Category: research

High dose Vitamin D improves cardiovascular health markers

kaitiscotland3 Comments

Adapted from UK Medical News 17 July 2018

Several different health measures, all which improve your cardiovascular outcomes, have been found to result from high dose vitamin D supplementation. You are likely to need to take at least 4,000 iu a day though, depending on how much extra sunshine you are exposed to regularly.

A meta-analysis of 81 randomised controlled trials looked at almost one thousand patients randomised to taking supplements or to a control group who did not. The active and control groups were both roughly 5,000 each.  The durations of the trials varied but averaged out at ten months. The doses ranged from 400 iu a day to 12,000 iu a day. The average taken was 3,000 iu a day.

The outcomes were related to the blood level of vitamin D achieved. Levels had to be over 86 nmol/L to get benefits. You need to take over 4,000 iu a day to get vitamin D concentrations of 100 nmol/L or more.  My comment:This does mean that the minimum levels advised by the Scottish Chief Medical Officer last year are way too low to see the benefits discussed here.

So what extra benefits do you see?

lower systolic and diastolic blood pressure.

lower high sensitivity C reactive protein.

lower serum parathyroid hormone.

lower triglycerides.

lower total cholesterol.

lower low density lipoprotein.

high density lipoprotein increased.

All benefits were numerically small but did reach statistical significance. Cardiovascular outcomes were not measured directly, only blood markers and blood pressure.

Mirhosseini N et al. Vitamin D Supplementation. Serum 25(OH)D Concentrations and cardiovascular disease risk factors: A systematic review and meta-analysis. Front Cardiovasc Med. 2018 July 12.

 

 

 

 

Metformin improves blood sugar and vascular health in type one children

kaitiscotland4 Comments

 From Diabetes in Control: Metformin Improves Vascular Health in Children With Type 1 Diabetes
Nov 18, 2017
In individuals with type 1 diabetes (T1DM), cardiovascular disease (CVD) is a major issue and the primary cause of death.

Vascular changes can be detected years before progression to CVD. Targeting blood sugar regulation early in patients at high risk of developing T1DM and in those already diagnosed with T1DM, could potentially help reduce vascular dysfunction risk and even reverse changes already made in vascular function.

Past studies have shown that in adults with T1DM, metformin reduces HbA1c, BMI, and required insulin doses. It has also been suggested that metformin leads to reduced cardiovascular events and better blood sugar regulation in patients with type 2 diabetes. Studies conducted on children with T1DM suggest the same benefits. However, there is currently no research on how metformin affects vascular function in children with T1DM.
A double blind, randomized, placebo-controlled trial was conducted to evaluate the association between metformin and vascular health in children with T1DM over a 12-month period. The study included a total of 90 children from a Women’s and Children’s Hospital in South Australia.  Children were randomly divided into two groups to receive either the metformin intervention or the placebo intervention. Children who weighed 60kg or greater received 1gm of metformin twice daily and those who weighed less than 60kg received 500mg twice daily. Doses were then increased to the complete dose over a period of 2 to 6 weeks.
Follow-up was conducted at 3, 6, and 12 months from the start of the study. Vascular function was obtained at baseline and at every follow-up visit using the brachial artery ultrasound, HbA1C, insulin dose, and BMI were among some of the other outcomes measured.
Results show that vascular function defined by GTN improved over the 12-month period by 3.3% in the metformin intervention group regardless of HbA1c when compared to the placebo group (95% CI 0.3 to 6.3; P=0.03). GTN was found to be the highest in the metformin group at 3 months when compared to placebo. Children in the metformin group also experienced significant improvement (P=0.001) in HbA1c levels at 3 months (8.4%; 95% CI 8.0 to 8.8) (68mmol/mol; 95% CI 64 to 73) when compared to the placebo group (9.3%; 95% CI 9.0 to 9.7). At 12 months, the overall difference between HbA1c improvement between the two groups was lower but remained a significant 1.0% (95% CI 0.4 to 1.5) 10.9mmol/mol (95% CI 4.4 to 16.4), P=0.001. In addition, it was found that children in the metformin group had a decreased insulin dose requirement of 0.2 units/kg/day throughout the 12-month period compared to those in the placebo group (95% CI 0.1 to 0.3, P=0.001).
The following study determined that children with T1DM with above average BMIs and taking metformin saw a significant improvement in vascular smooth muscle function compared to those not taking metformin. The study suggested that in addition to vascular health, metformin also improved HbA1c levels and reduced total daily insulin dose. It was found that improvements in both vascular function and HbA1c were the highest at 3 months. This is most likely due to medication adherence being the highest around 3 months.
Practice Pearls:
In children with above average weight and who were diagnosed with type 1 diabetes, metformin provides a significant improvement in vascular smooth muscle function.
Metformin provides a significant improvement in HbA1c levels in children with type 1 diabetes.
In addition to vascular health and HbA1c benefits, metformin further aids in reducing daily insulin dose in children with type 1 diabetes.
Reference:
Anderson JJA, Couper JJ, Giles LC, et al. Effect of Metformin on vascular function in children with type 1 diabetes: A 12 month randomized controlled trial. 2017. J Clin Endocrinol Metab. 2017; 0: 1-16.

Vegetable oil ingestion not so sunny after all

kaitiscotland6 Comments

Adapted from BMJ 9 Feb 13 Use of dietary linoleic acid for secondary prevention  of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis. Christopher E Ramsden et al

Despite lack of evidence to the contrary I still see NHS dieticians telling patients to avoid naturally occurring saturated fat such as butter, cream and the fat in animal meats. This study didn’t get much publicity at the time so here it is again.

The question was, does increasing dietary omega 6 linoleic acid in the place of saturated fat reduce the risk of death from coronary heart disease?

What happened was that in the Sydney Diet Heart Study, a RCT done between 1966 and 1973, saturated fat (thought to produce heart attacks) was replaced by omega 6 fatty acids from Safflower oil ( vegetable oil and margarines, thought to be heart healthy). Although the blood cholesterol levels decreased in the intervention group, deaths from all causes, coronary heart disease and cardiovascular disease, all increased.

The subjects were all men aged 30-59 who had had a recent heart attack.  As an example, all cause mortality was 17.2% in the intervention group compared to 11.8% in the control group. Results for cardiovascular disease were similar.

It is mystifying that dietary advice telling people to swap lard for vegetable oils and butter for margarine is still going on. Very telling is that date that this study was done. The results would have been out by 1975.

Obesity makes asthma particularly difficult to control

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From British Thoracic Society Winter Scientific Meeting December 2017 London

Researchers have demonstrated that diet induced obesity leads to the development of airways hyper-reactivity through the interplay of an immunological and metabolic pathway.

Resultant asthma can affect children as well as adults. Unfortunately obesity associated asthma responds poorly to standard asthma medications including steroids and can result in more hospitalisation and a reduced quality of life.

The most effective obesity treatment is probably bariatric surgery to achieve sustained weight loss. In contrast dietary management and drugs are far less effective.

Polycystic ovary syndrome is linked to autism in offspring

kaitiscotland2 Comments

Cambridge University Autism Research Centre has found that compared to women who do not have polycystic ovary syndrome, women who do have this have about double the risk of having a child with autism.  The risk was slightly higher in male children compared to female children.

Cherskov A et al. Polycystic ovary syndrome and autism: At test of the prenatal sex steroid theory. Transl Psychiatry. Aug 1 2018. doi:10.1038/s41398-018-01867.

The UK and US are the only western countries where life expectancy is falling

kaitiscotland5 Comments

Researchers looked at 17 high income countries to evaluate trends in national mortality.

In the UK there has been a drop of a few months in life expectancy for both men and women over the age of 65. Degenerative diseases were the main cause such as respiratory disease, circulatory disease, Alzheimer’s disease, nervous system disease and mental disorders.

In the USA drug overdoses were responsible for the decline in life expectancy.

The study looked at mortality between 2014 and 2015. A sixty five year old in the UK at that time would have been born in 1950, after the start of the NHS.

We will need to wait to see if this trend will reverse or not.

British Medical Journal. UK life expectancy drops while other western countries improve. National Health Services. 2018 August 16.

Younger age at diagnosis predicts earlier death in type one diabetes (on standard treatment)

kaitiscotland3 Comments

Researchers in Sweden have found that the earlier children are diagnosed with type one diabetes, the less their life expectancy is. Matters are worse for women than men. They think that adults diagnosed in childhood need increased input to deal with cardiovascular risk factors as they get older. Currently age of onset is ignored when it comes to stratifying risk.

Those diagnosed under the age of 10 had 4 times the hazard ratio for all cause mortality, over 7 times the risk of cardiovascular disease, 4 times the risk for non cardiovascular mortality,  over 11 times the risk of cardiovascular disease, 31 times the risk of having a myocardial infarction, over 6 times the risk for stroke, 13 times the risk of heart failure, but almost the same risk as controls for atrial fibrillation.

There is a better outlook for those diagnosed in their late twenties. The risk was almost 3 times the background rate for total mortality and the most prominent risk was again for cardiovascular mortality coming in at 6 times the background rate.

What this means is that if you are a girl diagnosed with type one under the age of ten, you may expect to live almost 18 years fewer than your classmates and if you are a boy, 14 years fewer.

My comment: More effort could also be given to youngsters on diagnosis achieving normal blood sugars by advising parents about the easiest ways to control blood sugars such as the adoption of a low carb diet and advanced insulin techniques. Although these statistics are shocking to see, it doesn’t have to be like this at all. Many diabetics have changed their life expectancy around and reverse some complications by adopting practices that improve glycaemic control and metabolic factors such as we describe on this site.

Rawshani A et al. Excess mortality and cardiovascular disease in young adults with type 1 diabetes in relation to age at onset: a nationwide, register-based cohort study. Lancet 2018;392:477-86;doi:10.1016/S0140-6736(18)31506-X

 

Public Health Collaboration Conference 2018: Achieving your optimal blood sugar target

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Videos of the lectures given at the Public Health Collaboration conference 2018 which was held in May over the royal wedding weekend have now been released on You Tube.

You can see my talk, Achieving your optimal blood sugar target, as well as others, on the link below. There are a wide variety of lifestyle topics discussed. Happy viewing.

 

https://www.youtube.com/results?search_query=public+health+collaboration+conference+2018

Exercise games can aid weight loss in overweight children

kaitiscotland5 Comments

USA researchers have proven that video games such as Kinect Sports and Just Dance can help overweight children lose weight and improve their cardiovascular risk factors.

Adherence to the programme of one hour three times a week was very high with 94.4 % sticking to the games. 46 families were involved with 23 families in the intervention and control groups.

BMI , blood pressure, total cholesterol and LDL cholesterol all improved in the intervention group.

The study was funded by the AHA.

What factors are most predictive of a heart attack?

kaitiscotland4 Comments

Dr Malcolm Kendrick recently discussed a paper in which computers analysed routine clinical data from UK GP practices to identify the factors that most accurately predicted a cardiovascular event over the next ten years.  All the 378,256  people whose records were analysed were initially free of cardiovascular disease and 48 variables were identified.

The top ten things that were most likely to see you in hospital with a heart attack or stroke, in order,  were:

Chronic Obstructive Pulmonary Disease

Prescribed oral steroids

Older age

Severe mental illness

South Asian ethnicity

Prescribed immunosuppressants

Socio-economic deprivation

Chronic Kidney Disease

 

The least predictive were LDL, Forced expiratory volume ( a measure of asthma) and AST/ALT ( a measure of liver function).  Total cholesterol was 25th.

Can machine learning improve cardiovascular risk prediction using routine clinical data? http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0174944