s Calcium-Only Supplements may Cause Myocardial Infarction | I2P: Information to Pharmacists - Archive
Publication Date 01/08/2010         Volume. 2 No. 7   
Information to Pharmacists

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News Flash

Newslflash updates for August 2010

Neil Johnston

Regular updates from the global world of pharmacy.
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Feature Contribution

From Intern to Practising Pharmacist - PSA's New Vision

Neil Johnston

Practical experience is hard to acquire once you have finished your academic studies.
It is a process we all have to experience at one stage of our career.
The transition from being a student to a practising pharmacist can be a difficult time and unless early career pharmacists equip themselves for the new challenges they face, they may not be maximising their career opportunities.
It is also the type of program that could earn incentive payments for the workplaces providing the experience in the community.

Comments: 1

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Pharmacist prescribing in NZ flags other issues

Neil Johnston

The Pharmacy Council recently promoted a discussion document to encourage feedback from the health care environment on the impending legislative changes that are intended to provide the opportunity for pharmacists to prescribe.
The proposed legislation will enable suitably qualified postgraduate educated and skilled clinical pharmacists to prescribe from the drug tariff for patients under their care.
These pharmacists will have to work as part of a primary health care team and it is expected they will become an integral part of that team.
All very exciting for our profession to witness that there is a recognition that pharmacists are capable of stepping up to the mark and are worthy of greater responsibilities.

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Is a pharmacist in your team selection?

Neil Johnston

Pharma-Goss for August 2010
When selecting a team to participate in a primary health care review of the diagnosis and management of hypertension patient one would hope that a pharmacist would be a natural selection.
But in the case of a paper published recently in Australian Family Physician (http://www.racgp.org.au/afp/201007/201007howes.pdf) a pharmacist did not rate a mention in the panel set up to identify the problems associated with diagnosing hypertension and maintaining a dose that suited the needs of the patient with maximum adherence.

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Guild’s eRx clarification camouflages the facts!! Why hide the truth?

Neil Johnston

The thought that first struck me after reading ‘the clarification’ about the eRx Script Exchange on the editorial page of the May Issue of the Pulse+IT magazine was - Why is this clarification so necessary?
On the surface it seemed like a reasonable statement to make.
It read: “Clarification - in the March 2010 edition of Pulse+IT it was reported that the electronic prescribing service operated by eRx Script Exchange had received 7.5 million scripts "sent to the eRx script hub by prescribers" as of the middle of January.  
Omitted from the article was reference to a workflow that allows pharmacists to send repeat prescriptions to the hub for later retrieval by any pharmacist connected to the eRx system.
The volume of transactions quoted in the March 2010 article included such scripts, in addition to scripts sent to the hub directly by prescribers.”

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Guild Takes Aim at Gillard & Abbott Over 5TH CPA

Neil Johnston

In The Australian Friday 23 July (Political creed: do no harm) Emma Connors reported that “sometime in the next four weeks both Julia Gillard and Tony Abbott are likely to sign a letter promising their support to a group of 5000 small business owners whose public standing allows them to extract an extraordinary pledge.”
She reported that the Guild had “asked the leaders of  both sides of politics to agree that the terms of the recently enacted Fifth Community Pharmacy Agreement will be upheld, including the all-important promise to keep supermarkets out of pharmacy”.

Comments: 4

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The failure of Gollmann-Bouw: Are their products what our market wants?

Neil Johnston

Editor's Note - 15th November 2012:
When this article was first published in August 2010, Gollman-Bouw had entered into liquidation following a very turbulent period under the stewardship of Mark Bouw, managing director of the Australian enterprise.
Since that date the automated dispensing market has settled down and is now demonstrating steady and solid growth.
New people have entered into an agreement with German company Gollmann Systems and they have no relationship with any of the people associated with the former entity.
Many of the initial teething problems have been overcome and a better understanding of the Australian pharmacy market has emerged.
Gollmann Systems are globally competitive and contain innovations not seen in some of their competitors.
Any prospective purchaser should short-list this product when seeking a solution for their pharmacy.

Comments: 4

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Private Labels Finding Favour

Neil Johnston

Since the global financial crisis began to bite, Australians have shifted more of their weekly purchases into private label.
In respect of the $70 billion pa food market, private label currently accounts for 23%, with the prospect of moving to 30% within five years.

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Food as Medicine

Neil Johnston

Many foods have health giving and medicinal properties.
Indeed, i2P reports frequently in its Preventive Medicine section, regular discoveries where food can be used to support various health conditions.
For example, raw beetroot juice has recently been found to be effective in treating high blood pressure (it contains nitrates) and is as effective as some antihypertensive drugs. Cinnamon is another food that is useful for diabetics, where cinnamon appears to have effects similar to metformin i.e. it sensitises insulin.
Ayurvedic medicine, developed in India over centuries, encompasses the use of many delicious foods enhanced with herbs and spices.
Ayurveda is an ancient Indian healing system. The central philosophy is that illness is caused by an imbalance of the body's three vital energies, or 'doshas'. Ayurveda uses a range of treatments including yoga, massage, acupuncture and herbal medicine.
More information can be found at the Australian government site - HealthInsite. http://www.healthinsite.gov.au/topics/Ayurvedic_Medicine
For Ayurveda diet and health information that can get you started, try this site http://www.joyfulbelly.com

Comments: 2

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Hung Parliament Means Listen to the People

Neil Johnston

People involved in e-health are bitterly disappointed with the "hung parliament" result.
At least Labour had a vision with its national broadband roll-out, even if it wasn't properly articulated in regard to cost.
Some proponents argue that the cost matters little - it is the advantage given to Australians who want to be pioneers in e-health. Opportunities could be lost and they may be priceless.
i2P went looking for some informed comment on the subject and found some excellent commentary written by Paul Budde, a telecommunications analyst.
His commentary follows:

Comments: 1

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Scientists tap into Antarctic octopus venom

Neil Johnston

Researchers have collected venom from octopuses in Antarctica for the first time, significantly advancing our understanding of the properties of venom as a potential resource for drug-development.
The study, conducted by an international team of researchers from the University of Melbourne, the Norwegian University of Technology and Science and the University of Hamburg, provides the first insight into the properties of Antarctic octopus venom.
It has also revealed the existence of four new species of octopus.

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Peruvian plant offers hope for sex lives of diabetic women

Neil Johnston

The effects of diabetes on organs such as the heart, eyes and kidneys are relatively well known, but women are now being warned of its potential to cause damage in another way – to sexual performance.
Victoria University’s Professor Lily Stojanovska and Dr Michael Mathai are conducting a study to assess the potential for improving sexual function in women with type 2 diabetes by taking a supplement from a plant traditionally used for this purpose in Peru.
The root of the plant Maca (Lepidium meyenii), which grows in the Peruvian Andes, has been used by locals for centuries, where it is reported to enhance fertility and to boost energy levels.

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Clinical Training for Health Profesionals

Neil Johnston

Some years ago an Australian hospital pharmacist pioneered wound management in Australian hospitals and went on to develop courses to train community pharmacists interested in setting up a specialty wound management clinic in their pharmacy setting.
This type of service initially established itself in a restricted number of pharmacy settings, but gradually faded away due to the pressure of PBS dispensing.
Now the opportunity is reappearing in WA at Curtin University with a purpose built facility established to train all health students (including pharmacy).
And here is the dilemma.
Many pharmacists would like to be involved in this type of activity but most community pharmacies are not physically designed to accommodate this service.
However, with the future development of Primary Health Care Organisations (PHCO's) under way, it may be possible for pharmacists to be part of the wound management team in that type of organisation.
Nicola Roxon is contributing $380,000 towards the project and is expected to be operational within three months.

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New hope for cerebral palsy prevention

Neil Johnston

University of Adelaide researchers are a step closer to finding a link between genetic susceptibility to cerebral palsy and a range of environmental risk factors during pregnancy, including infections and pre-term delivery.
During National Cerebral Palsy Awareness Week (August 1-7), Professor Alastair MacLennan from the University's Robinson Institute says their research shows that pregnant women who are genetically susceptible to infections and other environmental hazards could trigger cerebral palsy in their unborn babies.

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UK Vending Machines Trialled

Neil Johnston

Prescription vending machines are being deployed in the UK Sainsbury pharmacy chain. This is being done in conjunction with the normal in-store pharmacy service,
and is being promoted as an additional service for those who would prefer it.
It is not an automated dispensing solution.

Comments: 2

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Research breakthrough on the question of life expectancy

Neil Johnston

Why do we grow old and what can we do to stop it? This is the question asked by many, but it appears that we are now closer to an answer thanks to new research published by Monash University researcher Dr Damian Dowling.
According to the research published in the August edition of the prestigious journal, The American Naturalist, a small set of genes in mitochondria (a membrane-enclosed organelle found in most eukaryotic cells), passed only from mothers to offspring, plays a more dynamic role in predicting life expectancies than ever previously anticipated.

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Liesel Wett - the new CEO for the PSA

Neil Johnston

In a shrewd management decision, the Board of the Pharmaceutical Society of Australia has announced the appointment of Liesel Wett as the organisation’s new Chief Executive Officer.
Ms Wett, who is currently Deputy Chief Executive Officer and Chief Operating Officer of the Australian General Practice Network, is expected to take up her appointment on 1 October 2010.
Given that the PSA will need to develop closer and stronger ties with GP organisations, this appointment may well prove to be critical for the future professional development of pharmacists.
Pharmacists will be enabled to get inside and understand GP thinking, guided by Liesel Wett.

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Inflammation in Fat Cells Causes Insulin Resistance

Neil Johnston

Inflammation-causing cells in fat tissue may explain the link between obesity and diabetes, a team of Walter and Eliza Hall Institute researchers has shown.
The discovery, by Professor Len Harrison and Dr John Wentworth from the institute’s Autoimmunity and Transplantation division, opens the way for new anti-inflammatory treatments that prevent insulin resistance (where the body is unable to respond to and use the insulin it produces) and other complications associated with obesity.

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Cost Price Prescriptions - The Next Step?

Neil Johnston

The UK has started a new phase in private prescription discounting – no mark up on the drug and 50% off the dispensing fee.
“Millions could be saved every year if private prescription mark ups are abandoned, according to the Superdrug superintendent pharmacist.
Superdrug will dispense all private prescriptions with no mark up on the cost of the medicine, the company announced this week (3 August 2010).
It is also halving its minimum charge for dispensing medicines to £2.25.”

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The country can't face the technological future through copper wire

Neil Johnston

An opinion provided by the University of Sydney
By Professors Ben Eggleton and David Moss

Those who think our country can do without the national broadband network clearly do not fully understand the potential such a network offers to Australians. While other countries scramble to find ways to meet this exploding demand for global bandwidth, the opposition is wringing its hands and debating the need.
The network will do three things for Australia: it will pay for itself, it will stimulate the innovation economy and it will have multiple applications.

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Garlic may play vital role in treating hypertension

Neil Johnston

A University of Adelaide study shows that aged garlic extract may help lower blood pressure in the 3.7 million Australians who suffer hypertension.
Research trials by Dr Karin Ried and her colleagues from the University's Discipline of General Practice show that garlic could be used as an adjunct to conventional drugs for hypertension.
However, raw or cooked garlic, and garlic powder are not as effective in treating high blood pressure as aged garlic extract.

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Solar Diesel Power Station - World First in WA

Neil Johnston

The world's first solar-diesel power station has opened in Western Australia's Pilbara region at Marble Bar, known for its record high temperatures.
WA's Mines and Petroleum Minister Norman Moore opened Horizon Power's Pippunyah Solar Diesel Power Station on Friday.
The new $34 million station is powered by the biggest sun-tracking solar panel farm in Australia.

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Complementary Medicines Surveyed

Neil Johnston

 Recently, a research report was published online in BMC Complementary and Alternative Medicine that highlighted Australian consumer attitudes towards complementary medicines and pharmacists selling complementary medicines.
An abstract is published below.
Consumers have indicated in earlier surveys that they wanted pharmacists to be the primary source of information for them and to keep a range of products that they could feel safe with.
The profession initially responded to those needs with the PGA setting up a College of Clinical Nutrition and many pharmacists (including this editor) completed the Advanced Diploma of Clinical Nutrition (Pharmacy).
Unfortunately, the college was closed and an alternative resource was never re-established.
People who did receive training in the use of nutritionals gained a new perspective in respect of practicing their profession and tended to work in the area of preventive medicine when an opportunity presented itself.
We have again asked Mark Coleman to comment on the survey and his report appears below the article abstract.

Comments: 12

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Calcium-Only Supplements may Cause Myocardial Infarction

Staff Writer

articles by this author...

Editing and Researching news and stories about global and local Pharmacy Issues

A recent New Zealand study relating to calcium supplements has been published in the British Medical Journal. The results suggest that for people over 40 years of age there is a 30% higher risk of myocardial infarction if they are taking straight calcium supplements in the 1000 mg range daily. The risk is identified and noted as a ”modest increase in the risk of myocardial infarction” by the researchers. However, pharmacists need to check if any of their cardiac patients are taking calcium supplements, and if so, what dosage and combination with other nutrients is being taken (if any). The following is an abstract of the study:

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Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis

Mark J Bolland, senior research fellow1, Alison Avenell, clinical senior lecturer2, John A Baron, professor3, Andrew Grey, associate professor1, Graeme S MacLennan, senior research fellow2, Greg D Gamble, research fellow1, Ian R Reid, professor1

1 Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92 019, Auckland 1142, New Zealand, 2 Health Services Research Unit, University of Aberdeen, 3 Department of Medicine, and Department of Community and Family Medicine, Dartmouth Medical School, NH, USA

Correspondence to: I R Reid i.reid@auckland.ac.nz

Abstract

Objective To investigate whether calcium supplements increase the risk of cardiovascular events.

Design Patient level and trial level meta-analyses.

Data sources Medline, Embase, and Cochrane Central Register of Controlled Trials (1966-March 2010), reference lists of meta-analyses of calcium supplements, and two clinical trial registries. Initial searches were carried out in November 2007, with electronic database searches repeated in March 2010.

Study selection Eligible studies were randomised, placebo controlled trials of calcium supplements (500 mg/day), with 100 or more participants of mean age more than 40 years and study duration more than one year. The lead authors of eligible trials supplied data. Cardiovascular outcomes were obtained from self reports, hospital admissions, and death certificates.

Results 15 trials were eligible for inclusion, five with patient level data (8151 participants, median follow-up 3.6 years, interquartile range 2.7-4.3 years) and 11 with trial level data (11 921 participants, mean duration 4.0 years). In the five studies contributing patient level data, 143 people allocated to calcium had a myocardial infarction compared with 111 allocated to placebo (hazard ratio 1.31, 95% confidence interval 1.02 to 1.67, P=0.035). Non-significant increases occurred in the incidence of stroke (1.20, 0.96 to 1.50, P=0.11), the composite end point of myocardial infarction, stroke, or sudden death (1.18, 1.00 to 1.39, P=0.057), and death (1.09, 0.96 to 1.23, P=0.18). The meta-analysis of trial level data showed similar results: 296 people had a myocardial infarction (166 allocated to calcium, 130 to placebo), with an increased incidence of myocardial infarction in those allocated to calcium (pooled relative risk 1.27, 95% confidence interval 1.01 to 1.59, P=0.038).

Conclusions Calcium supplements (without coadministered vitamin D) are associated with an increased risk of myocardial infarction. As calcium supplements are widely used these modest increases in risk of cardiovascular disease might translate into a large burden of disease in the population. A reassessment of the role of calcium supplements in the management of osteoporosis is warranted.


The Australian Self Medication Industry (ASMI) has responded with a statement that follows:

Calcium supplements and cardiovascular events

The Australian Self Medication Industry (ASMI), the industry body representing non-prescription consumer healthcare products said today that consumers should not be alarmed by recent media coverage linking calcium supplements with an increased risk of heart disease and should seek advice from their healthcare professional if they are concerned about their use of these products.

ASMI was responding to media coverage regarding the safety of calcium supplements following the publication of a recent article by Bolland et al in the British Medical Journal [1].
The article by Bolland suggested that the role of calcium supplements should be reassessed because they could increase a person’s risks of heart disease.

ASMI Regulatory and Scientific Affairs Director, Steven Scarff said that there was good evidence that calcium supplements reduced the risk of fractures and hence played a useful role in the treatment of osteoporosis [2, 3], and that the association with heart disease was controversial [4].

Mr Scarff also said that, in contrast to the Bolland study, other recent studies had failed to find a relationship between calcium supplements and increased cardiovascular risk [5, 6, 7] or had in fact ruled out such a relationship [8].

Mr Scarff said that consumers should continue to aim for the recommended daily calcium intake of 1000-1300mg/day (depending on their age and sex [9]) and that they should do this through eating a healthy diet or from supplements where their dietary intake was inadequate.

References

[1] Bolland MJ, Avenell A, Baron JA, Grey A, Maclennan GS, Gamble GD, Reid IR. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ. 2010 Jul 29;341:c3691. doi: 10.1136/bmj.c3691.

[2] Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet. 2007 Aug 25;370(9588):657-66.

[3] Osteoporosis Australia web-site. Calcium Supplements and heart Disease. www.osteoporosis.org.au

[4] Gustavo Duque, Jacqueline J Close, Julien P de Jager, Peter R Ebeling, Charles Inderjeeth, Stephen Lord, Andrew J McLachlan, Ian R Reid, Bruce R Troen and Philip N Sambrook. Treatment for osteoporosis in Australian residential aged care facilities: consensus recommendations for fracture prevention. MJA 2010; 193 (3): 173-179

[5] Chung M, Balk EM, Brendel M, Ip S, Lau J, Lee J, Lichtenstein A, Patel K, Raman G, Tatsioni A, Terasawa T, Trikalinos TA. Vitamin D and calcium: a systematic review of health outcomes, Evid Rep Technol Assess (Full Rep). 2009 Aug;(183):1-420. Review.

[6]Wang L, Manson JE, Song Y, Sesso HD. Systematic review: Vitamin D and calcium supplementation in prevention of cardiovascular events. Ann Intern Med. 2010 Mar 2;152(5):315-23. Review.

[7] Sabbagh Z, Vatanparast H. Is calcium supplementation a risk factor for cardiovascular diseases in older women? Nutr Rev. 2009 Feb;67(2):105-8.

[8] Lewis JR, Calver J, Zhu K, Flicker L, Prince RL. Calcium supplementation and the risks of atherosclerotic vascular disease in older women: results of a 5-year RCT and a 4.5-year follow-up. J Bone Miner Res. 2010 Jul 7. [Epub ahead of print]

[9] Australian Government, DOHA, NHMRC Recommended Dietary Intakes

i2P staff researchers performed a quick literature search to identify any further information that could support any recommendations made by pharmacists to their patients.

* New Zealand scientists analyzed 11 studies of nearly 12,000 people. They found that people over 40 who took high-dose calcium pills had a 30 percent higher risk of a heart attack than those who didn't. Some changes should be recommended here.

* Eating calcium-rich foods like cheese and milk did not raise risk, according to their study in the British Medical Journal in July. In fact, various studies have shown people who ate the most calcium-rich foods had the lowest risks of heart disease.

* A Korean study found that women who took in less calcium had a higher risk of metabolic syndrome, a risk for heart disease. So calcium-only supplements, not calcium-rich foods, might be the problem.

* The New Zealand researchers state it's not worth the risk to take calcium-only tablets, containing 500 milligrams of calcium or more, as they reduce the risk of broken bones by only 10 percent. Meanwhile, calcium-only supplements raise blood calcium levels, which may cause calcium deposits in the arteries and veins. Supplement combinations with Vitamin D3 and Vitamin K2 would be safer and could virtually eliminate risk.

* The New Zealanders excluded people who used calcium combined with vitamin D3 and other nutrients. That's ironic, because many physicians don't recommend calcium alone anymore--it's long been recommended with vitamin D3.

* The New Zealand research did not apply to multivitamin-mineral combinations.
That's because most daily supplements contain very little calcium, usually 200 milligrams or less. So there's no need to throw out the multivitamins.

* Taking vitamin D with calcium seems to be safe for the heart. Recent studies involving the use of CT scans to measure hardening of the arteries (in women aged 50 to 59) as well as coronary artery calcium have confirmed very low or nil risk.
Scientists followed about 750 women over seven years. Half the women took 1,000 milligrams of calcium and 400 units of vitamin D every day, while the other half took no supplements. Scientists found no difference in the arteries of the two groups.
The study was published in the journal Menopause.

* There is some evidence that adequate vitamin K2, magnesium and several B vitamins, also affect how efficiently calcium can be used. Vitamin K2 may help direct calcium to the bones, away from the arteries. Vitamin K2 is found in leafy green vegetables and foods such as natto or curd cheeses.
While natto is the most potent natural source of vitamin K2, the nutrient is also readily available in fermented dairy products, especially cheeses.
Most cheeses are rich in vitamin K2… particularly, curd cheese. And even though it’s not as high in vitamin K2 as natto, curd cheese may be more palatable on a day-to-day basis for many people.
Raw curd cheese made from grass fed cows would be best.

* Physical activity has been proven to improve bone strength, so exercise should always be recommended even if calcium intake is sufficient.

* There is universal agreement that everyone needs calcium in their diet.
Current recommendations are 1,000 milligrams daily for adults under 50.
Older adults are advised to get more (around 1,200 milligrams daily).
People who eat less salt, protein and caffeine may not need as high a calcium intake as those who do.

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