Arefa MD's Morning Report: Vitamin D and Asthma, Statin Intensity, Gallstones and CVD

Arefa Cassoobhoy, MD, MPH


September 16, 2016

This feature requires the newest version of Flash. You can download it here.

Hello. I'm Dr Arefa Cassoobhoy, a practicing internist and a medical editor for Medscape and WebMD. Welcome to our weekly brief on recent medical news and findings.

Vitamin D Supplementation in Asthma

Low blood levels of vitamin D have been linked to an increased risk for asthma attacks in children and adults with asthma.[1]

A new Cochrane review suggests that the addition of vitamin D supplements to standard asthma medication can lead to fewer severe asthma attacks, particularly in patients with mild to moderate asthma.

The meta-analysis of nine double-blind, randomized, placebo-controlled trials included more than 400 children and 600 adults. Adding oral vitamin D to treatment decreased both the risk for a severe asthma exacerbation requiring oral steroids and the average number of annual asthma attacks. The supplementation also decreased the risk for an asthma attack requiring a visit to the emergency room or a hospital stay from 6 per 100 patients to around 3 per 100 patients.

Still, vitamin D had little or no effect on lung function or on the day-to-day symptoms of asthma. While vitamin D supplementation is an easy add, just to caution—definitive guidelines can't be made until we have more research and a better understanding of the implication of a low baseline vitamin D level.

Intensity of Statin Therapy: Go Higher

Next, clinicians are being advised to look more closely at the statins they are prescribing for their patients, especially those who meet indications for high-intensity statins based on the 2013 ACC and AHA guidelines.

Investigators analyzing the Patient and Provider Assessment of Lipid Management Registry (PALM) found that although the guidelines shifted from lipid goals to statin intensity, many patients at higher risk for heart disease were still being undertreated.

The study found that 74% of patients in whom statins were indicated were taking them, but only 45% were on the appropriate-intensity statin. The biggest gap came in those patients recommended for high-intensity statins. In that group, although 80% were on a statin, only about 30% were taking a statin that is considered high-intensity, such as higher-dose atorvastatin, rosuvastatin, and simvastatin.

Undertreatment was more common with primary prevention of heart disease. The groups most likely to be undertreated include women, African Americans, patients with diabetes, and those not seen by a cardiologist.

Researchers blame the undertreatment on what they call "clinical inertia." They note that new prescriptions were more likely to be written correctly, but that patients already on statins were less likely to be titrated up when warranted. They recommend that doctors look at their patients on statins and increase the statin intensity if appropriate.

Gallstones and Heart Disease

And finally, researchers confirm a link between gallstone disease and heart disease.

This meta-analysis examined databases involving more than 800,000 patients and 51,000 cases of heart disease. It included the Nurses' Health Studies, the Health Professionals Follow-Up Study, and four other prospective trials.

Six percent of women and 3% of men had a history of gallstones. They tended to be obese and have hypertension, diabetes, and high cholesterol. But investigators found that even when controlling for typical risk factors for heart disease, those patients with a history of gallstones had a 23% higher risk for heart disease.

They do mention that their study is observational and so causation cannot be established. However, it's warranted to have a higher index of suspicion for heart disease in your patients with a history of gallstones, even those without traditional cardiovascular risk factors.

For Medscape and WebMD, I'm Dr Arefa Cassoobhoy.

Follow Dr Cassoobhoy at @ArefaMD


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: