geoffrey modest medical blogs

Article in NY times today (see  http://www.nytimes.com/2013/04/08/health/study-points-to-new-culprit-in-heart-disease.html?nl=todaysheadlines&emc=edit_th_20130408&_r=0).seems  that presumptive coronary heart disease culprit of carnitine (in red meat, same Latin route at "carnivore") may be only partially correct. Published in Nature Medicine (see  cad red meat TMAO nature medicine 2013  in dropbox). Turns out to (maybe) be more complex:   --in regular meat eaters, eating a sirloin leads to an increase in TMAO (trimethylamine-N-oxide), which in lab studies leads to accumulation of cholesterol in macrophages and and also seems to decrease the ability to excrete excess cholesterol (for excruciating detail, see the paper itself), with some previous data that blood TMAO is assoc with CAD, both in humans and mice --in vegan who had a similar meal of sirloin (presumably with a significant bribe), no increase in TMAO. -- larger group of vegetarians given carnitine pi

It is with extreme trepidation (and self-reflection) that i circulate the following article (see  cad and male pattern baldness bmj 2013  in dropbox). Meta-anal of 3 cohort and 3 case-controlled studies. 37K men. Results:   --cohort studies: for men with severe baldness, CAD with RR 1.32; in the case-controlled studies RR 1.70 --younger men (both <55 and <60)with similar RR=1.44 --using the Hamilton scale of baldness, vertex baldness assoc with CAD, with a "dose response curve":  severe vertex baldness RR 1.48, moderate with RR 1.36. mild 1.18. all significant.  but frontal baldness not assoc with CAD   In sum, these were observational studies and given the inherent problems sorting out multiple, complex risk factors, the 30% increase attributable to vertex baldness is really pretty small.  Perhaps we should do an intervention study.... Hair transplants for one group?????

3 recent articles on vitamin d (there are lots of them in the dropbox)   1.  JAMA article (see  vit d knee OA progression not help  in dropbox ) which randomized 146 people twith symptomatic knee osteoarthritis to high dose vitamin d (2000 IU/d) vs placebo for 2 years and evaluated symptoms and progression of cartilage loss. results:     -baseline vit d increased from 23 ng/ml to 39 ng/ml with therapy     -nonsignificant decrease in sx in vit d group vs placebo     -nonsignificant diff in cartilage volume loss, with sl less volume loss in vit d group     -if look at subset with lower vit d at baseline,  more improvement in both sx and cartilage with vit d than with placebo, but still nonsignificant   so, not so impressive results. reasons? maybe vit d is overrated. maybe better to treat people before they get symptomatic OA. maybe better results if patients with lower baseline vit d (they did find better though nonsignif results in that subgroup.  i must admit that i v

a recent article brought up the issue of H Pylori eradication in patients on low-dose aspirin (see  hpylori gi bleed asa gastro 2013  in dropbox). this is an observational, prospective study looking at 3 groups of patients on low-do se  asa.  followed up to10 years (5K patient-yrs), primary endpoint is recurrence of gastroduod bleed.   -- group 1:  250 pts with Hpylori and bleeding ulcer, had their Hpylori eradicated and continued with asa after the ulcer healed. - -group 2:120  Hpylori negative asa users who developed bleeding ulcers. put on enteric-coated asa after ulcer healed --group 3: 540 pts (considered their "average risk group") new pts on asa without a hx of ulcers   results: incidence of ulcer bleed, per 100-pt yrs -no diff in incidence of bleeding between group 1 (0.97 per 100 pt-yrs) and group 3 (0.66) -group 2 (bleeding despite being h. pylori neg) with 5.22 (ie 8.5x that of the average risk group)   this study suggests that for ulcer re-bleed