July 2024
Can New Lab Tests Predict Heart Attacks and Strokes?
A primary goal of current medical research is to predict who is going to have cardiovascular events (heart attacks, strokes) and when. Blood-based lab tests like high-sensitivity CRP, cardiac troponin I and T, NT-proBNP, and BNP have garnered increasing interest for their potential predictive value. A recent study showed a small but statistically significant correlation between these elevated markers and cardiovascular events. For every standard deviation above normal lab values, the risk of heart attacks and stroke rises by 13-18%. For instance, individuals with values on these tests higher than 95% of the population face a 26-32% increased likelihood of experiencing a heart attack or stroke.
However, this study also showed that these markers' additional benefit in improving risk estimation is minimal. When added to conventional risk factors such as age, total cholesterol, HDL (good cholesterol) levels, blood pressure, diabetes status, and smoking habits, they contributed less than 1% improved accuracy. The markers were slightly more beneficial (~3% improved accuracy) in folks older than 65.
>> Dr. Neuman says: "We have an array of new tests beyond those listed, including Lp(a), ApoB, Homocysteine, Genetic Testing, and the popular CT Scan for Coronary Calcium Score. The application of these tests sparks considerable speculation and debate. For high-risk individuals - such as those with advanced age, diabetes, high blood pressure, elevated cholesterol, smokers, or a history of prior heart attack or stroke - these tests offer little new insight. For those with low risk, these tests may do more harm than good by increasing anxiety, expense, and risks associated with unnecessary medications and procedures. In cases where individuals are at intermediate risk and contemplating new strategies - whether dietary changes, increased physical activity, or cholesterol management - these tests can provide additional guidance (particularly the CT Calcium Score). There's also merit in using these tests to motivate low-risk individuals toward proactive lifestyle changes. I worry at night about over-prescribing medicines and procedures based on these tests alone without abnormalities in the established metrics. My advice for lowering cardiovascular event risk remains simple: eat plants, take walks, and find people who make you laugh and treat you right."
Vitamin D Screening No Longer Recommended for Healthy Adults
This month, updated guidelines published by the largest hormone/vitamin society actively discourage screening for low vitamin D in otherwise healthy adults. For adults below age 50, they do not recommend any vitamin D supplementation. For adults ages 50 and above, instead of screening, the focus is on ensuring a daily intake of 600 IU of vitamin D from dietary sources or multivitamins. Adults aged 75 and older are advised to aim for 800 IU daily.”
>> Dr. Neuman says: “I’ve witnessed numerous clients experience substantial improvement in their quality of life by addressing low iron. Many have seen improvements with medicines like Lyrica (pregabalin), Lexapro (escitalopram), and Ozempic (semaglutide). Countless have changed their perspective and quality of life from going to talk therapy. I have yet to have a client with a large positive effect size from vitamin D supplementation. These updated guidelines are a positive step towards redirecting our focus to more pertinent health discussions. Of note, the guidelines highlight the lack of conclusive evidence for or against different recommendations based on skin color."
Semaglutide (Ozempic, Rybelsus, WeGovy) Doesn't Increase Risk of Thyroid Cancer
There has been significant concern regarding the potential risk of certain types of thyroid cancer associated with GLP1 medications, such as semaglutide (generic of Ozempic, Rybelsus, WeGovy) and tirzepatide (Mounjaro, Zepbound). Initial warnings stemmed from studies done in rats, with limited human data until recently. A new study involving three million individuals who took semaglutide for an average of 3.9 years has found no statistically significant increase in risk. There was a trend towards a non-statistically significant decrease in risk. These medications are increasingly used not only for managing diabetes and weight loss but also for offering protective benefits for conditions like heart disease, kidney disease, fatty liver, and in treating PCOS and alcohol-related issues.
>> Dr. Neuman says: “It turns out that when you lose weight, cancer risk tends to go down. This study only looked at a 3.9-year average, so long-term human data is lacking. The study was conducted with a Scandinavian population, which differs from ours.”
