Senin, 07 Maret 2016

Hepatitis, rhabdomyolysis and multi-organ failure resulting from statin use

This paper was published in the British Medical Journal Case Reports 2009;2009. pii: bcr07.2008.0412

Study title and authors:
Hepatitis, rhabdomyolysis and multi-organ failure resulting from statin use.
Rajaram M.
St Helens and Knowsley Hospitals NHS Trust, Medicine-Gastro, Whiston Hospital, Warrington Prescot, L35 5DR, UK.

This paper can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/21686823

This paper reports the case of of a woman who developed hepatitis, rhabdomyolysis and multi-organ failure resulting from the use of statins.

(i) A 77-year-old female patient was admitted to hospital with malaise, anorexia and generally feeling unwell for a week.
(ii) She was taking atorvastatin 80 mg daily.
(iii) The dose of atorvastatin was increased from 40 mg to 80 mg daily approximately six months before admission.
(iv) Examination revealed she was jaundiced.
(v) Laboratory tests revealed the following abnormalities (normal levels in brackets):
Creatine kinase: 523 iu/l (25–200)
Lactate dehydrogenase: 1241 iu/l (240–525)
Total bilirubin: 284 μmol/l (2–22)
Alanine transaminase: 2314 iu/l (11–55)
γ glutamyl transferase: 132 iu/l (5–50)
Aspartate transaminase: 1269 iu/l (12–42)
Alkaline phosphatase: 438 iu/l (40–125)
Urea: 15.9 mmol/l (3.6–7.3)
Creatinine: 290μmol/l (45–110)
(vi) A diagnosis of hepatitis related to statin use with accompanying kidney failure was made.
(vii) The statin was stopped and her liver biochemistry improved.
(viii) However on the fourth day after admission, her kidney function deteriorated.
(ix) Examination revealed excess fluid around the lungs and abdominal areas.
(x) The patient was transferred to the intensive care unit and required haemofiltration. (Hemofiltration is a kidney replacement therapy similar to hemodialysis).
(xi) Despite improvement in her kidney function, the creatine kinase levels continued to rise and peaked at 107178 iu/l.
(xii) Two weeks after admission to the hospital, the patient died of multi-organ failure.

Rajaram concludes: "The cause of hepatitis, rhabdomyolysis, and acute renal failure in this patient was the increase in dose of atorvastatin and subsequent elevation of serum atorvastatin concentration. We suggest that the elevation of atorvastatin concentrations resulted in skeletal muscle damage and rhabdomyolysis, as indicated by the elevation of creatine kinase and subsequent deposition of myoglobin in the kidneys, causing acute renal failure as indicated by the elevation of urea and creatinine".

Senin, 29 Februari 2016

Statin use associated with a 59% increased risk of kidney failure

This study was published in the European Journal of Internal Medicine 2016 Feb 23. pii: S0953-6205(16)00059-5
 
Study title and authors:
Association of statin use and the risk of end-stage renal disease: A nationwide Asian population-based case-control study.
Lin SY, Lin CL, Hsu WH, Lin CC, Chang CT, Kao CH.
Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taiwan; Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan.
 
This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/26920930

End-stage renal disease (ESRD), also called kidney failure, is the last stage of chronic kidney disease. When your kidneys fail, it means they have stopped working well enough for you to survive without dialysis or a kidney transplant.

This study investigated the association of statins with end-stage renal disease. The study included 11,486 patients with end-stage renal disease who were compared with the same number of people from the general population.

The study found:
(a) Statin users had a 59% increased risk of developing end-stage renal disease compared to non-users.
(b) The risk of end-stage renal disease increased with higher accumulative dosage of statins.

Lin concluded: "This population-based case-control study showed that statin use might be associated with increased ESRD risks."

Links to other studies:
Statin use is associated with a 30-36% increased incidence of acute and chronic kidney disease
Statins associated with 30% increased risk of death in kidney transplant patients
Statins increase the risk of diabetes in kidney transplant patients

Rabu, 24 Februari 2016

Atorvastatin use associated with acute pancreatitis

This study was published in Medicine (Baltimore) 2016 Feb;95(7):e2545

Study title and authors:
Atorvastatin Use Associated With Acute Pancreatitis: A Case-Control Study in Taiwan.
Lai SW, Lin CL, Liao KF.
College of Medicine (S-WL, C-LL); Department of Family Medicine (S-WL); Management Office for Health Data (C-LL), China Medical University Hospital, Taichung;

This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/26886597

The aim of this study was to explore the relationship between atorvastatin use and acute pancreatitis. The study consisted of 5,810 cases aged 20 to 84 years with a first-time diagnosis of acute pancreatitis and 5,733 randomly selected controls without acute pancreatitis.

The study found that current users of atorvastatin had a 67% increased risk of acute pancreatitis compared with subjects with never use of atorvastatin.

Lai concluded: "Current use of atorvastatin is associated with the diagnosis of acute pancreatitis."

Links to other studies:
Statins increase the risk of acute pancreatitis by 44%
Use of statins associated with a 25% increased risk of pancreatitis
Pancreatitis induced by statins



Sabtu, 20 Februari 2016

Stroke victims taking statins have increased risk of death and a 140% increased risk of infection

This study was published in the European Journal of Neurology 2008 Jan;15(1):82-90

Study title and authors:
Simvastatin in the acute phase of ischemic stroke: a safety and efficacy pilot trial.
Montaner J, Chacón P, Krupinski J, Rubio F, Millán M, Molina CA, Hereu P, Quintana M, Alvarez-Sabín J.
Neurovascular Research Laboratory, Neurovascular Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain. 31862jmv@comb.es

This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/18070096

This study was a double-blind, randomised, multicentre clinical trial to study the effects of simvastatin in patients the first 90 days after a cortical stroke. The study included 60 patients with cortical strokes (a cortical stroke occurs when the blood supply to the outside, or cortex, of the brain is reduced or blocked, which results in brain damage) who were given either simvastatin or placebo at three to12 hours from symptom onset.

The study found:
(a) More patients taking simvastatin died compared to patients taking placebo.
(b) Patients taking simvastatin had a 140% increased risk of infection compared to patients taking placebo.

Links to other studies:
Patients taking statins after a stroke have a 68% increased risk of suffering another stroke
Statins increase the incidence of liver damage
Statins associated with increased bleeding in the brain in patients with intracerebral haemorrhage

Rabu, 17 Februari 2016

What I Eat

People often ask me what I eat.  I've been reluctant to share, because it feels egocentric and I'm a private person by nature.  I also don't want people to view my diet as a universal prescription for others.  But in the end, as someone who shares my opinions about nutrition, it's only fair that I answer the question.  So here we go.

In my food choices, I try to strike a balance between nutrition, cost, time efficiency, animal welfare, pleasure, and environmental impact.  I'm the chef of my household of two, and I cook two meals a day, almost every day, typically from single ingredients.  I prefer organic, but I don't insist on it.

Eggs from my hens
My diet changes seasonally because I grow much of my own food.  This started out with vegetables, but recently has expanded to staple foods such as potatoes, flour corn, and winter squash.  I also have a small flock of laying hens that turn table scraps, bugs, grass, and chicken feed into delicious eggs.

The primary guiding principle of my diet is to eat somewhere between a "Paleolithic"-style diet and a traditional agricultural/horticultural diet.  I think of it as a broad ancestral diet.  Because it's partially inspired by agricultural/horticultural diets, starch is the main calorie source.

My meals are organized around three food groups: a protein, a starch, and vegetables/fruit.  If any of those three are missing, the meal doesn't feel complete.  I'll start with those categories and move on from there.

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Senin, 15 Februari 2016

Higher saturated fat consumption decreases the risk of death from cardiovascular diseases

This study was published in the American Journal of Clinical Nutrition 2010 Oct;92(4):759-65
 
Study title and authors:
Dietary intake of saturated fatty acids and mortality from cardiovascular disease in Japanese: the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC) Study.
Yamagishi K, Iso H, Yatsuya H, Tanabe N, Date C, Kikuchi S, Yamamoto A, Inaba Y, Tamakoshi A
Department of Public Health Medicine, Graduate School of Comprehensive Human Sciences, and Institute of Community Medicine, University of Tsukuba, Tsukuba, Japan.
 
This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/20685950

This study investigated the association of saturated fat intake and the risk of death cardiovascular diseases. The study included 58,453 participants, aged 40 to 79 years, who were followed for up to 14.1 years.

The study found:
(a) Those who consumed the most saturated fat had a 31% decreased risk of death from all strokes compared to those who consumed the least saturated fat.
(b) Those who consumed the most saturated fat had a 48% decreased risk of death from intraparenchymal haemorrhage compared to those who consumed the least saturated fat. (Intraparenchymal haemorrhage is bleeding within the brain tissue).
(c) Those who consumed the most saturated fat had a 9% decreased risk of death from subarachnoid hemorrhage compared to those who consumed the least saturated fat. (Subarachnoid hemorrhage is bleeding into the two membranes that surround the brain).
(d) Those who consumed the most saturated fat had a 42% decreased risk of death from ischemic stroke compared to those who consumed the least saturated fat. (Ischemic stroke occurs when an artery to the brain is blocked).
(e) Those who consumed the most saturated fat had a 7% decreased risk of death from heart disease compared to those who consumed the least saturated fat.
(f) Those who consumed the most saturated fat had a 1% decreased risk of death from heart failure compared to those who consumed the least saturated fat.
(g) Those who consumed the most saturated fat had an 18% decreased risk of death from all cardiovascular diseases compared to those who consumed the least saturated fat. 

Links to other studies:
Middle-aged men and women who consume the most saturated fat live longer and have a reduced risk of dying from cardiovascular diseases
Saturated fat consumption is associated with a reduced risk of stroke
High saturated fat diets reduce the risk of intraparenchymal haemorrhage



Jumat, 12 Februari 2016

Is the "Obesity Paradox" an Illusion?

Over the last two decades, multiple independent research groups have come to the surprising conclusion that people with obesity (or, more commonly, overweight) might actually be healthier than lean people in certain ways.  This finding is called the "obesity paradox".  Yet recent research using more rigorous methods is suggesting that the paradox is an illusion-- and excess body fat may be even more harmful to health than we thought.

Introduction.  What is the obesity paradox, and why does it matter?

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