AHA: Lifestyle as Medication

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AHA: Lifestyle as Medication

The American Heart Association (AHA) has released a shiny new scientific statement on the treatment of mild-moderate hypertension and hyperlipidemia, and initial treatment should be—wait for it—lifestyle modification only. Sure, that makes sense.

Who should don the Fitbit and keep the medicine cabinet closed? Individuals with the following:

  • Systolic blood pressure 130 to 139 mm Hg OR diastolic blood pressure 80 to 89 mm Hg PLUS low atherosclerotic cardiovascular disease (ASCVD) risk (<10%)
  • Systolic blood pressure 120 to 129 mm Hg PLUS diastolic blood pressure <80 mm Hg

For those with hyperlipidemia, the recommendation is a bit more complex. The AHA recommends lifestyle modification only when chosen by adults 40 to 75 years with LDL-C >70 mg/dL and low ASCVD risk scores and a few additional complications (see the article for the full algorithm).

The lifestyle recommendations are the same tried and true interventions, but Table 1 in the article offers a helpful summary of exercise goals, while Table 2 compares different forms of exercise, diets, and other lifestyle modifications with their respective effect on blood pressure and cholesterol levels. Fun fact: dynamic resistance lowers LDL-C by an average of 6 mg/dL.

Lifestyle changes come first? No kidding!

Your reaction may be akin to family physician Dr. Frank Domino’s, who summed it up best:

“My initial response to this was ‘no kidding!’; we know just using a pill does not lower an individual’s risk very much; changing their lifestyle is the key to living longer and better. Yet, I have tempered my snark. This is a national organization that has finally said ‘don’t give a pill first.’”

You’re right, Dr. Domino. We couldn’t have said it better! We take back our snarky subhead. Kudos to the AHA for this official statement!

Trouble Passing Stool? Don’t Pass on Kiwi!

We’ve long known that psyllium and prunes are excellent natural options for easing chronic constipation, but what about our furry friend, the kiwifruit? Or “kiwi” for those of us in the know. Prior studies in the Eastern hemisphere have shown a link between kiwis and reduced chronic constipation, but researchers in Michigan wanted to put it to the test.

They pitted kiwis against prunes and psyllium in a randomized trial of 79 patients with chronic constipation. Patients were randomly assigned to a daily dose of two peeled whole kiwis, 12 prunes, or 12 g of psyllium for four weeks. Whoa, 12 prunes is a lot! It’s okay—these portions confer equal measures of fiber.

The researchers were interested to see what percentage of patients in each group experienced at least one more complete spontaneous bowel movement per week than they had at baseline.

And the winner was—drumroll…

It was a draw, essentially. Forty-five percent of the people in the kiwi group achieved the end point in comparison with 67% in the prune group and 64% in the psyllium group, but without statistical significance. Interestingly, fewer patients were dissatisfied with the kiwi treatment than with the other two treatments.

Although all three interventions boast impressive results in the treatment of chronic constipation, none can compete with good ol’ fashioned Colon Blow.

Rapid-Fire Practice Updates

Influenza and COVID-19 Vaccine Co-Administration: The CDC’s Advisory Committee on Immunization Practices (ACIP) states that COVID-19 vaccines and influenza vaccines can be co-administered in both adults and children.

Breast Cancer Screening: Both the American College of Radiology and the Society of Breast Imaging now recommend yearly breast cancer screening with mammography for women starting at age 40.

Cannabis: Alright Alright Alright…?

Well, no, not really, according to the largest longitudinal neuroimaging study of cannabis use to date.

Researchers looked at the association between cannabis use and cerebral cortical development in a cohort study of 799 adolescents. All were cannabis naïve at baseline. Behavioral and neuroimaging data were collected at baseline (around 14 years of age) and again at five-year follow-up (around 19 years of age).

Bad news, Spicoli. Cannabis use in this age group may be associated with dose-dependent cortical thinning in predominantly prefrontal regions where an abundance of cannabinoid 1 receptors exists. These cortices are also the area where the most significant age-related thickness changes take place in adolescents. Likely as a result of the cortical thinning, associations between greater attentional impulsiveness and cannabis use were found.

With more than one-third of high school seniors acknowledging cannabis use, this altered cerebral cortical development could be a significant concern.

Eh, data shmata, shrugs longtime cannabis advocate Willie Nelson. Cannabis is always on his mind, yet this 88-year-old music legend is sharp as a tack.

Well, despite Willie’s inexplicable cognitive acuity, let’s be sure to share these neurological findings with adolescents and parents.

Healthcare Humor

Patient: Will I be able to play the violin after the surgery?

PCP: Yes, of course.

Patient: Great, I never could before!

In Mosquito News…

The Aedes aegypti mosquito has a notorious superpower: disseminating dengue infection, among other infections, all over the world. But researchers may have confirmed its suspected kryptonite: a strain of Wolbachia pipientis bacteria.

Apparently, Wolbachia provide resistance against the dengue infection, so when an A aegypti mosquito is infected with Wolbachia, the mosquito is then incapable of spreading the dengue infection. It gets even better: when the Wolbachia-infected A aegypti mosquito mates with a wild-type mosquito, the offspring maintain the Wolbachia infection as well.

Researchers tested the efficacy of Wolbachia in a cluster-randomized trial in Indonesia, where dengue has a high prevalence. For the intervention group, Wolbachia-infected A aegypti mosquitoes were released into 12 geographic clusters; for the control group, no mosquitoes were released into an additional 12 geographic clusters. The trial enrolled 8,144 participants, aged 3 to 45 years with acute undifferentiated fever. The primary end point was symptomatic virologically confirmed dengue.

In the intervention group, 2.3% (67/2,905) of people were infected with dengue, and in the control group, 9.4% (318/3,401) of people were infected. The relative protective efficacy was 77.1%!

These findings are not only huge for attenuating dengue transmission, but also may mean that Wolbachia could help prevent the spread of chikungunya, Zika, and other viruses disseminated by the A aegypti mosquito. Nice work, Wolbachia! Not all superheroes wear a cape.

Did You Know…

…that the diabetes treatment exenatide is a synthetic form of a protein found in the saliva of the Gila monster? This protein (exendin-4) mimics the action of the glucagon-like peptide-1 hormone. Two physicians, John Eng and Jean-Pierre Raufman, made the unusual discoveryin the mid-1990s and lived to tell about it!

The Gila monster, aka Heloderma suspectum, has one of the worst reputations in the reptile world. Look no further than its name. But, although its bite is painful, it rarely causes death in humans.

We’re hoping this reptile’s role in controlling diabetes will help improve its bad rap.

In-Person Office Visits—Yay or Nay?

While most of you probably found virtual visits vexing early on in the pandemic, many of you may now embrace them, when appropriate. That happens sometimes—like our evolution with Chumbawamba’s “Tubthumping.”

Now that life and healthcare delivery are slowly returning to normal, internal medicine physician Cara Litvin is posing the following question to clinicians, “Do we still need the traditional office visit?”

Dr. Litvin says, “I truly believe that this combination of virtual visits and asynchronous care facilitated by technology, combined with in-person visits when the need arises, enables me to deliver better and more patient-centered care than in-person visits alone.” In fact, she wants healthcare to evolve further in this direction, using technology in creative ways to asynchronously complete tasks and improve patient care. She acknowledges, however, that the current pay-for-service model does not accommodate her ideal vision.

The American Medical Association (AMA) has also rallied behind this message. In May it launched an effort to re-envision the way we assess the full range of benefits generated by virtual care.

Where do you stand on the traditional office visit?

Apologies in advance to those of you now singing “I get knocked down, but I get up again” on repeat.

Happy Diamond Anniversary, CDC!

July 1 marked 75 years since the Centers for Disease Control and Prevention, then the Communicable Disease Center (CDC), first convened on a single floor of a small building in Atlanta, Georgia. Its first assignment: halt the spread of malaria in the United States.

Generations later, the CDC is still going strong as the country’s top health promotion, prevention, and preparedness agency. Way to go!

You’re in good company, CDC. We encourage you to share a cake with three other newly minted 75-year-olds: Tupperware, bikinis, and Cher.

Interested in more healthcare news? Here are some other articles we don’t want you to miss:

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Not your typical medical newsletter… We get it, you see a lot of medical newsletters, so hear us out. This newsletter is intended to be fun, refreshing, and informative!

Every other week, we’ll highlight important medical news, sprinkled with some witty commentary, fun facts, giveaways, and more… because learning should be fun! Subscribe to receive the Morning Report directly.