One of my favorite studies of all time is an article published in the 1980s demonstrating the benefit of aspirin treatment in acute myocardial infarction (heart attack). Why is such a seemingly normal study a favorite of mine? It has to do with the subgroup analysis which we will examine in this article. During the 1970s, aspirin was being studied for its potential beneficial effects in reducing the risk of vascular events such as heart attacks and strokes. Although treatment with aspirin is now standard of care in suspected myocardial infarction, investigators in the 70s had a hard time demonstrating statistically significant effect. Although many studies showed modest benefit, often these studies did not reach statistical significance or had inconsistent results among different subgroups in the study. In 1988, the ISIS-2 trial results were published in Lancet which demonstrated a modest, but clear benefit when aspirin was administered during suspected myocardial infarction. As the story goes, the authors submitted their work and the journal agreed to publish the results if a subgroup analysis was included.
0 Comments
Statins and CoQ10 Statin medications are widely prescribed and have been both glorified and demonized depending on who you listen to. What you may or may not know is that statins will deplete levels of an antioxidant, CoQ10. CoQ10 is an important cofactor in the Krebs cycle which is a major source of cellular energy. This side effect has been well-documented and in fact, one pharmaceutical company obtained a patent for a product combining a statin with CoQ10. I have included an excerpt from the patent below. You can also view the patent in its entirety by clicking here “Although cholesterol-lowering therapy through the use of HMG-CoA reductase inhibitors is generally free of side reactions, it would be of considerable benefit to counteract the myopathy observed in a small percent of patients. Since CoQ10 is of benefit in congestive heart failure patients the combination with HMG-CoA reductase inhibitors should be of value in such patients who also have the added risk of high cholesterol levels.” If you are taking a statin medication, you may want to consider measuring your CoQ10 levels with a blood test and/or supplementing with CoQ10.
Get The Correct Test
The most commonly ordered blood test to assess kidney function is the serum creatinine. This usually a good indicator of kidney function in the general population. However certain factors Tests your provider might routinely order to monitor your kidney function include serum creatinine (a blood test) and a urinalysis to screen for protein in the urine which is usually not present in individuals with healthy kidney function. These are good screenings tests for most people. However, there are several factors that can elevate serum creatinine such as
For example, my personal kidney function didn't look all that great using the creatinine to calculate my estimated GFR. However, the cystatin C blood test showed a much more favorable estimate of my GFR. Wrinkles and other signs of photodamage on the skin, particularly the face, accumulate as we age and many individuals find this process quite distressing. While it is unrealistic to expect to maintain flawless skin throughout one's entire life, there are many ways to mitigate and even reverse some of the cumulative damage. I will be discussing three such interventions which have been thoroughly studied with reproducible study results. Topical Tretinoin
This medication has been in use in the dermatology world for a long time. In fact, in 1995 topical tretinoin was FDA approved for reducing wrinkles among other skin benefits. When applied daily, individuals may notice improvements in as little as 8 weeks. Topical tretinoin works by increasing the rate at which skin cells turnover and also by decreasing inflammation in the skin, which can be particularly useful in the treatment of acne. Lifespan Extension
A very recent study found that higher levels of omega 3s in the bloodstream were associated a 5 year increase in lifespan. (McBurney et al., 2021) While this study followed a fairly large group of individuals for over a decade, the lifespan increase was based on a predictive model which incorporated patient outcomes, rather than just the patient outcomes themselves. While this is certainly a thought-provoking study, further research is warranted as noted by the authors. I certainly believe that a robust dietary intake of fatty fish and/or supplementation with omega 3 fatty acids is beneficial for health in general. However, I am not quite ready to personally claim that they will increase lifespan to such a great degree. Vitamin D & Pain
I have discussed the benefits of optimal vitamin D levels on muscle tissue in a previous article here. Vitamin D status also plays a role in musculoskeletal pain. Several studies across multiple countries have found prevalence of vitamin D deficiency (frequently described as levels below 20ng/mL) to be well over 80% in cases of chronic pain, including low back pain which is a leading cause of doctor’s visits and missed work in the United States. (Lewis, 2005) It is not clear exactly what mechanism is at play in myopathies associated with vitamin D deficiency. However, vitamin D may have an immunomodulatory effect which would reduce unnecessary chronic inflammation in the body perhaps contributing to the improvement seen when vitamin D levels are corrected. Vitamin D & The Immune System
The literature suggests that in vitamin D deficient populations, raising the vitamin D level to above 50 was associated with a achieving a negative COVID test faster as well as decreased levels of fibrinogen (elevated levels of which may play a part in the blood clots associated with COVID). (Rastogi et al., 2020) A meta-analysis (essentially a study of studies) found that vitamin D supplementation had the effect of reducing acute respiratory infections. Of note, this analysis was performed pre-COVID. (Martineau et al., 2017)
|
AuthorNurse Practitioner. Integrative Medicine. Using the best evidence-based strategies to optimize health and performance Archives
October 2021
Categories |
Click to upload your testimonials section background image
⇣
⇣
⇣ Drag elements to your slide 1 container ⇣
⇣ Drag elements to your testimonial 1 container ⇣
⇣ Drag elements to your testimonial 2 container ⇣
⇣ Drag elements to your testimonial 3 container ⇣
⇣ Drag elements to your testimonial 4 container ⇣
⇣ Drag elements to your testimonial 5 container ⇣
⇣ Drag elements to your Custom Footer Container ⇣
⇣ Drag elements to your Bottom Footer Container ⇣