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Dr Linda Calabresi
Dr Linda Calabresi
Dr Linda Calabresi

It’s been a tough week for GPs who want to march to the beat of their own drum with regard to COVID.

Dr Linda Calabresi

Overactive bladder affects up to 30% of adult women and yet, very often, the condition goes undiagnosed and untreated despite its potential to significantly affect quality of life.

Fiona Clark

Recurrent UTIs can have a profound effect on quality of life, but they aren’t that well understood, Urogynaecologist, Obstetrician and Gynaecologist Dr James Alexander said in a recent Healthed podcast.

Lynnette Hoffman

Half of patients with MCI develop dementia within five years — Here’s how we can help change that trajectory...

Emma Henshall

Vascular surgeon gives tips for the ideal workup in GP.

Clinical A/Prof David Horgan

Psychiatrist and Clinical Associate Professor David Horgan answers GPs questions, from how to safely combine an antidepressant, to finding the maximum dose and more.

Lynnette Hoffman

Evidence-based assessment and management is crucial, despite what they say on TikTok...

Dr Linda Calabresi

Glucosamine’s effectiveness in treating arthritis remains controversial, however a study suggesting that the supplement, when taken regularly, will help prevent heart attacks certainly adds to its appeal. According to findings from a large prospective study just published in The BMJ, habitual glucosamine use is associated with a 15% lower risk of cardiovascular events. Breaking that down a bit further, it appears regular glucosamine lowered the risk of dying from a cardiovascular event by 22%, lowered the risk of coronary heart disease by 18% and lowered the risk of stroke by 9%. All statistically significant results. The research involved over 440,000 people from the UK biobank who didn’t have cardiovascular disease at the outset. Courtesy of an initial questionnaire, researchers knew who was taking glucosamine and how often. Interestingly about 20% of the cohort, reported they took the non-vitamin, non-mineral supplement daily – a figure the researchers said was representative in other adult populations around the world – including Australia. The cohort was then followed for a median of seven years. Over this time there were over 10,000 CVD events including heart attacks and strokes, with over 3,000 of these resulting in death. Even though the study was basically observational, the size of the sample strengthens its value. As does the fact that the researchers obtained a wealth of information about the patient’s diet, medical history and lifestyle at the initial questionnaire, which was all utilised in the final analysis. Consequently the 15% lower risk of a cardiovascular event associated with taking glucosamine can’t be easily written off as caused by another confounder. The researchers were able to conclude the association was “independent of traditional risk factors, including sex, age, income, body mass index, physical activity, healthy diet, alcohol intake, smoking status, diabetes, hypertension, high cholesterol, arthritis, drug use, and other supplement use.” So how does it work? How does glucosamine positively affect the cardiovascular system? According to the study authors, there are a number of plausible mechanisms that could explain the link. One relates to the anti-inflammatory properties of glucosamine. There already exists evidence that regular glucosamine reduces CRP levels, a marker of systemic inflammation. Another theory relates to how glucosamine affects metabolism. “[A] previous study found that glucosamine could mimic a low carbohydrate diet by decreasing glycolysis and increasing amino acid catabolism in mice; therefore, glucosamine has been treated as an energy restriction mimetic agent,” they said. But while the study findings appear very exciting, the study authors themselves suggest caution, claiming their study had some limitations. Among these limitations was the fact that details about the dose, duration of use, type of glucosamine supplement was not recorded. Obviously further research is needed to test this association. Nonetheless, the trial is destined to fuel on-going interest in the supplement, albeit for a totally different condition from the one we’re used to.  

References:

Ma H, Li X, Sun D, Zhou T, Ley SH, Gustat J, et al. Association of habitual glucosamine use with risk of cardiovascular disease: prospective study in UK Biobank. BMJ. 2019 May 14; 365: l1628. DOI: 10.1136/bmj.l1628
Dr Linda Calabresi

Hormone replacement therapy has recently hit the headlines again and not in a good way. A research paper published in The Lancet reignited the controversy by again highlighting an association between hormone therapy and breast cancer. While the experts have been quick in their response, pointing out the numerous limitations of the study and the researchers’ conclusions, it is still more than likely GPs will again be grilled about the latest evidence with regard to this treatment. It’s an area of medicine that certainly has been heavily scrutinised over the past couple of decades and as such it is important GPs have ready access to the latest guidelines to best practice. Here is a great little resource that fits the bill perfectly.

Dr Linda Calabresi

Vaginismus is a surprisingly common condition, but women often fail to seek help because of embarrassment and sometimes shame, says sex and relationship expert Dr Rosie King, and the distress it causes should not be underestimated.