If you are worried about your cardiovascular health, one of the things you want to avoid is salt. This was based on ancient research that seems to show even moderate salt intake could do all kinds of bad things for your cardiovascular system.
I was always skeptical of these claims because if you’ve got a healthy set of kidneys, the body has an amazing ability to regulate salt levels in the body. Of course, maybe there is some level of salt consumption that increases the blood pressure, cause retention of water, and other issues that lead to cardiovascular issues.
Now for something completely different, let’s not talk about vaccines – we’re going to discuss statins! There have been more and more robust studies that statins prevent cardiovascular events, including death. Nevertheless, statins have been controversial, and are used by the alternative medicine (not medicine) lovers as an example of all kinds of medical malfeasance.
As I’ve mentioned before, I hang out on Quora answering questions about a lot of topics, mostly vaccines and cancer. But I also occasionally answer questions about statins, and I regularly state that statins prevent cardiovascular events. And just as regularly, I’ll get nasty comments (see Note 1) claiming everything from my being a Big Pharma shill to I don’t know anything about anything.
Two recent studies published in respected journals seem to indicate that diet soda increases risk of stroke and dementia. Not to give a free pass to sugary drinks, one of the studies seemed to indicate that either artificially sweetened or sugar filled drinks might be linked to a higher risk of Alzheimer’s disease.
Typical of the popular press and your average website, they accept the findings of these studies without any serious critique of these studies. US News blares a headline that says, “Health buzz: drinking diet soda linked to stroke, dementia risk, study says.” Thankfully, many of the headlines use the qualifier “may be linked,” but I’m afraid most people will overlook that nuanced discussion of these studies.
But what does the actual science say? Do these studies provide us with robust evidence that cutting out diet soda will suddenly decrease our risk of stroke, dementia or Alzheimer’s disease? Probably not, but let’s see what this data actually tells us.
Basically, chiropractic is the belief in the “vertebral subluxation processes” that purportedly can be used to treat and cure a vast range of diseases which have no scientifically verified connection to vertebral anatomy. It’s based on the same general type of pseudoscientific mysticism that one finds with acupuncture.
Of course, modern chiropractic has tried to divorce itself from the vertebral subluxation, and attempted to evolve into the slightly more mainstream chiropractic treatment technique that involves manual therapy, including manipulation of the spine, other joints, and soft tissues. Chiropractic treatment also includes exercises and health and lifestyle counseling. Barely anything more than a good masseuse would provide to an individual.
Despite this evolution of chiropractic to the point that some health insurance companies actually pay for the procedures, chiropractic is a typical pseudoscience–make outlandish claims, minimize or ignore the risks, and make money off of those who think, or want to believe, that it works.
It’s appalling that some people, many who think that vaccines are dangerous (they’re not), believe that a chiropractor, who has very little real medical training, should manipulate the neck of a baby to treat some imaginary, or even real, condition. It boggles the mind.
Little intro might be handy for this. This post has been on my mind for a long time now and finally I decided to pull my finger out and actually write it. What is to follow will be a mixture of factual, scientific and anecdotal writings. Because that is the way I roll. I have been itching to write something, anything about vaccinations for a little bit now, but so far decided not to because there are so many out there who do it and do a better job of it then I would dream of, so I’ll list some. Skeptical Raptor, Respectful Insolence, Red Wine & Apple Sauce, Just The Vax and many many more.
Prior to starting my nursing course I was very much into my slightly alternative medicine. I was on the fence regarding vaccines, not just the flu vaccine but all vaccines. Now that I think back on it I’m not really sure why. It was never really something that I thought about properly until I started my university course. What was probably a turning point for me was the amount of patients over 70 I came across who had to use callipers and wheelchairs because they contracted polio when they were kids. I have never come across a patient under 70 who has had polio. Never. This sort of got me thinking about the importance of vaccination, and if there is one thing that I have learned since starting uni is that evidence is the key. Continue reading “Student Nurse Perspective: The Flu Vaccine.”
This article, originally published on 2 January 2014 has been updated to include more information about studies regarding chickenpox in children and its effect on rate of shingles outbreaks.
Shingles, known medically as Herpes zoster (HZ), is caused by the Varicella zoster virus (VZV), which causes chickenpox in children. After the chickenpox infection, VZV latently persists, without symptoms, in the basal ganglia including the trigeminal ganglion. For unknown reasons, VZV is reactivated from latency, and moves along sensory nerves to the endings in the skin, where it replicates causing the characteristic HZ rash, commonly called shingles.
There is no known cure for VZV, though it can be treated with antiviral medications. Although the infection presents with a rash, commonly fairly painful, it usually subsides within three to five weeks. Unfortunately, about one in five patients develop a painful condition called postherpetic neuralgia, which is often difficult to manage. Because VZV is never eliminated, after a shingles attack, VZV again becomes latent, to attack again sometime in the future. Continue reading “Why we vaccinate-shingles may increase risk of stroke”
According to study author Dr. Ramanan Kumareswaran, physicians have known that patients tend to need more ICD shocks during flu season, and wanted to investigate ways of reducing this need to rely on the device.
The study surveyed 229 patients who had come in for appointments related to their ICD care from September through November 2011. Of those patients, 179 (78%) reported that they had received the influenza vaccination in the previous year. Patients who received the influenza vaccine were older than those who did not (70.8 vs. 64.8 years, P=0.0005). Finally, there was no difference in the prevalence of coronary artery disease, diabetes, renal disease, and prior stroke in patients the vaccinated and un vaccinated patients.
Some of the results of the survey were:
Patients who received the flu vaccine were more likely to reject statements such as, “The Flu shot is not effective” and “The Flu shot will make me sick” compared to individuals not receiving the influenza vaccine.
Vaccinated individuals also planned to obtain the influenza vaccine in the upcoming year.
Thirty nine (17.0%) individuals in the overall cohort received at least one ICD therapy during the two pre-defined periods – 10.6% who received the influenza vaccine received at least 1 ICD therapy during influenza season compared to 13.7% who did NOT receive the influenza vaccine (P=NS).
About 13.7% of the unvaccinated patients experienced at least one ICD therapy (meaning that the ICD device had to adjust the heart rate) during the flu season compared to the 10.6% of patients who were vaccinated. This wasn’t a significant difference. However, the average number of ICD therapies per person during influenza season was greater in individuals not receiving the influenza vaccination (0.45 therapies) compared to individuals who did receive the influenza (0.14 therapies).
“What is interesting is that if this is consistent over time, it could be of significant benefit to our patient population who already have compromised survival to start with,” wrote Dr. Sheldon Singh, one of the study’s authors.
The authors concluded:
A large proportion of patients with ICDs receive the influenza vaccine. Receipt of the influenza vaccine may be associated with a reduction in ICD therapies during influenza season.
Now, as I’ve said with the other study, from the same Canadian Cardiovascular Congress meeting, that showed that a link between getting the flu vaccination and reduced cardiovascular events, these studies are not peer reviewed. They aren’t published yet in journals. They haven’t been repeated by other researchers. But the study seems to be sound, and it is a very sound argument for getting the flu vaccination if you have serious cardiovascular issues.
In addition to preventing the disease, the flu vaccination may have a more important benefit to those who get the shot. Dr. Jacob Udell, a cardiologist at Women’s College Hospital and the University of Toronto, looked at published clinical trials on flu vaccinations, dating back to the 1960s, examining the vaccine’s effect on cardiovascular events. Dr. Udell presented his meta-review results at the 2012 Canadian Cardiovascular Congress on October 28 2012.
The combined studies examined a total of 3227 patients, with an equal split between patients with and without heart disease. Half of the patients were randomly assigned to receive flu vaccine, and those that did not received a placebo. Four randomized controlled trials of moderate quality conducted between 1994-2008 met inclusion criteria. Here are some of the most important results:
An approximate 50 per cent reduction in the risk of a major cardiac event (heart attack, stroke, or cardiac death) compared with placebo after one year of follow-up.
A similar trend was seen for the flu vaccine reducing death from any cause (approximately 40 per cent).
The influenza vaccine reduced cardiovascular events and cardiovascular death in people with or without heart disease.
The study concluded:
Influenza vaccine reduced non-fatal CV events and may reduce sudden CV death in patients with and without CVD. However, the very low number of observed CV events and important design limitations among these RCTs strongly limit their validity and make it challenging to draw a definitive conclusion. A large, adequately powered, international multicenter RCT testing the efficacy of influenza vaccine to reduce incident and recurrent CV events is prudent to confirm these findings.
But why would the flu vaccine reduce cardiovascular events? Nelson’s report suggested a couple of very plausible reasons:
“Udell said it may be that when people develop heart disease, some factor ‘tips them over the edge,’ such as plaque clogging arteries, or lower levels of oxygen as a result of the flu.” This is entirely possible, since those with atherosclerosis do have reduced blood flow to heart muscle. And the flu, being much more dangerous than most people believe, could just push someone over the line from having just enough oxygen for their heart muscle, to not enough.
“Dr. Sarah Samaan, a cardiologist and director of the Women’s Cardiovascular Institute at Baylor Heart Hospital in Plano, Texas, said the key to the link may be in reducing inflammation. When someone gets the flu, blood levels of inflammatory substances rise, and inflammation of the blood vessels can trigger heart attacks. ‘This happens because inflammation can make cholesterol plaques in the blood vessels unstable,’ Samaan explained. Unstable plaques are more likely to develop tiny cracks, which can cause blood clots to form. Such clots can block blood flow within arteries, causing a heart attack (if the blood vessel supplies the heart) or a stroke (if the artery feeds the brain), she said.” Again, entirely plausible.
Now, a couple of caveats about this study. First, it’s presented at a conference. Second, it’s not peer-reviewed. I’ll assume that it’s good work, but until it’s peer-reviewed and published in a great journal, it’s at the level of highly provocative. And it’s intensely interesting. But the great thing about meta-reviews is that they are easily repeated, and easily criticized if there’s a problem with the statistical analysis, so in light of that, I have high confidence in the quality of these results.
The 50% reduction in cardiovascular events is both clinically relevant, and may be higher than what will be seen in future randomized trials. But even if it’s 40%, 30%, or even 10%, that’s an amazing benefit of the flu vaccine for individuals at risk for cardiovascular events. The thing is that although a lot of people know that they are at risk, they have diabetes or are overweight, many people are unaware of their cardiovascular risks. They may have untreated hypertension. Or atrial fibrillations. Or any number of diseases where the risks of cardiovascular events are high, and can reduce the risk by a significant amount just by a simple and safe flu vaccination. And don’t listen to those myths about the flu vaccine, they just aren’t true. No, they aren’t true.
Vaccines save lives. And they might keep you from getting a heart attack!