Cardiovascular effects of cannabis (marijuana): A timely update.

Cannabis (medical marijuana) is generally considered a low toxicity drug. The plant belongs to the family Cannabaceae (Urticales). Two main species may be recognized: Cannabis sativa and Cannabis indica. Plants of this species contain many psychoactive components, the cannabinoids, including the primary psychoactive compound Δ-9-tetrahydrocannabinol (THC), the active substance present in Marijuana. The history of its cultivation and use dates back thousands of years. A possible first documented use for medical purposes of this drug is found in Chinese records dated from 28th century BC. Moreover, the presence of THC has been detected in several internal organs from an Egyptian mummy with a 14 C-dating of approximately 950 BC. Evidence of therapeutic potential for marijuana and its components has been suggested for a large number of medical conditions. Despite this, a variety of cardiovascular complications have been documented. Dysregulation of the endogenous lipid mediators endocannabinoids and their G-protein-coupled cannabinoid receptors CB1 and CB2 has been, in fact, linked to different cardiovascular pathologies. Here, we describe a timely update of possible cardiovascular effects of its use for medical purposes.

Reducing Hemoglobin A1C Levels in Type II Diabetes: A Retrospective Analysis of the Renew Procedure.

INTRODUCTION: Periodontal disease and type 2 diabetes are interrelated, with inflammation playing a significant role in the progression of both conditions. Previous research has demonstrated the potential of various treatments, such as diet, exercise, and periodontal therapies, to improve glycemic control in diabetic patients. METHOD: This study proposed a novel surgical approach, the Renew Procedure, as a potential solution to enhance glycemic control in type 2 diabetic patients with periodontal issues. The procedure involves the removal of all teeth, the elimination of oral and maxillofacial infections, the placement of dental implants, and the provision of implant-supported and implant-retained removable dentures. RESULTS: Preliminary findings indicated a significant reduction in HbA1c levels post-surgery, suggesting that this approach may improve overall oral health, reduce inflammation, and consequently lower HbA1c levels. CONCLUSION: Further research is necessary to confirm the efficacy of the proposed solution, but these initial results highlight the importance of addressing oral health through comprehensive strategies for diabetic and periodontitis patients.

The Use of Romhilt-Estes Criteria in the Presumptive Electrocardiographic Diagnosis of Left Ventricular Hypertrophy in Comparison to Voltage-Based Criteria.

Background The ECG diagnosis of left ventricular hypertrophy (LVH) has been challenging for over a hundred years. ECG diagnosis of LVH has shown good specificity but lacks sensitivity. In addition, voltage-based criteria can be affected by multiple conditions such as obesity and chronic lung disease. Therefore, we sought to compare Romhilt-Estes (R-E) criteria with commonly used voltage-based criteria in presumptive ECG diagnosis of LVH.  Methods This is a retrospective electronic medical record study from September 1, 2017, to September 1, 2018, of 499 consecutive ECGs from Boca Raton Regional Hospital. Different ECG criteria were used to identify the presence of LVH, including the Cornell criteria, modified Cornell criteria, Sokolow-Lyon criteria, and Romhilt-Estes criteria. The main study outcome was to compare the R-E criteria in presumptive ECG diagnosis of LVH to the voltage-based criteria (Cornell, modified Cornell, and Sokolow-Lyon).  Results After analyzing the ECGs using the different ECG criteria, R-E criteria were positive with LVH present (score ≥ 5 points) in 162 patients. In contrast, Cornell criteria were positive in 42 patients (8.4%), modified Cornell criteria in 50 patients (10%), and Sokolow-Lyon criteria in 13 patients (2.6%). In addition, R-E criteria showed higher positivity of LVH diagnosis compared to the sum of three voltage-based criteria (32.7% versus 21% respectively, p<0.001). Conclusion We presume that R-E criteria can help better diagnose LVH by ECG compared to other commonly-used voltage-based criteria. However, further studies are needed using confirmatory imaging to confirm the accuracy of R-E criteria and compare it with other voltage based-criteria.

Red Yeast Rice.

Red yeast rice (RYR), produced by the fermentation of the Monascus purpureus mold, has been used for a long time in Asian cuisine and traditional medicine. It consists of multiple bioactive substances, including monacolins, which potentially can be used as a nutraceutical. Monacolin K, which is chemically identical to lovastatin, has been recognized as responsible for the cholesterolreducing effect of this compound. While the European Food Safety Authority maintains that the use of monacolin K from RYR preparations of at least 10 mg can produce a normal blood cholesterol level, the United States Food and Drug Administration considers monacolin K, due to its similarity with lovastatin, an unapproved drug, and therefore marketing of products that label the monacolin content is prohibited. This mini-review summarizes the benefit of RYR in hyperlipidemia, maintains RYR use as a food, and addresses the importance of regulation regarding RYR and the need for clinical data and clear label information for consumers with reference to a toxin-free, nonaugmented, standardized amount of monacolins.

A multicenter study of nutraceutical drinks for cholesterol (evaluating effectiveness and tolerability).

BACKGROUND: We hypothesized that a nutraceutical formulation containing small amounts of bioactive constituents that exert cholesterol-lowering effects by different mechanisms may exhibit synergistic efficacy with a clean tolerability profile. The purpose of this study was to evaluate nutraceutical fruit-flavored drinks with and without red yeast rice (RYR) for effects on low-density lipoprotein (LDL) and total cholesterol. METHODS: In double-blinded fashion, 79 subjects were randomized to one of three fruit-flavored drinks, ie, a placebo, and two active drinks containing niacin, phytosterol esters, L-carnitine, vitamin C, and Co-Q-10, one with and without RYR, twice daily. Primary end points were LDL and total cholesterol percent reductions from baseline. Secondary end points were high-density lipoprotein and C-reactive protein percent change from baseline. Physician contact and laboratory work were obtained at baseline, 4 weeks, and 8 weeks of subject participation. RESULTS: A total of 59 subjects completed the study. The placebo group and the group receiving the nutraceuticals without RYR showed no change in primary or secondary end points. The nutraceutical drink with RYR reduced total cholesterol at week 4 by 13% (-35 mg/dL) and week 8 by 14% (-46 mg/dL). LDL cholesterol decreased 17.1% at 4 weeks (-28 mg/dL) and 17.8% at week 8 (-30 mg/dL). In the effective drink arm containing nutraceuticals and RYR there were no biochemical or subjective intolerance, with the exception of one subject who experienced headache. CONCLUSIONS: A nutraceutical drink with RYR can be a safe and effective natural alternative to pharmacologic therapies for people intolerant to or refusing statins but still in need of achieving and maintaining a healthy and low cholesterol level.