Arefa MD's Morning Report: Coronary Artery Calcium and Statins, Depression and Hormonal Contraceptives, Yoga and Low Back Pain

Arefa Cassoobhoy, MD, MPH


October 07, 2016

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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.

Coronary Artery Calcium Scoring: Can It Reduce Reliance on Statins?

Obtaining coronary artery calcium scores can prove valuable in determining which of your patients might benefit from statins and which won't. This German study included 3745 individuals without known heart disease and who were not on lipid-lowering meds. Researchers calculated both their cardiac risk scores using current algorithms and the coronary artery calcium scores from cardiac CT.

During the 10-year follow-up period, patients with baseline coronary artery calcium scores of 400 or higher had a cardiac event rate of 12.6%. But when baseline scores were less than 100, the chance of a cardiac event decreased to just over 3%.

This means that you may be able to better risk-stratify those patients who qualify for a statin per guidelines but who have a low coronary artery calcium score—especially those with a zero score. They may not need a statin after all.

Hormonal Contraceptives and Depression

Next, there is evidence that women who use hormonal contraceptives, even low-dose formulations, face an increased risk of developing depression.

Mood changes have long been associated with hormonal contraceptives. This new study looked at Danish data over 14 years. It included more than 1 million females between the ages of 15 and 34 years who had no baseline psychiatric diagnosis. The researchers included women using oral contraceptives, as well as those using the transdermal patch, vaginal ring, and hormonal intrauterine devices.

The investigators found that women who used hormonal contraception were more likely to start using antidepressants or receive a diagnosis of depression. This supports the theory that progesterone is involved in the etiology of depression.

Two key findings that I want to emphasize:

  • Teenagers appear to be most vulnerable; and

  • Depression symptoms were highest in the first 6 months of use and decreased thereafter.

Yoga vs PT for Low Back Pain

And finally, it seems that yoga may be just as good, if not better, than physical therapy (PT) for relief from back pain.

The study included over 300 low-income patients experiencing chronic back pain with no obvious cause, like spinal stenosis. Patients were randomly assigned to PT, yoga, or education and were followed for 1 year. The researchers found that for some patients, quality yoga was superior to PT in relieving back pain, especially among those who were more dedicated to practicing it.

Another benefit was seen in pain medication use. At the beginning of the study, almost 75% of the participants were taking pain medications, with about 20% using opioids. After 12 weeks, 20% of both the yoga and the PT groups had reduced their usage of pain meds.

This is also good news from a cost perspective. Quality yoga instruction is often less expensive than physical therapy. And in general, yoga is good for the brain, and practicing it may help with pain tolerance.

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

Follow Dr Cassoobhoy on Twitter at @ArefaMD


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