ORIGINAL RESEARCH & CONTRIBUTIONS

Statin-Associated Cardiomyopathy Responds to Statin Withdrawal and Administration of Coenzyme Q10

Peter H Langsjoen, MD, FACC1 ; Jens O Langsjoen, MD2 ; Alena M Langsjoen, MS1 ; Franklin Rosenfeldt, MD, FRACS3,4 Perm J 2019;23:18.257 E-pub: 08/26/2019 https://doi.org/10.7812/TPP/18.257

ABSTRACT Context: Heart failure (HF) is rapidly increasing in incidence and is often present in patients receiving long-term statin therapy.

Objective: To test whether or not patients with HF on long-term statin therapy respond to discontinuation of statin therapy and initiation of coenzyme Q10 (CoQ10) supplementation.

Design: We prospectively identified patients receiving long-term statin therapy in whom HF developed in the absence of any identifiable cause. Treatment consisted of simultaneous statin therapy discontinuation and CoQ10 supplementation (average dosage = 300 mg/d).

Main Outcome Measures: Baseline and follow-up physical examination findings, symptom scores, echocardiograms, and plasma CoQ10 and cholesterol levels.

Results: Of 142 identified patients with HF, 94% presented with preserved ejection fraction (EF) and 6% presented with reduced EF (< 50%). After a mean follow-up of 2.8 years, New York Heart Association class 1 increased from 8% to 79% (p < 0.0001). In patients with preserved EF, 34% had normalization of diastolic function and 25% showed improvement (p < 0.0001).

In patients with reduced EF at baseline, the EF improved from a mean of 35% to 47% (p = 0.02).

Statin-attributable symptoms including fatigue, muscle weakness, myalgias, memory loss, and peripheral neuropathy improved (p < 0.01).

The 1-year mortality was 0%, and the 3-year mortality was 3%.

Conclusion: In patients receiving long-term statin therapy, statin-associated cardiomyopathy may develop that responds safely to statin treatment discontinuation and CoQ10 supplementation

My comment: Apparently the administration of Co-enzyme Q10 on its own without statin discontinuation rarely works to restore cardiac function on its own in heart failure patients. This is discussed in the article. Co-enzyme Q10 is also helpful for gum disease which affects people with diabetes a lot.

Diabetes in Control

Occupational Consequences in Type 1 Diabetes

According to research presented by Dr. Andrea Dehn-Hindenberg from the Hannover Medical School in Germany, mothers in children with diabetes experience many challenges in their occupational settings.

 Diabetes is a persistent condition that requires regular maintenance to limit adverse consequences.

When a child is diagnosed with diabetes, self-management of the disease is often unimaginable. Therefore, the management of the condition is conducted by the guardians of those children.

Although treatment options are vast and full of new advancements, the treatment of children is a tedious and trying task for caretakers. They are frequently entrusted with giving diabetes treatment consistently while giving proper nurturing and support to the remainder of the family. They also end up adjusting their day-to-day life and their occupational demands.

Family psychosocial factors have been shown to influence diabetes results in kids. As a result, diabetes treatment should incorporate the entire family and consolidate their efforts and difficulties in their professional and daily lives to accomplish the best treatment results for those children with diabetes.

This trial sought to investigate parents’ work-related and financial issues following their children’s onset of type 1 diabetes. This study aimed to highlight the burdens that come from type 1 diabetes on families and provide the necessary information to technology developers and policymakers to improve the quality of life of these individuals.

Dr. Dehn-Hindenberg and her colleagues submitted this research to the Journal of Diabetes Care to examine and summarize the benefits in this patient population.

Participants in this study included mothers, fathers, and primary caregivers of adolescents with type 1 diabetes. The questionnaire involved occupational and financial components of caregivers from their child’s diagnosis of diabetes. It included both parents’ job status, professional engagement activities, and financial loss from the diagnosis.

A total of 1192 participants agreed to complete the questionnaire. However, 1144 participants were included in the final sample. 82% of the respondents in the questionnaire were mothers. The mean age of children was 6.7 years old, and the duration of diabetes was 5.9 years. At the time of the survey, 62.5% were aged six to ten, while 45% were 11 to 14.

Before the diagnosis of diabetes in their children, 22.8% of mothers worked full time. Among these mothers, 15.1% of them stopped working after their child was diagnosed. 91% of fathers worked full time before and after the diagnosis occurred in their children. Parents also reported constraints on their professional development. 50.7% of mothers said they were negatively impacted due to their child’s diabetes. 95.9% of fathers reported no change in their professional development. According to the results, a moderate to significant financial burden was reported in 46.4% of families: the younger the child, the more severe the financial obligation.

In conclusion, more studies should be done to evaluate the vast components of taking care of adolescents with type one diabetes. This study helps to give more information on complications that can affect those in this patient population. According to Dr. Dehn-Hindenberg, “the findings demonstrate that mothers, rather than fathers, compromised their occupational success to provide care for their children with diabetes.”

References

Dehn-Hindenberg, Andrea, et al. “Long-Term Occupational Consequences for Families of Children with Type 1 Diabetes: The Mothers Take the Burden.” Diabetes Care, vol. 44, no. 12, 2021, pp. 2656–2663., link

Sundberg, Frida, et al. “Managing diabetes in preschool children.” (2017). link

Iversen, Anne Solveig, et al. “Being mothers and fathers of a child with type 1 diabetes aged 1 to 7 years: a phenomenological study of parents’ experiences.” International journal of qualitative studies on health and well-being 13.1 (2018): 1487758. link

Kmeone Kingdom, MPH, PharmD Candidate, South College School of Pharmacy

ORIGINAL RESEARCH article

Front. Nutr., 07 March 2022
Sec. Nutritional Epidemiology
Volume 9 – 2022 | https://doi.org/10.3389/fnut.2022.806566

Priority Micronutrient Density in Foods

Ty Beal^1,2* and Flaminia Ortenzi³

• ¹Knowledge Leadership, Global Alliance for Improved Nutrition, Washington, DC, United States
• ²Department of Environmental Science and Policy, University of California, Davis, Davis, CA, United States
• ³Knowledge Leadership, Global Alliance for Improved Nutrition, Geneva, Switzerland

Background: Despite concerted efforts to improve diet quality and reduce malnutrition, micronutrient deficiencies remain widespread globally, especially in low- and middle-income countries and among population groups with increased needs, where diets are often inadequate in iron, zinc, folate, vitamin A, calcium, and vitamin B₁₂. There is a need to understand the density of these micronutrients and their bioavailability across diverse foods and the suitability of these foods to help meet requirements for populations with high burdens of micronutrient malnutrition.

Objective: We aimed to identify the top food sources of these commonly lacking micronutrients, which are essential for optimal health, to support efforts to reduce micronutrient malnutrition among various populations globally.

Methods: We built an aggregated global food composition database and calculated recommended nutrient intakes for five population groups with varying requirements. An approach was developed to rate foods according to their density in each and all priority micronutrients for various population groups with different nutrient requirements.

Results: We find that the top sources of priority micronutrients are organs, small fish, dark green leafy vegetables, bivalves, crustaceans, goat, beef, eggs, milk, canned fish with bones, mutton, and lamb. Cheese, goat milk, and pork are also good sources, and to a lesser extent, yogurt, fresh fish, pulses, teff, and canned fish without bones.

Conclusion: The results provide insight into which foods to prioritize to fill common micronutrient gaps and reduce undernutrition.

My comment: There has been a recent rise in nutritional deficiency diseases in the UK in both adults and children. Organ meats, tinned sardines, dark green leafy vegetables, eggs, milk, pork and pulses are good value for money foods that could help.

Adapted from BMJ 15 July 2023

Northern Ireland and Scotland have already instituted eye screening every two years for diabetic patients who are thought to be at low risk of eye complications.

Wales are now adopting this screening interval as well and England will follow suit from this coming October.

BMJ 20 May 2023 Adapted from Effectiveness of spironolactone for women with acne vulgaris in England and Wales by Santer M et al.

Women over the age of 18 living in England and Wales whose acne was bad enough to merit antibiotic treatment, were randomised to use either Spironolactone or placebo. They were allowed to continue the topical treatments that they were already using for their acne. Their scores on their acne specific quality of life were assessed by themselves and a clinical assessor evaluated their acne.

200 women were recruited to each group. The findings showed a small but statistically significant improvement after 24 weeks of spironolactone use at 100mg a day. Their average age was 29 years.

One fifth of those taking Spironolactone reported headaches.

The assessors thought that 19% of the women had noticeable skin improvement compared to 6% of the placebo group. The women themselves reported a quality of life improvement of 17 points in the placebo group and 21 in the Spironolactone group.

The authors think that this improvement is good enough to be a useful alternative to long term antibiotics.

My comment: Having suffered from acne since the age of 11 I am pleased to see another treatment being offered for this condition. Almost all teenagers of both genders get acne. In boys it tends to be more severe than in girls but it tends to resolve completely. For some women it never resolves and they have it persistently throughout their lives. If a woman still has it by the age of 24 the acne is likely the persistent type. Acne, even with the best treatment is very slow to respond, and at best will improve at 10% a month. This is for Roaccutane. I wonder what the effects would be over a longer length of time for the other women in the study. The results, though promising are not stunning, and diligent use of topical treatments and consideration of using anti-biotics and Roaccutane will also need to be considered to resolve symptoms.

Spironolactone is a diuretic that can be also used to control facial hair growth in women. It is sometimes used if someone has high blood pressure that does not respond to other drugs.

The Ketogenic Diet for Refractory Mental Illness: A Retrospective Analysis of 31 Inpatients