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Wednesday, June 29, 2011

Further Evidence showing that certain Antidepressant Medications Increase Risks of Birth Defects

Obstet Gynecol. 2011;118:111-120.

This is the latest study showing that Selective Serotonin Reuptake Inhibitors (SSRIs) increase the risk of heart defects in newborns. The first report to raise a red flag was published in the New England Journal of Medicine back in 1996 (Chambers et al. N Engl J Med. 1996;335:1010-1015).

Women who use SSRIs, particularly fluoxetine and paroxetine for depression while pregnant showed a 2-fold and 4-fold increased risk to ventricular heart defects in the newborns.

So far, these two specific SSRIs have been implicated and other SSRIs seem to be ok in the statistical analysis. There was also a statistically significant association between citalopram (a SSRI) and neural tube defects.

Fetal alcohol spectrum disorders have been observed to be nearly 10 times more common in SSRI-exposed offspring than in unexposed offspring. Therefore, expecting moms on SSRIs need to be especially cautious with alcohol use in pregnancy.

Yours in Health,
Ian Koo, ND

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Wednesday, June 22, 2011

Do you know anyone on high dose Statin medications with high blood sugar? You'll want to read further.

Researchers from the University of Glasgow report in the Journal of the American Medical Association (JAMA 2011; 305:2556-2564) that people on high doses of statin medications increases the risk of diabetes by 12%. Statin drugs are often prescribed for those who have high cholesterol and are thus at an increased risk of cardiovascular diseases.

This new report follows another study published last year in the Lancet, another well regarded science journal.

(Sattar N, Preiss D, Murray HM, et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomized statins trials. Lancet 2010; 375:735-742)

Researchers conclude that it is prudent to monitor ones' blood glucose levels if you are on statin therapy. It should be noted that the authors still believe that benefits of statin therapy (ie. prevention of cardiovascular events) outweighs the cons (ie. diabetes). This is a bit of a contradiction because having diabetes puts one in the high risk category of getting a cardiovascular event.

Hopefully some of you have seen your cholesterol numbers from your blood work and may have noticed a chart/guideline like the one below. This chart uses American numbers, but for the purpose of this explanation, it doesn't matter. The way we are taught to treat patients for high cholesterol is to first assess which category of risk a patients fall in. For example, if you smoke, have a history of cardiovascular events or have diabetes, you are automatically classified as a "high risk individual". So then you are put on statins to decrease your risks if you do not meet the cholesterol target guidelines which are also shown on the chart.

So here's what I see as the big picture:

High risk individuals => Drug therapy (statins) => Some people are at increased risk of developing diabetes => Diabetes increases ones risk of having cardiovascular problems => May need another drug to treat the high blood sugar (?)

So what should you be doing if you're on statins?
1. Monitor your blood sugar, especially if you're on high doses of the drugs.
2. Make LIFESTYLE changes! Yes, there are natural supplements that can lower your cholesterol, but the truth is, if you don't exercise, eat right and get adequate sleep, you won't have the foundation required to go off whatever medications you are on.

The guidelines (American figures), based on the 10-year risk of a heart attack, are summarized in the table below.

ATP III LDL-Cholesterol Goals and Cutpoints for Therapeutic Lifestyle Changes (TLC) and Drug Therapy in Different Risk Categories
Risk Category LDL-Cholesterol Goal Initiate TLC Consider Drug Therapy
High risk: CHD* or CHD risk equivalents†
(10-year risk >20%)
<100 mg/dL
(optional goal: <70 mg/dL)||
>=100 mg/dL# >=100 mg/dL††
(<100 mg/dL: consider drug options)**
Moderately high risk: 2+ risk factors‡
(10-year risk 10% to 20%)
<130 mg/dL¶ >=130 mg/dL# >=130 mg/dL
100–129 mg/dL; consider drug options)‡‡
Moderate risk: 2+ risk factors‡
(10-year risk <10%)
<130 mg/dL >=130 mg/dL >=160 mg/dL
Lower risk: 0–1 risk factor§ <160 mg/dL >=160 mg/dL >=190 mg/dL
(160–189 mg/dL: LDL-lowering drug optional)

Have a fantastic, fun-filled summer everyone!

Yours in Health,
Ian Koo, ND

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"The care you want, the health you need."