Recent observational research presented at the American Heart Association (AHA) 2023 Scientific Sessions reveals a 34% higher risk of heart failure within four years associated with daily marijuana use compared to non-use. The findings, while observational and indicating association rather than causation, contribute to a growing body of evidence on the potential cardiovascular effects of marijuana.
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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.
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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:
- 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.
- 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
- Patient Enrollment and Follow-Up:
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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
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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:
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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
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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:
- 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.
- 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.
- 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
- 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:
