MEDICAL NEWS BRIEFS #22

There are three (3) categories of Blood Pressure: New European guidelines for high blood pressure (HBP), hypertension define three categories. They are:

     1. Non-elevated BP: less than 120/70

     2. Elevated BP: above 120/70 but below 139/89

     3. Hypertension: 140/90 or higher

Patients in category 2 (120/70 to 139/89) should be on drug therapy if they have:

     Established cardiovascular disease

     Diabetes

     Chronic kidney disease stage III, IV, of V

   Treatment should lower the BP to a level tolerated by the patient. If their BP drops too low with position changes or activity, if they are 85 years old, are frail, and have limited life expectancy, caution is advised. Lowering BP too much can cause falling injuries. 

   Updated exercise guidelines recommend 75 minutes of moderate-intensity aerobic exercise per week.

Reference: Hughes S. New Blood Pressure Guidelines Lower Treatment Target. Medscape Medical News 2024 September 1. https://www.medscape.com/viewarticle/new-blood-pressure-guidelines. 

New Atrial Fibrillation Guidelines Emphasize Treating Underlying Illness: Identification and treatment of comorbidities and risk factors for atrial fibrillation are now receiving attention to reduce complications (ie. Stroke) of A Fib. Aggressive treatment of sleep apnea, Hypertension, heart failure, obesity, diabetes, alcohol consumption, and sedentary lifestyle are essential in lessening the long term effects of atrial fibrillation. Anti-coagulation remains a necessary treatment for stroke prevention. AF in many cases, is the result of uncontrolled comorbidities. Altering the impact of comorbidity diseases improves the prognosis for A Fib. 

Reference: Bosworth T. New Atrial Fibrillation Guidelines Confront Underlying Illness. Medscape Medical News 2024 September 1. https://www.medscape.com/viewarticle/new-atrial-fibrillation-guidelines. 

Intermittent Fasting Aids Patients with Prediabetes of Type 2 Diabetes: Periods of fasting lasting 12-16 hours have proven to be beneficial in metabolic disorders such as prediabetes and Type 2 Diabetes. All food is prohibited during the fast. Skipping at least one meal is required to obtain desired results. “Intermittent fasting was associated with a significant decrease in body mass index (BMI), A1C levels, and fasting blood glucose levels….changes in total cholesterol and triglycerides” were seen as well. Compared to a truly low-calorie diet, weight loss and drop in BMI were still significant, but less.” Intermittent fasting was less drastic than days-long fasts which were poorly tolerated. This proves to me that reducing caloric intake can effectively delay the onset of and long-term effects of Type 2 Diabetes.

Reference: Tellier P. Intermittent Fasting Aids Patients with Prediabetes and T2D. Medscape Medical News 2024 August 30. https://www.medscape.co/viewarticle/intermittent-fasting-aids-patients-with-prediabetes-T2D.

Can too much exercise be harmful? I just finished writing about how 75 hours of moderate intensity aerobic exercise can be beneficial for lowering blood pressure. But now, a study was published that showed marathon runners have higher median coronary calcium scores, but across the board they were quite low. A UK study of athletes showed men had more calcified plaque than their sedentary peers despite having coronary calcium scores of zero. Another study from Portugal showed male veteran athletes with “a high volume of exercise….[had] more coronary atherosclerosis.”  It appears exercise affects men and women differently since studies have repeatedly shown “high levels of physical activity (in men) were associated with more coronary calcium.” Higher exercise volume did not correlate with Coronary artery calcium progression over a mean follow-up of 7.8 years.” So, are some forms of exercise dangerous? Marathon runners, in particular, are at risk of dehydration, low blood pressure fainting, hyperthermia, exhaustion, and multiple lower extremity musculoskeletal problems. Those with undiagnosed heart problems do run the risk of sudden death, but the occurrences are rare. Still, they have a worrisome potential. Any exercise done beyond reasonable levels demands an pre-exercise cardiac evaluation of the patient.

Reference: Labos C. Too much of a Good Thing: Can Endurance Exercise Be Harmful? Medscape Medical News 2024 August 30. https://www.meape.com/viewarticle/too-much-good-thing-can-endurance-exercise-harmful.

Ozempic and Suicide: Is there a correlation? Fortunately, NO! In July of 2023, the European Medicine Agency reported that the use of GLP-1 receptor agonists (semaglutide, liraglutide, tirzepatide) could increase the risk for suicide and suicidal thoughts. One hundred fifty people in Iceland who took the drugs had thoughts of self-injury or suicide. GLP-1’s do cross the blood-brain barrier and affect receptors in the brain, prompting concern. So, an investigation ensued. Patients prescribed Ozempic were found to be more likely to have previously taken an antidepressant and visited a psychiatric clinic compared to diabetics on other drugs. The “authors calculated an overall risk for suicide that is 25% higher for Ozempic users.” The range was from a 17% reduction to an 88% increase. “When death from suicide and non-fatal self harm were combined, GLP-1’s appear to be protective.” For now, “the weight of evidence does not suggest a major risk here.” A study of “more than a million patients found the use of Ozempic and similar drugs might substantially decrease the rate of death from suicide.” Eli Lilly for one breathed a sigh of relief.

Reference: Wilson FP. Ozempic and Suicide: What Real-World data reveal. Medscape Medical News 2024 September 4. https://www.medscape.com/viewarticle/ozempic-and-suicide-what-real-world-data-reveal.