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...

  a recent Scottish study found that patients with diabetes who develop stage 4 chronic kidney disease (CKD) and continue metformin had improved survival (see dm metformin with lower GFR AmJKidnDis2025  in dropbox, or doi: 10.1053/ j.ajkd.2024.08.012) Details : -- 371,742 Scottish residents with type 2 diabetes were evaluated from the Scottish Diabetes Research Network-National Diabetes Study, from 2010-2019 -- 4,287 prevalent metformin users were identified who had incident stage 4 CKD (ie, eGFR <30); 1,713 of them (40.1%) discontinued the metformin     -- patients who stopped the metformin did so within 6 months of reaching CKD stage 4; those who continued metformin did so for at least 6 months     --55% of those who continued the metformin did stop it in the follow-up period (about 60 patients/year from years 7-12, about 25/year from year 13 to end of study): 44% continued throughout the follow-up -- median age 77, 51% women...

  The gut microbiome is hugely important in many aspects of human well-being. It is a major window through which our environment affects our threshold for developing a wide array of diseases. This blog will focus on some of the cardiovascular effects of a distorted (dysbiotic) microbiome.   -- a very recent article assessed the effects of the gut microbiome on cholesterol metabolism, specifically the microbiome's ability to convert cholesterol to coprostanol, a poorly absorbed sterol  (https://www.cell.com/action/showPdf?pii=S1931-3128%2820%2930295-X  ).  The researchers found that there was a clade of highly prevalent, but previously uncharacterized, IsmA-encoding bacterial species. This research group had previously found that the IsmA enzyme participated in converting cholesterol to coprostanol and identified uncultured  Eubacerium  species with the ismA gene; this conversion of cholesterol to coprostanol in patients, in 3 studies with paired s...