adult

Evaluating the Association Between Low-Density Lipoprotein Cholesterol Reduction and Relative and Absolute Effects of Statin Treatment

Rowan Hutchins — Sat, 06 May 2023 05:00:00 +0000

Date Added:

May 6, 2023

Journal/Publication:

JAMA Intern Med

Publisher:

JAMA

Publication Date:

March 14, 2022

Issue:

Volume:

182

URL:

Evaluating the Association Between Low-Density Lipoprotein Cholesterol Reduction and Relative and Absolute Effects of Statin Treatment

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamainternmed.2022.0134

Keywords

adult

cholesterol

stroke prevention

PMID (1):

35285850

MeSH

Cardiovascular Disease

cholesterol, LDL

Hydroxymethylglutaryl-CoA Reductase Inhibitors* / therapeutic use

myocardial infarction

The modest reduction in all-cause mortality affected by statins is largely independent of the amount of LDL cholesterol reduction suggesting a somewhat lipid independent anti-inflammatory effect. Two caveats: 1)The 0.8% absolute risk reduction is per around 3 years, so longer term treatment will have more impact; 2) absolute risk reduction is directly proportional to baseline risk, so higher risk individuals will benefit more. James W. Mold, MD, MPH.

Free full text

View

Importance The association between statin-induced reduction in low-density lipoprotein cholesterol (LDL-C) levels and the absolute risk reduction of individual, rather than composite, outcomes, such as all-cause mortality, myocardial infarction, or stroke, is unclear.

Objective To assess the association between absolute reductions in LDL-C levels with treatment with statin therapy and all-cause mortality, myocardial infarction, and stroke to facilitate shared decision-making between clinicians and patients and inform clinical guidelines and policy.

Data Sources PubMed and Embase were searched to identify eligible trials from January 1987 to June 2021.

Study Selection Large randomized clinical trials that examined the effectiveness of statins in reducing total mortality and cardiovascular outcomes with a planned duration of 2 or more years and that reported absolute changes in LDL-C levels. Interventions were treatment with statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) vs placebo or usual care. Participants were men and women older than 18 years.

Data Extraction and Synthesis Three independent reviewers extracted data and/or assessed the methodological quality and certainty of the evidence using the risk of bias 2 tool and Grading of Recommendations, Assessment, Development and Evaluation. Any differences in opinion were resolved by consensus. Meta-analyses and a meta-regression were undertaken.

Main Outcomes and Measures Primary outcome: all-cause mortality. Secondary outcomes: myocardial infarction, stroke.

Findings Twenty-one trials were included in the analysis. Meta-analyses showed reductions in the absolute risk of 0.8% (95% CI, 0.4%-1.2%) for all-cause mortality, 1.3% (95% CI, 0.9%-1.7%) for myocardial infarction, and 0.4% (95% CI, 0.2%-0.6%) for stroke in those randomized to treatment with statins, with associated relative risk reductions of 9% (95% CI, 5%-14%), 29% (95% CI, 22%-34%), and 14% (95% CI, 5%-22%) respectively. A meta-regression exploring the potential mediating association of the magnitude of statin-induced LDL-C reduction with outcomes was inconclusive.

Conclusions and Relevance The results of this meta-analysis suggest that the absolute risk reductions of treatment with statins in terms of all-cause mortality, myocardial infarction, and stroke are modest compared with the relative risk reductions, and the presence of significant heterogeneity reduces the certainty of the evidence. A conclusive association between absolute reductions in LDL-C levels and individual clinical outcomes was not established, and these findings underscore the importance of discussing absolute risk reductions when making informed clinical decisions with individual patients.

Author/s:

Byrne, P., Demasi, M., Jones, M.

Screening for Syphilis Infection in Nonpregnant Adolescents and Adults: US Preventive Services Task Force Reaffirmation Recommendation Statement

Aubrey Delammermore — Sat, 01 Oct 2022 05:00:00 +0000

Date Added:

October 1, 2022

Journal/Publication:

JAMA

Publisher:

JAMA

Publication Date:

September 27, 2022

Issue:

Volume:

328

Pages:

1243-1249

URL:

Screening for Syphilis Infection in Nonpregnant Adolescents and Adults: US Preventive Services Task Force Reaffirmation Recommendation Statement

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2022.15322

Keywords

PMID (1):

36166020

MeSH

preventative health services

Sexually Transmitted Diseases* / etiology

Syphilis* / diagnosis

Mass Screening / adverse effects

Humans

Updated recommendation from USPSTF on screening for syphilis. James W. Mold, MD, MPH

Free full text

View

Importance: Syphilis is a sexually transmitted infection that can progress through different stages (primary, secondary, latent, and tertiary) and cause serious health problems if left untreated. Reported cases of primary and secondary syphilis in the US increased from a record low of 2.1 cases per 100 000 population in 2000 and 2001 to 11.9 cases per 100 000 population in 2019. Men account for the majority of cases (83% of primary and secondary syphilis cases in 2019), and rates among women nearly tripled from 2015 to 2019.

Objective: To reaffirm its 2016 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a reaffirmation evidence update focusing on targeted key questions evaluating the performance of risk assessment tools and the benefits and harms of screening for syphilis in nonpregnant adolescents and adults.

Population: Asymptomatic, nonpregnant adolescents and adults who have ever been sexually active and are at increased risk for syphilis infection.

Evidence assessment: Using a reaffirmation process, the USPSTF concludes with high certainty that there is a substantial net benefit of screening for syphilis infection in nonpregnant persons who are at increased risk for infection.

Recommendation: The USPSTF recommends screening for syphilis infection in persons who are at increased risk for infection. (A recommendation).

Author/s:

US Preventative Services task Force, Mangione, C. M., Barry, M. J., Nicholson, W. K., Cabana, M., Chelmow, D., Coker, T. R., Davis, E. M., Donahue, K. E., Jaén, C. R., Kubik, M., Li, L., Ogedegbe, G., Pbert, L., Ruiz, J. M., Stevermer, J., Wong, B. J.

Recommended Adult Immunization Schedule, United States, 2022

Saige Blanchard — Mon, 28 Feb 2022 06:00:00 +0000

Date Added:

February 28, 2022

Journal/Publication:

Annals of Internal Medicine

Publisher:

American College of Physicians

Publication Date:

February 18, 2022

URL:

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.7326/M22-0036

Keywords

MeSH

Immunization Schedule

Advisory Committees

This is a summary of the 2022 CDC adult immunization recommendations. James W. Mold, MD, MPH

Free full text

View

In November 2021, the Advisory Committee on Immunization Practices (ACIP) voted to approve the Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2022. The 2022 adult immunization schedule, available at www.cdc.gov/vaccines/schedules/hcp/imz/adult.html, summarizes ACIP recommendations in the cover page, tables, notes, and appendix (Figure). The appendix lists the contraindications and precautions for all routinely recommended vaccines on the adult immunization schedule (Figure). The full ACIP recommendations for each vaccine are available at www.cdc.gov/vaccines/hcp/acip-recs/index.html. The 2022 schedule has also been approved by the director of the Centers for Disease Control and Prevention (CDC) and by the American College of Physicians (www.acponline.org), the American Academy of Family Physicians (www.aafp.org), the American College of Obstetricians and Gynecologists (www.acog.org), the American College of Nurse-Midwives (www.midwife.org), the American Academy of Physician Associates (www.aapa.org), and the Society for Healthcare Epidemiology of America (www.shea-online.org).

Author/s:

N., Wodi, A. P., Bernstein, H., Ault, K. A.

Electronic Nicotine Delivery Systems (ENDS)

Brian Desmarais — Sat, 18 May 2019 05:00:00 +0000

Date Added:

May 18, 2019

Publisher:

AAFP

Publication Date:

April 1, 2019

URL:

Electronic Nicotine Delivery Systems (ENDS)

Type:

Public Health Announcements

Format:

Web Page

Keywords

MeSH

electronic nicotine delivery systems

Antineoplastic Combined Chemotherapy Protocols

AAFP statement regarding e-cigarettes.

Free full text

View

Electronic nicotine delivery systems (ENDS), also called electronic cigarettes, e-cigarettes, vaping devices, or vape pens, are battery-powered devices used to smoke or “vape” a flavored solution which usually contains nicotine. The American Academy of Family Physicians (AAFP) recognizes the alarmingly increased use of ENDS, especially among youth and young adults, as well as its use by those attempting to quit smoking tobacco.

The AAFP calls for further research to assess ENDS’ safety, quality, and efficacy as a potential cessation device. The AAFP also recommends that the marketing and advertising of ENDS to children and youth cease immediately. The AAFP encourages members to screen for ENDS use starting with school-age children, to discuss the potential harms of ENDS, and to recommend cessation interventions with e-cigarette users. The AAFP encourages members to inform patients who use ENDS, especially children, that the majority of these products contain nicotine and are addictive. (2014 COD) (April 2019 BOD)