EDITOR & PUBLISHER: LAWRENCE SEGEL MD

LAWRENCE SEGEL 2012

LIFE LINE
Volume 8 Issue 8 November 2012
does have its negative implications. Given, the increasing use of CT, and the practice of defensive medicine, we can expect to see an increase in cancer claims in the future with diagnostic radiation as their underlying culprit. All things being equal, an MRI is a safer radiation alternative, if available. calcification? A German study looked at 24,000 participants with respect to calcium in both diet and supplements, and the effect on CVS events/mortality (Heart 2012;98: 920). After an average follow-up of 11 years, dietary calcium did not seem to increase the risk of events or mortality. However, patients with supplementary calcium had a 1.86X risk of MI, but no increase in cardiovascular mortality. Underwriting Tips: This is another study that suggests supplemental calcium (not dietary) increases the risk for cardiac events. Perhaps, the absorption for supplements is much quicker leading to higher

RADIATION AND CANCER

Diagnostic imaging use has been rising over the years. Hence, more patients are being exposed to ionizing radiation. Researchers looked at data from six U.S. healthcare systems that enrolled 1 to 2 million people over 1996-2010 (JAMA 2012;307: 2400). Use of plain x-rays only rose 1% annually from 1996-2010, but CT use rose 8%, MRI 10%, and PET 57%. Per capita, radiation exposure nearly doubled with CT accounting for most of the increase. Underwriting Tips: Radiation exposure at current rates has been predicted to account for 2% of future cancer cases, but editorialists think this may be an underestimation, if use continues to increase. Diagnosing disease with radiation delivering tools

CALCIUM SUPPLEMENT AND CAD

Calcium supplements are widely used to help prevent osteopenia and osteoporosis, especially in older women. But, do they have a deleterious effect by promoting vascular

Inside This Issue 1 RADIATION AND CANCER 2 CALCIUM SUPPLEMENTS 3 ALZHEIMERS AND CANCER RISK 4 QUESTION LIFE LINE 5

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levels and deposition in vessel walls. Benefit should clearly outweigh risk in those who decide to use them. interest worrying about cancer, anyway. And, if you have cancer, is it any better knowing you have a much better chance of remembering it in old age? Still, it is an interesting inverse association, none the less.

LIFE LINE
Generally, I do not allow myocardial infarcts better than Group 2. However, there are exceptions where I have allowed Group 1. These scenarios might show a cath w/o obstructive CAD or stress testing that does not show perfusion defects or wall motion abnormalities, and we can infer the MI must have been very small.
Schematic of Inferior MI

ALZHEIMERS AND CANCER

There is some evidence that people with Alzheimers disease have a lower risk of cancer, and vice versa (cancer survivors have a lower risk of Alzheimers). Researchers looked at data from 1,278 Framingham participants w/o Alzheimers at baseline who were cancer survivors with mean followup of 10 years (BMJ 2012;344: 1442). Analysis was adjusted for age, sex, and smoking status. Risk of Alzheimers was significantly lower for any cancer survivor (HR 0.67) including smoking related cancers (HR 0.26). And, vice versa! Participants who developed Alzheimers had lower rates of any cancer (HR 0.29), and smoking related cancer (HR 0.21). Underwriting Tip: Yikes so one way to lower your cancer risk is to have Alzheimers disease, and a way to lower your dementia risk is to get cancer! Not, exactly appetizing choices. Also, I dont see a way it alters clinical practice. If you have such a life limiting disease as Alzheimers, theres not a great deal of

QUESTION LIFE LINE

Question: I have a 62 year old male applicant who had an inferior MI in 2008. His cath showed an RCA obstruction that was stented. His recent 2011 perfusion showed a small inferior perfusion defect, EF 60%, and no ischemia. I am confused about what baseline CAD group I should use since he is 1 vessel disease with good EF, but he did have a documented MI. Answer: If you look in the MUM description that we use to help slot our CAD group ratings, you will see inferior MI under Group 2. His history also co-relates well with the perfusion results (and Group 2).