geoffrey modest medical blogs

A recent New Zealand study assessed the efficacy and safety of higher allopurinol doses in patients with pretty severe gout and comorbidities (see  gout allopurinol higher dose annrheum2017  in dropbox , or doi: 10.1136/annrheumdis-2016-210872​). Details: --183 patients with gout and taking creatinine clearance (CrCL)-based allopurinol therapy were randomized to continuing routine care vs monthly escalating allopurinol dose to achieve a target serum urate level of <6 mg/dL. Non-blinded study, patients followed 12 months --mean age 60, 87% male, mean duration of gout 17 years, creatinine 1.58, CrCL 60, BMI 35, 44% palpable tophi, 38% on colchicine/13% NSAIDs/13% on prednisone. 34% diabetic/72% hypertensive/57% hyperlipidemic, 43% cardiovascular disease --52% had CrCL <60ml/min, 13% CrCL <30 ml/min --mean baseline serum urate level (SU) was 7.15 mg/dL on mean allopurinol dose of 269 mg/d. --dose ...

A recent cohort study found an association between those patients who achieved an early reduction in HbA1c with metformin and a significant reduction in subsequent cardiovascular events (see  dm  control and heart disease diabcare2017  in  dropbox , or DOI: 10.2337/dc16-2271). Details: -- a population-based cohort study in northern Denmark from 2000-2012 assessed 24,752 new-onset diabetics 6 months after initiating metformin therapy -- median age 62.5, 55% males. Median follow-up 2.6 years -- primary endpoint: subsequent rates of acute myocardial infarction, stroke, or death, controlling for baseline HbA1c and other confounding factors (age, sex, year of starting metformin therapy, microvascular and macrovascular complications, obesity, alcoholism, antiplatelet drugs, statins,  antihypertensives , psychiatric medications, achieved cholesterol target, and use of other unspecified glucose lowering therap...

this is blog from 5/7/2017: These guidelines update the 2013 guideline for the management of heart failure, focusing on biomarkers, new therapies for both heart failure with reduced ejection fraction ( HFrEF ) and heart failure with preserved injection fraction ( HFpEF ), as well as new information on managing comorbidities including anemia, hypertension, and  sleep apnea ; and some new insights into the prevention of heart failure  (see  DOI: 10.1161/CIR.0000000000000509) . This guideline is a 2 nd part to the 2016 guideline on new therapies (see  http://blogs.bmj.com/ebm/2016/06/10/primary-care-corner-with-geoffrey-modest-md-heart-failure-guidelines-the-new-meds/ ), which included recommendations for the angiotensin receptor- neprilysin inhibitor valsartan/ sacubitril (an ARNI) and the sinoatrial node modulator ivabradine . Seven of 17 on the AHA memberscommittee had ties to drug companies, though neither the chair nor vice chair did. My ...

The second study from the Framingham Study Offspring cohort database found that increased intake of sugary sweet beverages was associated with lower total brain volume by MRI and poorer performance on neuropsychological testing (see  alzheimer and sugar AlzDement2017  in  dropbox , or doi.org/10.1016/j.jalz.2017.01.024 ). For first study, see   http://gmodestmedblogs.blogspot.com/2017/05/stroke-and-dementia-and-artificial.html Details: --4276 participants had neuropsychological testing and 3846 had brain MRI imaging --mean age 54, 46% male, 21% high school degree/31% some college/46% college grads, systolic BP 121 mmHg/17% on BP treatment, total  chol  194/HDL 57, 8% diabetes, 2% atrial fibrillation, 10% current smoker, waist-to-hip ratio 0.9 (the WHO defines abdominal obesity as >0.90 for men and >0.85 for women) --total consumption of sugary beverages:              ...

Two studies came out from the Framingham Heart Study database by the same authors in 2 different journals, one on the association between consuming artificially-sweetened beverages and the later development of stroke and dementia, and the other on sugary beverages and preclinical Alzheimer's disease. I will divide these into 2 blogs. An evaluation of the Framingham Heart Study Offspring cohort, with data from 1971 and evaluated over 9  examination cycles, found that artificially-sweetened soft drink consumption was associated with a higher risk of stroke and dementia (see  stroke and artificial sweeteners stroke2017  in dropbox, or DOI: 10.1161/STROKEAHA.116.016027).  Details -- 2888 participants >45yo were evaluated for incident stroke;  1484 who were >60yo were evaluated for incident dementia -- mean age 62 for the younger group and 45% men, 69 for the older group and 46% men -- beverage intake was quantified at cohort examinations 5 ...

A recent editorial provided reasonably convincing evidence that there is a relationship between low vitamin D levels and statin associated muscle symptoms, SAMS (see  statin myopathy and vitamin d def athero2017  in dropbox, or  Glueck CJ. Atherosclerosis. 2017; 256: 125). See article for the references. Details/summary of data: -- one study showed an inverse relationship between CK levels and vitamin D levels in patients on simvastatin, independent of symptoms -- a non-blinded study with high-dose vitamin D to normalize serum levels found that up to 95% of 134 patients with SAMS were free of muscle symptoms on reinstating statins, and this continued for up to 24 months later (the last time point measured) -- another trial of 150 patients with SAMS with a median vitamin D of 21ng/ml and given vitamin D supplements found that 87% were successfully able to restart their statins and remain symptom-free for 24 months -- a meta-analysis of 2420 patients ...