Health Topics – Johns Hopkins Medicine Podcasts

Men who used statins were much more likely to develop diabetes than men who were otherwise very similar but weren’t taking the cholesterol-lowering drug, a study of a large number of veterans shows. Rita Kalyani, a diabetes expert at Johns Hopkins, explains.

Kalyani: They were looking back to see of those who developed diabetes in a certain period of time, how many of those had used statins in the past versus those who hadn’t. What they found was that people who used statins were much more likely to develop diabetes that those who didn’t and this is not a new finding. It adds to the evidence base of the potential link between statins and progression of diabetes. It is generally felt that cardiovascular risk reduction far outweighs the potential increase in glucose that may occur with use of statins.  :32

Kalyani says anyone who is currently taking statins and is concerned about their own diabetes risk should talk with their doctor about how to lower that risk. At Johns Hopkins, I’m Elizabeth Tracey.

Weight loss ought to be the cornerstone of treatment for newly diagnosed type 2 diabetes, a recent study concludes. Rita Kalyani, a diabetes expert at Johns Hopkins, says such a strategy might be best employed in preventing the disease to begin with.

Kalyani: Prevention of obesity is a key modifiable risk factor for the development of prediabetes and diabetes. Perhaps something that we don’t monitor as often as we should is central adiposity, which is usually measured by waist circumference. Waist circumference should probably be measured more commonly in order to better assess those people who might be at highest risk. The way that we assess obesity needs to be better defined. The advantage to waist circumference is that there are well defined ethnic specific cutoffs for both men and women from the World Health Organization.  :33

Kalyani says you can ask for your waist circumference to be measured if your doctor doesn’t do so. At Johns Hopkins, I’m Elizabeth Tracey.

A drug that causes fat to be metabolized, and in particular around organs like the heart where fat is especially dangerous, has been shown to work well in male mice, research by David Kass, a cardiologist at Johns Hopkins, and colleagues has shown.

Kass: An oral med. It’s been used already in people. There are a couple of large pharmaceutical companies that are developing PD9 inhibitors, almost entirely for neurocognitive diseases. We have side effect profile already and it’s pretty benign. There was no significant adverse effect signature of this oral molecule.  :17

Kass says only male mice and females without ovaries benefit however.

Kass: There’s a pretty striking sex dimorphism. It worked in males. It doesn’t work in intact female mice at all, but you take their ovaries out it works as well if not even better than the males.  :13

Kass notes that the drug has already been used in people so it may be a short step to clinical trials. At Johns Hopkins, I’m Elizabeth Tracey.

A type of mouse used to study obesity and heart problems has demonstrated the efficacy of an existing medicine to help them lose weight, and in the places where it matters most, around organs like the heart. That’s according to new research by David Kass, a cardiologist at Johns Hopkins, and colleagues.

Kass: The difference in body weight between the two groups was 27%. There were many more mice in the treatment arm that actually lost weight. The placebo arm most of the mice gained weight, the relative difference was substantial. And then we did scans and showed that yup this is total body fat. That’s what disappeared, that’s where the weight is going. Lean mass wasn’t changed, and what makes this particularly attractive is that this happened without any change in activity, without any change in food intake. They ate just as much.  :29

Kass says this medication was originally developed as a potential treatment for Alzheimer’s disease so it has already been used in people. At Johns Hopkins, I’m Elizabeth Tracey.

Many women being treated with chemotherapy for breast cancer report ‘brain fog,’ or cognition issues. Now a new study examines whether exercise can help reduce or even eliminate this side effect of treatment. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, explains.

Nelson: When it came to exercise itself and to cognitive issues it was all impacted. So if you look at the immediate end of chemotherapy, the amount of physical activity was less, the cognitive decline was maximal at that point. And that the physical activity and the cognitive decline had largely, although not completely, had largely recovered by six months later. And then they went to look at the women who had the higher levels of physical activity and they seemed to be impacted less at each of the time points.  :30

Nelson says it’s also known that regular exercise can reduce a woman’s chance of developing breast cancer at all. At Johns Hopkins, I’m Elizabeth Tracey.

It stands to reason that people with cancer might be more susceptible to developing severe Covid-19 disease, and now a new analysis confirms it. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the data.

Nelson: It does encompass 18500 subjects with cancer and Covid-19 diagnoses. The 30 day mortality ranged from 13% to 50-60%. Age, gender and comorbidity they all made a difference. The groups that did particularly poorly with cancer were folks with thoracic cancers. The other are hematologic cancers, particularly things like multiple myeloma, and melanoma. And the final group of course are folks undergoing bone marrow transplantation.  :30

Nelson says people with cancer should be sure to get fully vaccinated, received boosters, and use masks. They should also consider limiting their exposure to people they know are also vaccinated while avoiding large groups. At Johns Hopkins, I’m Elizabeth Tracey.

The United States Preventive Services Task Force, or USPSTF, recently issued new guidelines on who should be screened for lung cancer. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the impact.

Nelson: What this study did is it used real world data. What they found was that rather that 34 and a half thousand that would have been eligible in 2013 an additional 18 and a half thousand would be eligible under the 2021 guidelines. What is most interesting is by the new guidelines with additional people being eligible for screening, you had more women who become eligible, and more minorities including Asians, Hispanics, and African Americans.  :29

The study found that an additional 30% of lung cancers were identified at an early stage, and in people who were younger and had fewer other illnesses. Nelson says this improves their chances of long term survival. At Johns Hopkins, I’m Elizabeth Tracey.

If you’re one of the vast number of people who are experiencing mental illness, a new book by Johns Hopkins psychiatrist Meg Chisholm may help. The title of the book is “From Survive to Thrive, Living Your Best Life With Mental Illness,” and Chisholm says it relies on a concept of flourishing in life to improve mental health over the long term.

Chisholm: The first step is getting the acute symptoms under control. Once the acute symptoms are under control where do we go from here? And I think a lot of people stop at just getting the acute symptoms under control, which doesn’t bode well in the long run for staying well. If you don’t have a lot of meaning and purpose in your life why would you continue taking your antidepressant? There’s so much more to life than just being disease free. Doctors traditionally haven’t asked about these aspects of a person’s life and they haven’t seen them as relevant to their health.  :33

Chisholm says people need to advocate for themselves to integrate flourishing into their treatment plan. At Johns Hopkins, I’m Elizabeth Tracey.

Mental health problems have spiked during the Covid-19 pandemic, and a new book by Johns Hopkins psychiatrist Meg Chisholm may help. Called “From Survive to Thrive, Living Your Best Life With Mental Illness,” the book aims to go beyond simply managing symptoms.

Chisholm: What the components are of a good life, what most people mean when they say that they’re leading their best life possible.  And that is happiness, life satisfaction, physical and mental health, close social relationships, character and virtue, and meaning and purpose, as well as financial and material security and stability. From these big epidemiologic longitudinal datasets, there seems to be a causal link between these four pathways and these outcomes of a flourishing life. And those are family, work, education and community.    :33

Chisholm says these must be integral to any plan for managing mental illness and moving beyond it. At Johns Hopkins, I’m Elizabeth Tracey.

For the majority of people with type 2 diabetes, weight loss of 15% of their body weight should be first among therapies to manage the condition, a recent study concludes. Rita Kalyani, a diabetes expert at Johns Hopkins, comments.

Kalyani: It’s not new to focus on obesity as a cornerstone of management in type 2 diabetes. The degree of weight loss they’re suggesting of 15% or more is what we usually see after bariatric surgery. It’s always been a challenge to maintain that degree of weight loss over time. Now that we have newer agents in the GLP1 agonist class that are given once weekly and at higher doses have been found to attain 15% or more weight loss in a substantial proportion of patients, now we have medical options.  :34

Kalyani says other medical options are also on the horizon and says that when weight loss of this magnitude is achieved, many of the abnormalities seen in type 2 diabetes disappear. At Johns Hopkins, I’m Elizabeth Tracey.