Are statins enough? When to consider PCSK9 inhibitors
For well over 30 years, physicians have understood the role of LDL (low-density lipoprotein, or “bad”) cholesterol in the development of cardiovascular disease (CVD). LDL cholesterol levels are directly correlated with increasing CVD risk and, as summarized in a recent blog post, lowering LDL cholesterol levels, through both lifestyle changes and medications, has been shown to reduce this risk.
Statins are the first-line choice of medications for lowering LDL cholesterol. They are widely prescribed for both primary prevention (reducing CVD risk in patients without known CVD) and secondary prevention (preventing subsequ...
Source: Harvard Health Blog - June 8, 2020 Category: Consumer Health News Authors: Alyson Kelley-Hedgepeth, MD Tags: Drugs and Supplements Heart Health Source Type: blogs
1 hour of CPR, then ECMO circulation, then successful defibrillation....
An elderly woman had sudden ventricular fibrillation.She was unable to be defibrillated but was cannulated and placed on ECMO in our Emergency Department (ECLS - extracorporeal life support). ECMO Flow was achieved after approximately 1 hour of high quality CPR.After good ECMO flow was established, she was successfully defibrillated.Here is her monitor rhythm:Notice the " Shark Fin " morphology in lead I monitor rhythm.Also notice that the arterial line mean arterial pressure is 63 mmHg, but there is no waveform (and SpO2 says " no pulse " ), as the flow is continuous on ECMO and the LV function at this point was ext...
Source: Dr. Smith's ECG Blog - May 18, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
The Case for Opening (some) Pools In COVID19 Pandemic
The COVID crisis has decimated water exercise. Can we rethink pool closures?
A significant number of my older patients relied on pools for their fitness. During a pandemic, you can stay active or fit only if you have good legs and joints. Walkers, runners, and cyclists have no problem; they play outside in the Spring weather. People with bone/joint problems, fitness swimmers, and young children who normally take swim lessons this time of year are out of luck.
Consider the place I swim—the Mary T Meagher Natatorium, named after Mary T, a Louisville native, who won Olympic gold in 1984. The place is an ode to Sparta...
Source: Dr John M - May 12, 2020 Category: Cardiology Authors: Dr John Source Type: blogs
Like Minds on COVID19
At the nearly the same time I posted yesterday, The Lancet published this editorial from Swedish epidemiologist Prof Johan Giesecke. Some excerpts:
It has become clear that a hard lockdown does not protect old and frail people living in care homes—a population the lockdown was designed to protect. Neither does it decrease mortality from COVID-19, which is evident when comparing the UK’s experience with that of other European countries.
…
Everyone will be exposed to severe acute respiratory syndrome coronavirus, and most people will become infected
—
There is very little we can do to prevent this spread: a l...
Source: Dr John M - May 5, 2020 Category: Cardiology Authors: Dr John Source Type: blogs
Can We Discuss Flatten-the-Curve in COVID19? My Eight Assertions
Conclusion:
I did not have a clear answer for my couple. But after thinking and writing about this question it seems that the most reasonable approach in this crisis is transparent information–no matter how stark. And, crucially, we must have space for public debate.
I hate this virus. I wish it never came. But we can make it worse by avoiding hard discussions on tradeoffs, the limits of modern medicine and risk.
JMM
P.S. I am very interested in your rebuttals to any of my assertions but will block vitriol and politicized nonsense.
Related posts:
The Debacle of Hydroxychloroquine and Azithromycin for ...
Source: Dr John M - May 4, 2020 Category: Cardiology Authors: Dr John Source Type: blogs
Keeping Kids Healthy in the Age of Coronavirus: Dr. Greene on The People ’ s Pharmacy
Transcript
[00:00:00] Joe Graedon: I’m Joe Graedon.
[00:00:01] Terry Graedon: And I’m Terry Graedon. Welcome to this podcast of the People’s Pharmacy.
[00:00:06] Joe Graedon: You can find previous podcasts and more information on a range of health topics at PeoplesPharmacy.com.
[00:00:14] How’s your family holding up during the coronavirus pandemic? Isolation can be especially challenging for children.
[00:00:22] This is the People’s Pharmacy with Terry and Joe Graedon.
[00:00:33] Terry Graedon: Children appear less susceptible than older adults to serious complications of COVID-19...
Source: Conversations with Dr Greene - April 21, 2020 Category: Child Development Authors: Alan Greene MD Tags: Dr. Greene's Blog COVID COVID-19 Viral Infection Source Type: blogs
Keeping Kids Healthy in the Age of Coronavirus: Dr. Greene on The People s Pharmacy
Transcript
[00:00:00] Joe Graedon: I’m Joe Graedon.
[00:00:01] Terry Graedon: And I’m Terry Graedon. Welcome to this podcast of the People’s Pharmacy.
[00:00:06] Joe Graedon: You can find previous podcasts and more information on a range of health topics at PeoplesPharmacy.com.
[00:00:14] How’s your family holding up during the coronavirus pandemic? Isolation can be especially challenging for children.
[00:00:22] This is the People’s Pharmacy with Terry and Joe Graedon.
[00:00:33] Terry Graedon: Children appear less susceptible than older adults to serious complications of COVID-19...
Source: Conversations with Dr Greene - April 21, 2020 Category: Child Development Authors: Alan Greene MD Tags: Dr. Greene's Blog COVID COVID-19 Viral Infection Source Type: blogs
Drugs for COVID-19: A Publishing Epidemic
As of April 9, PubMed listed 2,868 scientific publications which incorporate the word “COVID”. 323 of these (11.3%) were related to drugs under study for treatment of the disease. No fewer than thirty-one such drugs had been proposed since this pandemic first appeared on the planet four months earlier.
Graph 1 depicts the cumulative numbers of COVID-19 infection (per 100,000 global population) and introductions of relevant drugs into the Literature during February 14 to April 3. Note that both increased by a factor of approximately 16-fold during this period.
In a...
Source: GIDEON blog - April 12, 2020 Category: Databases & Libraries Authors: Uri Blackman Tags: Epidemiology Graphs Source Type: blogs
Lifestyle changes are important even if you take medications
A friend of mine takes a statin medication each day to lower his cholesterol. More than once I’ve heard him say “I ate too much! I’m going to have to take an extra pill.”
Never mind that it doesn’t work that way — a single additional statin pill won’t make much difference to his cholesterol or his health. And never mind that you shouldn’t self-adjust the dose of your medications (talk to your doctor before making any changes in medication dosing).
But my friend’s overindulging does bring up the question of whether starting medications for conditions like high blood pressure or high cholesterol might lead ...
Source: Harvard Health Blog - April 6, 2020 Category: Consumer Health News Authors: Robert H. Shmerling, MD Tags: Exercise and Fitness Health Healthy Eating Heart Health Hypertension and Stroke Source Type: blogs
Meet VLDL: The REAL Cause of Heart Disease
Here’s a video from my YouTube channel. (Oh, you didn’t know I had a YouTube channel? You can find almost 300 additional videos there.)
VLDL particles, NOT LDL cholesterol, determine whether heart disease is in your future or not, as VLDL is a pivotal lipoprotein particle that influences the composition of virtually all other lipoprotein particles in the bloodstream.
Statin cholesterol drugs therefore focus on the wrong measure. Good news: You have profound control over VLDL particles and their consequences using nutrition and selected nutritional supplements to reduce VLDL and the triglycerides they contain. T...
Source: Wheat Belly Blog - March 12, 2020 Category: Cardiology Authors: Dr. Davis Tags: Open cholesterol small ldl triglycerides vldl wheat belly Source Type: blogs
As Physicians Today, We Must Both Represent the “System” and Disregard it
By HANS DUVEFELT, MD
Healthcare today, in the broadest sense, is not a benevolent giant that wraps its powerful arms around the sick and vulnerable. It is a world of opposing forces such as Government public health ambitions and more or less unfettered market ambitions by hospitals and downright profiteering by some of the middlemen who stand between doctors and patients, such as insurers, Pharmacy Benefits Managers, EMR vendors and other technology companies.
Within healthcare there is also a growing, more or less money-focused sector of paramedicine, promoting “alternative” belief systems, some of which may be ...
Source: The Health Care Blog - March 5, 2020 Category: Consumer Health News Authors: Christina Liu Tags: Medical Practice Physicians Primary Care Hans Duvefelt Healthcare system Source Type: blogs
Fight Aging! Newsletter, March 2nd 2020
In conclusion, the recently demonstrated protective effects of NMN treatment on neurovascular function can be attributed to multifaceted sirtuin-mediated anti-aging changes in the neurovascular transcriptome. Our present findings taken together with the results of recent studies using mitochondria-targeted interventions suggest that mitochondrial rejuvenation is a critical mechanism to restore neurovascular health and improve cerebral blood flow in aging.
Wnt/β-Catenin Signaling as a Point of Intervention to Spur Greater Neural Regeneration
https://www.fightaging.org/archives/2020/02/wnt-%ce%b2-catenin-signal...
Source: Fight Aging! - March 1, 2020 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
The Next Recommendation on Lowering Cholesterol May be to Start Earlier
The clinical work on lowering blood cholesterol that has taken place over recent years has demonstrated that if there is a lower limit beyond which low cholesterol levels become harmful, then that limit is very low indeed. Certainly below 10% of the normal human level. There are a number of uncommon mutations that produce individuals with up to half of the normal amount of blood cholesterol, people who exhibit significantly reduced risk of cardiovascular disease as a result of this difference from the norm. This is all quite interesting: why did we evolve to have the blood cholesterol that we do, if we need only a small fr...
Source: Fight Aging! - February 28, 2020 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs
Better Decisions Call for Slow Medicine
Should you get a mammogram at age 45? Should you start taking a statin? Is now the time to get a hip replacement? You can go down rabbit holes trying to research these online, talk to friends about their experiences, or have a few too many opinions thrown at you in online communities. And when […] (Source: EMR and HIPAA)
Source: EMR and HIPAA - February 20, 2020 Category: Information Technology Authors: Geri Lynn Baumblatt Tags: Ambulatory Clinical Communication and Patient Experience Healthcare IT Hospital - Health System LTPAC Chronic Care Disease Management Source Type: blogs
32 yo with right sided chest pain. Zero ST Elevation, but that does not matter.
DiscussionIn hindsight I feel there are very few alternative causes for an ECG like this other than an acute LAD occlusion. I believe this is one of those ' subtle STEMI ' cases where neither the ECG nor the symptoms are very obvious or severe and the usual evolution is not seen.I think of these cases as ' insidious infarcts ' and I have seen this in all infarct territories and I do not think they are particularly rare. Essentially the patient is fairly comfortable and the ECG is not obvious but the patient ended up with Q waves, huge troponins and we missed the opportunity to reperfuse the artery when it counts. These pat...
Source: Dr. Smith's ECG Blog - February 17, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
