geoffrey modest medical blogs

  A recent article found that statins decreased liver fibrosis progression and lowered the risk of hepatocellular carcinoma and hepatic decompensation in patients with chronic liver disease (see   statin dec risk HCC if chr liver dz JAMAIntMed2025  in dropbox,, or doi:10.1001/jamainternmed.2025.0115)   Details : -- 16,501 participants were reviewed from the Research Patient Data Cape Registry, an aggregation of clinical data from 10 hospitals within the Mass General Brigham healthcare system in Boston, a database of roughly 4 million patients, with data from 2000 to 2023 on patients at least 40 years old with chronic liver disease (CLD) and a baseline Fibrosis-4 (FIB-4) score of 1.3 or higher    -- 6750 females (40.9%) and 9751 males (59.1%), including 3610 statin users (meaning being on statins for 180 days between their first CLD diagnosis and statin initiation) and 12,891 nonusers (no statin use for the 180-day period)         -- excl...

2 recent articles confirmed (yet again) the adverse effects of drinking alcohol: the 1 st  (below) found  an increasing prevalence of alcoholic fatty liver disease (see  alcohol fatty liver dz inc JAMA2019  in dropbox, or Wong T. JAMA 2019; 321 (17): 1724), and the 2 nd showed that even small amounts of alcohol are associated with cancer, will send out next. Details: -- data from the National Health and Nutrition Examination Survey (NHANES), from 2001-2016, a nationally representative survey of non-institutionalized US population, which includes both interviews and health examinations -- alcoholic fatty liver disease (AFLD) was defined based on alcohol use (> 28 g/d for women and> 42 g/d for men), in conjunction with elevated AST or ALT levels but no elevation of total bilirubin, evidence of hepatitis B or C infections, or of metabolic syndrome -- alcoholic fibrosis was assessed using the validated instruments of the AST/platelet ratio, and th...

A systematic review from the VA synthesized data on use of metformin in patients with chronic kidney disease (CKD), congestive heart failure (CHF), or chronic liver disease (CLD) with hepatic impairment (s ee  dm metformin dec HF CKD annals2017 in  dropbox , or doi:10.7326/M16-1901 ). The goal was to assess all-cause mortality, major adverse cardiac events (MACE s ) , and other outcomes in patients with these underlying diseases (patients with these diseases having been the ones in whom the FDA initially had warned against using metformin). Details: -- 17 observational studies that included patients with CKD, CHF, or CLD with hepatic impairment were analyzed. These studies compared patients on diabetes regimens that included Metformin vs those that did not. Results: --CKD     -- 6 studies were included, with sample sizes ranging from 1246 to 11,481 patients, median age ranging from 65 to 76. Only one study...