Drugs & MedicationsPreventive Medicine


Statins Have Another Use: Hormone replacement therapy (HRT), be it the oral or transdermal form, places women at a greater risk of developing VTE—venous thrombo-embolism—ie. blood clots in the veins. The “odds ratio” for this occurrence was 1.53, meaning (I think) these women are 1.53 times more likely to have blood clots than if they didn’t take hormone replacement therapy. Women who were prescribed a statin in addition to HRT were only 1.29 times as likely to have VTE. “High intensity” statin therapy, meaning taking the maximum dose of a more potent statin, further reduces the odds ratio to 1.06. Statins are known to have an anti-inflammatory effect that has placed them in a broader therapeutic spectrum. The anti-inflammatory effect is important in the prevention of atherogenesis and thrombogenesis, the formation of arteriosclerotic plaques and blood clots, respectively. As I’ve said many times, statins have some many beneficial effects that, like fluoride, they should be in the water. 

Reference: Manson JE “Do statins offset venous thrombosis risk with hormone therapy?” Medscape Medical News 2024 Jan 4.

GLP-1’s For Weight Loss Stop Working: Yes, that’s right. These expensive drugs primarily used to treat diabetes have a down side. When one takes the injection of semaglutide (Ozempic, Rybelsus, Wegovy) or tirzepatide (Mounjaro), the long term result is a 15%-20% loss of weight. When you stop the drug (ie. you can no longer afford it) the weight you lose comes back. AND if you continue the drug ad infinitum you eventually reach a plateau where further weight loss is impossible. So you’re darned if you do and darned if you don’t. It seems our bodies become accustomed to the GLP-1 and “resets” its low point. When your weight goes below the reset point, the hunger hormone ghrelin is released stimulating the appetite, and a “tug-of-war” between weight gain and loss begins. To continue losing, one must add another weight loss drug to the GLP-1 (phentermine, topiramate, eg.). When the next plateau is reached, another change is in order. So we still don’t live in a perfect world and still haven’t found the secret magic potion that makes losing weight easy. I don’t think that will ever happen.

Reference: Larkin M. “Why do GLP-1 drugs stop working, and what to do about it?” Medscape Medical News 2024 Jan 12.

Could Household Chemicals Cause More Then Previously Thought? Disinfecting agents, personal care products, and organophosphate flame retardants have recently been discovered to cause brain damage. Quaternary ammonium and organophosphate compounds were discovered to be potently cytotoxic (strong enough to kill nerve cells) and thus are potentially hazardous to human health. Nerve cells that are critical to the development of mature neural elements are “injured” by these chemicals and are suspected of negatively affecting brain development. Quaternary ammonium, or quat, is found in shampoos, shaving cream, hand soap, toilet bowl cleaners, fabric softeners, and Lysol. ie. everywhere! Organophosphates are found in pesticides, flea and tick collars, yard pest control, and “nerve gas.” From this data, we are warned not to implicate them in the development of dementias and other long term neurologic disorders. Any connection has yet to be proven, but cellular damage is well established.

Reference: Brooks M. “Common Household Chemicals Tied to Brain Cell Damage” Medscape Medical News 2024 March 26

Long Naps Raise Blood Sugar: Long naps lasting more than 60 minutes were associated with higher Hgb A1C levels. Of the study participants with Type II Diabetes, 34% took longer naps and had higher A1C levels. Shorter naps were those lasting less than 60 minutes. Napping frequency had no influence on A1C levels. “Restorative naps” lasting 20-30 minutes, better known as “power naps,” actually lower A1C levels. No reason for A1C changes was given in this article.

Reference: Talwadekar M. “Do Daytime Naps Raise Glucose Levels?” Medscape Medical News 2024 March 28. 

What should be recommended to all patients with a recent heart attack? 

Influenza Vaccine

Smoking cessation counseling 

Cardiac rehabilitation

Beta Blocker, Aspirin 81 mg daily. 

Reference: AFP Clinical Answers 2024 Apr;109(4):312.

Is compression therapy with bandages, stockings, or other devices safe and effective for treating venous ulcers in adults? YES. Faster, more complete ulcer healing over 12 months, reduced pain and improved quality of life. 

Reference: AFP Clinical Answers 2024 Apr;109(4):312.

Vacation Habits of Physicians. A Medical Economics survey of practicing physicians’ vacation habits was quite interesting. In the previous year, 60% of physicians had taken 3 weeks of vacation or less, and 20% took only 5 days or fewer. Additionally, 70% of respondents performed patient-care tasks while vacationing and one third of those spent 30 minutes doing this each day. Physicians limit vacation time for several reasons. For many, they don’t have someone to cover for them when they’re gone leaving patients use the ER or immediate care center. Others find the backlog of patients that develops when not in the office too overwhelming to deal with upon return. Still others feel patient needs supersede their need for time off. Seventy-five percent of physicians take 7 days or less for vacation. Just over half (56%) of vacationing physicians work on vacation, as much as 30 minutes a day. They do this “to keep up with charts, lab results, paperwork….to prevent having too much work upon return….some things just need to get done no matter what…I need to keep in touch with my patients.” Ninety-six percent travel somewhere to sightsee/explore new places (82%), do outdoor activities (50%), sit on a beach (48%), just chill (31%), or stay home (14%). While 91% vacation with spouse (62%) or entire family (29%). Not surprisingly, Hawaii and Walt Disney World are the most popular destinations. 

Reference: 2024 Physician Vacation and Time Off Survey Med Econ 2024 Apr;:33-35. 

Thiazide Diuretics vs. Other Antihypertensive Drug Classes: While thiazide diuretics (specifically chlorthalidone-Hygroton) did not show decreased mortality compared to other antihypertensive drugs (CCB-calcium channel blockers, ACE-angiotensin converting enzyme inhibitors, BB-beta blockers, AB-alpha blockers), they did decrease total cardiovascular events and heart failure, decrease stroke risk, and had a far lower incidence of discontinuation and withdrawal. Thus, they should be considered first-line treatment for hypertension for the reduction of those events. Chlorthalidone, because of its long half-life (it stays around longer), is the thiazide of choice.

Reference: Sarkar A, Sarkar KD. Thiazide Diuretics vs. other antihypertensive drug classes. Am Fam Phys 2024 March;109(3):209.

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