Podcasts about Spironolactone

Episode 212: Managing HFpEFHyo Mun and Jordan Redden (medical students) explain how to manage HFpEF with medications and touch some basics about nonpharmacologic treatments. Dr. Arreaza asks insightful questions to guide the discussion. Written by Hyo Mun, MSIV, American University of the Caribbean; and Jordan Redden, MSIV, Ross University School of Medicine. Comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Treatment of HFpEFArreaza: Mike, if you had to name the one therapy everyone with HFpEF should be on, what is it?Mike: That's easy! SGLT-2 inhibitors. This is the one slam-dunk we have in HFpEF. Empagliflozin (Jardiance) or dapagliflozin (Farxiga) should be started in essentially every patient with HFpEF, and it doesn't matter if they have diabetes or not.Jordan: And that's worth repeating, because people still think of these as “diabetes drugs.” They're not anymore. In HFpEF, SGLT-2 inhibitors reduce heart-failure hospitalizations, improve symptoms, improve quality of life, and even reduce cardiovascular death.Dr. Arreaza: They're also simple. Empagliflozin 10 mg daily or dapagliflozin 10 mg daily. No titration, no drama. The effectiveness of these meds was established around 2019 with DAPA-HF and later with DELIVER. These were trials thatdemonstrated that dapagliflozin reduces worsening heart failure and cardiovascular events across the full spectrum of heart failure, from reduced to preserved ejection fraction, independent of diabetes status.Mike: And the number needed to treat is about 28 to prevent one heart-failure hospitalization. That's excellent for a disease where we historically had almost nothing that worked.Jordan: They're also safe in chronic kidney disease down to an eGFR of about 25, which makes them even more useful in this population.Dr. Arreaza: Alright. We got SGLT-2 inhibitor, what's next?Mike: Volume management. Loop diuretics are still the backbone of symptom control in HFpEF. If the patient is volume overloaded, you diurese, and you diurese aggressively.Jordan: The goal is euvolemia. Dry weight, no edema, no orthopnea, no waking up gasping for air. A lot of these patients end up needing chronic oral loop diuretics to stay there.Dr. Arreaza: Something to remember: HFpEF patients don't tolerate congestion well, and being “a little wet” is not benign. Let's move into RAAS inhibition. Where do ARBs and ACE inhibitors fit in?Mike: Between ARBs and ACE inhibitors, ARBs are the winners in HFpEF. They actually reduce heart failure hospitalizations—drugs like candesartan, losartan, valsartan. ACE inhibitors? Not so much. They showed minimal benefit in older HFpEF patients, which is why we go with ARBs instead.Jordan: But a lot of clinicians get nervous about ACE inhibitors and ARBs because of kidney function, so it's worth talking through how these drugs actually work in the kidney.Dr. Arreaza: Yes, misunderstanding may lead to unnecessary drug discontinuation.Jordan: Under normal conditions, the afferent arteriole brings blood into the glomerulus, and the efferent arteriole is constricted by angiotensin II. That constriction keeps pressure high in the glomerulus and maintains filtration.Mike: Here's what happens with an ACE inhibitor: you block angiotensin II, the efferent arteriole relaxes, glomerular pressure drops, and GFR dips slightly. Creatinine bumps up a little, and that scares people, but that's actually the whole point—that's how you get kidney protection long-term.Jordan: High intraglomerular pressure causes hyperfiltration injury and scarring over time. Lowering that pressure protects the kidney long-term. The short-term GFR drop is the price you pay for long-term benefits.Dr. Arreaza: So let's talk about CKD, because this is where people panic.Mike: Right. ACE inhibitors and ARBs are not contraindicated in chronic kidney disease. In fact, they're recommended even in advanced stages. They reduce progression to kidney failure by about a third.Jordan: The key is how you use them. Start low. Check creatinine and potassium one to two weeks after starting, then periodically. A creatinine rise up to 30% from baseline is acceptable. That's not kidney injury, that's physiology.Dr. Arreaza: And what about potassium creeping up?Mike: You adjust the dose or add a potassium binder. You don't just automatically stop the drug.Dr. Arreaza: Now there is one absolute contraindication everyone needs to know about! (board exam test)Jordan: Bilateral renal artery stenosis. This is the big one. In these patients, the kidneys are completely dependent on angiotensin II–mediated efferent constriction to maintain GFR. Take that away, and GFR collapses.Mike: Creatinine can jump dramatically within days. If you see a creatinine rise of 20% or more shortly after starting an ACE inhibitor, you should be thinking about bilateral renal artery stenosis and stopping the drug immediately.Dr. Arreaza: After revascularization, though, many patients can tolerate ACE inhibitors again, so this isn't always permanent. What about cardiorenal syndrome? That's where things get uncomfortable.Mike: It is uncomfortable, but cardiorenal syndrome isn't a contraindication. These patients have severe heart failure and kidney disease, and their mortality is actually higher than patients with heart failure alone.Jordan: ACE inhibitors still reduce mortality and slow kidney disease progression in this group. Studies show that stopping ACE inhibitors during acute heart-failure admissions increases in-hospital mortality three- to four-fold.Dr. Arreaza: So we are cautious, but we don't avoid it.Mike: Exactly. Start low, titrate slowly, monitor labs closely, accept up to a 30% creatinine rise. You only stop if kidney function keeps worsening, or potassium gets dangerously high.Dr. Arreaza: Alright. Let's move on. What about mineralocorticoid receptor antagonists… MRA?Jordan: Spironolactone or eplerenone might reduce hospitalizations in HFpEF, but the data is mixed. This is more of a “select patients” situation.Mike: And you have to watch potassium and kidney function carefully, especially if they're already on an ACE inhibitor or ARB.Dr. Arreaza: What about sacubitril-valsartan, also known as Entresto®?Mike: Entresto may help patients with mildly reduced EF roughly in the 45 to 57% range. It's not first-line for HFpEF, but in select patients, it's reasonable.Dr. Arreaza: Now let's clarify one of the biggest sources of confusion: beta blockers.Jordan: Beta blockers are not a treatment for HFpEF itself. They're only indicated if the patient has another reason to be on them, like coronary disease or atrial fibrillation.Mike: And timing really matters here. You absolutely do not start beta blockers during acute decompensated heart failure. Their negative inotropic effects can make things worse when patients are volume overloaded.Jordan: But, and this is critical, you also don't stop them if the patient is already taking one. Abrupt withdrawal causes a sympathetic surge and dramatically increases mortality.Dr. Arreaza: If a patient is admitted on a beta blocker, what do we do?Mike: Continue it at the same dose or reduce it slightly if they're really unstable. Once they're euvolemic and stable, you can carefully titrate up.Jordan: And watch for chronotropic incompetence. HFpEF patients often rely on heart-rate response to exercise, and beta blockers can worsen exercise intolerance.Dr. Arreaza: Beyond medications, HFpEF is really about treating comorbidities. Aerobic activity can be an initial strategy to improve exercise intolerance and has evidence of improving aerobic function and quality of life. Sodium restriction: improves symptoms, does not decrease risk of death or hospitalizations.Mike: Hypertension control is huge. For diabetes, the SGLT-2 inhibitors will perform double duty. For obesity, weight loss improves symptoms, and GLP-1 agonists like semaglutide are absolute gamechangers.Jordan: Don't forget sleep apnea, atrial fibrillation, and lifestyle. Exercise improves the quality of life, even if it doesn't change hard outcomes. Lifestyle is the main treatment. Dr. Arreaza: And when should you refer to cardiology?Mike: You should refer when the diagnosis isn't clear; symptoms are not responding to treatment, difficult volume management, end-organ dysfunction, or if you are concerned about advanced heart failure.Dr. Arreaza: So, it has been a great discussion. What is the takeaway?Mike: HFpEF treatment isn't about one magic drug -- it's about volume control, SGLT2 inhibitors, smart use of RAAS blockade, and aggressive management of comorbidities.Jordan: And it's understanding the physiology, so you don't withhold life-saving therapies out of fear.Dr. Arreaza: Well said. If you found this helpful, share it with a friend or colleague and rate us wherever you listen. This is Dr. Arreaza, signing off.Jordan/Mike: Thanks! Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Barzin A, Barnhouse KK, Kane SF. Heart Failure With Preserved Ejection Fraction. Am Fam Physician. 2025;112(4):435-440.Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure. Circulation. 2022;145(18):e895-e1032.Kittleson MM, Panjrath GS, Amancherla K, et al. 2023 ACC expert consensus decision pathway on management of heart failure with preserved ejection fraction. J Am Coll Cardiol. 2023;81(18):1835-1878.Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385(16):1451-1461.Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022;387(12):1089-1098.Pitt B, Pfeffer MA, Assmann SF, et al. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014;370(15):1383-1392.Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction. Lancet. 2003;362(9386):777-781.Solomon SD, McMurray JJV, Anand IS, et al. Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med. 2019;381(17):1609-1620.Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med. 2023;389(12):1069-1084.Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022;28(3):583-590.Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from COVID-19. JAMA Cardiol. 2020;5(11):1265-1273.Basso C, Leone O, Rizzo S, et al. Pathological features of COVID-19-associated myocardial injury. Eur Heart J. 2020;41(39):3827-3835.Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601-615.Badve SV, Roberts MA, Hawley CM, et al. Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in adults with estimated GFR less than 60 mL/min per 1.73 m². Ann Intern Med. 2024;177(8):953-963.Navis G, Faber HJ, de Zeeuw D, de Jong PE. ACE inhibitors and the kidney: a risk-benefit assessment. Drug Saf. 1996;15(3):200-211.Textor SC, Novick AC, Tarazi RC, et al. Critical perfusion pressure for renal function in patients with bilateral atherosclerotic renal vascular disease. Ann Intern Med. 1985;102(3):308-314.Hackam DG, Spence JD, Garg AX, Textor SC. Role of renin-angiotensin system blockade in atherosclerotic renal artery stenosis and renovascular hypertension. Hypertension. 2007;50(6):998-1003.Ronco C, Haapio M, House AA, et al. Cardiorenal syndrome. J Am Coll Cardiol. 2008;52(19):1527-1539.Prins KW, Neill JM, Tyler JO, et al. Effects of beta-blocker withdrawal in acute decompensated heart failure. JACC Heart Fail. 2015;3(8):647-653.Jondeau G, Neuder Y, Eicher JC, et al. B-CONVINCED: Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode. Eur Heart J. 2009;30(18):2186-2192.Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

Episode 211: Understanding HFpEF.  Hyo Mun and Jordan Redden (medical students) explain the pathophysiology of heart failure with preserved ejection fraction (HFpEF) and how it differentiates from HFrEF. Dr. Arreaza asks insightful questions and summarizes some key elements of HFpEF. Written by Hyo Mun, MS4, American University of the Caribbean; and Jordan Redden, MS4, Ross University School of Medicine. Comments and edits by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.What is EF? Just imagine, the heart is a pump, blood gets into the heart through the veins, the ventricles fill up and then squeeze the blood out. So, the percent of blood that is pumped out is the EF. Let's start at the beginning. What is HFpEF?Mike: HFpEF stands for heart failure with preserved ejection fraction. Basically, these patients squeeze normally—their ejection fraction is 50% or higher—but here's the thing: the heart can't relax and fill the way it should. The muscle gets stiff, almost like a thick leather boot that just won't stretch. And because the ventricle can't fill properly, pressure starts backing up into the lungs and the rest of the body. That's when patients start experiencing shortness of breath, leg swelling, fatigue—all those classic symptoms.Dr. Arreaza: And this is where people get fooled by the ejection fraction.Mike: Exactly. The ejectionfraction tells you total left ventricular emptying, not just forward flow.Jordan: The classic example is severe mitral regurgitation. You can eject 60% of your blood volume and still be in cardiogenic shock because most of that blood is leaking backward into the left atrium instead of going into the aorta. So, you get pulmonary edema, hypotension, fatigue, all with a “normal” EF. Which is honestly terrifying if you're over-relying on echo reports without thinking clinically.Dr. Arreaza: And in HFpEF, functional mitral regurgitation often shows up later in the disease. It's not usually the primary cause; it's more of a marker of advanced disease. Moderate to severe MR in HFpEF independently predicts worse outcomes, including a higher risk of mortality or heart failure hospitalization. So, let's contrast this with HFrEF. How are these two different?Mike: HFrEF—heart failure with reduced ejection fraction—is a pumping problem. The heart muscle is weak and can't contracteffectively. Ejection fraction drops below 40%, and this is your classic systolic dysfunction.Jordan: HFpEF, on the other hand, is diastolic dysfunction. The heart muscle is thick, fibrotic, and noncompliant. It squeezes fine, but it just doesn't relax, even though the EF looks reassuring on paper.Mike: I like to explain it this way: HFrEF is a weak heart that can't squeeze. HFpEF is a stiff heart that can't relax. Totally different problems.Dr. Arreaza: And then there's the gray zone: heart failure with mildly reduced EF, or HFmrEF. That's an EF between 41 and 49% with evidence of elevated filling pressures. It really shares the features of both worlds. So, what actually causes HFpEF versus HFrEF?Jordan: HFpEF is basically what happens when all the problems of modern living catch up with you. You've got chronic hypertension, obesity, diabetes, metabolic syndrome, aging, systemic inflammation—all of these things slowly remodel the heart over years. The muscle gets thick and stiff, and eventually the ventricle just loses its ability to relax. So, HFpEF is really a disease of metabolic dysfunction and chronic stress in the heart. Mike: HFrEF is more about direct injury. Think about myocardial infarctions, ischemic cardiomyopathy, viral myocarditis, alcohol toxicity, chemotherapy like doxorubicin, genetic cardiomyopathies, or chronic uncontrolled tachycardia. These insults actually damage or kill heart muscle cells, leading to a dilated, weak ventricle that can't pump effectively.Dr. Arreaza: So the short version: HFpEF is caused by chronic metabolic and hypertensive stress, while HFrEF is caused mainly by myocardial damage. A question we get a lot: does HFpEF eventually turn into HFrEF? What do you guys think?Mike: In most cases, no. HFpEF patients usually stay HFpEF throughout their disease course. They don't just “burn out” and turn into HFrEF.Jordan: They're generally separate disease entities with different pathophysiology. A patient with HFpEF can develop HFrEF if they have a big myocardial infarction or ongoing ischemia that damages the muscle, but that's not the natural progression.Mike: Interestingly though, the opposite can happen. Some HFrEF patients actually improve their ejection fraction with good medical therapy—that's called HF with improved EF—and it's a great sign that treatment is working.Dr. Arreaza: Another question. How do HFpEF and HFrEF compare to restrictive cardiomyopathy and constrictive pericarditis?Jordan: Clinically, they can all look very similar: dyspnea, edema, fatigue, but the underlying mechanisms are completely different.Mike: In HFpEF, the myocardium itself is stiff from hypertrophy and fibrosis. The problem is intrinsic to the heart muscle, and EF stays preserved. Echoshows diastolic dysfunction with elevated filling pressures.Jordan: In HFrEF, the myocardium is weak. The ventricle is often dilated and contracts poorly, with a reduced EF.Mike: Restrictive cardiomyopathy is different. Here, the myocardium gets infiltrated by abnormal stuff—amyloid, iron, sarcoid—and that makes it extremely stiff. It can look like HFpEF on the surface, but it's usually more severe. On Echo You'll see biatrial enlargement, small ventricles, and preserved EF. And importantly, it's a pathologic diagnosis, so you need advanced imaging or biopsy to confirm it.Jordan: Constrictive pericarditis is another mimic, but here the myocardium is usually normal. The problem is that the pericardium is thickened, calcified, and rigid. This will physically prevent the heart from being filled. Imaging shows pericardial thickening, septal bounce, and respiratory variation in flow, and cath shows equalization of diastolic pressures, which is the hallmark of constrictive pericarditis.Dr. Arreaza: So the takeaway is: HFpEF is a clinical syndrome driven by common metabolic and hypertensive causes, while restrictive and constrictive diseases are specific pathologic entities. If “HFpEF” is unusually severe or not responding to treatment, you need to think beyond HFpEF. Which type of heart failure is more common right now?Mike: Good question, the answer is: HFpEF. It now accounts for up to 60% of all heart failure cases, and it's still rising.Dr. Arreaza: Why is that?Jordan: Because people are living longer, gaining weight, and developing more metabolic syndrome. HFpEF thrives in older, or people with obesity, hypertension, or diabetes: basically, the modern American population. At the same time, better treatment of acute MIs means fewer people are developing HFrEF from massive heart attacks.Mike: HFpEF is the heart failure epidemic of the 21st century. It's honestly the cardiology equivalent of type 2 diabetes.Dr. Arreaza: Let's talk aboutCOVID-19. (2025 and still talking about it) Does it actually increase heart failure risk?Mike: Yes, absolutely. COVID increases both acute and long-term heart failure risk.Jordan: During acute infection, COVID can cause myocarditis, trigger massive inflammation, and precipitate acute decompensated heart failure, especially in patients with pre-existing disease. It also causes microthrombi, which can injure the myocardium.Mike: And after infection, even mild cases are linked to a significantly higher risk of developing new heart failure within the following year. Both HFpEF and HFrEF rates go up.Dr. Arreaza: I remember seeing this in 2021, we had a patient with acute COVID and HFrEF, her EF was about 10%, I lost contact with the patient and at the end I don't know what happened to her. What's the pathophysiology of COVID and heart failure?Mike: COVID causes direct viral injury through ACE2 receptors, triggers massive inflammation that damages the endothelium and heart muscle, leads to microvascular clotting and fibrosis—all mechanisms that promote HFpEF.Jordan: Add autonomic dysfunction, persistent low-grade inflammation, and worsening metabolic syndrome, and you've got a perfect storm for heart failure.Dr. Arreaza: Bottom line: COVID is a cardiovascular disease as much as a respiratory one. If someone had COVID and now has unexplained dyspnea or fatigue, think about heart failure. Get an echo, get a BNP, start treatment. Last big question: why did we have so many therapies for HFrEF but essentially none for HFpEF for years?Mike: HFrEF is mechanistically straightforward. You've got a weak heart with excessive neurohormonal activation going on — so you block RAAS, block the sympathetic system, drop the afterload. The drugs make sense.Jordan: HFpEF is messy. It's not one disease. It's stiffness, fibrosis, inflammation, microvascular dysfunction, metabolic disease, atrial fibrillation, all overlapping. One drug can't fix all of that.Mike: And some drugs that worked beautifully in HFrEF actually made HFpEF worse. Take Beta blockers, for example.  They slow heart rate, which is a problem because HFpEF patients rely on heart rate to maintain their cardiac output.Jordan: The breakthrough came with SGLT-2 inhibitors: diabetes drugs that unexpectedly addressed multiple HFpEF mechanisms at once: volume, metabolism, inflammation, and myocardial energetics.Dr. Arreaza: The miracle drug for HFpEF! Alright, let's wrap up.Mike: Bottom line: HFpEF is common, complex, and dangerous: even if the EF looks “normal.”Jordan: And if you're relying on ejection fraction alone, HFpEF will humble you every time.Dr. Arreaza: If you liked this episode, share it with a friend or a colleague and rate us wherever you listen. This is Dr. Arreaza, signing off.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Barzin A, Barnhouse KK, Kane SF. Heart Failure With Preserved Ejection Fraction. Am Fam Physician. 2025;112(4):435-440.Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure. Circulation. 2022;145(18):e895-e1032.Kittleson MM, Panjrath GS, Amancherla K, et al. 2023 ACC expert consensus decision pathway on management of heart failure with preserved ejection fraction. J Am Coll Cardiol. 2023;81(18):1835-1878.Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385(16):1451-1461.Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022;387(12):1089-1098.Pitt B, Pfeffer MA, Assmann SF, et al. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014;370(15):1383-1392.Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction. Lancet. 2003;362(9386):777-781.Solomon SD, McMurray JJV, Anand IS, et al. Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med. 2019;381(17):1609-1620.Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med. 2023;389(12):1069-1084.Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022;28(3):583-590.Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from COVID-19. JAMA Cardiol. 2020;5(11):1265-1273.Basso C, Leone O, Rizzo S, et al. Pathological features of COVID-19-associated myocardial injury. Eur Heart J. 2020;41(39):3827-3835.Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601-615.Badve SV, Roberts MA, Hawley CM, et al. Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in adults with estimated GFR less than 60 mL/min per 1.73 m². Ann Intern Med. 2024;177(8):953-963.Navis G, Faber HJ, de Zeeuw D, de Jong PE. ACE inhibitors and the kidney: a risk-benefit assessment. Drug Saf. 1996;15(3):200-211.Textor SC, Novick AC, Tarazi RC, et al. Critical perfusion pressure for renal function in patients with bilateral atherosclerotic renal vascular disease. Ann Intern Med. 1985;102(3):308-314.Hackam DG, Spence JD, Garg AX, Textor SC. Role of renin-angiotensin system blockade in atherosclerotic renal artery stenosis and renovascular hypertension. Hypertension. 2007;50(6):998-1003.Ronco C, Haapio M, House AA, et al. Cardiorenal syndrome. J Am Coll Cardiol. 2008;52(19):1527-1539.Prins KW, Neill JM, Tyler JO, et al. Effects of beta-blocker withdrawal in acute decompensated heart failure. JACC Heart Fail. 2015;3(8):647-653.Jondeau G, Neuder Y, Eicher JC, et al. B-CONVINCED: Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode. Eur Heart J. 2009;30(18):2186-2192.Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/. 

Aldosterone antagonists, such as spironolactone and eplerenone, are potassium-sparing diuretics that block aldosterone at the mineralocorticoid receptor in the distal nephron. By reducing sodium and water reabsorption while conserving potassium, they play a key role in heart failure, resistant hypertension, and primary hyperaldosteronism. Clinically, they improve mortality in heart failure with reduced ejection fraction, making them much more than just “add-on” diuretics. From a safety standpoint, the biggest concerns with aldosterone antagonists are hyperkalemia and renal function decline. These risks increase in patients with chronic kidney disease or when combined with ACE inhibitors, ARBs, or potassium supplements. Spironolactone can also cause endocrine-related adverse effects such as gynecomastia and menstrual irregularities, which is why eplerenone may be preferred in some patients. Direct-acting vasodilators, most notably hydralazine and minoxidil, lower blood pressure by relaxing arteriolar smooth muscle and reducing systemic vascular resistance. Hydralazine is commonly used in heart failure in combination with nitrates, particularly in select patient populations, while minoxidil is reserved for severe, refractory hypertension due to its potency. Despite their effectiveness, direct-acting vasodilators come with important clinical trade-offs. Reflex tachycardia and fluid retention are common, so they are typically prescribed alongside a beta blocker and a diuretic. Hydralazine is associated with drug-induced lupus, while minoxidil can cause significant edema and hypertrichosis, making careful patient selection and monitoring essential. Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE! Support The Podcast and Check Out These Amazing Resources! NAPLEX Study Materials BCPS Study Materials BCACP Study Materials BCGP Study Materials BCMTMS Study Materials Meded101 Guide to Nursing Pharmacology (Amazon Highly Rated) Guide to Drug Food Interactions (Amazon Best Seller) Pharmacy Technician Study Guide by Meded101

Send us a textWelcome back Rounds Table Listeners! We are back today with a Classic Rapid Fire episode. This week, Drs. Mike and John Fralick discuss two recent papers: the effects of spironolactone on heart failure and cardiovascular death in patients undergoing maintenance dialysis, and antibiotic prophylaxis in patients with cirrhosis and upper gastrointestinal bleeding. Two papers, here we go!Spironolactone versus placebo in patients undergoing maintenance dialysis (ACHIEVE): an international, parallel-group, randomised controlled trial (0:00 – 7:19)Prophylactic Antibiotics for Upper Gastrointestinal Bleeding in Patients With Cirrhosis: A Systematic Review and Bayesian Meta-Analysis (7:20 – 15:08)And for the Good Stuff (15:09 – 17:51):The $500m slugger who helped Canada get to the World SeriesClinical practice guidelines one-pagers coming soon to Trial Files: https://trialfiles.substack.com/Questions? Comments? Feedback? We'd love to hear from you! @roundstable @InternAtWork @MedicinePods

The FiltrateJoel Topf‍ ‍@kidneyboy.bsky.social‬Swapnil Hiremath@hswapnil.medsky.socialAC @medpeedskidneys.bsky.socialSpecial GuestMike Walsh Associate Professor in the Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University as well as a Scientist at the Population Health Research Institute and a nephrologist at St. Joseph's Healthcare Hamilton where he is the Chair of the Clinical Nephrology Research Group. Editing and Show Notes bySophia AmbrusoThe Kidney Connection written and performed by Tim YauShow NotesALCHEMIST (NephJC Shorts, Rossignol et al Lancet 2025)AC is in her 83rd year of med-peds fellowship.Joel's monologue brings us all down.Prophylactic ICD therapy doesn't improve sudden cardiac death or all-cause mortality in HD patients in the ICD2 trial (Jukema JW et al. Circulation 2019)Initiation with statins do not impact MACE endpoints or atherosclerotic events (4D AURORA trial Fellstrom BC et al. NEJM 2009 & SHARP trial Baigent C et al. Lancet 2011)Mike tries to liven up the mood by mentioning positive outcomes with iron therapy in heart failure with the PIVOTAL trial (Macdougall IC et al. NEJM 2018)TOPHAT trial revealed treatment with spironolactone in HFpEF did not affect MACE outcomes. (Pitt B et al. NEJM 2014)NephTrials ‘Run-in periods in clinical trials: What can we ACHIEVE?'SPIN D trial - spironolactone dose finding trial in ESRD (Charytan DM et al. Kidney Int 2018)Mike shares the human experience of the trial after being instructed to end the trial prematurely and being told they have “answered their question”Study in Japan - spironolactone predominantly benefits male over females (cannot find this)Male vs female benefit not observed in ACHIEVE despite Mike's initial hypothesisSwap compares and contrasts ACHIEVE, ALCHEMIST & Meta-analysis (Pyne L et al. Lancet 2025)Mike discusses how nonadherence to spironolactone impacted the intention to treat outcomes in the trial.What is a high risk of bias for dummies?Mike, Swap & Joel ponder future nsMRA or ASI trials hemodialysis?Tubular secretionsSwap is probably stalking Martha Wells by now, has moved on from Witch King, now onto Queen Demon on Good ReadsAC is adding to her brood, 2 dogs (Snickers & Harper), 1 childDungeon Crawler Call - a science fantasy book series by Matt Dinniman (on goodreads), which he lovingly referred to as complete nerd trash.Joel is binging on the series Task on HBO max, featuring Mark Ruffalo as FBI agent.NephJC is having its annual fundraiser (get your tickets here) at ASN. Providing a party shuttle that is leaving every 30 minutes from the conference center. As always, it will feature a live podcast recording covering the ASN late breaking, high impact clinical trials.Swap describes the high impact model at ASN this year - go big or go home.

Send us a textWelcome back Rounds Table Listeners! Today we have a solo episode with Dr. Mike Fralick. This week, he discusses a recent trial examining whether amiloride is noninferior to spironolactone in reducing systolic blood pressure in patients with resistant hypertension. Here we go!Spironolactone vs Amiloride for Resistant Hypertension: A Randomized Clinical Trial (0:00 – 8:10).Run-in studies:Application and impact of run-in studiesApplication and Impact of Run-In Studies for the Evaluation of Statin Efficacy and SafetyThe Good Stuff (8:11 - 9:14):Trial Files: https://trialfiles.substack.com/Heme Onc Trial Files: https://hemeonctrialfiles.substack.com/Allergy & Immunology Trial Files: https://allergyimmtrialfiles.substack.com/Critical Care Trial Files: https://criticalcaretrialfiles.substack.com/Questions? Comments? Feedback? We'd love to hear from you! @roundstable @InternAtWork @MedicinePods

The FiltrateJoel Topf @kidneyboy.bsky.social‬Swapnil Hiremath @hswapnil.medsky.socialNayan Arora captainchloride.bsky.socialSopia Ambruso @sophia-kidney.bsky.socialSpecial Guests Brendon Neuen @brendonneuen.bsky.social Associate Professor and Program Lead, Renal and Metabolic at The George Institute for Global Health. Nephrologist and Director of Kidney Trials at Royal North Shore Hospital.Neuen has had three prior appearances on Freely Filtered: EMPA Kidney, DUPLEX and Sparsentan in FSGS, FLOW and SemaglutideMuthiah Vaduganathan @mvaduganathan on X. Cardiologist at Brigham and Women's Hospital and Harvard Medical School. Assistant Professor of Medicine.Editing byJoel TopfThe Kidney Connection written and performed by Tim YauShow NotesDONATE to NephJC! Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes NEJM | NephJC SummaryFIDELIO Bakris et al, NEJM 2020 | NephJC Summary; subgroup throws doubt on efficacy of finerenone in patients on flozinsFIGARO Pitt et al, NEJM 2021; subgroups clearly shows finerenone works, flozins or notNEJM editorial (wrongly) saying do not use Flozins unless on RASi Don't use dual RAS blockade ONTARGET Yusuf et al, NEJM 2008; VA NEPHRON-D Fried et al NEJM 2013Why we cannot study finerenone in HFrEF (RALES Pitt et al NEJM 1999) Muthu is jealous of GFR slope and albuminuria surrogate endpoints and wants to borrow them for HFpEF (Inker et al EHJ 2025)Combination therapy and CV outcomes in hypertension (Wang et al JAMA Card 2024 on low dose combinations and BP; Egan et al Blood Pressure 2022 review of topic) CONFIRMATION HF trial registry entry (Finerenone and Empagliflozin in hospitalized patients with HF)23:20: Nayan and Swap miss a chance to say ‘de-flozination' to discuss stopping a flozin which would allow a patient to be included in the trial Finerenone is a CYP3A4 substrate (Heinig et al Clin Pharmacokinetics 2023); Useful list of CYP3A4 inducers and inhibitors Everyone should get an ABPM (Bugeja et al CMAJ 2022)EASiKIDNEY study design Albuminuria mediates CKD benefits with Finerenone (Agarwal et al Ann Intern Med 2023)GFR slope and Albuminuria and the FDA (Taylor et al eClin Med 2025) Dapagliflozin and Eplerenone combination crossover trial (Provenzano et al JASN 2022)Joel gets promoted! (PBFluids reflection) Bluesky NephJC Chat discussion on ‘renal remission' Withdrawal of Finerenone and worse outcomes from FINEARTS (Vaduganathan et al JACC 2025)Combination therapies Analysis from Brendan and Muthu (Neuen et al Circulation 2024)Do not use KFRE when GFR > 60 (KDIGO Practice Point 2.2.4: Note that risk prediction equations developed for use in people with CKD G3–G5, may not be valid for use in those with CKD G1–G2) Finerenone vs Spironolactone trial in Primary Aldosteronism (Hu et al Circulation 2025)FIND CKD trial design (Heerspink et al NDT 2025) FINE-ONE trial design (Heerspink et al Diab Res Practice 2023) Tubular SecretionsNayan keeping his chin up as Yankees lose and Mariners follow (MLB Playoffs)Sophia's adventures with Beekeeping (Royal Jelly?) Brendon loves listening to ‘Susan' by Raye Muthu is back into Taekwondo Swap is still reading Martha Wells (Witch King on GoodReads)Joel will be hiking the Laugavegur trail in Iceland

Dhineli Perera talks to Laxmi Iyengar, dermatology research fellow and GP, and Jane Li, consultant dermatologist, about male and female pattern hair loss. Laxmi and Jane discuss presentations and available treatments, as well as important considerations for prescribing. Read the full article in Australian Prescriber.

Un nouvel épisode du Pharmascope est disponible! Dans ce 162e épisode, Nicolas et Isabelle discutent d'études publiées récemment. Au menu : hypertension résistante, gastro-entérite, perte de poids… Avec des mentions spéciales pour la transplantation fécale… et les patates! Les objectifs pour cet épisode sont les suivants: Discuter des avantages et désavantages de l'amiloride dans le traitement de l'hypertension résistante Discuter des avantages et désavantages de l'ondansétron pour la gasto-entérite chez les enfants Discuter des avantages et désavantages de l'ajout de la cagrilintide au sémaglutide pour la perte de poids Ressources pertinentes en lien avec l'épisode Lee CJ, et coll. Spironolactone vs Amiloride for Resistant Hypertension: A Randomized Clinical Trial. JAMA. 2025 Jun 17;333(23):2073-2082. Freedman SB, et coll.; Pediatric Emergency Research Canada Innovative Clinical Trials Study Group. Multidose Ondansetron after Emergency Visits in Children with Gastroenteritis. N Engl J Med. 2025 Jul 17;393(3):255-266. Garvey WT, et coll.; REDEFINE 1 Study Group. Coadministered Cagrilintide and Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2025 Aug 14;393(7):635-647. Juul FE, et coll. Fecal Microbiota Transplantation Versus Vancomycin for Primary Clostridioides difficile Infection : A Randomized Controlled Trial. Ann Intern Med. 2025 Jul;178(7):940-947. Mousavi SM, et coll. Total and specific potato intake and risk of type 2 diabetes: results from three US cohort studies and a substitution meta-analysis of prospective cohorts. BMJ. 2025 Aug 6;390:e082121.

In this episode of Sex Positivity: Unfiltered, we sit down with Emmy, a trans woman whose story is equal parts educational, emotional, and laugh-out-loud relatable. We talk about dysphoria, survival, joy, and the real-life glow-up of choosing to live authentically.This conversation is raw, and empowering — the kind that makes you feel like you're right here on the couch with us.

262: If you want to get rid of your acne for real, do not miss this episode. Clearstem founders Danielle Gronich and Kayleigh Christina have built more than just a skincare company - they've created a community of people dedicated to treating the root cause of acne so it stays away for good. For my listeners thinking about going on Acutane, Spironolactone, or any of the other intense hormone-disrupting acne treatments, please hear out Danielle and Kayleigh first (Alix Earle, they got you). They're sharing some of their tried-and-true tips for better skin, and the supplements, topicals, and dietary shifts to make it happen.  Topics Discussed: → Why acne is more than skin deep  → Foods most closely linked to acne  → Top pore clogging agents  → Why Spironolactone became the new “it” acne drug - and how to ween yourself off of it  → A acne-safe skincare regiment for Alix Earle that will actually work   → Acne treatment myths  Sponsored By: → Clearstem | Check out https://www.clearstem.com/REALFOODOLOGY for 15% off! Timestamps:  → 00:00:00 - Introduction  → 00:02:41 - Antiaging & Acne  → 00:05:00 - Acne Struggles   → 00:14:39 - Clearstem Acne Panel: How it Works   → 00:19:53 - Pore Cloggers + Filler Agents  → 00:33:55 - Foods That Cause Acne  → 00:39:10 - Supplements, Antidepressants, & Acne → 00:43:46 - Acne Medication Myths  → 00:50:10 - Vitamins That Impact Acne  → 00:54:50 - Acutane and Spirolactone  → 00:59:05 - Clearstem's Advice for Alix Earle  → 01:03:10 - Courtney's Clearstem Recs Check Out: → Clearstem Instagram  → Kayleigh Christina  → Danielle Gronich Check Out Courtney:  →  LEAVE US A VOICE MESSAGE →  Check Out My new FREE Grocery Guide! →  @realfoodology →  www.realfoodology.com →  My Immune Supplement by 2x4 →  Air Dr Air Purifier →  AquaTru Water Filter →  EWG Tap Water Database Produced By: Drake Peterson

In this episode of Perimenopause: Head to Toe, Dr. Rachel Pope is joined by expert dermatologist Dr. Melissa Mauskar, who dives into how perimenopause and menopause affect our skin. From changes in the face to thinning skin, Dr. Mauskar explains why skin and hair transformations during this time are not only inevitable but also manageable.Dr. Mauskar is an Associate Professor in the Departments of Dermatology and OB-GYN at UT Southwestern Medical Center. She specializes in dermatology, with a focus on vulvar health and dermatologic changes that come with different stages of a woman's life.In this episode, you'll learn: How estrogen, progesterone, and testosterone affect your skin. Why you might notice acne, dryness, or thinning hair in your 40s and beyond. The importance of topical estrogen for maintaining skin thickness. How perimenopause might trigger or worsen conditions like eczema, psoriasis, and even melasma. Tips for preventing skin aging, including the importance of sunscreen and good skincare routines.If you've noticed changes in your skin, this episode offers expert advice on how to address them and what you can do to prevent further damage.About Dr. Mauskar:Dr. Melissa Mauskar is an expert in dermatology and vulvar health, with extensive experience in addressing the skin changes that women experience during perimenopause and menopause. She is the founder of the Vulvar Health Program at UT Southwestern and frequently presents at symposia on women's health dermatology.

This week our intrepid primary care docs discuss 4 new POEMs: spironolactone vs amiloride for resistant hypertension, mirtazapine for insomnia in older adults, baloxivir for influenza post exposure prophylaxis, and platelet-rich plasma injections for knee osteoarthritis. We've got opinions!Show notes:Spironolactone vs amiloride for resistant hypertension: pubmed.ncbi.nlm.nih.gov/40366680/ Mirtazapine for chronic insomnia: https://pubmed.ncbi.nlm.nih.gov/40135470/ Baloxavir to prevent flu in household contacts: https://pubmed.ncbi.nlm.nih.gov/40267424/ Platelet-rich plasma for knee OA: https://pubmed.ncbi.nlm.nih.gov/39751394/

THE LANCET 2003;362:767-771Background: Angiotensin II which plays a role in ventricular remodeling and progression of heart failure can be produced by pathways independent of angiotensin convening enzyme. Preliminary studies showed that the combination of angiotensin II blockers with angiotensin-converting enzyme inhibitors (ACEi) improves hemodynamics and reduces ventricular remodeling.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.The Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM)-Added trial sough to assess if adding the angiotensin-receptor blocker (ARB), candesartan, to ACEi could improve outcomes in patients with systolic heart failure.Patients: Eligible patients had left ventricular ejection fraction of 40% or less within the previous 6 months, and NYHA class II, III or IV symptoms. Patients with NYHA class II symptoms had to have cardiac-related hospitalization within 6 months. Patients also had to have treatment with ACEi at a constant dose for at least 30 days.Exclusion criteria were not provided in the main manuscript.Baseline characteristics: Patients were recruited from 618 centers in 26 countries. The trial randomized 2,548 patients – 1,276 randomized to receive candesartan and 1,272 to receive placebo.The average age of patients was 64 years and 79% were men. The average left ventricular ejection fraction was 28%. Cardiomyopathy was ischemic in 62% of the patients. The NYHA class was II in 24% of the patients, III in 73% and IV in 3%.Approximately 48% had hypertension, 30% had diabetes, 56% had prior myocardial infarction, 9% had stroke, 27% had atrial fibrillation and 17% were current smokers.At the time of enrollment, 90% were taking a diuretic, 58% were taking digoxin, 55% were taking beta-blockers, 17% were taking spironolactone and all but two patients were taking ACEi.Procedures: The trial was double-blinded. Patients were assigned in a 1:1 ratio to receive candesartan starting at 4 or 8mg once daily or placebo. The treatment was doubled every two weeks to a target dose of 32mg once daily.After randomization, follow up occurred at 2, 4, and 6 weeks, 6 months and every 4 months thereafter.Endpoints: The primary outcome was a composite of cardiovascular death or heart failure hospitalizations. All deaths were classified as cardiovascular unless there was a clear non-cardiac cause.Analysis was performed based on the intention-to-treat principle. The estimated sample size to have 80% power at 5% alpha was 2,300 patients. The sample size calculation assumed 16% relative risk reduction in the primary outcome with candesartan assuming an 18% annual event rate in the placebo arm.Results: The median follow up time was 41 months. The mean candesartan daily dose was 24mg at 6 months.Candesartan reduced the primary endpoint of cardiovascular death or heart failure hospitalizations (37.9% vs 42.3%, adjusted HR: 0.85, 95% CI: 0.75 – 0.96; p= 0.01). Candesartan reduced the individual components of the primary outcome - (23.7% vs 27.3%; p= 0.021) for cardiovascular death and (24.2% vs 28.0%; p= 0.018) for heart failure hospitalizations. There was no significant reduction in all-cause death (29.5% with candesartan vs 32.4%; p= 0.105). The number of patients who had any hospitalization was similar in both groups (66.8% with candesartan vs 67.5%; p= 0.7), however, the total number of hospitalizations was lower with candesartan (2,462 vs 2,798; p= 0.023).Serum creatinine at least doubled in 7% of the patients in the candesartan group vs 6% in the placebo group. In the subset of patients taking spironolactone, serum creatinine at least double in 11% of the patients taking candesartan compared to 4% of the patients taking placebo.Hyperkalemia, defined as serum potassium of 6 mmol/L or higher, occurred in 3% of the patients in the candesartan group vs 1% in the placebo group. In the subset of patients taking spironolactone, hyperkalemia occurred in 4% of the patients taking candesartan compared to 1% of the patients taking placebo.There were two cases of angioedema in the candesartan group and three in the placebo group. All patients were taking an ACEi.There were no significant subgroup interactions, including in patients taking both beta-blockers and ACEi at baseline.Conclusion: In patients with systolic heart failure, adding candesartan to an ACEi reduced the primary composite outcome of cardiovascular death or heart failure hospitalizations with a number needed to treat of approximately of 23 patients over 41 months of follow up. The total number of all-cause hospitalizations was reduced by 336 with candesartan. All-cause death was not significantly reduced with candesartan.While the results of the trial appear impressive, the high number of adverse outcomes with candesartan in patients taking spironolactone is concerning. Spironolactone led to significant reduction in all-cause mortality in patients with systolic heart failure, as seen in the RALES trial, and should be prioritized over adding candesartan. Notably, fewer than 20% of patients in the trial were on spironolactone at baseline; if more had been, the incremental benefit of candesartan would likely have been reduced due to an increased risk of adverse effects from triple neurohormonal blockade (ACEi, ARBs, and mineralocorticoid receptor antagonists). Furthermore, spironolactone acts by blocking the aldosterone receptor, which is downstream in the renin–angiotensin–aldosterone system. Since candesartan blocks angiotensin II upstream in the same pathway, simultaneous inhibition at multiple points may lead to diminishing benefit.Finally, the differences observed in the subgroup of patients on beta-blockers between this trial and Val-HeFT remain unclear and may simply reflect the play of chance. As we previously discussed, patients receiving both an ACEi and beta-blockers had worse outcomes with valsartan in the Val-HeFT trial.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

Dr. Azi and Nurse Lacie are back with an episode that gets to the root of one of the most talked-about topics in beauty: hair loss. From hormonal imbalances to genetic causes and the latest treatment options, they're breaking down the science behind why we lose hair—and what we can do about it. Together, they answer your most asked questions: How do you know if you're really losing hair? What treatments actually work? Can you support your hair growth with the right ingredients? And what's the deal with PRP, Spironolactone, and Dutasteride? Whether you're dealing with shedding, thinning, or patchy spots, this episode of More Than a Pretty Face is packed with the facts (and a few rapid-fire fun moments, too).   Timeline of what was discussed: 00:00  Introduction 02:25  Beauty & Blemish 08:05  The Most Common Type of Hair Loss 12:57  Ways to Test If You're Going Through Hair Loss 15:39  What Are Some Treatment Options? 21:23  PRP Treatment & Dutasteride Injections 23:51  Taking Spironolactone for Hair Loss 24:29  The Science Behind Hair Growth Cycles 29:48  New Hair Loss Research & Innovations 31:32  Alopecia Areata: What You Should Know 34:23  Rapid Fire Questions   ______________________________________________________________ Submit your questions for the podcast to Dr. Azi on Instagram @morethanaprettyfacepodcast, @skinbydrazi, on YouTube, and TikTok @skinbydrazi. Email morethanaprettyfacepodcast@gmail.com. Shop skincare at https://azimdskincare.com and learn more about the practice at https://www.lajollalaserderm.com/ The content of this podcast is for entertainment, educational, and informational purposes and does not constitute formal medical advice. © Azadeh Shirazi, MD FAAD.  

This week's topics include treating resistant hypertension, gabapentanoids and the risk of self harm, risk for depression after diagnosis of a medical condition, and fatty liver and pregnancy.Program notes:0:35 Depression after medical condition diagnosis1:36 Any of a number of medical conditions2:37 A much lower risk in comparison group3:37 Major depressive disorder could be number one cause of YLL4:01 Fatty liver and pregnancy outcomes5:01 Matched to those with obesity or T2D6:01 Screening general population not indicated7:00 Gabapentanoids and risk of self harm8:01 Rates of self harm variable 9:04 Use has increased fourfold10:00 Treatment of resistant hypertension11:01 Spironolactone or amiloride12:33 End

N Engl J Med 1999;341:709-717Background: The renin–angiotensin–aldosterone system (RAAS) is activated in patients with systolic heart failure. While this activation initially helps increase blood volume and maintains blood pressure, chronic activation promotes cardiac fibrosis and remodeling. In patients with systolic heart failure, inhibition of the RAAS with angiotensin-converting enzyme inhibitors (ACEi) significantly reduced mortality and morbidity, as seen in the CONSENSUS and SOLVD trials.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.Preliminary data suggested that adding the aldosterone-receptor blocker spironolactone to ACEi, reduced the levels of atrial natriuretic peptide and did not lead to serious hyperkalemia.The Randomized Aldactone Evaluation Study (RALES) sought to test the hypothesis that spironolactone would significantly reduce the risk of all-cause death in patients with severe systolic heart failure.Patients: Eligible patients had left ventricular ejection fraction of 35% or less, had NYHA class IV heart failure within the 6 months before enrollment and NYHA class III or IV at the time of enrollment, and were treated with ACEi (if tolerated) and a loop diuretic.Patients were excluded if they had primary operable valvular disease (other than mitral or tricuspid regurgitation), congenital heart disease, unstable angina, primary liver failure, active cancer or any life-threatening condition, other than heart failure, prior heart transplant or awaiting heart transplant, serum creatinine >2.5 mg/dL, or serum potassium > 5.0 mmol/L.Baseline characteristics: Patients were recruited from 195 centers in 15 countries. The trial randomized 1,663 patients – 822 randomized to receive spironolactone and 841 to receive placebo.The average age of patients was 65 years and 73% were men. The average left ventricular ejection fraction was 25%. Cardiomyopathy was ischemic in 55% of the patients and non-ischemic in the rest. The NYHA class was III in 71% of the patients and IV in 29%.Data on baseline comorbid conditions were not provided.At the time of enrollment, 100% were taking loop diuretics, 94% were taking ACEi, 73% were taking digitalis, and 10% were taking beta-blockers. The mean daily dose of ACEi were as following: 63mg for captopril, 15mg for enalapril, and 14mg for lisinopril.Note: Max daily dose is 450mg for captopril, 40mg for enalapril, and 40mg for lisinopril.Procedures: The trial was double-blinded. Patients were assigned in a 1:1 ratio to receive spironolactone 25mg PO daily or placebo.The dose could be increased to 50mg daily after 8 weeks of treatment, If the patient had worsening heart failure and had no evidence of hyperkalemia. In the event of hyperkalemia, the dose could be lowered to 25 mg every other day. Laboratory testing including potassium were performed every 4 weeks for the first 12 weeks, then every 3 months for up to 1 year and every 6 months thereafter until the end of the study.Endpoints: The primary outcome was all-cause death. Secondary end points included death from cardiac causes, hospitalization for cardiac causes and change in the NYHA class.Analysis was performed based on the intention-to-treat principle. The planned sample size was not mentioned in the methods. However, the results mention that recruitment was complete. The sample size calculation assumed 38% mortality rate in the placebo group and that spironolactone would reduce mortality by 17% (relative risk reduction). The power of the study was set at 90% with a two-sided alpha of 5%.Results: Recruitment was complete in Dec, 1996 with follow up planned through Dec, 1999. However, the study was stopped early on Aug, 1998 after interim analysis showed significant reduction in mortality with spironolactone. The mean follow up time was 24 months. After 24 months of follow up, the mean daily dose of spironolactone was 26 mg.Spironolactone reduced all-cause death (35% vs 46%, RR: 0.70, 95% CI: 0.60 - 0.82; p< 0.001). Death from cardiac causes was also reduced with spironolactone (27% vs 37%, RR: 0.69, 95% CI: 0.58 - 0.82; p

Drs Carol H. Wysham and Christopher M. Kramer discuss heart failure and type 2 diabetes, and the role of incretin therapies in the management of HFpEF. Relevant disclosures can be found with the episode show notes on Medscape https://www.medscape.com/viewarticle/1002048. The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources The Incidence of Congestive Heart Failure in Type 2 Diabetes: An Update https://pubmed.ncbi.nlm.nih.gov/15277411/ Hypertension in Diabetes: An Update of Basic Mechanisms and Clinical Disease https://pubmed.ncbi.nlm.nih.gov/34601960/ Type 2 Diabetes Mellitus and Heart Failure: A Scientific Statement From the American Heart Association and the Heart Failure Society of America: This statement does not represent an update of the 2017 ACC/AHA/HFSA heart failure guideline update https://pubmed.ncbi.nlm.nih.gov/31167558/ Insulin Resistance and Hyperinsulinaemia in Diabetic Cardiomyopathy https://pubmed.ncbi.nlm.nih.gov/26678809/ Cardiovascular Disease and Risk Management: Standards of Care in Diabetes-2024 https://pubmed.ncbi.nlm.nih.gov/38078592/ The Paradox of Low BNP Levels in Obesity https://pubmed.ncbi.nlm.nih.gov/21523383 Tirzepatide for Heart Failure With Preserved Ejection Fraction and Obesity https://pubmed.ncbi.nlm.nih.gov/39555826/ Cardiovascular Effects of Incretin-Based Therapies: Integrating Mechanisms With Cardiovascular Outcome Trials https://pubmed.ncbi.nlm.nih.gov/35050311/ Beyond Weight Loss: the Emerging Role of Incretin-Based Treatments in Cardiometabolic HFpEF https://pubmed.ncbi.nlm.nih.gov/38294187/ Heart Failure With Preserved Ejection Fraction: Mechanisms and Treatment Strategies https://pubmed.ncbi.nlm.nih.gov/34379445/ Obesity and Heart Failure With Preserved Ejection Fraction: New Insights and Pathophysiological Targets https://pubmed.ncbi.nlm.nih.gov/35880317/ Epidemiology of Heart Failure in Diabetes: A Disease in Disguise https://pubmed.ncbi.nlm.nih.gov/38334818/ Semaglutide in Patients With Heart Failure With Preserved Ejection Fraction and Obesity https://pubmed.ncbi.nlm.nih.gov/37622681/ Mechanisms of Benefits of Sodium-Glucose Cotransporter 2 Inhibitors in Heart Failure With Preserved Ejection Fraction https://pubmed.ncbi.nlm.nih.gov/37674356/ Finerenone in Heart Failure With Mildly Reduced or Preserved Ejection Fraction https://pubmed.ncbi.nlm.nih.gov/39225278/ Effects of Tirzepatide on Circulatory Overload and End-Organ Damage in Heart Failure With Preserved Ejection Fraction and Obesity: A Secondary Analysis of the SUMMIT Trial https://pubmed.ncbi.nlm.nih.gov/39551891/ Effects of Tirzepatide on the Clinical Trajectory of Patients With Heart Failure, a Preserved Ejection Fraction, and Obesity https://pubmed.ncbi.nlm.nih.gov/39556714/ Tirzepatide Reduces LV Mass and Paracardiac Adipose Tissue in Obesity-Related Heart Failure: SUMMIT CMR Substudy https://pubmed.ncbi.nlm.nih.gov/39566869/6 Spironolactone for Heart Failure With Preserved Ejection Fraction https://pubmed.ncbi.nlm.nih.gov/24716680/

Struggling with stubborn acne, eczema, psoriasis, or dry, irritated skin—no matter how many creams, medications, or skincare products you've tried? In today's episode, we're breaking down exactly why your skin issues aren't actually about your skin… and why the key to clear, healthy skin starts with healing your gut.We'll cover: ✔️ Why medications like Spironolactone and Accutane don't fix the root cause✔️ How gut imbalances like leaky gut, bacterial overgrowth, and sluggish liver function show up on your skin✔️ Common mistakes (like overusing aggressive topicals) that may be making things worse✔️ The step-by-step approach we use with clients to heal skin issues from the inside out✨ Want to learn exactly how to start healing your skin naturally?Grab your free Skin & Gut Health Guide to learn the WHYs behind your skin issues & what will actually help you overcome them so you can effortlessly have clear, glowing skin! DM me the word “SKIN” on Instagram, and I'll send it straight to you or follow this link to get it right away!

In this bonus episode, we're hanging out with Dr. John Barbieri as he breaks down the FASCE Trial, a major study comparing spironolactone and oral antibiotics for acne treatment. Tune in to hear his insights on the findings, their impact on clinical practice, and what this means for the future of acne management!

In this episode, Dr. Valentin Fuster discusses a study on sodium zirconium cyclosilicate (SZC) for managing hyperkalemia in heart failure patients on mineralocorticoid receptor antagonists (MRAs) like spironolactone. While SZC effectively reduced hyperkalemia and allowed higher spironolactone doses, concerns over worsening heart failure events highlight the complex balance between treatment benefits and risks.

In this episode of To The Root, Robyn Spangler takes a deep dive into Spironolactone—one of the most commonly prescribed medications for hormonal acne. Originally developed to treat high blood pressure, this medication has gained popularity for its ability to reduce androgen-driven acne. But does it address the root cause, or is it merely a temporary solution?Robyn explores the science behind Spironolactone, how it impacts androgen levels, and why it works for some but not others. She also discusses key considerations such as potential rebound breakouts, the role of potassium balance, and what its effectiveness (or lack thereof) can reveal about your underlying skin health. Whether you're currently using Spironolactone, considering it, or looking for long-term solutions, this episode provides essential insights to help you make informed decisions about your skincare journey.Tune in now to gain clarity on Spironolactone's role in acne treatment and explore holistic strategies for lasting skin health!Highlights: Understanding Androgen-Driven Acne: How Spironolactone suppresses androgens and its impact on sebum production.Rebound Effects & Discontinuation: Why acne may return after stopping the medication and how to prevent it.The Role of Potassium: How Spironolactone affects potassium levels and why proper mineral balance is crucial.Assessing Your Acne Type: What it means if Spironolactone worked for you—or didn't—and how that can guide your root cause approach.Long-Term Considerations: Why addressing underlying factors like insulin resistance, stress, and hormonal imbalances is key to sustainable skin health.Connect with Robyn:Instagram: @nutritionbyrobyn Website: https://www.theclearskinlab.com

The CLEAR SYNERGY (OASIS 9) Trial: A 2x2 Factorial Randomized Controlled Trial of Colchicine versus placebo and Spironolactone versus placebo in Patients with Myocardial Infarction.

CLEAR SYNERGY (OASIS 9): A 2x2 Factorial Randomized Controlled Trial of Colchicine Versus Placebo and Spironolactone Versus Placebo in Patients with Myocardial Infarction

In order to create space for growth and alignment...we must shed things that no longer serve us. FIRST THING: Amy reads a special email from a listener, Kristin, who shares an update on her eating disorder. Her story is a powerful reminder of how far we can come when we commit to growth. SECOND THING: Amy's giving facial fitness a go as she takes a break from Botox (because she fears muscle atrophy!!) and she's just working out her face from videos on YouTube. Below are a few that she likes so far. As for Botox, she shares some tips on how to avoid muscle atrophy if you're still getting injections (which she likely will do again one day herself!) 10-Minute Exclusive Face Fitness Practice 5 min massage for changing your face! 10 Minute Face Yoga To Do Each Evening To Lift And Firm The Skin THIRD THING: Amy opens up about her personal decision to stop taking Adderall for ADHD and Spironolactone for her face. Medications like Adderall and Spironolactone have their place and can be highly effective, but it’s essential to evaluate their role in your life continually. FOURTH THING: Amy shares a quote that fits the theme of today's episode. "Shedding is necessary. Letting go of what no longer serves us creates space for growth, for new things to flourish." -Unknown HOST: Amy Brown // RadioAmy.com // @RadioAmySee omnystudio.com/listener for privacy information.

Ep. 157 On today's episode of Pursuit of Wellness, Dr. Tyna Moore, a naturopathic and chiropractic physician with expertise in regenerative medicine, joins us to provide clarity on GLP-1 medications. With a background in metabolic health and chronic pain management, Dr. Tyna explains how GLP-1s can benefit individuals with weight loss goals, PCOS, and insulin resistance. She shares valuable advice on individualizing doses, understanding how these medications interact with insulin and muscle mass, and how to approach conversations with doctors about your dosage. We also cover the risks associated with Ozempic, especially in those dealing with metabolic dysfunction, and discuss how these drugs impact areas like fertility and chronic pain. Leave Me a Message - click here! For Mari's Instagram click here! For Pursuit of Wellness Podcast's Instagram click here! For Mari's Newsletter click here! For Dr. Tyna's Instagram click here! For Dr. Tyna's Website click here! Sponsored By:  The holidays are closer than ever, so make sure you order by December 16th to get their gift (or yours) underneath the tree in time! Visit Carawayhome.com/POW to take advantage of this limited-time offer for up to 20% off your next purchase. Again that's Carawayhome.com/POW to get new kitchenware before the holidays. Caraway. Non-Toxic cookware made modern. Visit BetterHelp.com/POW today to get 10% off your first month. That's betterhelp.com/POW. Head to Manukora.com/POW to get $25 off the Starter Kit, which comes with an MGO 850+ Manuka Honey jar, 5 honey travel sticks, a wooden spoon, and a guidebook! Visit clearstemskincare.com and use code POW at checkout for 20% off your first purchase. Again, that's code POW for 20% off your first purchase on clearstemskincare.com. The Fits Everybody collection is available in sizes XXS to 4X. You can shop now at SKIMS.com. After you place your order, be sure to let them know I sent you! Select "podcast" in the survey and be sure to select my show in the dropdown menu that follows. And if you're looking for the perfect gifts for the whole family - SKIMS just launched their biggest Holiday Shop ever - also available at SKIMS.com.  Show Links: Ozempic Uncovered University   Dr. Tyna's GLP1s Done Right Dr Tyna GLP1 Episodes  Finding A Doctor  Episode Keywords + Tags (YouTube) Health, Wellness, Fitness, Nutrition, Pursuit of Wellness, Dr. Tyna, Semaglutide, Microdosing, Weight Loss, GLP-1, Regenerative Medicine, Metabolic Health, Podcast Host, Peptide, PCOS, Obesity, Fertility, Social Media Influencers, Mucus, Mucinex, TikTok, Cystic Acne, Epigenetic, Infertility, Spironolactone, Androgen, Orthorexia, Peptide, Menstrual Cycle, Anti Inflammatory, Pharmaceuticals, Hormones, Insulin Signaling, Insulin Reception, Insulin Resistant, Metabolic Pathways, Waist Circumference, Skinny Fat, Muscle Mass, Toned, Lean, Arm Sculpting, Crohn's, Microbiome, Ozempic, Muscle Loss, Heroin Chic, Chain Smoking, Metabolic Dysfunction, Dosage, Individualized Dosing, Freedom, Chronic Pain Topics Discussed 00:00:00 - Introduction  00:03:54 - Dr. Tyna's journey 00:06:44 - Initial success stories 00:07:54 - Fertility  00:09:20 - GLP-1's and cystic acne 00:16:22 - PCOS diagnosis 00:21:09 - Low dose GLP-1 benefits 00:29:18 - Who metabolic health applies to 00:31:53 - Pick up the weights! 00:34:41 - GLP-1's and the microbiome 00:37:20 - Ozempic mistakes 00:41:49 - How Ozempic affects the body 00:45:24 - Individualized dosing 00:48:01 - How to talk to your doctor about low dosing 00:52:56 - Cycling do's and don'ts 00:54:05 - Clarity around the different drugs 01:00:01 - GLP-1's and addiction 01:02:46 - Dr. Tyna's Ozempic Done Right University 01:05:45 - Wellness to Dr. Tyna

In this episode of the To The Root Podcast, Robyn Spangler R.D. outlines a practical, evidence-based approach to addressing acne at its root causes. She discusses the five primary contributors to acne—hormones, infections, inflammation, stress, and topical irritants—and explains why restrictive diets and quick-fix solutions often fail to provide lasting results. Robyn also shares insights on how past acne medications like Accutane, antibiotics, or Spironolactone can offer valuable clues about underlying issues. Whether you're managing your own skin concerns or supporting clients in their journey, this episode offers a clear roadmap to natural, sustainable skin healing.For a deeper understanding of skin healing, visit theclearskinlab.com/freecourse  to access Robyn's free two-part video training and a comprehensive mineral guide. Get started on the path to clear skin today.Use the code ROOT at check-out for 10% off Rayvi: https://rayvishop.com/ Highlights:Identifying the five key drivers of acne and their subcategories.Why addressing root causes can eliminate the need for long-term dietary restrictions.How medications reveal patterns in hormonal, inflammatory, or infection-driven acne.The role of testing in uncovering hidden contributors like gut health, mineral depletion, and iron overload.How stress impacts skin health and the importance of improving stress resilience.Connect with Robyn:Instagram: @nutritionbyrobyn Website: https://www.theclearskinlab.com

JACC Associate Editor Michelle M. Kittleson, MD, PhD, FACC, interviews author Mikhail Kosiborod, MD, FACC about his REALIZE-K study published in JACC and presented at AHA. In participants with HFrEF and hyperkalemia, SZC led to large improvements in the percentage of participants with normokalemia while on optimal spironolactone dose, and reduced risk of hyperkalemia and down-titration/discontinuation of spironolactone. More participants had HF events with SZC than placebo; this difference was limited to those with very high NTproBNP levels.

Did you miss AHA 2024? Listen here to brief discussions of the latest research. Eric Rubin is the Editor-in-Chief of the Journal. Jane Leopold is a Deputy Editor of the Journal. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. E.J. Rubin, J. Leopold, and S. Morrissey. NEJM at AHA — Routine Spironolactone in Acute Myocardial Infarction. N Engl J Med. DOI: 10.1056/NEJMe2414472.

Send us a message with this link, we would love to hear from you. Standard message rates may apply. In this episode of Your Checkup, we dive into simple, effective ways to start managing acne at home. From understanding the importance of cleansing routines to selecting the right over-the-counter treatments, we'll guide you through the basics of skincare that can make a big difference. Tune in to learn how to tackle common triggers like excess oil, clogged pores, and inflammation, while also debunking popular acne myths that could be holding you back from clearer skin. Whether you're dealing with breakouts or want to prevent them, this episode is your starting point! Please find out detailed show notes below Acne BasicsAcne is the most common skin disorder in North America, affecting 85% of teenagers.Pimples form when skin cells block a hair follicle. This is made worse by oil (sebum) production and bacteria on the skin.Acne SeverityAcne can range from mild to moderate to severe.At-home treatments can usually handle mild acne. Moderate and severe acne usually require prescription medications from a primary care doctor or dermatologist.Acne Treatment LayersHygiene: Wash your face no more than two times a day with a gentle, non-soap cleanser and warm water. Don't use washcloths or loofahs.Moisturization: Use a non-comedogenic moisturizer, especially if other treatments dry out your skin.Sun Protection: Protect your skin from the sun with sunscreen (SPF 30 or higher) or protective clothing. Too much sun can worsen acne and age your skin.Over-the-Counter Treatments for Mild AcneTopical Retinoids: Adapalene 0.1% gel is the only topical retinoid available over the counter in the US.Apply a thin layer to the entire affected area (don't spot treat) once a day, usually at night. Start every other night to reduce irritation, working up to every night over a few weeks.Use a pea-sized amount for the entire face and make sure your skin is dry.Don't use with benzoyl peroxide.Benzoyl Peroxide: Comes in cleansers, gels, lotions, creams, pads, masks, and washes. Concentrations range from 2.5% to 10%.Apply once a day.Benzoyl peroxide can bleach fabric and hair.Salicylic Acid: A good alternative if your skin can't tolerate topical retinoids.These treatments may take up to 12 weeks to work.Combination TherapyUsing benzoyl peroxide in the morning and a retinoid at night can be effective.Sometimes topical clindamycin is used with benzoyl peroxide.Treatment for Moderate to Severe AcneFor severe or widespread acne, or acne that's causing scarring, doctors will start systemic therapy right away, instead of waiting to see if topical treatments work.Doxycycline is an antibiotic that reduces inflammation and fights bacteria.Spironolactone is a medication that can help regulate hormones.IsotretinoinImportant NotesDon't pick or squeeze pimples: This can worsen acne and may cause swelling and scarring.Be patient: It can take several weeks for treatments to show results.Talk to a doctor: If you have concerns about your acne or at-home treatments aren't working,Support the showProduction and Content: Edward Delesky, MD & Nicole Aruffo, RNArtwork: Olivia Pawlowski

Thank you for joining us for our 2nd Cabral HouseCall of the weekend! I'm looking forward to sharing with you some of our community's questions that have come in over the past few weeks…   Renne: hi dr. cabral! after many years of stubborn acne and not seeing the results from my functional efforts, i reached a point where i was willing to try spironolactone for reducing androgen production. after only 8 days on 50mg, i developed intense right side flank/kidney pain that was also associated with heart flutters. i stopped the meds and everything subsided after 3 or so days. could my low potassium have caused this? any thoughts?   Angie: Thank you for making functional medicine more accessible and affordable to all! I have a few questions…. How do I know what podcast episode to listen to for the answers? I did the two week detox and I still don't feel well. I didn't lose any weight, I was hungry the whole time, my stomach still feels bloated and I am still gassy. What now? Also can you tell me what you think of Truvani's products by the food babe?    Lorie: My right eye waters off and on all day long. Especially in the cold, or when air blows on me. It is not dry eye or a problem with my tear duct being blocked. Is there anything I can do for it? The eye doctors have not been able to help me. This has been going on for at least 15 years. Thank you   Mia: I have been dealing with gut issues for a while and recently developed Mast cell activation syndrome. Could the root cause of MCAS be the gut issues? And, could dealing with that could resolve the MCAS?I keep hearing MCAS is progressive and not curable (and mine is progressively getting worse every few months) and am very scared because the symptoms of MCAS are quite terrible. Is there any suggested testing or tips to dealing with it?   Terri: Hi Dr. Cabral~ Thank you for having the best podcast ANYWHERE and for being so generous with your time and knowledge. I am a 61-year-old woman and have normal, although probably not optimal, thyroid levels. I recently shot up rather suddenly into the 6+ TSH range with really no explanation that I can think of from a dietary or environmental exposure standpoint. My question is… I had a few recent incidences of ingesting an NAC supplement with an inadequate amount of water and the burning in my throat was excruciating and lasted about 15-20 minutes each time. Is it possible that this could have damaged my thyroid and if so, is it reparable? Thanks so much for taking my question!   Thank you for tuning into this weekend's Cabral HouseCalls and be sure to check back tomorrow for our Mindset & Motivation Monday show to get your week started off right! - - - Show Notes and Resources: StephenCabral.com/3180 - - - Get a FREE Copy of Dr. Cabral's Book: The Rain Barrel Effect - - - Join the Community & Get Your Questions Answered: CabralSupportGroup.com - - - Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - Get Your Question Answered On An Upcoming HouseCall: StephenCabral.com/askcabral - - - Would You Take 30 Seconds To Rate & Review The Cabral Concept? The best way to help me spread our mission of true natural health is to pass on the good word, and I read and appreciate every review!  

On this episode of the Real Life Pharmacology Podcast, I cover 5 more medications of the top 200. Fenofibrate is a medication used primarily to reduce triglycerides. This medication differs from statins which tend to focus on LDL management. Doxazosin is an alpha-blocker. The primary indications of doxazosin are hypertension and BPH. Naproxen is an NSAID. Of all the NSAIDs, naproxen is one of the lower-risk agents with regard to cardiovascular risk. Spironolactone is an aldosterone antagonist and also classified as a potassium sparing diuretic. Memantine is an NMDA antagonist that is indicated for the management of Alzheimer's dementia. If you are looking for study materials and our list of popular Amazon books, check out meded101.com/store!

Tired of dealing with acne, whether you're a teenager or an adult? Want to achieve clear, glowing skin naturally with solutions that actually work? This episode is for you. If you're ready to ditch birth control, Spironolactone, harsh topicals, Accutane, and endless rounds of antibiotics, tune in. Our guest, Kayleigh Christina—one of the leading holistic acne experts and co-founder of CLEARSTEM—shares her groundbreaking approach to skincare. With CLEARSTEM, they're shifting the skincare paradigm by addressing acne and aging at the root cause. As a Certified Holistic Nutritionist, Kayleigh struggled with cystic acne in her mid-twenties and finally found lasting clarity through this comprehensive, root-cause method to skin health. In 2017, she and Danielle Gronich, both passionate about holistic wellness, joined forces to create safer, more effective skincare solutions. Today, their work has empowered millions to achieve clear skin for life. To learn more about CLEARSTEM and receive 15% of your first purchase visit www.clearstemskincare.com and use code HEALINGTHESOURCE at checkout.  Follow CLEARSTEM and Kayleigh Christina on Instagram. And don't forget CLEARSTEM's other queen of a founder, Danielle Gronich Follow the host, Claudia Gilani, @healingthesource and check out HealingTheSource.org

On this episode, Dr. Sadaf is joined by dermatologist Dr. Mary Alice Mina to discuss everything you need to know skin care as we age. Dr. Mina is a board-certified dermatologist and during this discussion, she shares her expertise on how our skin changes through different life stages including puberty, pregnancy, perimenopause, and menopause. Find out how and why hormone fluctuations can influence our skin health, why sugar can negatively impact our skin, and the critical role sun protection plays in aiding our skin as we age.Disclaimer: Anything discussed on the show should not be taken as official medical advice. If you have any concerns about your health, please speak to your medical provider. If you have any questions about your religion, please ask your friendly neighborhood religious leader. It's the Muslim Sex Podcast because I just happen to be a Muslim woman who talks about sex.To learn more about Dr. Sadaf's practice and to become a patient visit DrSadaf.comLike and subscribe to our YouTube channel where you can watch all episodes of the podcast!Feel free to leave a review on Apple Podcasts and share the show!Follow us on Social Media...Instagram: DrSadafobgynTikTok: DrSadafobgyn

Hair loss is a common and troublesome issue affecting millions of Americans. Today we look into the common cause of hair loss and how to improve hair growth, thickness and coverage. Listen to discover: What stages hair goes through as it grows How hormones and hormone replacement affects hair growth Autoimmune conditions that cause hair loss How medical conditions, stress and life changes can cause loss of hair The length of time it takes to regrow hair Over the counter and prescription medications to enhance hair growth How PRP can enhance our hair The benefit of exosomes Using procedures like light therapy and microneedling to avoid surgery Hair transplant options If you're noticing thinning hair or a receding hairline, this is one episode you don't want to miss! Key Moments in this episode are: 01:28 Stages of hair growth 04:35 Androgenic alopecia 05:47 Telogen effluvium 08:21 Alopecia areata 09:18 Other causes of hair loss 11:31 Can hair regrow on its own? 12:01 Simple changes to enhance hair growth 13:52 Minoxidil for hair loss 14:47 Finasteride for hair loss 16:55 Duasteride for hair loss 17:56 Spironolactone for hair loss 19:12: PRP (platelet-rich plasma) for hair loss 20:32 Exosomes for hair loss 24:59 Low level laser therapy for hair loss 27:10 Microneedling for hair loss 28:29 Hair restoration surgeries Learn more about PRP for hair loss here: https://www.foundationsfl.com/prp Discover the power of exosomes for hair restoration here: https://www.foundationsfl.com/derive Understand how Keravive can improve scalp health here: https://www.foundationsfl.com/keravive Follow us! Instagram @foundationskristinjacksonmd Website https://www.foundationsfl.com/ FB facebook.com/advancedurogynecology Loved this episode? Share with a friend.

Dr. Feldman on RESISTANCE TO OTHERS' IDEAS -Mind over matter over wound healing -Intradermal Botox: Just as good or possibly better! -Spironolactone works! ...but not until 6 months -Appropriate use criteria for dermpath studies -Want to donate to the cause? Do so here!Donate to the podcast: uofuhealth.org/dermasphereCheck out our video content on YouTube:www.youtube.com/@dermaspherepodcastand VuMedi!: www.vumedi.com/channel/dermasphere/The University of Utah's DermatologyECHO: ⁠physicians.utah.edu/echo/dermatology-primarycare -⁠ Connect with us!- Web: ⁠dermaspherepodcast.com/⁠ - Twitter: @DermaspherePC- Instagram: dermaspherepodcast- Facebook: www.facebook.com/DermaspherePodcast/- Check out Luke and Michelle's other podcast,SkinCast! ⁠healthcare.utah.edu/dermatology/skincast/⁠ Luke and Michelle report no significant conflicts of interest… BUT check out ourfriends at:- ⁠Kikoxp.com ⁠(a social platform for doctors to share knowledge)- ⁠www.levelex.com/games/top-derm⁠ (A free dermatology game to learnmore dermatology!

In episode 575, James and Mike invite Jamie Falk back to the podcast to help us sift through all the evidence for using oral contraceptives and spironolactone to treat acne. We find that they actually do work. We go over all the numbers for the benefits and harms. Have a listen. Show notes Tools for […]

In today's episode of "The Food Code" podcast, we're thrilled to have Lindsey Carter, a board-certified nurse practitioner with over 20 years of nursing experience. Lindsey shares her holistic approach to healthcare, emphasizing the importance of treating the root cause rather than just the symptoms. Join us as we dive into various skin health topics and practical advice for maintaining optimal skin health.Tune in to learn:[00:00:00] Introduction and Passion for Root Cause[00:01:47] Comprehensive Approach to Healthcare[00:02:00] Understanding the Constant Changes in Our Bodies[00:09:43] The Importance of Ceramides for Skin Health[00:13:21] The Impact of Diet and Gluten on Skin Health[00:15:00] Effective Topical Treatments for Acne[00:22:01] Understanding the Use and Safety of Spironolactone for Acne[00:27:00] The Importance of Medical-Grade Skincare Products for Optimal Skin Health[00:29:20] The Relationship Between Gut Health and Skin Conditions[00:34:47] Treating Contact Dermatitis: Identifying the Source and Using Topical Steroids[00:42:00] The ABCDEs of Moles: How to Identify Concerning Moles[00:44:48] Managing Skin Tags: When to Seek Treatment[00:48:10] Preventing Skin Irritation and Infection: Avoid Picking at the Skin***Connect with Lindsey:

Hey there! Welcome back to the second part of Acne Meds! Today, we're diving into the world of antibiotics and gut health. We'll chat about our own experiences and the big costs, both in terms of finance and how our bodies feel, in a healthcare system that loves quick fixes and prescriptions. We'll dig into the not-so-fun side effects of antibiotics, like messing up our gut bacteria and how acne can come back after treatment.  We'll mix in some serious thoughts with funny stories, all to remind ourselves why it's important to question our treatments and stand up for what we need. Let's ditch the idea of instant fixes and focus on making lifestyle changes that keep our guts happy. After all, our gut health is connected to everything else going on in our bodies! So, get comfy as we share our own tales of long-term antibiotic use, and remember, it's all about finding that balance between what helps and what hurts. Let's dive in! In this episode, we discuss:High Cost of Healthcare and Gut HealthThe Side Effects of Oral AntibioticsGarlic's Efficacy in Preventing Gastrointestinal IssuesSpironolactone and Antibiotic HerbsChallenges of Western Medicine and Pharmaceutical Use Implications of Continuous Antibiotic Use Show Note Links:  Antibiotics use in Canada: Preserving antibiotics now and in the future Let's ConnectApply to work with us in The Clear Skin Solution here.Download The Gut Loving Cheat Sheet here.Follow Katie on Instagram here. 

Are you ready for a pop quiz and a lot of insights into the complexities of acne treatment? Today, we're exposing truths, debunking myths, and sharing personal stories from our own encounters with acne medications. We unpack the allure and limitations of isotretinoin, a medication once hailed as a 'miracle drug,' detailing its wide range of potential side effects, from dryness to birth defects. Through personal clinical experiences, we discuss the gravity of choices around medication, reminding you that while isotretinoin can target acne causes like excess oil and inflammation, it may not address the root problem.Switching gears, we also explore the multifaceted impact of birth control pills and highlight the importance of understanding bodily responses to hormonal changes. From gut health to mental well-being, we paint a holistic picture of the consequences of birth control and the concept of estrogen dominance, proving that education is pivotal!In this episode, we discuss:Birth Control and Acne MedicationsImportance of Medical SupervisionPersonal Experiences with Birth ControlEstrogen Dominance and CandidaRegulating Detoxification ProcessesTransitioning off Birth ControlAre you ready to embark on a journey of informed health choices? Tune in to this episode for a deep dive into acne medication and birth control, and arm yourself with knowledge. See you next Wednesday for part2, The Impacts of Antibiotics & Spironolactone!Let's ConnectApply to work with us in The Clear Skin Solution, here.Download The Gut Loving Cheat Sheet, here.Follow Katie on Instagram, her 

In today's episode, I, your host Ashlene, am excited to share the inspiring story of Olivia, a woman I had the privilege of working with last year. Olivia's journey highlights the transformative power of relinquishing the struggle to control her health and instead embracing a path of healing. Her experience resonates with many women who grapple with hormonal imbalances, experiencing a sense of chaos and frustration in their health journeys. Olivia's insights provide a fresh perspective on addressing the root cause of PCOS-related hormonal imbalances, offering valuable lessons for anyone navigating similar challenges.Olivia's Struggles:Olivia, 31 years old, grappled with a myriad of symptoms including acne, irregular periods, and mood swings, which greatly impacted her self-esteem and confidence. Despite trying various treatments such as Accutane and Spironolactone, Olivia found herself in a relentless battle against her symptoms, feeling disconnected from her body and trapped in a cycle of despair. Through her healing journey, Olivia began to see her body in a new light and embrace a new mindset toward creating the health she wanted.My hope in this episode is that Olivia's journey reminds you of the importance of approaching health with patience, understanding, and a willingness to listen to the body's signals. Through Olivia's experience, I encourage you to reflect on your mindset towards your health and explore new ways of nurturing your body towards harmony and well-being.You can take the quiz to discover your root cause hereThe full list of Resources & References Mentioned can be found on the Episode webpage at:https://nourishedtohealthy.com/95Let's continue the conversation on Instagram! What did you find helpful in this episode and what follow-up questions do you have?

Acne impacts millions, causing more than just physical symptoms. In a conversation with Dr. John Barbieri, Director of Advanced Acne Therapeutics Clinic at Brigham and Women's Hospital and Assistant Professor at Harvard Medical School, we explore cutting-edge acne treatments. Dr. Barbieri, with his deep insights into Spironolactone, isotretinoin, and the innovative 1726 nanometer laser, Avi Clear, underscores the significance of aligning treatment with patient needs, advocating for shared decision-making in acne management. Please SUBSCRIBE to the Derm Club Podcast wherever you like to listen whether on YouTube, Apple, or Spotify. Together, let's explore the fascinating secrets of dermatology and skincare. Connect with me across Social: Twitter: https://twitter.com/drhankopelman Instagram: https://www.instagram.com/doctor.han/ TikTok: https://www.tiktok.com/@drhankopelman Blog: https://www.hannahkopelman.com/blog/ The content of this podcast is for entertainment and educational purposes only. This content is not meant to be a substitute for medical advice or treatment for any medical condition. --- Send in a voice message: https://podcasters.spotify.com/pod/show/hannah-kopelman/message

Jamie McGuire joins me on this episode to challenge mainstream beauty and health standards! I so admire how outspoken and well-rounded Jamie is when it comes to not just skin health, but overall well-being.  We chat about her journey to how she got to where she is now as an integrative skin AND gut health coach (and why I think those two things should always go hand-in-hand). We discuss why the sun might not be as scary/damaging for us as we've been told, how seed oils can make you burn faster, what the deal is with all those awful acne-targeted medications like Accutane and Spironolactone, is Tretinoin actually a holy grail, should we be washing our faces in the morning, and are lasers in or out?! References: Jamie's Instagram Jamie's Offerings (courses/ebooks) Jamie's Website Clearstem Skincare products (great for acne-prone girlies!) discount code: HEALINGTHESOURCE Follow the host, Claudia @healingthesource  

Autoimmune progesterone dermatitis - Sirolimus for KP rubra - Spironolactone does not cause cancer - Dupi -> Th17/23 issues - Berdazimer for molluscum - Want to donate to the cause? Do so here! http://www.uofuhealth.org/dermasphere Check out our video content on YouTube: https://www.youtube.com/@dermaspherepodcast and VuMedi!: https://www.vumedi.com/channel/dermasphere/ The University of Utah's Dermatology ECHO: ⁠https://physicians.utah.edu/echo/dermatology-primarycare - ⁠ Connect with us! - Web: ⁠https://dermaspherepodcast.com/⁠ - Twitter: @DermaspherePC - Instagram: dermaspherepodcast - Facebook: https://www.facebook.com/DermaspherePodcast/ - Check out Luke and Michelle's other podcast, SkinCast! ⁠https://healthcare.utah.edu/dermatology/skincast/⁠ Luke and Michelle report no significant conflicts of interest… BUT check out our friends at: - ⁠Kikoxp.com ⁠(a social platform for doctors to share knowledge) - ⁠https://www.levelex.com/games/top-derm⁠ (A free dermatology game to learn more dermatology!)

Joining me this week is my guardian angel, Emily Morrow, an Integrative Health Practitioner and Nutritional Therapy Practitioner. Emily saved me from a life of acne and hormonal imbalances and now she's here to share her wisdom, insights, and candid tales of her own health battles. She taught me the importance of digging deeper, of looking beyond the symptoms to the root cause of our health concerns - a lesson that has transformed my life.We delve into often misunderstood topics like cholesterol, hormones, and diets. We also discuss gut and liver health, an often overlooked aspect, especially in adolescents. We focus on skincare, supplements, and lifestyle changes for acne management, and the significant connection between mental health and acne. Emily shares her knowledge on how to use dietary switches for improved wellness, addressing acne with individualized approaches, and managing stress for overall healthMake sure you listen all the way to the end for some rapid Q & A, where we learn about acne safe makeup, fragrance in candles, deodorants to use, red light therapy, body acne and eczema.Products Mentioned:Organo King CoffeeTherO3 - BubblerClearstemskincare.com and use code POW for 15% off your orderPhospholipid Complex - BodyBioCir-Q Tonic Golden Thread SupremeLiquid Glutathione Morinda SupremeSchisandra SupremeCamu SupremeAshwagandha SupremeGastro DigestBlack Cumin OilSpore PowderIllicium SupremeHigher Dose Sauna BlanketCastor Oil PacksPriia Acne Safe Makeup LineLeave Me a Message - click here!For Mari's Instagram click here!For Pursuit of Wellness Podcast's Instagram click here!For Emily's Website click here! For Emily's Instagram click here!Timestamps2:09 - My skin journey and how I met Emily2:40 - Emily's journey 4:09 - Implications of tonsil surgery 5:31 - Importance of finding the root of your health issues7:03 - Mold toxicity, how it shows itself9:00 - Common issues Emily sees in lab work 11:05 - Can kids take the same supplements as adults?11:36 - Normal is not optimal 15:00 - Cholesterol Myths16:30 - PCOS18:33 - How YOU can find and build your health team and what tests you should be asking for?23:00 - What are common things Emily sees in acne patients lab work24:00 - 4 acne pillars25:15 - What is Spironolactone and Accutane doing to our bodies?27:55 - A look at my bloodwork + the steps I took to heal my acne33:05 - Dairy and skin health 35:00 - Why you don't want to heat your olive oil and what to use instead 36:40 - Coffee to buy, and coffee to avoid 40:13 - Foods to fight mold and parasites47:11 - Potatoes and why they are good for acne50:00 - Supplements Emily had me take to heal my acne + what she had me avoid54:00 - Cassava flour and why some should avoid it55:00 - Lifestyle tips for better skin59:33 - Stress and acne: are they related? 01:01:01 - “Be thankful for your acne because its your body telling you something” 01:06:00 - Food sensitivity tests: are they worth it?01:07:00 - Rapid Fire Q+A: Acne Safe Makeup, Fragrance and Candles, Deodorants to Use, Red Light Therapy, Body Acne, EczemaProducts Mari Mentioned:Organo King CoffeeClearstemskincare.com and use code POW for 15% off your orderProducts Guest Mentioned:Clearstemskincare.com and use code POW for 15% off your orderPria Acne Safe Makeup LineThis episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct, or indirect financial interest in products, or services referred to in this episode.Control Body Odor ANYWHERE with @lumedeoderant and get $5 off your Starter Pack (that's over 40% off) with promo code POW at lumepodcast.com #lumepodBrought to you by BETTERHELP. Give online therapy a try at betterhelp.com/pow and get on your way to being your best selfUse code POW15 at checkout for 15% off your entire order at www.vionicshoes.comProduced by Dear MediaSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

On this episode, I discuss spironolactone pharmacology, adverse effects, drug interactions and much more. Spironolactone has numerous indications including hypertension, CHF, ascites, and acne. I break them all down in this podcast episode. Hyperkalemia is a major concern with spironolactone. Patients with baseline levels at 5 or above should generally avoid this medication. Gynecomastia is one of the most commonly tested adverse effects of spironolactone. Be sure you don't miss this one on your board and pharmacology exams!

Today on the show we have Candace Marino, aka The LA Facialist, who has been a medical esthetician for over a decade, developing custom complexion protocols and unique techniques for a highly–discerning celebrity clientele. Candace has such a direct, “no-bs” approach to skincare and I love hearing her honest and real takes on what works and what doesn't, the impact of skin issues on overall health, as well as how to overcome individualized skin problems. On this episode, we discuss the connection to skin and inner wellness, the minimal daily must-have routine you need, products that are too harsh, how to heal acne scars, what the skin barrier does, the benefits (or not) of things like: zit stickers, red & blue light, Botox & fillers, Accutane & Spironolactone, AviClear, Sculptra, and more. There are so many specific tips and takeaways here for anyone at any point in their skin journey to benefit from, I hope you enjoy Candace's tips and she was kind enough to provide a discount code sitewide for my listeners below!Discount code is live POW15 for 15% off any order $100+ at www.thelafacialist.comFor Mari's Instagram click here!For Pursuit of Wellness Podcast's Instagram click here!For Canace's Instagram click here!For The La Facialist Website click here!To shop Bloom Nutrition Greens click here! To download Mari's workout plan & recipes click here!Please note that this episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct or indirect financial interest in products or services referred to in this episodeGo to www.Clearstemskincare.com and use code POW for 15% off your orderGo to www.apolloneuro.com/pursuit and save $40Go to www.butherbox.com/pursuit and use code PURSUIT to claim this deal to get $20 off your first orderGo to www.honeylove.com/POW and save 20% offGo to www.betterhelp.com/POW to get 10% off your first monthProduced by Dear Media See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Exercise, sudden cardiac death in sports, new TAVI data, behavioral psychology, EHR doing good things, maybe, and coffee are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Fitness and Longevity Even Small Changes in Fitness Tied to Lower Mortality Risk https://www.medscape.com/viewarticle/989906 - Changes in Cardiorespiratory Fitness and Survival in Patients With or Without Cardiovascular Disease https://www.jacc.org/doi/full/10.1016/j.jacc.2023.01.027 II. SCD in Sports Sports-Related Sudden Cardiac Arrest 'Extremely' Rare in Women https://www.medscape.com/viewarticle/990025 - Incidence of Cardiac Arrest During Sports Among Women in the European Union https://www.jacc.org/doi/full/10.1016/j.jacc.2023.01.015 - Sex-Related Differences in Sports-Related Sudden Cardiac Death Should Be Reflected in Guideline Screening Recommendations∗   https://www.jacc.org/doi/full/10.1016/j.jacc.2023.01.014 - Association between physical activity and risk of incident arrhythmias in 402 406 individuals: evidence from the UK Biobank cohort https://doi.org/10.1093/eurheartj/ehz897 III. EVOLUT Three Year Data Encouraging 3-Year Data for TAVR in Low-Risk Patients: EVOLUT https://www.medscape.com/viewarticle/989144 - Three-Year Outcomes After Transcatheter or Surgical Aortic Valve Replacement in Low-Risk Patients with Aortic Stenosis https://www.jacc.org/doi/10.1016/j.jacc.2023.02.017 - Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients https://www.nejm.org/doi/full/10.1056/nejmoa1816885 - Outcomes 2 Years After Transcatheter Aortic Valve Replacement in Patients at Low Surgical Risk https://www.jacc.org/doi/10.1016/j.jacc.2020.12.052 IV. Behavioral Psychology NUDGE-FLU: Electronic 'Nudges' Boost Flu Shot Uptake in Seniors https://www.medscape.com/viewarticle/989108 - The Effect of Electronic Nudges on Influenza Vaccination Rate in Older Adults With Cardiovascular Disease: a Prespecified Analysis of the NUDGE-FLU Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.064270 - Influenza Vaccination After Myocardial Infarction: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.121.057042 EHR Alerts Boosted MRA Prescribing in HFrEF: BETTER CARE-HF https://www.medscape.com/viewarticle/989110 - Cluster-Randomized Trial Comparing Ambulatory Decision Support Tools to Improve Heart Failure Care https://doi.org/10.1016/j.jacc.2023.02.005 - The Effect of Spironolactone on Morbidity and Mortality in Patients with Severe Heart Failure https://www.nejm.org/doi/full/10.1056/nejm199909023411001 V. Coffee - Acute Effects of Coffee Consumption on Health among Ambulatory Adults https://www.nejm.org/doi/full/10.1056/NEJMoa2204737 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net