The Latest on Drug Safety Labeling: Naproxen & Saxagliptin

The FDA has insisted naproxen back down from claims that it is safer than other NSAIDs. It is also investigating possible heart failure risk with the diabetes drug saxagliptin.
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Study Finds No Advantage to Annual Mammography

Canadian researchers found that the widely-promoted procedure was ineffective at reducing mortality outcomes in women under age 60.
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Children Receive Well Over RDA for Most Vitamins

On average, supplements contained more than the recommended daily allowance of every vitamin except D and choline.
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Keep Achilles Pain from Nipping at Your Heels

One of the best ways to prevent Achilles tendinitis is by building limber lower legs apart from the distance run itself.
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10 Lesser Known Training Principles

Beyond the most common concepts that form the basis of our training are equally important, lesser known ideas worth keeping in mind as you pursue improved athletic performance.
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To Curb Appetite, Study its Very Origins

New research moves us closer to a complete picture of appetite regulation.
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The Clinic

Avoid Running with a Foot Drop
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Knee Pain from Nowhere
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Cramping and Nausea During Ironman Events
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Spike in Sugar Level Only After Intense Workouts
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The Back Page

Winter Track: Finding a facility “Indoors”

AMAA BOSTON 2014 – Our All-Star Lineup

Seen and Heard while Running this Winter (go to articles)

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BP Data Over Many Years Predicts Arterial Hardening

High blood pressure has been long understood to be an important indicator of heart disease risk. What is known as  “mid-blood pressure,” which is calculated as systolic and diastolic readings added and divided by two, is considered an important marker of coronary heart disease risk among younger populations in particular. But until now, single blood pressure measures were the most widely used—long-term blood pressure patterns and their effect on cardiovascular disease risk were poorly characterized. And just how important blood pressure levels over multiple decades are to arterial health may surprise you.

Atherosclerosis, the disease in which plaque builds up inside the arteries, is a complex process that starts when fatty substances, calcium, cholesterol and cellular waste build up in the wall of an artery. It's no surprise that this increases blood pressure; further still, many researchers think that high blood pressure itself could be a cause of arterial-lining damage that may initiate the build-up. The other two widely understood sources of damage to this innermost layer of the artery (the endothelium) are cigarette smoking and elevated blood levels of triglycerides and cholesterol. As plaque hardens over time, not only is blood pressure further elevated but oxygen carried in the blood often reaches organs in limited amounts. If a piece of the plaque breaks off or a blood clot forms on the plaque's surface, a whole artery can become blocked, very possibly resulting in a heart attack or stroke.

A new JAMA study reports that long-term patterns in blood pressure beginning in young adulthood are helping to identify patients at risk for developing coronary artery calcium. The researchers studied 3,500 adults from four urban U.S. sites, aged 18 to 30 at baseline, who had multiple blood pressure measurements over the next 25 years. At the end of follow-up, participants had a CT scan to measure their coronary artery calcium score. A score of 100 or greater was considered to be evidence of subclinical atherosclerosis.

The prospective cohort blood pressure data came from examining systolic, diastolic and mid-blood pressure at baseline and years 2, 5, 7, 10, 15, 20 and 25. Compared with patients who had low blood pressure throughout the study, those who had relatively elevated blood pressure throughout the study had 2.5 times the risk for atherosclerosis, and those with high blood pressure throughout the study had a 4-fold increase in risk.

The study notes that blood pressure trajectories throughout young adulthood vary, and “higher BP trajectories were associated with an increased risk of CAC in middle age. Long-term trajectories in BP may assist in more accurate identification of individuals with subclinical atherosclerosis.”

At two-and-a-half times increased risk, the data on people without hypertension is startling. Most participants with “elevated blood pressure” did not meet the definition for actual hypertension, but fell within the range of prehypertension. This underscores the importance of blood pressure monitoring in general and of never ignoring a diagnosis of prehypertension, which is defined as blood pressure between 120/80 mm Hg and 139/89 mm Hg.

JAMA, 2014, Vol. 311, No. 5, pp. 490-497,

National Heart, Lung, and Blood Institute, NIH,

AHA, Atherosclerosis,

Examining Acetaminophen's “Safe” Role in Pain Relief

Acetaminophen (e.g., Excedrin, Tylenol) is found in numerous prescription and o-t-c products designed to treat pain and reduce fever. Acetaminophen is easier on the stomach than aspirin and other NSAIDs, and has been touted as a good option for people who take an anticoagulant (e.g., warfarin, clopidogrel). But because it is so widely used and perceived as safe, people tend to take it without thinking. The FDA has decided to weigh in on the matter, strongly recommending that doctors limit the maximum dose per tablet to 325 mg. Their concerns are not unwarranted: acetaminophen is a leading cause of liver failure in the U.S.

Recall that ibuprofen (e.g., Advil, Motrin) treats fever and pain too but, as an NSAID, also reduces the inflammatory response. Because it thins the blood the same way aspirin does, it's not surprising that the most common side effect of ibuprofen use is GI damage. A study in Medicine & Science in Sports & Exercise found that ibuprofen aggravates exercise-induced small intestinal injury and induces gut barrier dysfunction in otherwise healthy athletes. The authors concluded that NSAID consumption by athletes “is not harmless and should be discouraged.”

If you have some form of cardiovascular disease, it might make sense to occasionally take acetaminophen rather than an NSAID for a fever, headache or pulled muscle. Many runners use NSAIDs more than they need to or should. While NSAIDs do reduce pain and muscle soreness, there is evidence that they also prevent “good inflammation” and can be hard on the system with prolonged use.

Blood pressure is not unaffected
A small Swiss trial reported on not long ago in this publication warned that acetaminophen—though primarily an analgesic and lacking in anti-inflammatory properties—can nevertheless still behave very much like NSAIDs, somehow affecting the cardiovascular system. In the study, 33 men and women with cardiovascular disease (typical candidates for the drug over an NSAID) took a standard daily dose of 1,000 mg of acetaminophen or an identical placebo for two weeks. After a two-week break, each volunteer took the other treatment.

Average systolic blood pressure increased from 122.4 to 125.3 mmHg when patients were on the acetaminophen regimen, and average diastolic pressure increased from 73.2 to 75.4 mmHg. Blood pressure stayed steady when participants took the placebo. Though these increases aren’t enormous, they indicate that acetaminophen raises blood pressure too.

editorial board

Kenneth Cooper, MD
Kevin Beck
Jack Daniels, PhD
Randy Eichner, MD
Mary Jo Feeney, MS, RD
Mitchell Goldflies, MD
Paul Kiell, MD
Sarah Harding Laidlaw, MS, RD
Paul Langer, DPM
Douglas Lentz, CSCS
Todd Miller, MD
Gabe Mirkin, MD
Col Francis O’Connor, MD
Stephen Perle, DC, CCSP
Pete Pfitzinger, MS
Charles L. Schulman, MD
Bruce Wilk, PT, OCS
Mel Williams, PhD
Michael Yessis, PhD
Jeff Venables, Editor

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Charles L. Schulman, MD, AMAA Pres.
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Gayle Barron
Sue Golden
Senator Bill Frist, MD
Jeff Galloway
Jeff Harbison
Ronald M. Lawrence, MD, PhD
Jeff Moore
Noel D. Nequin, MD
David Pattillo

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