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Anchor lead: Does one class of medicines for blood pressure cause an increased risk for lung cancer? Elizabeth Tracey reports

Do people who take a common class of blood pressure medicines known as ACE inhibitors have a greater risk for lung cancer? That was the finding of a recent study of about a million people who had high blood pressure and were taking various medicines to lower it. When followed for an average of 6+ years those taking ACE inhibitors had about a 14% increased risk relative to another type of drug. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, isn’t impressed.

Nelson: Well I think if there were a definite association with one of the antihypertensive drugs with a significant risk to develop cancer it would be abandoned quickly in favor of others that work by different mechanisms. In general there’s a growing trend to use more than one agent in controlling blood pressure adequately and I think the selection of blood pressure lowering regimen is something that a patient should take on with his or her physician.   :26

Nelson says everyone with high blood pressure should be treated, since it’s an important risk factor for cardiovascular disease. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: If you’ve been taking fish oil or vitamin D supplements you may want to think again, Elizabeth Tracey reports

Both fish oil and vitamin D supplements have been extremely popular in recent years, but new evidence presented at the recent American Heart Association meeting should result in far fewer people taking them. That’s according to Roger Blumenthal, a preventive cardiologist at Johns Hopkins.

Blumenthal: It’s real clear that routine use of fish oil capsules  in the standard doses or vitamin D supplementation in people who are not clearly vitamin D deficient didn’t have any significant impact on either cancer or heart disease.  So sometimes while we think certain supplements may be helpful we really need to do good randomized controlled trials and right now routine supplementation with vitamin D or fish oil supplements I predict will go down in frequency in the next year.   :30

Blumenthal says no harms appear to be related to taking the supplements but health benefits are lacking in rigorous studies. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: New cholesterol guidelines bring statin use into focus, Elizabeth Tracey reports

Have you been told you need a statin in the wake of new cholesterol guidelines released at the recent American Heart Association meeting? Roger Blumenthal, one of the guidelines authors, and a cardiologist at Johns Hopkins, says for most, these medicines work well.

Blumenthal: Eighty out of a hundred people don’t have any problem when you put them on statin therapy. Ten out of a hundred typically will stop it within the first three months because they either have some muscle aches or an upset stomach. Serious side effects are extremely rare, but of those 10 out of a hundred people who stop it within the first three months five out of a hundred do just fine when you either dose it less frequently or you switch to a different statin. Sometimes people  do better on a lower dose of a statin  every other day and then slowly, gradually increase the frequency until they get up to an every day of the week dosing pattern.   :33

Blumenthal says risk reduction with statin use is real and well worth the effort. At Johns Hopkins, I’m Elizabeth Tracey.

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The Johns Hopkins Center for Transgender Health

Patient Johnny Boucher discusses gender affirming treatment with surgeon Devin O’Brien Coon, medical director of the Center for Transgender Health. They talk frankly about who makes a good candidate for phalloplasty and how to measure surgical success, the complexities of identifying as a genderqueer/non-binary individual, and the benefits of online support groups.

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Anchor lead: Should you take a statin or not? New cholesterol guidelines have been released, Elizabeth Tracey reports

Seems like everyone is on a statin to reduce their cholesterol. Now new guidelines released at the recent American Heart Association meeting recommend first, prevention, followed by a personalized approach to management. Roger Blumenthal, one of the guideline’s developers and a professor of cardiology at Johns Hopkins, says there is also a role for coronary calcium scanning.

Blumenthal: The guidelines also say that if the patient or the clinician is still uncertain about what a person’s risk really is then a coronary calcium scan is really the best way to determine if someone’s at very high risk or very low risk. If you have a family history of heart disease but you don’t know if you take after that one relative who had bypass surgery in his fifties or you take after other relatives who lived into their nineties and were still playing tennis. The best snapshot in time of what a person’s personal risk is is the selective use of a coronary calcium scan.  :30

Blumenthal notes that coronary calcium scanning is also quick and inexpensive. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: New guidelines for managing high cholesterol have been released, Elizabeth Tracey reports

How might the new cholesterol guidelines released at the recent American Heart Association meeting affect you? Roger Blumenthal, one of the authors of the guidelines and a professor of cardiology at Johns Hopkins, explains.

Blumenthal: Lifestyle improvements is key. It’s always better to prevent the development of high cholesterol, high blood pressure, diabetes. The second category is primary prevention. We now have better tools to estimate what a person’s true risk is of a heart attack or stroke, and then finally the third category is those people who’ve already had a cardiac event. We now have a clear recognition that lower is better when it comes to the bad LDL cholesterol, with proven therapies. :27

Blumenthal says assessing risk can be accomplished using a standardized risk assessment tool that takes into account things like age, smoking status and sex, and that if ambiguity remains a coronary calcium scan, which looks for the presence of calcium in the heart’s arteries, can help make the call. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: The FDA has moved to regulate various aspects of the e-cigarette market, Elizabeth Tracey reports

Flavored e-cigarettes will now be behind the counter, so to speak, with an eye toward reducing access to minors. That’s per a recent FDA proposal aimed to curb the meteoric rise in e-cigarette use in high schoolers. Michael Blaha, a preventive cardiologist at Johns Hopkins, applauds the action.

Blaha: I’m in strong support of what the FDA is doing there, because there’s no doubt we’re having an epidemic of e-cigarette use amongst young people. I’m very scared of what this could cause in terms of nicotine addiction or future gateway to other use. And I think regulating flavorings is absolutely the first place to start. The FDA is also cracking down on companies like Juul Laboratories for their direct promotion of these to minors. And I think this is exactly what needs to happen and hopefully we’ll see a reduction in e-cigarette use in minors in the next couple of years.  :29

Blaha says there is some evidence that e-cigarettes are useful in helping smokers of combustible cigarettes to quit, but they are also a primary introduction to nicotine addiction for others. At Johns Hopkins, I’m Elizabeth Tracey.

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