Catherine Buettner

Correlates of use of different types of complementary and alternative medicine by breast cancer survivors in the nurses' health study

PurposeAmong breast cancer survivors, we identified the prevalence and correlates of use of different types of complementary and alternative medicine (CAM).Patients and methodsWe included 2,022 women diagnosed with breast cancer 1998–2003 who responded to a survey about CAM use. We performed logistic regression to determine demographic and disease factors associated with use of different CAM therapies (including relaxation/imagery, spiritual healing, yoga, energy healing, acupuncture, massage, chiropractic, high-dose vitamins, herbs, and homeopathy). We also measured quality of life (QoL) using the SF36 and optimism using LOT-R and fit linear regression models to compare mean scores among CAM users and nonusers.ResultsSixty-two percent of respondents used CAM. Younger age was the most consistent correlate of CAM use, but factors associated with CAM use varied by type of CAM. Chemotherapy was associated with use of relaxation/imagery (OR 1.3 95%CI 1.1–1.7). Radiotherapy was associated with use of high-dose vitamins (OR 1.5 95% CI 1.2–2.0). Tamoxifen or anastrozole treatment was associated with use of homeopathy (OR 0.5 95%CI 0.3–0.9). Users of most types of CAM had worse QoL scores than nonusers, but better QoL was found among users of yoga. The lowest QoL scores were associated with the use of energy healing. Optimism was higher among users of relaxation/imagery.ConclusionsFactors associated with CAM use varied according to type of CAM. Our finding of worse QoL among women using energy healing and better QoL among women using yoga suggests the need for longitudinal studies to determine the temporal relationships between these therapies and QoL.

National use of prescription medications for insomnia: NHANES 1999-2010.

STUDY OBJECTIVES To determine current patterns and predictors of use of prescription medications commonly used for insomnia (MCUFI) in the U.S. DESIGN Cross-sectional study. SETTING National Health and Nutrition Examination Survey, 1999-2010. PARTICIPANTS 32,328 noninstitutionalized community-dwelling U.S. adults. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS WE DEFINED MCUFI USE AS USE OF ANY OF THE FOLLOWING MEDICATIONS IN THE PRECEDING MONTH: benzodiazepine receptor agonists (eszopiclone, zaleplon, zolpidem, estazolam, flurazepam, quazepam, temazepam, triazolam), barbiturates (amobarbital, amobarbitalsecobarbital, chloral hydrate), doxepin, quetiapine, ramelteon, and trazodone. We estimated prevalence of MCUFI use and concurrent use of another sedating medication. We determined predictors of MCUFI use using multivariate logistic regression. Overall, 3% percent of adults used a MCUFI within the preceding month. Zolpidem and trazodone were used most commonly. Overall MCUFI use increased between 1999-2000 and 2009-2010 (P value for trend < 0.001). Concurrent use of other sedating medications was high, with 55% of MCUFI users taking at least one other sedating medication and 10% taking ≥ 3 other sedating medications. Concurrent use of MCUFIs with opioids (24.6%) and non-MCUFI benzodiazepines (19.5%) were most common. After adjustment, adults seeing a mental health provider (aOR 4.68, 95% C.I. 3.79, 5.77), using other sedating medications (aOR 4.18, 95% C.I. 3.36, 5.19), and age ≥ 80 years (aOR 2.55, 95% C.I. 1.63, 4.01) had highest likelihood of MCUFI use. CONCLUSION In this nationally representative sample, reported use of prescription medications commonly used for insomnia (MCUFIs) within the preceding month was common, particularly among older adults and those seeing a mental health provider, with high use of sedative polypharmacy among MCUFI users.

Systematic Review of the Effects of Ginseng on Cardiovascular Risk Factors

Objective: To examine the evidence for the efficacy of ginseng (Panax spp.) on cardiovascular risk factors, including blood pressure, lipid profiles, and blood glucose, and to summarize reported cardiovascular adverse events. Data Sources: We searched MEDLINE, AMED, BIOSIS, CAB, EMBASE, and the Cochrane Controlled Trials databases through July 2005 and performed hand searches of bibliographies. Study Selection and Data Extraction: Short- or long-term, randomized, controlled trials and nonrandomized studies published in English were included. Data were extracted in a standardized manner, and 2 independent investigators assessed methodologic quality of the studies. Thirty-four studies were identified with results for blood pressure, lipids, and/or blood glucose. Due to heterogeneity of the studies, we were unable to perform a meta-analysis. Data on cardiovascular adverse events were extracted from events reported in identified studies and from case reports. Data Synthesis: The majority of studies were short term. Ginseng may slightly decrease blood pressure compared with placebo (range 0–4%). We found mixed results for an effect on lipids, with 5 of 9 studies showing improvement in one or more lipid parameters compared with baseline (range 7–44%). We identified several studies showing that ginseng lowers blood glucose, but overall studies were inconsistent. Conclusions: Current evidence does not support the use of ginseng to treat cardiovascular risk factors. Some studies suggest a small reduction in blood pressure. Despite some evidence showing that ginseng lowers blood glucose and improves lipid profiles, well-designed, randomized, controlled trials evaluating its effects are lacking.

Complementary and alternative medicine use among adults with migraines/severe headaches.

(Headache 2011;51:1087‐1097)

n-3 Fatty Acids and Periodontitis in US Adults

BACKGROUND Periodontitis is a common, chronic inflammatory disease. Although n-3 fatty acids have anti-inflammatory properties, it is unclear whether n-3 fatty acids can treat or prevent periodontitis. METHOD We studied 9,182 adults aged 20 years and older who participated in the National Health and Nutrition Examination Survey between 1999 and 2004. Periodontitis was assessed by dental exam and was defined as >4 mm pocket depth and >3 mm attachment loss in any one tooth. Intake of n-3 fatty acids was assessed by 24-hour dietary recall. We used multivariable logistic regression to estimate the associations between periodontitis and intakes of docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and linolenic acid (LNA). RESULTS The weighted prevalence and 95% confidence interval (CI) of periodontitis was 8.2% (95% CI 7.0 to 9.4). Compared with the lowest tertiles, the adjusted odds ratios for periodontitis associated with the highest tertiles of dietary n-3 intake were 0.78 (95% CI 0.61 to 1.00; P=0.009) for DHA, 0.85 (95% CI 0.67 to 1.08; P=0.10) for EPA, and 0.86 (95% CI 0.60 to 1.23; P=0.28) for LNA. The associations were little changed by multivariable adjustment or exclusion of individuals reporting use of dietary supplements containing DHA, EPA, or LNA. CONCLUSIONS In this nationally representative sample, higher dietary intakes of DHA and, to a lesser degree, EPA, were associated with lower prevalence of periodontitis. Interventional studies are needed to confirm the potential protective effects of n-3 fatty acids on periodontitis.

Statin Use and Musculoskeletal Pain Among Adults with and without Arthritis

BACKGROUND Musculoskeletal symptoms are common adverse effects of statins, yet little is known about the prevalence of musculoskeletal pain and statin use in the general population. METHODS We conducted a cross-sectional study of the National Health and Nutrition Examination Survey 1999-2004. We estimated the prevalence of self-reported musculoskeletal pain according to statin use and calculated prevalence ratio estimates of musculoskeletal pain obtained from adjusted multiple logistic regression modeling. RESULTS Among 5170 participants without arthritis, the unadjusted prevalence of musculoskeletal pain was significantly higher for statin users reporting pain in any region (23% among statin users, 95% confidence interval [CI], 19-27, compared with 18% among those not using statins, 95% CI, 17-20; P=.02) and in the lower extremities (12% among statin users, 95% CI, 8-16, compared with 8% among those not using statins, 95% CI, 7-9; P=.02). Conversely, among 3058 participants with arthritis, statin use was not associated with higher musculoskeletal pain in any region. After controlling for confounders, among those without arthritis, statin use was associated with a significantly higher prevalence of musculoskeletal pain in any region, the lower back, and the lower extremities (adjusted prevalence ratios: 1.33 [CI, 1.06-1.67]; 1.47 [CI, 1.02-2.13]; 1.59 [CI, 1.12-2.22], respectively). Among participants with arthritis, no association was observed between musculoskeletal pain and statin use on adjusted analyses. CONCLUSION In this population-based study, statin use was associated with a higher prevalence of musculoskeletal pain, particularly in the lower extremities, among individuals without arthritis. Evidence that statin use was associated with musculoskeletal pain among those with arthritis was lacking.

Evaluation of skeletal muscle during calf exercise by 31-phosphorus magnetic resonance spectroscopy in patients on statin medications.

Muscle pain is a common side effect of statin medications, but the cause is poorly understood. We characterized phosphocreatine (PCr) exercise recovery kinetics in 10 patients with hypercholesterolemia before and after a 4‐week regimen of statin therapy using 31‐phosphorus magnetic resonance spectroscopy (31P‐MRS). 31P spectra were obtained before, during, and after exercise on a calf flexion pedal ergometer. Creatine kinase (CK) serum levels were drawn before and after statin therapy. The mean metabolic recovery time constant in subjects increased from 28.1 s (SE = 6.5 s) to 55.4 s (SE = 7.4 s) after statin therapy. The unweighted mean of the pre/post‐recovery time difference was −27.3 s (SE = 12.4 s; P = 0.02). Pre‐ and post‐therapy CK levels were not significantly different (P = 0.50). Metabolic recovery time in the calf is prolonged in patients after statin use. This suggests that statins impair mitochondrial oxidative function, and 31P MRS is a potential study model for statin‐associated myopathy. Muscle Nerve, 2011

Factors and common conditions associated with adolescent dietary supplement use: an analysis of the National Health and Nutrition Examination Survey (NHANES)

BackgroundLittle is known about the prevalence of dietary supplement (DS) use in American adolescents. We conducted this study to analyze the prevalence of DS use and factors associated with this use in a national population-based sample.MethodsWe used data from the 1999 – 2002 National Health and Nutrition Examination Surveys (NHANES) for adolescents age 11 to 19. Using weighted logistic regression, we identified demographic and clinical factors associated with the use of any DS, vitamins or minerals, herbs and other DS.ResultsAmong the 5,306 responses representing approximately 36 million Americans 11–19 years old, 27% reported use of one or more DS in the prior month. The most commonly used DS were: multivitamins (16%) and vitamin C (6%). In the multivariable analysis, African American [adjusted odds ratio 0.40 (0.31–0.50) 95% CI] and Mexican American [0.55 (0.44–0.69)] adolescents were less likely to use DS compared with non-Hispanic whites. DS use was more common in those who used prescription medications [1.37 (1.10–1.72)] and among those who had a diagnosis of chronic headaches [1.25 (1.04–1.50)]. DS use was less common among those reporting fair or poor health status [0.59 (0.40–0.88)].ConclusionTwenty seven percent of American adolescents use DS. DS use is higher among teens that use prescription medications; physicians and pharmacists should be aware of this, ask patients, and check for potential interactions.

Simvastatin and vitamin D for migraine prevention: A randomized, controlled trial

The aim of this work was to assess efficacy and tolerability of simvastatin plus vitamin D for migraine prevention in adults with episodic migraine.

Sex and the migraine brain.

The brain responds differently to environmental and internal signals that relate to the stage of development of neural systems. While genetic and epigenetic factors contribute to a premorbid state, hormonal fluctuations in women may alter the set point of migraine. The cyclic surges of gonadal hormones may directly alter neuronal, glial and astrocyte function throughout the brain. Estrogen is mainly excitatory and progesterone inhibitory on brain neuronal systems. These changes contribute to the allostatic load of the migraine condition that most notably starts at puberty in girls.