those with a history of such events may need more frequent cholesterol checks. Knowledge is undeniably a powerful tool in this context—the more you know, the better equipped you are to reduce the risk of future heart attacks and strokes.

    The journey to lower cholesterol begins with mindful eating. The AHA recommends adopting a diet rich in fruits, vegetables, whole grains, poultry, fish, and nuts, while minimizing red meat and full-fat dairy. Monitoring fat intake is crucial, particularly by reducing saturated fat to less than 6% of daily calories and avoiding trans fats.

    Incorporating at least 150 minutes of moderate-intensity aerobic exercise per week, such as brisk walking or swimming, can have a significant impact on cholesterol levels and overall cardiovascular health. For smokers, quitting is imperative. Additionally, modest weight loss of 5% to 10% can lead to improvements in cholesterol levels and overall heart health.

    Disclaimer: The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information does not substitute for professional diagnosis and treatment. Please do not initiate, modify, or discontinue any treatment, medication, or supplement solely based on this information. Always seek the advice of your health care provider first. Full Disclaimer 

  • ED and Heart Health

    Erectile dysfunction is frequently associated with the same factors responsible for cardiovascular disease, such as inflammation, arterial narrowing (endothelial dysfunction), or artery hardening (atherosclerosis). Consequently, erectile dysfunction can often serve as an early warning sign or an indicator of an individual’s overall cardiovascular health. If you’re grappling with erectile dysfunction, it is advisable to consult your healthcare provider for a thorough evaluation of your heart health. This proactive approach can help identify potential cardiovascular issues and allow for timely intervention.

    Engaging in regular exercise for a minimum of 30 minutes, three times a week, has been discovered to yield results almost on par with pharmaceutical options like Viagra and similar medications when it comes to enhancing erectile function. This revelation stems from a recent comprehensive analysis of the most reliable research available on the connection between aerobic exercise and erectile function.
    The findings of this study, published in The Journal of Sexual Medicine, reveal that aerobic activities, such as walking or cycling, have a positive impact on erectile function for all men dealing with erectile dysfunction. Notably, this improvement occurs regardless of factors such as body weight, overall health, or the use of medication. In fact, men with the most severe cases of erectile dysfunction experienced the most significant benefits.

    While the medical community has long recognized the relationship between erectile function and cardiovascular health, the evidence supporting the impact of exercise on this condition has been limited. The study’s results demonstrated that the more severe the erectile dysfunction, the more exercise aided in enhancing erectile function. On a standardized scale ranging from 6 to 30, men with severe erectile dysfunction who incorporated exercise into their routines reported a notable 5-point enhancement in erectile function. Those with mild and moderate cases of erectile dysfunction experienced improvements of 2 and 3 points, respectively.

    In comparison, pharmaceutical treatments like phosphodiesterase-5 inhibitors, such as sildenafil (commonly known as Viagra) or tadalafil (Cialis), could lead to improvements within the range of 4 to 8 points, as pointed out by the study authors. Similarly, testosterone replacement therapy was found to result in an improvement of 2 points. These findings highlight the valuable role of exercise in addressing erectile dysfunction, particularly for those with more severe cases, while also underlining the effectiveness of established pharmaceutical treatments.

    Disclaimer: The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information does not substitute for professional diagnosis and treatment. Please do not initiate, modify, or discontinue any treatment, medication, or supplement solely based on this information. Always seek the advice of your health care provider first. Full Disclaimer

  • Newer Obesity Medications Could Interact With Birth Control Pills

    For women grappling with obesity and undergoing treatment with drugs such as semaglutide (known as Ozempic) or tirzepatide (referred to as Mounjaro), the benefits of these medications are remarkable. Belonging to a novel category known as GLP-1 receptor agonists, they offer substantial and rapid weight loss, improved blood sugar management, and an enhanced quality of life. These drugs represent a significant departure from the long-established view that surgical procedures were the most effective long-term solution for obesity.

    However, the quest for accelerated weight loss and enhanced blood sugar control carries an unexpected caveat. Many women dealing with obesity, who are also taking oral contraceptives, might be unaware that these medications, particularly Mounjaro, can impede the absorption and efficacy of birth control pills, potentially increasing the risk of unintended pregnancies.

    One of the mechanisms through which drugs like Ozempic operate is by delaying the transit of food from the stomach to the small intestine. While research in this area is still evolving, it is theorized that this delay in gastric emptying may influence the absorption of birth control pills. Another hypothesis suggests that vomiting, a common side effect associated with these medications, might also interfere with the contraceptive’s effectiveness. At lower doses, the impact on absorption and gastric emptying may be minimal. However, as the dosage increases, these concerns become more prevalent, sometimes resulting in diarrhea, which is another factor that can disrupt the absorption of any medication.

    In the United States, approximately 42% of women are obese, with 40% of them falling between the ages of 20 and 39. While these new drugs hold the potential to improve fertility outcomes for obese women, particularly those with polycystic ovary syndrome (PCOS), only one drug, Mounjaro, currently carries a warning about its potential impact on birth control pill efficacy. Regrettably, it appears that some healthcare providers may not be fully informed about or may not be advising their patients regarding this risk. Furthermore, the data remains inconclusive regarding whether other drugs in the same class, like Ozempic, pose similar risks.

    For patients seeking to safeguard themselves from unplanned pregnancies, it is advisable to use condoms when commencing treatment with GLP receptor agonists. While the effect on gastric emptying is generally minimal at lower doses, it becomes more significant with higher dosages or the onset of diarrhea. While this aspect was not a conventional subject of discussion, it is now recommended that patients consider adding a barrier contraceptive method such as a condom, at least four weeks before initiating their initial dose or when adjusting the dosage. Additionally, it is advisable to schedule the GLP receptor agonist injection at least one hour apart from any other medication, including oral contraceptives.

    Disclaimer: The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information does not substitute for professional diagnosis and treatment. Please do not initiate, modify, or discontinue any treatment, medication, or supplement solely based on this information. Always seek the advice of your health care provider first. Full Disclaimer