cardiovascular diseases

Atorvastatin, Cardiovascular Events, and Disability-free Survival in Older Adults

Nathan Hinkle — Sat, 12 Sep 2026 05:00:00 +0000

Date Added:

September 12, 2026

Journal/Publication:

The New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

August 29, 2026

Pages:

1-13

URL:

Atorvastatin, Cardiovascular Events, and Disability-free Survival in Older Adults

Type:

Clinical Research Results

Format:

Article

DOI (1):

DOI: 10.1056/NEJMoa2607314

Keywords

Atorvastatin

cardiovascular events

statins

MeSH

Atorvastatin / therapeutic use

cardiovascular diseases

myocardial infarction

RPR Commentary: Older patients with no history of CV disease who took a statin had fewer CV events but didn't live longer or have less disability. My conclusion is that statins should be used selectively in older people who are at increased risk of CV events. James W. Mold, MD, MPH

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Abstract
Background
The effectiveness and safety of statins for the primary prevention of cardiovascular events and the extension of disability-free survival among older adults remain uncertain.
Methods
We conducted a double-blind, randomized, placebo-controlled trial at general medical practices across Australia. Community-dwelling adults at least 70 years of age with no history of cardiovascular disease, diabetes, or dementia were randomly assigned in a 1:1 ratio to receive atorvastatin at a dose of 40 mg once daily or identical placebo. The two primary end points were a composite of death from cardiovascular causes, nonfatal myocardial infarction or stroke, or coronary revascularization (to assess effects on major cardiovascular events) and a composite of death from any cause, dementia, or persistent physical disability (to assess effects on disability-free survival). Analyses were performed according to a hierarchical testing plan.
Results
A total of 9971 participants were enrolled: 4984 were assigned to receive atorvastatin and 4987 to receive placebo. The mean (±SD) age of the participants was 74.7±4.5 years, and 51.9% were women. After a median of 5.9 years, a primary cardiovascular event had occurred in 297 participants (10.9 events per 1000 person-years) in the atorvastatin group and in 412 participants (15.5 events per 1000 person-years) in the placebo group (hazard ratio, 0.70; 95% confidence interval [CI], 0.61 to 0.82; P<0.001). Death from any cause, dementia, or persistent physical disability occurred in 637 participants (21.6 events per 1000 person-years) in the atorvastatin group and in 676 participants (23.0 events per 1000 person-years) in the placebo group (hazard ratio, 0.94; 95% CI, 0.84 to 1.05; P=0.25). Serious adverse events occurred in 131 participants (2.7%) in the atorvastatin group and in 129 (2.7%) in the placebo group, with musculoskeletal, hepatobiliary, and diabetes-related adverse events occurring more commonly in the atorvastatin group.
Conclusions
Treatment with atorvastatin led to a lower risk of major cardiovascular events than placebo at a median of 5.9 years but did not result in longer disability-free survival among community-dwelling older adults without clinical cardiovascular disease. (Funded by the National Health and Medical Research Council and others; STAREE ClinicalTrials.gov number, NCT02099123.)

Author/s:

Sophia Zoungas, Rory Wolfe, Chris Moran, Stephen J. Nicholls, Geoffrey C. Cloud, Christopher M. Reid, Andrew M. Tonkin, Lawrence Beilin, Anthony S. Wierzbicki, Trevor T.-J. Chong, Jonathan C. Broder, Andrea J. Curtis, Zachary Flanagan, Ingrid Hopper, Joanne Ryan, Simone Spark, John J. McNeil, Mark R. Nelson

Familial Hypercholesterolemia

Nathan Hinkle — Tue, 30 Jun 2026 21:32:37 +0000

Date Added:

June 30, 2026

Journal/Publication:

JAMA

Publisher:

The American Medical Association

Publication Date:

June 29, 2026

Pages:

E1-E3

URL:

Familial Hypercholesterolemia

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

doi: 10.1001/jama.2026.8822

Keywords

MeSH

cardiovascular diseases

RPR Commentary: A review of familial hypercholesterolemia. The heterozygotic form is common enough to be important in primary care. The best screening test is the family history. James W. Mold, MD, MPH

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Familial hypercholesterolemia (FH) is a family of genetic disorders characterized by impaired hepatic clearance of low-density lipoprotein (LDL) particles, due to pathogenic variants that impair LDL receptor function.1,2 Lifelong elevation of LDL cholesterol (LDL-C) results in accelerated atherosclerosis and increased risk of atherosclerotic cardiovascular disease (ASCVD). Worldwide, heterozygous FH affects approximately 1 in 250 to 350 individuals, based on genetic epidemiology studies of pathogenic variants in FH-associated genes.1-3 Homozygous FH is rare, occurring in approximately 1 in 160 000 to 500 000 individuals.2 Among people with untreated heterozygous FH, approximately half of men develop fatal or nonfatal coronary events by age 50 years and approximately one-third of women by age 60 years.

Author/s:

James H. Stein, Matthew C. Tattersall

Statin Therapy for Primary Prevention and Clinical Outcomes in Adults Aged 80 and Older: A Retrospective Comparative Cohort Study

Megan George — Tue, 10 Mar 2026 15:14:46 +0000

Date Added:

March 10, 2026

Journal/Publication:

Journal of the American Geriatric Society

Publication Date:

March 7, 2026

URL:

Statin Therapy for Primary Prevention and Clinical Outcomes in Adults Aged 80 and Older: A Retrospective Comparative Cohort Study

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1111/jgs.70375

Keywords

prevention

cardiovascular disease

statins

PMID (1):

41793188

MeSH

female

Humans

cardiovascular diseases

Electronic Health Records

Hydroxymethylglutaryl-CoA Reductase Inhibitors

Proportional Hazards Models

retrospective studies

aged

Statins taken for primary prevention in adults over 80 were associated with a reduction in 4-year mortality rates of 31%. James W. Mold, MD, MPH

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Background: Evidence supporting the use of statins for primary prevention of cardiovascular disease (CVD) in individuals aged ≥ 80 years remains limited. This study aimed to evaluate the long-term clinical benefits and safety of statins for primary prevention in patients aged 80 years and older.

Methods: We conducted a population-based retrospective cohort study using electronic medical records and pharmacy dispensing data from Clalit Health Services in Israel, covering the period from January 2015 to December 2020. Patients aged ≥ 80 years without prior CVD who were persistent statin users were compared with similar patients not receiving statins. Exclusions included prior CVD, dialysis, or death within 1 year of follow-up. Outcomes included all-cause mortality, new coronary events, myopathy, dementia, and diabetes mellitus. Cox proportional hazards models, adjusted for potential confounders, were used to assess the association between statin use and clinical outcomes.

Results: Among 15,745 patients (mean age 84.5 years; 66% female), 8413 were statin users. Over a 4-year mean follow-up, statin use was associated with a 31% reduction in mortality (HR 0.69; 95% CI: 0.34-0.74; p < 0.001) and a 20% reduction in new coronary events (HR 0.80; 95% CI: 0.68-0.94; p = 0.008). No significant differences were observed in the incidence of myopathy, diabetes, or dementia. Benefits were not observed in patients who discontinued statins before age 80.

Conclusions: In patients aged ≥ 80 years, statin therapy for primary prevention was associated with reduced all-cause mortality and coronary morbidity, without increased risk of adverse events. Early discontinuation diminished these benefits.

Author/s:

Ophir Lavon, Wafaa Hamodi, Sameer Kassem

Colchicine for the secondary prevention of cardiovascular events

Megan George — Tue, 02 Dec 2025 16:21:13 +0000

Date Added:

December 2, 2025

Journal/Publication:

Cochrane Library

Publication Date:

November 13, 2025

URL:

Colchicine for the secondary prevention of cardiovascular events

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.1002/14651858.CD014808.pub2

Keywords

Coronary Intervention

coronary artery disease

secondary prevention

PMID (1):

41224205

MeSH

Randomized Controlled Trials as Topic

Coronary Artery Bypass

Percutaneous Coronary Intervention

coronary artery disease

cardiovascular diseases

acute coronary syndrome

secondary prevention

Confidence Intervals

Angioplasty

Low dose colchicine taken after an MI or stroke for at least 6 months reduces the risk of subsequent MI or stroke with minimal adverse effects (mostly GI). James W. Mold, MD, MPH

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Rationale
People with cardiovascular disease are at risk of recurrent major adverse cardiovascular events, and chronic low‐grade inflammation may be a major underlying factor. Treatment with low‐dose colchicine has been proposed for the secondary prevention of cardiovascular events in individuals at high cardiovascular risk. A previous Cochrane review showed considerable uncertainty regarding the benefits and harms of this approach.

Objectives
To evaluate the benefits and harms of low‐dose colchicine in the prevention of cardiovascular events in adults with a history of stable CVD or following myocardial infarction or stroke.

Search methods
We conducted a comprehensive search of the literature until February 2025 using Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the drugs@FDA database, references of key papers, and references of included studies.

Eligibility criteria
Randomised controlled trials (RCTs) comparing the use of low‐dose colchicine for a minimum of six months versus any control intervention in patients of any age with cardiovascular disease (i.e. history of stable cardiovascular disease, previous myocardial infarction or stroke).

Outcomes
Our critical outcomes were all‐cause mortality, myocardial infarction, and serious adverse events.

Our important outcomes were cardiovascular mortality, stroke, all‐cause hospitalisations, coronary revascularisation (percutaneous coronary intervention (PCI)/angioplasty or coronary artery bypass graft (CABG)), quality of life, and gastrointestinal adverse events (i.e. diarrhoea, nausea, abdominal pain, or vomiting).

Risk of bias
Two authors independently assessed the risk of bias using the Cochrane RoB2 tool.

Synthesis methods
We conducted meta‐analyses using the random‐effects model. We generated forest plots to facilitate visualisation of the data. We did not perform any subgroup analysis.

We used GRADE to assess the certainty of evidence for all critical outcomes and for cardiovascular mortality, stroke, and coronary revascularisation. This was carried out by two review authors working independently.

Included studies
We included 12 studies involving 22,983 randomised participants. The follow‐up in the studies ranged from 6 to 80 months. Overall, 11,524 participants were assigned to low‐dose colchicine treatment and 11,459 were assigned to a control intervention, which constituted either usual care plus placebo or usual care only. The doses of colchicine used were 0.5 mg once or twice daily. At baseline, the mean age of participants ranged from 57 to 74 years. Most participants (79.4%) were male.

Synthesis of results
There is high‐certainty evidence that low‐dose colchicine treatment reduces the risk of myocardial infarction, with a risk ratio (RR) of 0.74 (95% confidence interval (CI) 0.57 to 0.96; 22,153 participants, 8 studies; I2 = 51%), yielding an absolute risk reduction of 9 fewer events (95% CI 16 fewer to 2 fewer) per 1000 patients, when the myocardial infarction rate is about 4% (36 events per 1000 patients) in the control group.

There is also high‐certainty evidence that low‐dose colchicine reduces the risk of stroke with a RR of 0.67 (95% CI 0.47 to 0.95; 22,483 participants, 10 studies; I2 = 40%), yielding an absolute risk reduction of 8 fewer events (95% CI 12 fewer to 1 fewer) per 1000 patients, when the stroke rate is about 2% (22 events per 1000 patients) in the control group.

There is high‐certainty evidence that the use of low‐dose colchicine does not increase the rate of serious adverse events (RR 0.98, 95% CI 0.94 to 1.02; 15,677 participants, 4 studies; I2 = 0%). However, gastrointestinal adverse events were more common under treatment with colchicine (RR 1.68, 95% CI 1.11 to 2.57; 22,185 participants, 10 studies; I2 = 91%).

For all other outcomes assessed, the evidence is of moderate certainty. Colchicine probably results in little to no difference in all‐cause mortality (RR 1.01, 95% CI 0.84 to 1.21; 22,747 participants, 10 studies; I2 = 1%; moderate‐certainty evidence), in cardiovascular mortality (RR 0.94, 95% CI 0.73 to 1.22; 22,271 participants; 8 studies; I2 = 13%; moderate‐certainty evidence), and coronary revascularisation (RR 0.83, 95% CI 0.64 to 1.08; 13,705 participants, 5 studies; I2 = 40%; moderate‐certainty evidence).

There is no evidence about the benefits or harms of colchicine on quality‐of‐life or on the risk of all‐cause hospitalisation.

Authors' conclusions
People with cardiovascular disease using low‐dose colchicine as secondary prevention for at least six months benefit from reduced rates of myocardial infarction and stroke, without an increase in serious adverse events. Moderate‐certainty evidence did not show a benefit from low‐dose colchicine for the risk of mortality (i.e. all‐cause and cardiovascular mortality) or coronary revascularisation rates. Colchicine use was associated with an increased risk of gastrointestinal adverse events, which were typically described as mild and transient in nature. Additional studies are warranted to investigate the benefits and harms of low‐dose colchicine in relevant subgroups and in specific indications, such as long‐term use in individuals with stable coronary artery disease versus limited‐time use following acute coronary syndrome.

Funding
Review author FE was supported by the Margot und Erich Goldschmidt & Peter René Jacobson Foundation. Review author CMS was supported by the Janggen Pöhn Foundation and the Swiss National Science Foundation (MD‐PhD grant Number: 323530_221860).

Registration
This review is based on its protocol, which is available via DOI 10.1002/14651858.CD014808, and a previous review, which is available via DOI 10.1002/14651858.CD011047.pub2.

Author/s:

Fahim Ebrahimi, Ramin Ebrahimi, Maximilian Beer, Christof Manuel Schönenberger, Hannah Ewald, Matthias Briel, Perrine Janiaud, Julian Hirt

Metabolic Dysfunction–Associated Steatotic Liver Disease in Adults: A Review

Megan George — Tue, 11 Nov 2025 14:43:19 +0000

Date Added:

November 11, 2025

Journal/Publication:

JAMA

Publication Date:

November 10, 2025

URL:

Metabolic Dysfunction–Associated Steatotic Liver Disease in Adults: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.19615

Keywords

liver disease

steatotic liver disease

MASLD

Steatohepatitis

PMID (1):

41212550

MeSH

Glucagon-Like Peptide-1 Receptor Agonists

semaglutide

cardiovascular diseases

prevalence

diabetes mellitus

diabetes mellitus, type 2

Prediabetic State

liver cirrhosis

A review of metabolic dysfunction–associated steatotic liver disease in adults. James W. Mold, MD, MPH

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Importance Metabolic dysfunction–associated steatotic liver disease (MASLD) includes a range of liver conditions, progressing from isolated steatosis (characterized by fat accumulation in the liver without inflammation) to metabolic dysfunction–associated steatohepatitis (MASH), which involves fat accumulation and inflammation in the liver. The presence of MASLD is associated with increased morbidity and mortality due to liver-related complications, hepatocellular carcinoma, cardiovascular disease, and certain extrahepatic cancers.

Observations The most common chronic liver disease worldwide, MASLD affects approximately 30% to 40% of the general adult population globally (with varying prevalence across continents), including approximately 60% to 70% of individuals with type 2 diabetes and approximately 70% to 80% of those with obesity. It is typically diagnosed based on an ultrasonographic finding of hepatic steatosis, along with at least 1 of 5 features of the metabolic syndrome (abdominal overweight or obesity, prediabetes or type 2 diabetes, hypertension, elevated level of plasma triglycerides, and low level of high-density lipoprotein cholesterol) for women who consume less than 140 g/wk of alcohol (<2 standard drinks/d) and for men who consume less than 210 g/wk (<3 standard drinks/d) and have no other known causes of steatosis such as use of a particular medication (eg, corticosteroids, tamoxifen, or methotrexate), hepatitis C, or iron overload. Other risk factors for MASLD include older age (≥50 years) and male sex (male:female ratio approximately 2). The Fibrosis-4 index (a scoring system incorporating age, serum levels of aspartate aminotransferase and alanine aminotransferase, and platelet count) and vibration-controlled transient elastography (a noninvasive imaging technique) are commonly used to stage hepatic fibrosis in patients with MASLD. Cardiovascular disease is the leading cause of death, followed by certain extrahepatic cancers (primarily gastrointestinal, breast, and gynecologic cancer) and liver-related complications, including cirrhosis, hepatic decompensation (ascites, hepatic encephalopathy, or variceal bleeding), and hepatocellular carcinoma. First-line treatment of MASLD involves behavioral modifications (including hypocaloric low-carbohydrate and low-fat diets, physical exercise, and avoidance of alcohol) and management of type 2 diabetes, obesity, hypertension, and hyperlipidemia. Bariatric surgery should be considered for patients with MASLD and a body mass index greater than 35. Resmetirom (a liver-directed, thyroid hormone receptor β-selective agonist) and subcutaneous semaglutide (a glucagon-like peptide-1 receptor agonist) are conditionally approved by the US Food and Drug Administration (FDA) for the treatment of adults with MASH who have moderate to advanced fibrosis.

Conclusions A highly prevalent condition among adults worldwide, MASLD is associated with liver-related complications, hepatocellular carcinoma, cardiovascular disease, and certain extrahepatic cancers. First-line treatment includes behavioral modifications, including a weight-reducing diet, physical exercise, and avoidance of alcohol. Resmetirom and semaglutide are conditionally FDA-approved medications for the treatment of adults with MASH and moderate to advanced fibrosis.

Author/s:

Herbert Tilg, Salvatore Petta, Norbert Stefan, Giovanni Targher

Ultraprocessed Foods and Cardiometabolic Health—New Report on a “Growing Public Health Challenge”

Hope Smashey — Sat, 13 Sep 2025 19:26:39 +0000

Date Added:

September 13, 2025

Journal/Publication:

JAMA

Publication Date:

September 12, 2025

URL:

Ultraprocessed Foods and Cardiometabolic Health—New Report on a “Growing Public Health Challenge”

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.15322

Keywords

United States

American Heart Association

Cardiovascular Diseases

PMID (1):

40938604

MeSH

United States

Dietary Patterns

american heart association

cardiovascular diseases

Policy

A review of what we know about ultra-processed foods and their impact on health outcomes including a link to a categorized list of food based upon the degree of processing. James W. Mold, MD, MPH

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This Medical News article discusses a new American Heart Association science advisory on ultraprocessed foods, cardiometabolic health, and policy recommendations for improving dietary patterns.

Author/s:

Samantha Anderer

Testosterone Treatment in Middle-Aged and Older Men with Hypogonadism

Megan George — Tue, 02 Sep 2025 13:52:11 +0000

Date Added:

September 2, 2025

Journal/Publication:

The New England Journal of Medicine

Publication Date:

August 6, 2025

URL:

Testosterone Treatment in Middle-Aged and Older Men with Hypogonadism

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1056/NEJMra2404637

Keywords

PMID (1):

40768717

MeSH

cardiovascular diseases

Urinary Retention

Hypogonadism

prostatic neoplasms

Cognitive Dysfunction* / therapy

pulmonary embolism

Lower Urinary Tract Symptoms

Anemia

A review of testosterone replacement in middle-aged and older men with hypogonadism. James W. Mold, MD, MPH

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•
In clinical trials involving middle-aged and older men with hypogonadism, testosterone treatment led to improved sexual activity and libido, correction of anemia, and modestly improved energy, mood, and walking ability. (The following key points also refer to findings from clinical trials involving this patient population.)
•
Testosterone treatment did not improve cognition in men without a previously diagnosed cognitive disorder and did not prevent progression to diabetes in men with prediabetes or improve glycemic control in those with diabetes.
•
Testosterone treatment did not increase the risk of major cardiovascular events among men with preexisting cardiovascular disease.
•
Testosterone treatment did not increase the risk of prostate cancer or acute urinary retention and did not worsen lower urinary tract symptoms.
•
Testosterone treatment was associated with an increased risk of clinical fractures and pulmonary embolism.
•
The decision to administer testosterone treatment in a man with hypogonadism should be based on the severity of the hypogonadism and an assessment of the potential benefits and risks of treatment.

Author/s:

Shalender Bhasin, Peter J Snyder

Managing Adverse Effects of Incretin-Based Medications for Obesity

Megan George — Fri, 01 Aug 2025 13:22:15 +0000

Date Added:

August 1, 2025

Journal/Publication:

JAMA Insights

Publication Date:

July 29, 2025

URL:

Managing Adverse Effects of Incretin-Based Medications for Obesity

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.11153

Keywords

Cardiovascular Diseases

overweight

PMID (1):

40728833

MeSH

diabetes mellitus, type 2

Glucagon-Like Peptide-1 Receptor Agonists

cardiovascular diseases

overweight

Gastric Inhibitory Polypeptide

renal insufficiency

Information on how to deal with the side effects of obesity medications. James W. Mold, MD, MPH

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This JAMA Insights explores optimal strategies for managing the adverse effects associated with incretin-based medications for obesity, including semaglutide and tirzepatide.

Author/s:

Robert F Kushner, Jaime P Almandoz, Domenica M Rubino

Diagnosis and Treatment of Type 2 Diabetes in Adults A Review

Hope Smashey — Tue, 01 Jul 2025 19:34:58 +0000

Date Added:

July 1, 2025

Journal/Publication:

JAMA

Publication Date:

June 23, 2025

URL:

Diagnosis and Treatment of Type 2 Diabetes in Adults: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.5956

Keywords

diabetes

type 2 diabetes

treatment

PMID (1):

40549398

MeSH

diabetes mellitus

Type 2

cardiovascular diseases

dipeptidyl-peptidase IV inhibitors

Insulin Resistance

Insulin Secretion

Glucose Tolerance Test

overweight

risk factors

An evidence-based review of the treatment of patients with Type 2 diabetes mellitus. James W. Mold, MD, MPH

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Importance: Type 2 diabetes involves progressive loss of insulin secretion from pancreatic β cells in the setting of insulin resistance and manifests clinically as hyperglycemia. Type 2 diabetes accounts for 90% to 95% of all cases of diabetes globally, with estimates ranging from 589 million to 828 million people worldwide. In the US, type 2 diabetes affects approximately 1 in 6 adults.

Observations: Risk factors for type 2 diabetes include older age, family history, overweight or obesity, physical inactivity, gestational diabetes, Hispanic ethnicity, and American Indian or Alaska Native, Asian, or Black race. Diabetes is diagnosed if fasting plasma glucose is greater than or equal to 126 mg/dL, hemoglobin A1C is greater than or equal to 6.5%, or 2-hour glucose during 75-g oral glucose tolerance testing is greater than or equal to 200 mg/dL. Approximately one-third of adults with type 2 diabetes have cardiovascular disease and 10.1% have severe vision difficulty or blindness. The prevalence of type 2 diabetes is 39.2% among patients with kidney failure. Although weight management is an important component of treatment for type 2 diabetes, no specific diet has been proven to be most effective for improving health outcomes. Physical activity can reduce hemoglobin A1C by 0.4% to 1.0% and improve cardiovascular risk factors (ie, hypertension and dyslipidemia). Randomized clinical trials have reported absolute reductions in microvascular disease (3.5%), such as retinopathy and nephropathy, myocardial infarction (3.3%-6.2%), and mortality (2.7%-4.9%), with intensive glucose-lowering strategies (hemoglobin A1C <7%) vs conventional treatment 2 decades after trial completion. First-line medications for type 2 diabetes include metformin and, in patients with cardiovascular or kidney comorbidities or at high cardiovascular risk, glucagon-like peptide-1 receptor agonists (GLP-1RAs) or sodium-glucose cotransporter 2 inhibitors (SGLT2is). Common add-on medications include dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1RAs, dipeptidyl peptidase-4 inhibitors, sulfonylureas, and thiazolidinediones. Approximately one-third of patients with type 2 diabetes require treatment with insulin during their lifetime. Several randomized clinical trials have demonstrated benefits of specific SGLT2i and GLP-1RA medications compared with placebo for atherosclerotic cardiovascular disease (12%-26% risk reduction), heart failure (18%-25% risk reduction), and kidney disease (24%-39% risk reduction) over 2 to 5 years. Most trial participants with type 2 diabetes were taking metformin. High-potency GLP-1RA and dual GIP/GLP-1RA medications result in weight loss of greater than 5% in most individuals with type 2 diabetes, and weight loss may exceed 10%.

Conclusions: Type 2 diabetes affects up to 14% of the global population and is associated with preventable long-term complications, such as cardiovascular disease, kidney failure, vision loss, and increased mortality. In addition to lifestyle modifications including diet, exercise, and weight management, metformin is generally first-line therapy for attainment of hemoglobin A1C targets. For individuals with type 2 diabetes and cardiovascular or kidney disease or at high cardiovascular risk, guidelines recommend early treatment with SGLT2i and/or GLP-1RA medications.

Author/s:

Rita R Kalyani, Joshua J Neumiller, Nisa M Maruthur, Deborah J Wexler

Lipoprotein(a)

Erin Blanchette — Wed, 30 Apr 2025 21:25:24 +0000

Date Added:

April 30, 2025

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

April 24, 2025

URL:

Lipoprotein(a)

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.2373

Keywords

Cardiovascular Risk Factors

diet

PMID (1):

40272827

MeSH

Lipoproteins

LDL

Lipoprotein(a)

cardiovascular diseases

diet

A summary of what we know currently about lipoprotein (a) and its association with ASCVD, James W. Mold, MD, MPH

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Lipoprotein(a) is a low-density lipoprotein-like particle that carries oxidized phospholipids and has proinflammatory and proatherogenic properties. In prospective studies, higher levels of lipoprotein(a) are associated with significantly higher risk of atherosclerotic cardiovascular disease (ASCVD) and all-cause mortality.1 In a meta-analysis of 29 069 patients, the incidence of ASCVD events per 1000 person-years was 80.0 (95% CI, 75.3-84.9) among people with lipoprotein(a) greater than or equal to 50 mg/dL and 55.3 (95% CI, 53.4-57.3) for people with lipoprotein(a) less than 15 mg/dL (adjusted hazard ratio, 1.35 [95% CI, 1.11-1.66]).2 A similar association of elevated lipoprotein(a) with ASCVD was observed among 460 506 participants from the UK Biobank study.3 Medications such as pelacarsen, olpasiran, and lepodisiran reduce lipoprotein(a) production in the liver and lower plasma lipoprotein(a) by up to 99%, and are currently undergoing testing in randomized clinical trials to determine whether they reduce rates of ASCVD in people with elevated lipoprotein(a).4

Author/s:

Samia Mora, Florian Kronenberg

Managing Hypercholesterolemia in Adults Older Than 75 years Without a History of Atherosclerotic Cardiovascular Disease: An Expert Clinical Consensus From the National Lipid Association and the American Geriatrics Society

Alex Haga — Mon, 14 Apr 2025 18:17:35 +0000

Date Added:

April 14, 2025

Journal/Publication:

Journal of the American Geriatrics Society

Publication Date:

April 10, 2025

URL:

Managing Hypercholesterolemia in Adults Older Than 75 years Without a History of Atherosclerotic Cardiovascular Disease: An Expert Clinical Consensus From the National Lipid Association and the American Geriatrics Society

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1111/jgs.19398

Keywords

hypercholesterolemia

older adult

primary prevention

PMID (1):

40207842

MeSH

cardiovascular diseases

cholesterol

primary prevention

A summary of the evidence and recommendations regarding treatment of people over 75 with statins. James W. Mold, MD, MPH

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The risk of atherosclerotic cardiovascular disease increases with advancing age. Elevated LDL-cholesterol and non-HDL-cholesterol levels remain predictive of incident atherosclerotic cardiovascular events among individuals older than 75 years. Risk prediction among older individuals is less certain because most current risk calculators lack specificity in those older than 75 years and do not adjust for co-morbidities, functional status, frailty, and cognition which significantly impact prognosis in this age group. Data on the benefits and risks of lowering LDL-cholesterol with statins in older patients without atherosclerotic cardiovascular disease are also limited since most primary prevention trials have included mostly younger patients. Available data suggest that statin therapy in older primary prevention patients may reduce atherosclerotic cardiovascular events and that benefits from lipid-lowering with statins outweigh potential risks such as statin-associated muscle symptoms and incident Type 2 diabetes mellitus. While some evidence suggests the possibility that statins may be associated with incident cognitive impairment in older adults, a preponderance of literature indicates neutral or even protective statin-related cognitive effects. Shared decision-making which is recommended for all patients when considering statin therapy is particularly important in older patients. Randomized clinical trial data evaluating the use of non-statin lipid-lowering therapy in older patients are sparse. Deprescribing of lipid-lowering agents may be appropriate for select patients older than 75 years with life-limiting diseases. Finally, a patient-centered approach should be taken when considering primary prevention strategies for older adults.

Author/s:

Vera Bittner, Sunny A Linnebur, Dave L Dixon, Daniel E Forman, Ariel R Green

Obesity in Adolescents: A Review

Alex Haga — Sat, 10 Aug 2024 18:21:58 +0000

Date Added:

August 10, 2024

Journal/Publication:

JAMA

Publication Date:

August 5, 2024

URL:

Obesity in Adolescents: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2024.11809

Keywords

PMID (1):

39102244

MeSH

cardiovascular diseases

diabetes mellitus

diabetes mellitus, type 2

depression

Life Style

exercise

A review of obesity management in adolescents. James W. Mold, MD, MPH

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Importance: Obesity affects approximately 21% of US adolescents and is associated with insulin resistance, hypertension, dyslipidemia, sleep disorders, depression, and musculoskeletal problems. Obesity during adolescence has also been associated with an increased risk of mortality from cardiovascular disease and type 2 diabetes in adulthood.

Observations: Obesity in adolescents aged 12 to younger than 18 years is commonly defined as a body mass index (BMI) at the 95th or greater age- and sex-adjusted percentile. Comprehensive treatment in adolescents includes lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery. Lifestyle modification therapy, which includes dietary, physical activity, and behavioral counseling, is first-line treatment; as monotherapy, lifestyle modification requires more than 26 contact hours over 1 year to elicit approximately 3% mean BMI reduction. Newer antiobesity medications, such as liraglutide, semaglutide, and phentermine/topiramate, in combination with lifestyle modification therapy, can reduce mean BMI by approximately 5% to 17% at 1 year of treatment. Adverse effects vary, but severe adverse events from these newer antiobesity medications are rare. Surgery (Roux-en-Y gastric bypass and vertical sleeve gastrectomy) for severe adolescent obesity (BMI ≥120% of the 95th percentile) reduces mean BMI by approximately 30% at 1 year. Minor and major perioperative complications, such as reoperation and hospital readmission for dehydration, are experienced by approximately 15% and 8% of patients, respectively. Determining the long-term durability of all obesity treatments warrants future research.

Conclusions and relevance: The prevalence of adolescent obesity is approximately 21% in the US. Treatment options for adolescents with obesity include lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery. Intensive lifestyle modification therapy reduces BMI by approximately 3% while pharmacotherapy added to lifestyle modification therapy can attain BMI reductions ranging from 5% to 17%. Surgery is the most effective intervention for adolescents with severe obesity and has been shown to achieve BMI reduction of approximately 30%.

Author/s:

Aaron S Kelly, Sarah C Armstrong, Marc P Michalsky, Claudia K Fox

The Women’s Health Initiative Randomized Trials and Clinical Practice

Alex Haga — Mon, 13 May 2024 21:25:57 +0000

Date Added:

May 13, 2024

Journal/Publication:

JAMA

Publisher:

JAMA

Publication Date:

May 1, 2024

URL:

The Women’s Health Initiative Randomized Trials and Clinical Practice

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jama.2024.6542

Keywords

PMID (1):

38691368

A summary review of the results of the Womens Health Initiative Study pertaining to HRT, Vit D/calcium supplementation, and low-fat diet in menopausal women. James W. Mold, MD, MPH

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Importance: Approximately 55 million people in the US and approximately 1.1 billion people worldwide are postmenopausal women. To inform clinical practice about the health effects of menopausal hormone therapy, calcium plus vitamin D supplementation, and a low-fat dietary pattern, the Women's Health Initiative (WHI) enrolled 161 808 postmenopausal US women (N = 68 132 in the clinical trials) aged 50 to 79 years at baseline from 1993 to 1998, and followed them up for up to 20 years.

Observations: The WHI clinical trial results do not support hormone therapy with oral conjugated equine estrogens plus medroxyprogesterone acetate for postmenopausal women or conjugated equine estrogens alone for those with prior hysterectomy to prevent cardiovascular disease, dementia, or other chronic diseases. However, hormone therapy is effective for treating moderate to severe vasomotor and other menopausal symptoms. These benefits of hormone therapy in early menopause, combined with lower rates of adverse effects of hormone therapy in early compared with later menopause, support initiation of hormone therapy before age 60 years for women without contraindications to hormone therapy who have bothersome menopausal symptoms. The WHI results do not support routinely recommending calcium plus vitamin D supplementation for fracture prevention in all postmenopausal women. However, calcium and vitamin D are appropriate for women who do not meet national guidelines for recommended intakes of these nutrients through diet. A low-fat dietary pattern with increased fruit, vegetable, and grain consumption did not prevent the primary outcomes of breast or colorectal cancer but was associated with lower rates of the secondary outcome of breast cancer mortality during long-term follow-up.

Conclusions and relevance: For postmenopausal women, the WHI randomized clinical trials do not support menopausal hormone therapy to prevent cardiovascular disease or other chronic diseases. Menopausal hormone therapy is appropriate to treat bothersome vasomotor symptoms among women in early menopause, without contraindications, who are interested in taking hormone therapy. The WHI evidence does not support routine supplementation with calcium plus vitamin D for menopausal women to prevent fractures or a low-fat diet with increased fruits, vegetables, and grains to prevent breast or colorectal cancer. A potential role of a low-fat dietary pattern in reducing breast cancer mortality, a secondary outcome, warrants further study.

Author/s:

Manson, J.E., Crandall, C.J., Rossouw, J.E.

Lipid-lowering therapies for cardiovascular disease prevention and management in primary care

Rowan Hutchins — Sun, 15 Oct 2023 05:00:00 +0000

Date Added:

October 15, 2023

Journal/Publication:

CFP

Publisher:

College of Family Physicians of Canada

Publication Date:

October 1, 2023

Issue:

Volume:

Pages:

701-711

URL:

Lipid-lowering therapies for cardiovascular disease prevention and management in primary care

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.46747/cfp.6910701

Keywords

randomised controlled trials

systematic review

PMID (1):

37833094

MeSH

PCSK9 Inhibitors

Hydroxymethylglutaryl-CoA Reductase Inhibitors

cardiovascular diseases

An analysis of the evidence of the impact of various lipid lowering strategies in cardiovascular events and mortality. James W. Mold, MD, MPH

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Objective: To assess the benefits and harms of lipid-lowering therapies used to prevent or manage cardiovascular disease including bile acid sequestrants (BAS), ezetimibe, fibrates, niacin, omega-3 supplements, proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors, and statins.

Author/s:

Nicolas Dugré, Adrienne J. Lindblad, Danielle Perry, G. Michael Allan, Émélie Braschi, Jamie Falk, Liesbeth Froentjes, Scott R. Garrison, Jessica E.M. Kirkwood, Christina S. Korownyk

Mortality and Morbidity in Mild Primary Hyperparathyroidism: Results From a 10-Year Prospective Randomized Controlled Trial of Parathyroidectomy Versus Observation

Saige Blanchard — Thu, 14 Apr 2022 05:00:00 +0000

Date Added:

April 25, 2022

Journal/Publication:

Annals of Internal Medicine

Publisher:

American College of Physicians

Publication Date:

April 19, 2022

URL:

Mortality and Morbidity in Mild Primary Hyperparathyroidism: Results From a 10-Year Prospective Randomized Controlled Trial of Parathyroidectomy Versus Observation

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.7326/M21-4416

Keywords

PMID (1):

35436153

MeSH

Humans

cause of death

Parathyroidectomy

Hyperparathyroidism, Primary

cardiovascular diseases

prospective studies

In mild hyperparathyroidism, surgery did not result in fewer adverse events over 15 years of follow-up. James W. Mold, MD, MPH

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Background: Primary hyperparathyroidism (PHPT) is a common endocrine disorder associated with increased risk for fractures, cardiovascular disease, kidney disease, and cancer and increased mortality. In mild PHPT with modest hypercalcemia and without known morbidities, parathyroidectomy (PTX) is debated because no long-term randomized trials have been performed.

Objective: To examine the effect of PTX on mild PHPT with regard to mortality (primary end point) and key morbidities (secondary end point).

Design: Prospective randomized controlled trial. (ClinicalTrials.gov: NCT00522028).

Setting: Eight Scandinavian referral centers.

Patients: From 1998 to 2005, 191 patients with mild PHPT were included.

Intervention: Ninety-five patients were randomly assigned to PTX, and 96 were assigned to observation without intervention (OBS).

Measurements: Date and causes of death were obtained from the Swedish and Norwegian Cause of Death Registries 10 years after randomization and after an extended observation period lasting until 2018. Morbidity events were prospectively registered annually.

Results: After 10 years, 15 patients had died (8 in the PTX group and 7 in the OBS group). Within the extended observation period, 44 deaths occurred, which were evenly distributed between groups (24 in the PTX group and 20 in the OBS group). A total of 101 morbidity events (cardiovascular events, cerebrovascular events, cancer, peripheral fractures, and renal stones) were also similarly distributed between groups (52 in the PTX group and 49 in the OBS group). During the study, a total of 16 vertebral fractures occurred in 14 patients (7 in each group).

Limitation: During the study period, 23 patients in the PTX group and 27 in the OBS group withdrew.

Conclusion: Parathyroidectomy does not appear to reduce morbidity or mortality in mild PHPT. Thus, no evidence of adverse effects of observation was seen for at least a decade with respect to mortality, fractures, cancer, cardiovascular and cerebrovascular events, or renal morbidities.

Author/s:

Pretorius, M., Lundstam, K., Heck, A., Fagerland, M. W., Godang, K., Mollerup, C., Fougner, S. L., Pernow, Y., Aas, T., Hessman, O., Rosen, T., Nordestrom, J., Jansson, S., Hellstrom, M., Bollerslev, J.