Family Medicine
Secondary analysis of a RCT | Bempedoic acid reduces CV events in statin-intolerant patients with high CV risk
26 Jun, 2023 | 00:49h | UTCSummary: This secondary analysis of a Randomized Clinical Trial (RCT) evaluated the efficacy of bempedoic acid in primary prevention of cardiovascular events among statin-intolerant patients at high cardiovascular risk. From a total of 13,970 participants, 4206 met the criteria for primary prevention and were analyzed in this study. Those allocated to receive bempedoic acid showed a significant reduction in major cardiovascular events, reflected in a hazard ratio of 0.70.
The average age of this patient cohort was 68 years, and most participants (66%) were diagnosed with diabetes. Treatment with bempedoic acid also led to a significant 21.3% reduction in low-density lipoprotein cholesterol (LDL-C) levels and a 21.5% decrease in high-sensitivity C-reactive protein levels, suggesting improved cardiovascular health.
This study underscores the potential benefits of lipid-modulating therapy for primary prevention in high-risk patients, who are often undertreated. However, it is important to note the inherent limitations of this secondary analysis. The analysis was performed on a subgroup within a larger clinical trial, which could potentially lead to false-positive findings due to multiple testing. Furthermore, the results may not generalize to younger populations, those with lower pretreatment LDL-C levels, those without diabetes, or those with a lower baseline cardiovascular risk.
Article: Bempedoic Acid for Primary Prevention of Cardiovascular Events in Statin-Intolerant Patients – JAMA (free for a limited period)
Editorial: Bempedoic Acid for High-Risk Primary Prevention of Cardiovascular Disease: Not a Statin Substitute but a Good Plan B – JAMA (free for a limited period)
See also: Visual Abstract
Commentary: Study Suggests Bempedoic Acid Could Find Role in Primary Prevention – HCP Live
Original Study: RCT | Bempedoic acid shows modest reduction in cardiovascular events for statin-intolerant patients
Cohort Study | Association of preterm birth with increased asthma and COPD risk in adulthood
26 Jun, 2023 | 00:45h | UTCSummary: This population-based register study investigated the correlation between gestational ages (GA) and obstructive airway diseases like asthma and chronic obstructive pulmonary disease (COPD) in adulthood. The study used registry data from 706,717 individuals born between 1987-1998 in Finland (4.8% preterm), and 1,669,528 individuals born from 1967-1999 in Norway (5.0% preterm). The study observed care episodes of asthma and COPD using nationwide healthcare registers.
The results showed an increased risk of obstructive airway disease in adulthood for those born at <28 or 28–31 completed weeks of gestation. Even after adjustments, the risk remained 2-3 times greater compared to those who were born full term (at 39-41 completed weeks). Additionally, the risk for COPD at age 30–50 was significantly higher for those born at <28 weeks, with an odds ratio (OR) of 7.44. The study also identified that bronchopulmonary dysplasia (BPD) in infancy increased the odds of obstructive airway disease for those born at <28 and 28–31 weeks.
These findings suggest that preterm birth is a notable risk factor for asthma and COPD in adulthood, and this risk was observed across all gestational ages before full term. The study recommends diagnostic vigilance for adults born very preterm presenting with respiratory symptoms. However, the researchers also noted the potential limitations of using registry data, which might include residual confounding from unmeasured confounders and lack of data on certain prenatal or early life factors.
Article: Preterm birth and asthma and COPD in adulthood: a nationwide register study from two Nordic countries – European Respiratory Journal (free for a limited period)
Commentary on Twitter
In this population-based study of 2.4 million people from Finland and Norway, adults born preterm were at higher risk for asthma and COPD at ages 18–50 years. The risks were observed across all gestational ages before full term in a dose-response manner. https://t.co/bGsAOrwAxV pic.twitter.com/WmCoc6cPu2
— ERS publications (@ERSpublications) June 22, 2023
Review | Evaluation and management of diabetes-related foot infections
23 Jun, 2023 | 13:36h | UTCEvaluation and Management of Diabetes-related Foot Infections – Clinical Infectious Diseases
Related: Guideline Series | Prevention and management of diabetes-related foot disease
Guideline | Management of adrenal incidentalomas
23 Jun, 2023 | 13:33h | UTCRelated:
Investigation and assessment of adrenal incidentalomas – Clinical Medicine Journal
#377 Adrenal Incidentalomas with Dr. William Young – The Curbsiders
Cohort Study | Increased depression risk observed in first two years of oral contraceptive use
23 Jun, 2023 | 13:19h | UTCNews Release: New study links contraceptive pills and depression – Uppsala University
Commentary: Depression Risk May Rise During First Two Years of Oral Contraceptive Use – Psychiatric News Alert
Commentary on Twitter
Population-based cohort study of oral #contraceptive use and risk of #depression suggests that the use of OCs, particularly during the first 2 years, increases the risk of depression.https://t.co/spWuqCMKfW@therese_johans #mentalhealth #epidemiology pic.twitter.com/xMO0yiqPvt
— Epidemiology & Psychiatric Sciences (@EpiPsychSci) June 19, 2023
Choosing Wisely | Recommendations for advance care planning
22 Jun, 2023 | 15:18h | UTCSee complete lists of low-value practices: Choosing Wisely U.S. / Choosing Wisely UK / Choosing Wisely Australia AND Choosing Wisely Canada
RCT | LMWH does not increase live birth rates in women with thrombophilia and recurrent miscarriage
21 Jun, 2023 | 13:39h | UTCHeparin for women with recurrent miscarriage and inherited thrombophilia (ALIFE2): an international open-label, randomised controlled trial – The Lancet (link to abstract – $ for full-text)
Commentary on Twitter (thread – click for more)
New study: Many women with recurrent miscarriage are tested for inherited thrombophilia. If confirmed positive, daily subcutaneous low-molecular-weight heparin (LMWH) is given.
This is despite an absence of evidence that such treatment is beneficial ? https://t.co/0IuFhvjlZr
— The Lancet (@TheLancet) June 2, 2023
Review | Deadly drug rashes: early recognition and multidisciplinary care
21 Jun, 2023 | 13:28h | UTC
Position statement | Gastrointestinal bleeding and endoscopic procedures in patients on antiplatelet and/or anticoagulant therapy
21 Jun, 2023 | 13:22h | UTCPosition statement from the Indian Society of Gastroenterology, Cardiological Society of India, Indian Academy of Neurology and Vascular Society of India on gastrointestinal bleeding and endoscopic procedures in patients on antiplatelet and/or anticoagulant therapy – Indian Journal of Gastroenterology (if the link is paywalled, try this one)
The foot in diabetes – a reminder of an ever-present risk
21 Jun, 2023 | 13:10h | UTCThe foot in diabetes – a reminder of an ever-present risk – Clinical Medicine Journal
Related: Guideline Series | Prevention and management of diabetes-related foot disease
RCT | Thrice-weekly oral iron shows non-inferiority and fewer gastrointestinal effects in treating iron-deficiency anemia
20 Jun, 2023 | 12:48h | UTCA randomized controlled trial of thrice-weekly versus thrice-daily oral ferrous fumarate treatment in adult patients with iron-deficiency anemia – Ann Hematol (if the link is paywalled, try this one)
Guidelines for the management of trigeminal neuralgia
20 Jun, 2023 | 12:43h | UTCGuidelines for the management of trigeminal neuralgia – Cleveland Clinic Journal of Medicine
SR | Long‐acting muscarinic antagonist (LAMA) plus long‐acting beta‐agonist (LABA) vs. LABA plus inhaled corticosteroid (ICS) for COPD
20 Jun, 2023 | 12:26h | UTC
RCT | Testosterone replacement does not appear to increase cardiovascular events in hypogonadal men at high risk
19 Jun, 2023 | 14:13h | UTCCardiovascular Safety of Testosterone-Replacement Therapy – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary on Twitter
Presented today at #ENDO2023: In the TRAVERSE study, a randomized trial involving men with hypogonadism and preexisting or a risk of cardiovascular disease, testosterone therapy was noninferior to placebo with respect to major adverse cardiac events. https://t.co/V3FTTsOLd1
— NEJM (@NEJM) June 16, 2023
Review | Celiac disease: who should I test, and how?
19 Jun, 2023 | 13:54h | UTCCeliac disease: Who should I test, and how? – Cleveland Clinic Journal of Medicine
Review | Role of GLP1 receptor agonists in achieving weight loss and improving CV outcomes in people with overweight and obesity
19 Jun, 2023 | 13:40h | UTC
Brief Review | Why is cuff size so important and other factors that affect accurate blood pressure measurement
16 Jun, 2023 | 14:12h | UTC
Cohort Study | Alcohol consumption and risks of more than 200 diseases in Chinese men
16 Jun, 2023 | 13:55h | UTCAlcohol consumption and risks of more than 200 diseases in Chinese men – Nature Medicine
News Release: Alcohol consumption increases the risks of over 60 diseases – University of Oxford
Consensus Statement | Concussion in sport
15 Jun, 2023 | 15:14h | UTC
Evidence-based clinical practice guideline for deprescribing opioid analgesics
15 Jun, 2023 | 15:08h | UTC
RCT | Cannabis-based medicines show no significant relief for moderate-to-severe cancer pain
15 Jun, 2023 | 15:10h | UTCCannabis‐based medicines and medical cannabis for adults with cancer pain – Cochrane Library
Summary: Cannabis-based medicines for cancer pain – Cochrane Library
RCT | No significant kidney outcome differences observed across glucose-lowering medications in T2D patients
15 Jun, 2023 | 15:02h | UTCComparative Effects of Glucose-Lowering Medications on Kidney Outcomes in Type 2 Diabetes: The GRADE Randomized Clinical Trial – JAMA Internal Medicine (link to abstract – $ for full-text)
See also: Visual Abstract
Commentaries:
No differences found in effects of secondary diabetes drugs on kidney outcomes – ACP Diabetes
Do glucose-lowering medications have different effects on kidney outcomes? – News Medical
SR | Quality improvement strategies for diabetes care: Effects on outcomes for adults living with diabetes
15 Jun, 2023 | 14:57h | UTC
Cohort Study | 63.1% of uncomplicated appendicitis in children successfully treated non-operatively at 1 year
15 Jun, 2023 | 14:45h | UTC
Commentary on Twitter
1y outcomes of CASCADE examining?treatment for uncomp?itis in kids ➡️overall success: 63.1%, 21.5% req?during hospitalisation, 10.4% recurrence @1y. Overall comp: 7.3%?vs. 1.3% in success Non?treatment. Thoughts?https://t.co/AuIgSKkU6w#SoMe4Surgery #some4peds #emgensurg pic.twitter.com/9mM5NFOEh1
— BJS Open (@BjsOpen) June 7, 2023
M-A | Postpartum care up to 1 year after pregnancy
14 Jun, 2023 | 14:39h | UTC