Michelle Routhenstein, MS, RD, CDCES, CDN’s Post

#EpiTales #9 (Confounding by Indication): The Case of the Mysterious Bias. Mohamed: Morning, Amira! You look confused today. Found something interesting Amira: Hi, Mohamed! I reviewed a study on statins. It showed higher cardiovascular events in patients taking statins. Isn’t that surprising? 🫨 Mohamed: Interesting! But it might be a case of confounding by indication. It’s like a hidden twist in our plot. 🕵️♂️ Amira: What do you mean? Mohamed: Let me explain. Patients with severe cardiovascular risks are more likely to be prescribed statins. Their high inherent risk can make statins look harmful if we don’t adjust for these baseline conditions. Imagine it like this: initially, a study from the Multi-Ethnic Study of Atherosclerosis (MESA) suggested higher cardiovascular events for those on statins. But after adjusting for risk factors using propensity score matching, the real protective effect of statins was reveal Amira: Wow, I didn’t see that coming! Any other examples? Mohamed: Absolutely! Think about paracetamol and asthma. Studies initially suggested that children taking paracetamol had a higher risk of developing asthma. However, the underlying conditions leading to paracetamol use, like infections, were the actual cause of increased asthma risk. This confounding made paracetamol look guilty! 🚨 Amira: This is fascinating! So, how do we prevent these biases? Mohamed: Great question! Here’s how: 1- Randomized Controlled Trials (RCTs): Randomly assign treatments to balance known and unknown confounders. 2- Propensity Score Matching "controversial by nature" : Match patients based on their likelihood of receiving the treatment considering their characteristics 3- Instrumental Variables: Use variables related to treatment assignment but not directly to the outcome. These steps help uncover the true effects of treatments without bias. 🎯 Amira: Thanks, Mohamed. This really clarifies the importance of proper adjustments in research. Mohamed: Anytime, Amira. Remember, uncovering the truth in research is like solving a mystery. Keep digging for those clues! 🔍 References Jorgensen, N.W., Sibley, C.T. & McClelland, R.L. Using imputed pre-treatment cholesterol in a propensity score model to reduce confounding by indication: results from the multi-ethnic study of atherosclerosis. BMC Med Res Methodol 13, 81 (2013). https://lnkd.in/d28XaUZS Catalogue of bias collaboration, Aronson JK, Bankhead C, Mahtani KR, Nunan D. Confounding by indication. In Catalogue Of Biases. 2018. https://lnkd.in/dw44p2h3

No one wants to die of a heart attack. Also known as a myocardial infarction (M.I.), a heart attack ❤️ , along with strokes 🧠 , retinal artery occlusion 👁 , acute mesenteric ischemia 🤢 , and critical limb ischemia 💪 , represent a cluster of diseases associated with atherosclerotic cardiovascular disease (ASCVD). What does this all even mean? High levels of a specific type of cholesterol, can accumulate in the arteries and, coupled with an inflammatory response, result in plaques called atherosclerosis. 😨 Without effectively addressing these plaques through lifestyle, medical, or sometimes even surgical treatments, the risk of these plaques blocking off an artery or breaking off the blood vessel wall and blocking off a smaller artery or vessel downstream becomes even more concerning. 🚨 A blocked blood vessel means decreased to absent blood flow to our body's tissues. Decreased to absent blood flow means decreased oxygen delivery, which means decreased metabolism and energy production, ⚡ which means... Cell death ➡ tissue death ➡ organ death ➡ multi-organ damage or failure if not addressed in an adequate and/or timely manner 🚨 And no. Unfortunately, just because you are a young, healthy, exercising-loving individual with no family history of any of the above conditions, it does not mean you get to ignore the reality of these conditions. The world in which we live, including the air quality ⛅ , degree of microplastic exposure 🍶 , and highly processed food items 🥫 , has introduced many variables with still unknown and likely concerning effects. It is a very different world from the one where even our parents lived in their 20s and 30s. So, here are some things to consider to protect and perhaps restore our blood vessels, organs, overall health, and quality of life: 1. Meet regularly and often with a qualified healthcare professional to discuss your health and risks 👩⚕️ 2. Maintain a healthy sleep 😴 , diet 🥑 , and exercise 🏃♂️ to protect and optimize your metabolic function 3. Take ownership of your health with curiosity 🤔 and intentionality 😤 Despite our consumer-driven model of healthcare, no one can "give" you health. Be intentional. Be curious. Do your best to claim your health by working with trusted healthcare providers, even if life hasn't dealt you a good hand. For those who haven't been dealt a good hand, my heart goes out to you. ❤️ It is for you I went into medicine. We will continue to work to better understand you and how we can best help you live your healthiest and happiest life. #healthcare #medicine #metabolism #cardiovasculardisease #publichealth ——————————————————————————————————— My name is Wyatt Corbin, and I am a resident physician passionate about public health and health education. *All my posts are purely educational or expressive of my thoughts and opinions, are not to be intended or taken as medical advice, and do not represent my employer or educational institution.*

Is it time to have a Heart Check Up? Heart disease is a term used to refer to different heart conditions. These conditions include Coronary Artery Disease (CAD), Heart Failure, Arrhythmia, Cardiac Arrest, Heart Attack, Pericarditis and #Congenital Heart Defect. A heart check is performed to help discover any symptoms or potential risk factors that could lead to #heartdisease #Cardiovascular #Health #Checkup helps you understand your risk factors for heart disease and predict your likelihood of having a heart attack or stroke in the next five years. There are several factors your doctor focuses on during a heart exam. 1. Family history If heart disease runs in your family, your risk of developing it is higher based on genetic factors. Your doctor may ask several questions about any history of heart disease in your family. 2. Cholesterol During a heart exam, your doctor will measure the amount of cholesterol in your body. This will be done with a Lipid Panel Scan, which involves measuring three lipids in your blood. This type of scan will look at low-density lipoproteins (LDL), high-density lipoproteins (HDL), and triglycerides. If you have high LDL (bad cholesterol), low HDL (good cholesterol), or high triglyceride levels, you are at higher risk for heart disease. 3. Blood Pressure Levels Doctors will also look at the amount of pressure your blood puts on the artery walls as your heart pumps. High blood pressure is a major risk factor for heart disease. 4. Sugar Levels (Diabetes) Also pay attention to the level of sugar in your blood, also known as blood sugar levels. This is to control diabetes, another risk factor for heart disease and stroke. 5. Amount of C-Reactive Protein Doctors also screen for the amount of C-reactive protein (CRP) in your blood. High CRP levels are a direct indication of an inflammation or infection in your body. If your test records show high levels of CRP, this is an indicator of high-risk cardiovascular disease. 6. Abdominal Aorta Measurements The abdominal aorta is the main artery in your heart and the largest blood vessel in your body. When the lining of this blood vessel becomes swollen or enlarged, it leads to a condition known as Abdominal Aortic Aneurysm. This condition is usually silent and only noticed in emergencies. Therefore, doctors may use ultrasound to measure your aorta during a heart exam. Healthy days Dr Emre Erturk Cardiology Specialist www.emreerturk.com.tr 0216 565 40 65 Şahika street No:32 Göztepe/Kadıköy ISTANBUL PK:34732

💊💉🩺Statins: Does it help in Lowering Cholesterol and Reducing Cardiovascular Risk? As a pharmacist, we see many patients who are concerned about their cholesterol levels and their risk of heart disease. Statins are one of the most effective medications we have to help manage cholesterol and prevent cardiovascular events like heart attacks and strokes. Here's what we want to share from our experience: Statins are highly effective: Studies show they can reduce LDL ("bad") cholesterol by up to 40%, significantly reducing the risk of cardiovascular disease. This is especially important for people with high blood pressure, diabetes, or a family history of heart disease. Statins are generally safe: While some people experience muscle aches, these are usually mild and go away on their own. There are also ways to manage them, like starting with a lower dose or trying a different type of statin. Don't stop taking your statin without talking to your doctor: Even if you experience side effects, there may be solutions. Stopping your statin can increase your risk of a heart attack. Here are some additional things to consider: ⚫Talk to your doctor about potential interactions with other medications you're taking. ⚫If muscle aches are a concern, discuss trying a hydrophilic statin, which may cause fewer side effects. ⚫We can explore alternative treatment options if statins aren't right for you. Remember, statins are a powerful tool in reducing heart disease risk. By working together with your doctor and pharmacist, you can find a safe and effective way to manage your cholesterol and protect your heart health. This post is for informational purposes only and should not be taken as medical advice. Always consult with your doctor about the best course of treatment for you. Let's connect! We’re passionate about helping seniors thrive, and we believe pharmacists play a vital role in their well-being. Let's discuss how we can support your medication needs. TIB Pharmacy T: (510)-573-0064 A: 5886 Mowry School Rd, Newark CA, 94560 #LongTermCare #MedicationManagement #BetterHealth #Teamwork #TIBPharmacy #NewarkPharmacy #pharmacyservices #longtermcare #LTCPharmacy #HospicePharmacy #EndOfLifeCare #hospicespecialized #ltcspecialized #ltcathome #enteraltherapy #MedicationManagement #PackagingPower #SimplifyYourHealth https://lnkd.in/e8vwk_qU

Recent published article about cardiovascular diseases CVDs promoting healthy lifestyles, including a healthy diet, regular exercise, and smoking cessation, remains a critical component of preventing cardiovascular diseases. Targeted prevention strategies, genetic testing, and risk stratification can also improve the accuracy of risk assessment and guide individualized prevention strategies. As the field continues to evolve, collaboration between researchers, clinicians, industry partners, and policymakers will be essential to address challenges and limitations and ensure that new advances are implemented equitably and effectively. By investing in research and innovation and promoting healthy lifestyles, we can reduce the global burden of cardiovascular diseases and improve outcomes for patients. Addissouky TA, El Tantawy El Sayed I, Ali MMA, Wang Y, El Baz A, Elarabany N, et al. Shaping the Future of Cardiac Wellness: Exploring Revolutionary Approaches in Disease Management and Prevention. J Clin Cardiol. 2024;5(1):6-29. https://lnkd.in/d5KusaQX

There are several factors that contribute to the association between insulin resistance and heart disease:⁠ ⁠ 1️⃣ Plaque build up: Insulin resistance can lead to atherosclerosis, a condition where arteries become narrow due to the buildup of plaque. When cells are resistant to insulin, the body compensates by producing more insulin. Elevated insulin levels can promote the production of fatty deposits in the blood vessels, contributing to plaque formation and heart disease.⁠ 2️⃣ Inflammation: Insulin resistance is often accompanied by chronic low-grade inflammation in the body. This inflammation can damage the inner lining of blood vessels, making them more susceptible to plaque buildup and narrowing. Inflammation is an important factor in the development and progression of heart disease.⁠ 3️⃣ Abnormal lipids: Insulin resistance is associated with changes in lipid metabolism, leading to abnormal levels of cholesterol and triglycerides in the blood. This dyslipidemia contributes to the formation of atherosclerotic plaques in the coronary arteries and can make the heart overwork.⁠ 4️⃣ High blood pressure: Insulin resistance can lead to elevated blood pressure by promoting increased sodium retention, endothelial dysfunction, and a pro-inflammatory state, collectively impacting vascular function and blood vessel health.⁠ 5️⃣ Blood vessel dysfunction: Insulin resistance can impair the function of the endothelium, the inner lining of blood vessels. Endothelial dysfunction reduces the ability of blood vessels to dilate and regulate blood flow properly, contributing to the development of these heart related conditions.⁠ ⁠ ⚠️ If the above is not addressed, it can contribute to progression of heart disease and heart related complications.⁠ ⁠ ❤️ In my 6 week heart optimization group program, we dive into how to address these 5 things via science based nutrition in order to optimize heart health and reduce cardiovascular complications.⁠ ⁠ ⭐️ My next group starts on February 9th and spots are filling up fast! To secure your spot enroll today: https://lnkd.in/ecCQWHrQ #atherosclerosis #bloodvessels #inflammation #heartdisease #heartattacksurvivor #heartattack #plaque #coronaryarterydisease #heartdiseaseawareness #heartdiseaseprevention #heartattackprevention #calciumheartscan #cardiovasculardisease #cardiovascularhealth #highbloodpressure #highbloodpressurediet #highcholesterol #highbloodsugar #hearthealthydiet #hearthealth #hearthealthawareness #hearthealthyliving #highcholesteroldiet #highcholesterolproblems #cholesterollowering #cholesterolcontrol #cholesterolawareness #cardiacrehab #cardiacrehabilitation #cardiacbypass

Thrilled to announce the publication of our systematic review titled “Ideal cardiovascular health and cardiovascular related events: a systematic review and meta-analysis” in the European Journal of Preventive Cardiology.📈 📊 In 2010, the American Heart Association introduced Life’s Simple 7 (LS7), a scoring system using seven #lifestyle factors to measure #cardiovascular health in populations and these factors are diet, physical activity, smoking, blood pressure, blood lipids, blood sugar, and weight. We systematically reviewed and summarized the evidence on the association between LS7 and multiple cardiovascular diseases and cardiometabolic diseases. A higher #LS7 score, which indicates a healthier lifestyle, was related to lower risks of CVDs. Promoting healthy lifestyle (higher LS7 score) could possibly lead to prevention of CVDs. Many thanks to the Julius Centre Cardiovascular Epi Team, Femke te Hoonte, Qi Sun, Kangrui Wu, Shiqi Fan, Ziyi Wang, Michiel Bots, Yvonne van der Schouw, Alicia Uijl, and Robin Vernooij. It was great to work with you! Explore more about our findings below! #LS7 #LifeSimple7 #AHA #IdealCardiovascularHealth #HealthyLifestyle #AmericanHearthAssociation

Your genes, family history and/or a high Lp(a) can increase your risk of heart disease, but epigenetic research shows that through science based heart healthy lifestyle behavior change that modify modifiable cardiovascular risk factors these genes can be down-regulated. What that means is that you must take a more proactive preventative approach to reduce your risk of developing heart disease.  What does a proactive preventative approach entail? 1. Take ownership of your health - don’t wait until the doctor says you need to take this more seriously or should take medication. ⭐️ Ask questions from your care team, request labs that may not be routinely done (ie if you don’t know your Lp(a) or ApoB or HsCRP ask for it!), review your labs, assess your trends, and understand what lab levels you need to achieve based on your medical history and genetic history. ⭐️ If these labs (cholesterol, blood sugar, blood pressure, etc) are elevated or trending in the wrong direction, optimize your nutrition and lifestyle and retest in 3 months to ensure they are normalized. ⚠️Those who have a genetic history or are at increased risk, need to have stricter laboratory standards (ie LDL less than 70mg/dL, ApoB less than 80mg/dL, HgA1c less than 5.4%, blood pressure 110/70mmHg, hsCRP less than 1mg/dL, etc).  2. Understand what is going on - ask questions from healthcare providers who can take the time to explain the WHY behind the recommendations. 3. Seek support from a registered dietitian who specializes in heart disease and can help manage any cardiometabolic conditions, teach you how to improve your cardiovascular risk profile, and understands how to take a preventive stance in your blood vessel health. ⭐️ I teach you how to be proactive in your health in my 6 week heart optimization group program. I take the time to answer all of your questions and explain the WHY behind it so you can implement this for the long haul. ❤️ My next and last 2023 six week heart optimization group program will begin on October 27th and there are limited spots available. Enroll now to secure your spot: https://lnkd.in/efbtVMdC Study reference: https://lnkd.in/eWKp4b72 #highcholesterol #highbloodpressure #highcalciumscore #lowercholesterol #lowerbloodpressure #heartdiseaseprevention #cholesteroldiet #hearthealthydiet #cardiacdiet #cholesteroltips #lowerbloodpressurenaturally #heartattackrecovery #cardiacbypasssurgery #cardiacrehab #heartdiseaseawareness #heartattacksurvivor #atherosclerosis #lowcholesterol #foodovermedicine #cardiacbypasss #hearthealth #hearthealthy #antiinflammatory #antiinflammatorydiet #coronaryarterydisesae #heartdiseasesupport #cardiacsurgery #heartsurgerysurvivor #heartattackprevention #heartdisease

There will be so many discussions about Tro Kalayjian's message below, the weekend of Aug 15th - 18th at the upcoming 9th Annual Symposium for Metabolic Health. To delve deeper, we hope you can join us and/or share the opportunity for more to learn from. Livestream tickets with recording to watch anytime are available, and in person last minute still available! CME for all healthcare professionals available, and it's Open to the Public. https://lnkd.in/gig6m9Rs 📣 But at the very least, please share Tro's message far and wide to help raise awareness and reach more people. ✴ The check engine light is already on for so many people, but people need to be able to see the light and not ignore it. 💡 Medical professionals need to know the things to check earlier than Hba1c.

I have a serious problem with the term “pre-diabetes.” The prefix “pre” is used to describe what comes before something. In reality, “pre”-diabetes is actually AFTER or “post” 15 years of the high insulin levels & inflammation associated with the modern lifestyle. Prediabetes is usually diagnosed by checking an a1c level, which is the percentage of hemoglobin that binds to sugar as a percentage of normal hemoglobin. If you a1c is between 5.7 and 6.4, you are considered to have “pre-diabetes” To achieve this level of pre-diabetes, you must sustain enough carbohydrate/glycemic excursions & weight gain where your average glucose rises sufficiently above normal levels. The a1c describes your speed, your are past your speed limit. But we NOW know is that your engine has likely been redlining for years prior to this diagnosis. Fasting insulin levels consistently rise 10 years prior to a diabetes diagnosis, which demonstrates that your body is attempting to manage the damage from diet but its failing! And this problem is A LOT WORSE than some slightly off-numbers on your lab work. The amount of heart damage and nerve damage seen in pre-diabetes is ASTOUNDING! More than 30% of patients newly diagnosed with diabetes also have neuropathy. In many cases this longterm nerve damage develops over years. Countless patients in my clinic, receive CACs, or heart CAT scans upon starting our programs and the amount of results above 400 (which is severe coronary disease) is unbelievable! Countless people in their early 40/50s are coming to me, finally trying to lose weight or sometimes they were sent to me after their primary doc found pre-diabetes/diabetes… what we are finding is that the disease processes have already set in & often is very severe. We have diagnosed, innumerable patients, with triple vessel (severe) cardiac disease in tandem with their “new” pre-diabetes or diabetes diagnosis The bottom line is this: Medicine, in its current state, is reactionary. They react to a problem AFTER it occurs. They mistakenly call this disease “pre-diabetes”, its actually POST-diabetes. It’s POST 10-15 years of a disease process your body can no longer handle. So here’s my advice for the average person: 1) talk to your doctor about a CAC 2) talk to your doctor about a CIMT 3) check a fasting insulin 4) get an NMR lipid panel 5) ask for a CGM 6) get a sleep study 7) and eat real food 8) eliminate stress as best as possible 9) take your health seriously Your life depends on it Hopefully, this information helps you or your family share this message and spread the knowledge that pre-diabetes is NOT "pre", its "post"