The authors studied older adults, average age 78, who were treated with statins to measure the beneficial effects in stroke prevention, survival and functional outcomes. The results showed that statins did not decrease stroke severity and did not improve 30-day survival. However, use of statins after that first stroke did improve survival at 12 months, along with improving the function at the 12 month interval. The authors stated a limitation of their study, one being that the use of statins may have been a marker of disease severity hence outcomes were poorer. Also found in this study was that people with poorly controlled diabetes treated with statins had more long term benefits. Lastly, statin use did not influence the rate of recurrent stroke during the first year of follow-up.

These findings suggest that statin use after the first stroke may be beneficial in the long term, but the question remains as to whether preventing that first stroke with the use of statins has strong enough evidence to make general recommendations. Regardless, in all cases, the patient and the physician should make an informed decision as to whether the addition of a statin to other interventions, whether they be dietary, exercise, blood pressure treatment, etc., would be beneficial in preventing the effects from one of the most disabling events an older adult can experience.

If you’re interested in one of the leading causes of death by disease, Adverse Drug Events, here’s a list of web sites that may be useful to you.

http://www.drugcite.com/

http://www.fdable.com/aers/fda_adverse_events?gclid=COmq1qf8wqwCFQrHKgodIn3hpg

http://www.drugwatch.com/

https://www.medmarx.com/

http://www.tga.gov.au/DAEN/daen-entry.aspx

http://www.psip-project.eu/

http://treato.com/

https://www.rxisk.org/Default.aspx

http://www.adverseevents.com/

http://www.drugalert.org/

http://www.ismp.org

http://www.ismp-canada.org

http://www.ncbi.nlm.nih.gov/pubmed/23121724

Other links related to statins and peripheral neuropathy:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3103035/

http://www.jfponline.com/Pages.asp?AID=9452

http://www.sciencedaily.com/releases/2002/05/020514075710.htm

Vitamin D: Dr. Oz said “Because it’s difficult to get enough from food, I recommend taking 1000units in supplement form daily, with a healthy fat to improve absorption”. CRoH was painting a different picture in the article “Do you really need more vitamin D?”. Comments in their article were: “But many of the claims about vitamin D may be wishful thinking”, and “There’s no need for a test of your vitamin D levels unless your doctor finds you at risk for deficiency”.

My understanding is that many older adults, perhaps over 50%, have low or less than ideal levels of vitamin D in their blood. And evidence suggests that older adults are at higher risk for falls, fractures, poor memory health, and muscle weakness, if their levels are low. Also, by taking a supplement and not having your level checked, specifically 25-hydroxy vitamin D, less than 50% will get their levels to where geriatricians would target. The best advice for older adults is to have their level checked and work with their physician to treat to get their vitamin D level to above 30 or higher. There is no harm by doing this and many older adults, in a large population, benefit from higher levels of vitamin D.  By the way, in one study, just taking a supplement as recommended did not get levels to where they needed to be in over 50% of the participants.

Blood Pressure: Both Dr. Oz and CRoH made statements about blood pressure, which were not age specific. “Dr. Oz says “The systolic pressure-the top number-should never be over 120″, and CRoH said “The ideal systolic pressure, or top number, is below 120…”. If you go to my recent post, http://elderdrugs.com/2013/04/blood-pressure-lowering-for-older-adults-what-is-a-safe-target/, you will find more recent evidence that says lower is not better for most older adults. This evidence started to emerge over 5 years ago in studies in male veterans which showed that treating to below 120/80 was wrought with more harm than good. Other studies have since emerged that suggest a higher target, say for example 150/95, may be safer and as effective at lowering risk of stroke. The newer target is suggested at 130/90. My recommendation is to discuss blood pressure goals with your physician since not everyone should follow general recommendations, as is implied in these general health news reports.

In conclusion, general health information in the media is concerning in that it may be inaccurate, and at best not specific to your health care needs. Try not to react to health information in the news and have more meaningful discussions with more than one health professional and search for current guidelines. Use this information to work with your physician to come up with a plan that is more specific to your needs.

There are many studies, the first that came out several years ago and based in an elderly, male Veteran’s population, showed that lowering blood pressure too low is actually wrought with more harm than good. We also now have evidence from other studies that going far below 130/90 doesn’t necessarily produce any further risk lowering benefit, and may actually cause harm. This newer evidence, which actually isn’t that new but just coming to the surface in review committees who make consensus recommendations, is especially strong for people with diabetes. Studies such as the ACCORD trial, INVEST, ABCD, and HOT were well-designed studies and proper interpretation of these studies shows that aggressive lowering of blood pressure is not always aligned with good outcomes.

So what is a good target blood pressure? Any target blood pressure goal should be individualized, to consider life-expectancy, fall risk, and risk for adverse medication effects. What’s the point of lowering blood pressure in a 92 year old to 110/70 if the person is lethargic and dizzy all the time and, as an outcome, falls, breaks a hip and then experiences the negative sequelae thereafter, eg. pneumonia, immobility, chronic pain and fear of falling. Blood pressure goals in the older adult should be about 130/90, in general, but also individualized, as mentioned above. In general, going far below 130/90 is not associated with strong evidence to suggest any further benefit.

In their study, “People with Alzheimer’s who were more physically active weren’t cured, but they had less deterioration in their brain matter volume, compared with the sedentary individuals”. The study used MRI scans from 876 individuals, along with clinical data, over a 20 year period. Measurements of cognition were not mentioned in the results of this study. Linking increased gray matter volume to better performance of memory and learning would strengthen the results of this study.

http://www.ncbi.nlm.nih.gov/pubmed/22921881

In Endocrine Today (March 2013), they quote Dr. Robert P. Heaney, Professor of Medicine in the Division of Endocrinology at Creighton University, who I view as the “premier bone doc” out there. I read his research ten years ago and came to appreciate the broad knowledge base he has developed from his research and study of the evidence over the years. His claim is that we do not get enough calcium and vitamin D, and that is the lingering issue, not that we should stop taking these vital nutrients, as USPSTF implies. Here are a few quotes from Dr. Heaney: ” The new USPSTF recommendations are not very helpful and might confuse patients and lead some people into not taking supplements that could potentially help them. There’s a heavy reliance in the report on two large systematic reviews; both of which were severely flawed.”  “…looking at what was the ancestral intakes of these nutrients….you will find that the vitamin D intake would be several times what we currently have; at least 2 1/2 to 3 times the current levels. The same is true for calcium. The ancestral intake of vitamin D, for example, produces a blood level of about 50ng/ml;”…”entirely safe levels”. Lastly, “The USPSTF approach is simply not well suited to nutrients. Fundamentally, they asked the wrong question and not surprisingly they got the wrong answer”.

So if you study people with inadequate intakes of calcium and vitamin D, and call it “normal”, you’ll get poor outcomes thereby concluding that taking supplements at those levels is not healthy, or not supported by good evidence, when in fact we need to understand that we need even more of these vital supplements to reach “normal” or healthy levels. The recommendation is that older adults, especially those with osteoporosis or low vitamin D levels, get enough calcium and/or vitamin D, which, more often than not, is more than what we’re taking. It should also be noted that nearly half of older adults have low vitamin D levels, yet another reason to consider supplementation.

BACKGROUND: This product was being used solely as an off label use by an ophthalmologist for macular degeneration and is packaged in sterile syringes (see Press Release for a list of lot numbers). This product would be administered by a licensed physician in a surgery or physician’s office setting and syringes were distributed to doctors’ offices in Georgia, Louisiana, South Carolina, and Indiana from December 18, 2012 to present.

RECOMMENDATION: Doctors that have product which is being recalled should stop using the Avastin immediately. Consumers with questions regarding this recall may contact Clinical Specialties by phone at 866-880-1915 or e-mail at clinicalrx@bellsouth.net Monday through Friday between the hours of 10 am to 5 pm EST. Consumers should contact their physician or healthcare provider if they have experienced any problems that may be related to taking or using this drug product.

Read the MedWatch safety alert, including a link to the Press Release, at:

http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm344664.htm