Cardiometabolic Syndrome

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PLAVIX and PPI in ACS

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The Journal of the American Medical Association, March 4, 2009 (Vol. 301, No 9 Pg. 937-944), contains an article entitled Risk of Adverse Outcomes Associated with Concomitant Use of Clopidogrel (PLAVIX) and Proton Pump Inhibitors (PPI) following Acute Coronary Syndrome (ACS).
Available proton pump inhibitors (PPI) include:

• omeprazole (Prilosec),
• lansoprazole (Prevacid),
• rabeprazole (Aciphex),
• pantoprazole (Protonix),
• esomeprazole (Nexium), and
• Zegarid, a rapid release form of omeprazole.

The common treatment for ACS is an inpatient placement of a stent or medical treatment. Upon discharge, the common medical treatment is the use of PLAVIX and daily aspirin is common to protect from thrombosis and ischemia. The PPIs are added to reduce risk of gastrointestinal bleeding.

Of 8205 patients treated with ACS in this manner, a significant number of patients had complications after discharge. Death or rehospitalization for ACS occurred in 29.8% taking PLAVIX plus PPI. The use of the PPI without PLAVIX was not associated with death or rehospitalization.

I have also observed an increase in older diabetic patients who require this re-hospitalization after inpatient treatment for ACS and follow-up treatment with PLAVIX. This leads me to believe that it is time to consider follow-up medical treatment with alternatives to PLAVIX.

Cardiovascular Disease and D3 Deficiency

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Cardiovascular disease and D3 deficiency.

This is the first careful review of Framingham data that looked at blood levels of Vitamin D3 and cardiometabolic disease. It was noted that important covariates included obesity, minimal exercise and blood pressure. Vitamin D deficiency and risk of cardiovascular disease.
TJ Wang, et. al Circulation 2008 1;117(4):503-11

41% were taking a standard multivitamin. This is one of many studies indicating a link between Vitamin D3 deficiency and myocardial infarction, stroke, left ventricular hypertrophy, and death. Trials are planned with forms of vitamin D and vitamin D analogues to determine the roles, if any, these micronutrients play in Cardiometabolic Disease prevention.

Carotid Ultrasound

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The Mayo Clinic Proceeding has an article this month on how carotid artery ultrasound can assess the amount of generalized atherosclerosis.

No question that the science indicates it is very good and could be utilized to check the risk of stroke and the amount of generalized atherosclerosis.

I tried to do it in many institutions of health care. Hospitals, free standing radiographic facilities and Stanford University Department of Radiology.

Every single one had no idea what I was after and none did it correctly despite telephone conversation with radiologist prior to the exam.

This test is useless because despite all the science behind it no one has yet told the radiologists.

Forefront - Robert Sherman

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Another Forefront report is about preventing type 1 diabetes. Robert Sherman, MD has found a protein called Reg II a new islet derived auto antigen protein that appears to prompt the immune system to go daft and destroy the beta cells.

Normally, the Reg proteins cause the cells to grow and regenerate more beta cells. In the case of type 1 diabetes the new auto antigen does just the opposite and kills the beta cell. Why these crazy things happen is the subject of his research.

Somehow this is why the people of Finland seem to have discovered that if children under one year of age can cut the incidence of diabetes 1 by 80% by using 1,000 IU of D3 daily. Remember D2 is not D3 and will not work to prevent diabetes.

Just last June at the American Diabetes National meeting, a paper was presented that said that that when the D3 was increased to 2,000 IU 80% at one year of age, Diabetes 2 was presented in a period of time that is not quite clear. No one yet knows if you have to take more D to prevent diabetes years later.

If Vitamin D is so hot, can you take more to push things from 80% to 100%? Stay tuned. Remember Vitamin D is a hormone, not a fat soluble vitamin and most doctors have not even got that right yet. We do know that D3 is a marvelous immune modulator. We know it drops the incidence of many cancers 96%.

It’s your time.