Humans

Importance Male hypogonadism is a clinical syndrome of signs and symptoms of testosterone deficiency and consistently low morning serum testosterone concentrations. The prevalence of hypogonadism due to hypothalamus, pituitary, or testes pathology is less than 1%, and the prevalence due to obesity (body mass index ≥30) is from 2% to 8%.

Observations The most common signs and symptoms of hypogonadism are decreased libido, decreased spontaneous erections, and small testes. Primary hypogonadism is characterized by deficient testicular production of testosterone despite elevated luteinizing hormone (LH) concentrations. The most common cause of primary hypogonadism is Klinefelter syndrome (≥2 X chromosomes and 1 Y chromosome), which affects 2 in 1000 men and is frequently undiagnosed. Secondary hypogonadism is caused by hypothalamic or pituitary dysfunction and is characterized by low testosterone concentrations and low or inappropriately normal LH and follicle-stimulating hormone (FSH) concentrations. The most common permanent causes of secondary hypogonadism are head and neck radiation and severe head trauma. The most common potentially reversible causes of secondary hypogonadism are obesity, severe illness, and medication use (opioids, corticosteroids, checkpoint inhibitors, and medications that cause hyperprolactinemia). Testing for hypogonadism is reserved for men with signs and symptoms of androgen deficiency. Hypogonadism is confirmed if an individual’s serum testosterone concentration is less than 264 to 300 ng/dL in at least 2 fasting samples collected between 7 and 10 am and measured with an accurate and external quality-controlled assay. Assessment of calculated free testosterone concentration derived using total testosterone and sex hormone–binding globulin (SHBG) concentrations is necessary for men with obesity, diabetes, and other conditions that cause low serum SHBG concentrations. Patients diagnosed with hypogonadism should have serum FSH and LH concentrations measured to distinguish primary from secondary hypogonadism. For men with obesity-induced hypogonadism, the recommended first-line management is weight loss. In men with obesity, weight loss of at least 5% typically increases serum total testosterone concentration significantly, and weight loss is associated with improved physical function, libido, and erectile function. Men with permanent hypogonadism, or those unable to discontinue medications that cause hypogonadism, may be treated with testosterone. The testosterone formulation (injection, gel, or pill) and dosage should be individualized with monitoring of serum testosterone concentration, hematocrit percentage, and possibly prostate-specific antigen concentration.

Conclusions and Relevance Primary hypogonadism affects less than 1% of men, whereas secondary hypogonadism due to obesity (body mass index ≥30) occurs in 2% to 8%. First-line treatment for obesity-induced hypogonadism is weight loss. Testosterone therapy should be initiated for men with permanent hypogonadism or those who are unable to discontinue medications that cause hypogonadism.

Author/s:

Bradley D. Anawalt, Kim M. O’Connor, Mathis Grossmann

Hearing Aids for Adults With Mild to Moderate Hearing Loss

Megan George — Fri, 29 May 2026 19:31:08 +0000

Date Added:

May 29, 2026

Journal/Publication:

JAMA

Publication Date:

May 27, 2026

URL:

Hearing Aids for Adults With Mild to Moderate Hearing Loss

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2026.4740

Keywords

PMID (1):

42201716

MeSH

Hearing Loss, Sensorineural

Hair Cells

Auditory Perception

Social Isolation

A review of hearing aids, types, characteristics, benefits, and limitations in adults with mild to moderate hearing loss. James W. Mold, MD, MPH

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Hearing loss is defined as an impaired ability to hear sounds at thresholds considered to be normal. Projections based on audiometric data from the National Health and Nutrition Examination Survey estimate that by 2030, approximately 55 million US adults will have hearing loss, including 35 million with mild loss (25-40 dB) and nearly 20 million with moderate or greater loss (>40 dB).1 The most common cause of hearing loss among hearing aid users is bilateral sensorineural hearing loss due to cochlear hair cell or auditory nerve degeneration. Functional effects of hearing loss differ with severity. Mild hearing loss may affect the ability to understand speech in noisy environments; moderate or greater hearing loss affects the ability to have individual conversations in a quiet room.

Untreated hearing loss is associated with social isolation that can reduce quality of life.2 A meta-analysis of 5 randomized trials (825 adults with mild to moderate hearing loss) that compared those not receiving hearing aids with those who received hearing aids that amplified sounds via air conduction had improved ability to discriminate sound and speech and hearing-related quality of life based on Hearing Handicap Inventory for the Elderly,2 which quantifies self-perceived functional and emotional hearing handicap (such as negative feelings and psychological distress from communication problems). The Hearing Handicap Inventory for the Elderly scores (lower scores indicate less handicap; scale, 0-100) improved by −26.5 (95% CI, −42.2 to −10.8) points with hearing aids, exceeding the minimal clinically important difference of 18.7 points.2

Amplification with hearing aids is the primary treatment for hearing loss, but use is limited. Traditional Medicare does not cover hearing aids, and coverage for associated services remains limited. In a nationally representative cohort using data from the National Health and Aging Trends Study, hearing aid use among US adults aged 71 years and older with hearing loss was 29.2% in 2021, including 14.4% among those with mild loss and 45.3% among those with moderate hearing loss.3 Although reasons for nonuse were not directly assessed, lower-income individuals, along with those who have milder degrees of hearing loss, are less likely to use hearing aids.3 Until recently, hearing aids in the US could only be obtained through licensed hearing care professionals such as audiologists. However, since October 2022, the US Food and Drug Administration has allowed adults to buy hearing aid devices without a medical examination, prescription, or professional fitting. This regulatory change has enabled over-the-counter (OTC) direct-to-consumer hearing aids, with potential to broaden access.

Author/s:

Karina C. De Sousa, De Wet Swanepoel

Hepatitis B: A Review

Megan George — Tue, 05 May 2026 13:47:25 +0000

Date Added:

May 5, 2026

Journal/Publication:

JAMA

Publication Date:

May 4, 2026

URL:

Hepatitis B: A Review

Type:

Meta-analyses, Reviews, and Guidelines, Patient Education Materials

Format:

Article

DOI (1):

10.1001/jama.2026.6070

Keywords

hepatitis

hepatitis B

Hepatitis B Core Antigens

Hepatitis B Surface Antigens

Antiviral Agents

Liver Failure

vaccination

PMID (1):

42081318

MeSH

Hepatitis B Core Antigens

Hepatitis B Surface Antigens

Hepatitis B e Antigens

A review of the epidemiology, characteristics, diagnosis, management, and prevention of hepatitis B. W. Mold, MD, MPH

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Importance: Hepatitis B virus (HBV) infection affects an estimated 254 million people worldwide and causes approximately 1.1 million deaths annually. In 2022, there were approximately 1.2 million new HBV infections worldwide and 14 000 in the US.

Observations: HBV is a DNA virus transmitted through percutaneous or mucosal exposure to infected blood, semen, or body fluids. Mother-to-child transmission, which is the principal cause of chronic HBV infection globally, occurs in 70% to 90% of infants born to mothers who are hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) positive and in 5% to 20% of those born to HBsAg-positive/HBeAg-negative mothers. However, HBV vaccination and administration of hepatitis B immune globulin within 12 to 24 hours of birth prevent approximately 94% of perinatal infections, and adding antiviral therapy in pregnant women with high HBV DNA reduces transmission to less than 1%. Although universal birth-dose HBV vaccination is the most effective strategy for eliminating HBV infection, global birth-dose HBV vaccine coverage was only 45% in 2024. The risk of developing chronic infection (HBsAg positive for more than 6 months) is 90% if HBV infection occurs during infancy, 30% in children aged 1 to 5 years, and less than or equal to 5% in immunocompetent adolescents and adults. HBV infection is diagnosed by serologic testing: HBsAg indicates ongoing infection, antibody to HBsAg indicates immunity, and antibody to hepatitis B core antigen indicates ongoing or past infection. Serum HBV DNA levels quantify virus-replication activity. Assessment of liver inflammation and fibrosis with alanine aminotransferase (ALT) and noninvasive tests such as Fibrosis-4 index and liver elastography guide treatment decisions. Chronic HBV infection may progress to cirrhosis and hepatocellular carcinoma (HCC); the 5-year cumulative risk of cirrhosis is 8% to 15% in untreated chronic HBV infection, and annual HCC incidence is 3% to 5% among patients with cirrhosis. Antiviral therapies-pegylated interferon alfa and nucleos(t)ide analogues (entecavir or tenofovir)-suppress HBV DNA replication and reduce the risk of HCC by approximately 50%. Antiviral treatment is recommended for all patients with chronic HBV and cirrhosis and for those without cirrhosis who have high HBV DNA with elevated ALT or significant inflammation/fibrosis. Patients at high risk of HCC should undergo surveillance with ultrasonography and alpha-fetoprotein testing every 6 months.

Conclusions and relevance: HBV infection causes approximately 1.1 million deaths annually worldwide. Universal HBV vaccination, particularly birth-dose administration, is the most effective strategy to prevent HBV infection. Among patients with HBV infection, antiviral therapy decreases progression to cirrhosis and liver failure and reduces the risk of HCC.

Author/s:

Wen-Juei Jeng, Terry Cheuk-Fung Yip, Anna S. Lok

Treatment of Anxiety for Adults in Primary Care Settings: A Review

Megan George — Tue, 05 May 2026 13:42:15 +0000

Date Added:

May 5, 2026

Journal/Publication:

JAMA Internal Medicine

Publication Date:

May 4, 2026

URL:

Treatment of Anxiety for Adults in Primary Care Settings: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamainternmed.2026.0395

Keywords

anxiety

Anxiety disorders

anxiety disorder

PMID (1):

42081227

MeSH

anxiety

anxiety disorder

anxiety disorders

Medically Unexplained Symptoms

Humans

Adults

Selective Serotonin Reuptake Inhibitors

Cognitive Behavioral Therapy

Benzodiazepines

Norepinephrine

A review of the various categories of anxiety disorders in adults and their management. James W. Mold, MD, MPH

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Importance Anxiety disorders and symptoms are prevalent and burdensome, and patients are most likely to seek treatment in primary care settings. However, anxiety is underdetected and undertreated. This narrative review details behavioral and pharmacological treatment options that are feasible and effective in primary care.

Observations Screening for anxiety is recommended for primary care patients younger than 65 years. Given that anxiety often involves somatic symptoms, assessment should include patient-reported symptom measures, clinical interview, physical examination, and appropriate laboratory tests. For subthreshold symptoms (those that do not meet diagnostic criteria for anxiety disorders) and adjustment-related anxiety, starting with self-help and behavioral treatment is recommended. When deciding between behavioral, pharmacological, or combined treatment for anxiety disorders, consider the presentation, patient preferences, potential adverse effects, and treatment history, and engage in shared decision-making. Cognitive-behavioral therapy (CBT) is the first-line behavioral treatment for anxiety. Brief CBT in primary care delivered by embedded behavioral health clinicians is effective. First-line pharmacotherapy for anxiety disorders includes several selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors, which tend to be well tolerated without considerable long-term adverse effects. The main decision for pharmacological treatment is between a daily medication and a short-acting medication taken as needed for intermittent symptoms or while awaiting the effect of a daily medication. Benzodiazepines are not recommended due to risk of adverse effects, especially with long-term use. The Collaborative Care Management model, which involves collaboration between primary care clinicians, consulting psychiatrists, and care managers who monitor patient progress and provide behavioral treatment, improves anxiety outcomes compared to usual primary care.

Conclusions and Relevance Clinicians should recognize common anxiety presentations and understand how to differentiate between anxiety and other psychiatric or medical conditions. Referring patients to behavioral health specialists for CBT and/or prescribing recommended pharmacotherapy with Collaborative Care Management can help to reduce patient morbidity and improve functioning.

Author/s:

Robyn L. Shepardson, Jeffrey S. Khan, Katherine A. Buckheit

Diagnosis and Management of Resistant Hypertension: A Review

Megan George — Wed, 29 Apr 2026 21:23:10 +0000

Date Added:

April 29, 2026

Journal/Publication:

JAMA

Publication Date:

March 23, 2026

URL:

Diagnosis and Management of Resistant Hypertension: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2026.1221

Keywords

hypertension

drug therapy

Drug Resistance

Antihypertensive Agents

blood pressure

PMID (1):

41870448

MeSH

Antihypertensive Agents* / therapeutic use

blood pressure

Blood Pressure Monitoring

Ambulatory

drug resistance, bacterial

drug therapy

Combination

Hypertension* / complications

female

male

Humans

Hypertension* / drug therapy

Hypertension* / epidemiology

Hypertension* / therapy

Recommendations for the diagnosis and management of patients with resistant hypertension. James W. Mold, MD, MPH

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Importance: Hypertension, defined as office systolic blood pressure (SBP) 130 mm Hg or greater and/or diastolic blood pressure 80 mm Hg or greater, affects 43.9% of women and 49.5% of men in the US. Approximately 19.7% of patients treated for hypertension have apparent resistant hypertension (blood pressure ≥130/80 mm Hg) despite using 3 or more antihypertensive medications, preferably a renin-angiotensin system blocker, a calcium channel blocker, and a thiazide-type diuretic, at maximally tolerated doses.

Observations: Approximately 10% of patients treated for hypertension have true resistant hypertension confirmed with home or 24-hour ambulatory blood pressure monitoring to exclude white-coat hypertension (approximately 37.5% of apparent resistant hypertension) and after excluding medication nonadherence (approximately 50%) and secondary hypertension such as primary aldosteronism (approximately 5%-25%). Conditions associated with resistant hypertension include obesity, diabetes, chronic kidney disease, and sleep apnea. Resistant hypertension is associated with increased risk of cardiovascular death vs controlled blood pressure at 5 years to 10 years (absolute risk increase, 10.3% [95% CI, 8.7%-12.1%]). Lifestyle modifications for resistant hypertension include a low-sodium diet (<1500 mg/d), reducing or avoiding alcohol, 150 min/wk or more of aerobic exercise, and weight loss. Illicit drugs (eg, cocaine) and medications that increase blood pressure (eg, nonsteroid anti-inflammatory drugs, serotonin-norepinephrine reuptake inhibitors) should be avoided. Sleep apnea should be treated when diagnosis is confirmed. Pharmacologic optimization includes use of combination tablets of antihypertensives; intensifying diuretic therapy by using chlorthalidone; and sequential addition of antihypertensive medications using evidence-based algorithms. In a meta-analysis of 20 studies (9 randomized clinical trials [RCTs] and 11 observational studies [331 participants]), use of antihypertensive therapies that combine 2 to 3 medications into a single formulation reduced SBP by -3.99 mm Hg (95% CI, -7.92 to -0.07) vs equivalent doses given separately. For patients with apparent or true resistant hypertension who have an estimated glomerular filtration rate of 45 mL/min/1.73 m2 or greater and a serum potassium level of 4.5 mmol/L or less, adding spironolactone (25-50 mg/d) compared with placebo lowers office SBP by -13.3 mm Hg (95% CI, -17.89 to -8.72 [4 RCTs]) and 24-hour ambulatory SBP by -8.46 mm Hg (95% CI, -12.54 to -4.38 [2 RCTs]) in a network meta-analysis of 24 RCTs (3485 patients with resistant hypertension). A meta-analysis of 10 RCTs (2478 participants) reported that compared with a sham procedure, catheter-based renal denervation, which disrupts the sympathetic nerves in the renal artery walls, decreased 24-hour ambulatory SBP by -4.4 mm Hg (95% CI, -6.1 to -2.7) and office SBP by -6.6 mm Hg (95% CI, -9.7 to -3.6).

Conclusions and relevance: True resistant hypertension affects 10% of patients treated for hypertension and is diagnosed after excluding white-coat hypertension, medication nonadherence, and secondary hypertension such as primary aldosteronism. First-line treatment includes lifestyle modifications, diuretic therapy with chlorthalidone, and combination tablets of antihypertensives. Spironolactone and renal denervation decrease blood pressure in patients with true resistant hypertension.

Author/s:

Michel Azizi, Wanpen Vongpatanasin, Naomi D. L. Fisher

Diagnosis and management of bronchiectasis

Megan George — Wed, 22 Apr 2026 20:03:10 +0000

Date Added:

April 22, 2026

Journal/Publication:

Canadian Medical Association Journal

Publication Date:

June 19, 2017

URL:

Diagnosis and management of bronchiectasis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1503/cmaj.160830

Keywords

MeSH

A concise review of the diagnosis and management of patients with bronchiectasis. James W. Mold, MD, MPH

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Bronchiectasis is a chronic, debilitating respiratory condition that affects people of all ages. It is most prevalent in women and those older than 60 years, and prevalence is increasing. Patients have daily excessive sputum and associated symptoms, recurrent chest infections and impaired health-related quality of life. In North America, management guidelines are lacking. This review discusses best evidence to guide the long-term management of non–cystic fibrosis bronchiectasis in adults, focusing on the two most common single-entity types of bronchiectasis in adults: idiopathic and postinfectious bronchiectasis (Box 1). Table 1 lists all the types of bronchiectasis by cause.

Author/s:

Maeve P. Smith

Does This Patient Have Volume Overload?: The Rational Clinical Examination

Megan George — Fri, 10 Apr 2026 00:10:03 +0000

Date Added:

April 9, 2026

Journal/Publication:

JAMA

Publication Date:

February 23, 2026

URL:

Does This Patient Have Volume Overload?: The Rational Clinical Examination

Type:

Clinical Decision Aids

Format:

Article

DOI (1):

10.1001/jama.2026.0446

Keywords

Dyspnea

Edema

Intravascular Volume Overload

PMID (1):

41729549

MeSH

Dyspnea

Edema* / diagnosis

Jugular Veins / diagnostic imaging

Humans

sensitivity and specificity

Physical Examination*

Volume overload

A review of the signs of volume overload. James W. Mold, MD, MPH

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Importance Accurate assessment of intravascular volume facilitates management decisions about fluid management in patients with volume overload.

Objective To identify the most accurate clinical examination, radiographic, and laboratory findings for assessing volume overload in nonintubated patients.

Data Sources and Study Selection MEDLINE was searched (1946 to January 6, 2026) to identify peer-reviewed English-language studies about the diagnostic accuracy of the clinical examination of spontaneously breathing patients with intravascular volume overload.

Data Extraction and Synthesis Three authors independently extracted data for each finding and calculated sensitivity, specificity, and likelihood ratios (LRs). A 2-level mixed logistic regression model was used to pool estimates.

Results Forty studies, involving 11 490 adult patients, were included, with a prevalence of volume overload of 35% to 69%. Thirty-three of those studies evaluated patients with dyspnea. Prevalence of volume overload was more likely when the physical examination revealed jugular venous distention with the highest point of pulsation more than 3 cm in a vertical line above the sternal angle (LR, 4.1 [95% CI, 2.9-5.6]; specificity, 92%), lower extremity edema (LR, 2.2 [95% CI, 1.5-3.1]; specificity, 80%), or crackles on auscultation (LR, 2.7 [95% CI, 1.7-4.5]; specificity, 81%). Vascular congestion on chest radiography increased the likelihood of intravascular volume overload (LR, 5.9 [95% CI, 2.9-12.0]; specificity, 91%). Point-of-care ultrasonography that identified bilateral pulmonary B-lines suggested volume overload (LR, 4.0 [95% CI, 2.6-6.1]; specificity, 77%), and absence of pulmonary B-lines made volume overload unlikely (LR, 0.09 [95% CI, 0.04-0.23]; sensitivity, 93%). Inferior vena cava collapsibility index of less than 50% increased the likelihood of volume overload (LR, 3.9 [95% CI, 2.5-6.1]; specificity, 79%), and a collapsibility index of at least 50% made it less likely (LR, 0.22 [95% CI, 0.11-0.45]; sensitivity, 82%). Point-of-care ultrasonographic measurement of jugular venous pressure (JVP; >8 cm) also increased the likelihood of volume overload (LR, 2.8 [95% CI, 2.2-3.5]; specificity, 71%), although JVP of 8 cm or less identified patients less likely to have volume overload (LR, 0.26 [95% CI, 0.20-0.33]; sensitivity, 81%). A plasma brain-type natriuretic peptide (BNP) level of 100 ng/mL or higher was the single best test to identify those most likely to have volume overload (LR, 6.9 [95% CI, 2.4-20.4]; specificity, 87%), and a normal value made it less likely (LR, 0.14 [95% CI, 0.08-0.24]; sensitivity, 87%).

Conclusions and Relevance A BNP level of 100 ng/mL or higher and presence of vascular congestion on chest radiography may be the most useful tests to identify patients with volume overload. Absence of pulmonary B-lines using point-of-care ultrasonography or BNP levels of less than 100 ng/mL may be most useful to exclude volume overload.

Author/s:

Benjamin Drum, Bryce La Course, Mark Kelly

Does This Child Have a Concussion?: The Rational Clinical Examination Systematic Review

Megan George — Thu, 09 Apr 2026 23:08:13 +0000

Date Added:

April 9, 2026

Journal/Publication:

JAMA

Publication Date:

April 6, 2026

URL:

Does This Child Have a Concussion?: The Rational Clinical Examination Systematic Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Poster

DOI (1):

10.1001/jama.2026.1233

Keywords

PMID (1):

41941197

MeSH

A review of the evaluation of children with head injuries to detect evidence of concussion. James W. Mold, MD, MPH

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Importance: Concussion is a mild traumatic brain injury with associated abnormalities in brain function, rather than structural injury. An estimated 1.1 million to 1.9 million pediatric concussions occur annually in the US.

Objective: To determine the accuracy of clinical history and physical examination findings for identifying concussion in children and adolescents who have had a plausible mechanism of injury.

Data sources and study selection: PubMed, Embase, ClinicalTrials.gov, Cochrane Library, CINAHL, Web of Science, and Google Scholar were searched from January 2002 through December 2025 without language restrictions. Observational studies including patients aged 2 to 18 years evaluated for concussion in outpatient, emergency, or inpatient settings were included.

Data extraction and synthesis: Four reviewers independently extracted study characteristics and diagnostic accuracy data and assessed study quality with the Rational Clinical Examination levels of evidence.

Main outcomes and measures: Sensitivity, specificity, and likelihood ratios (LRs) for symptoms and physical signs associated with concussion were calculated using random-effects meta-analysis when summary measures were appropriate.

Results: Of 7110 screened abstracts, 23 studies (level 4 evidence; case-control design) met inclusion criteria. The presence of mental fog (LR, 11.8-12.0; specificity, 0.96), noise sensitivity (LR, 6.9; 95% CI, 3.6-13.1; specificity, 0.94), nausea (LR, 6.7; 95% CI, 3.1-14.6; specificity, 0.93), and light sensitivity (LR, 6.4; 95% CI, 2.1-19.7; specificity, 0.93) were most useful for increasing the likelihood of a concussion diagnosis. The absence of headache was the most useful symptom for decreasing the likelihood of concussion (LR, 0.20; 95% CI, 0.10-0.39; sensitivity, 0.74). Signs that increased the likelihood of concussion were abnormal near-point convergence, which is the inability to maintain ocular convergence on a near target (LR, 7.0; 95% CI, 2.0-24.9; specificity, 0.97); abnormal smooth pursuits, which are jerky, irregular eye movements when tracking a target (LR, 6.5; 95% CI, 2.4-17.5; specificity, 0.96); and saccades, which are inaccurate or slow eye movements with overshooting or undershooting when looking between 2 or more targets (LR, 4.8; 95% CI, 1.8-13.1; specificity, 0.92); however, none of these findings had a sensitivity of more than 0.40. A consensus statement by the International Conference on Concussion in Sport recommends the Sport Concussion Assessment Tool to systematize the comprehensive evaluation of patients with symptoms concerning for concussion.

Conclusions and relevance: While no single finding was sufficient to confirm or exclude concussion, the presence of mental fog, noise and light sensitivity, nausea, or ocular abnormalities were most useful to identify patients more likely to have had a concussion, while absence of a headache made a concussion less likely. These symptoms and signs are integrated into structured clinical assessments to support the clinical diagnosis and management of pediatric concussion.

Author/s:

Sonal N. Shah, Haley M. Chizuk, Hiu-Fai Fong

2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Megan George — Tue, 31 Mar 2026 13:32:45 +0000

Date Added:

March 31, 2026

Journal/Publication:

JACC

Publication Date:

March 13, 2026

URL:

2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.jacc.2025.11.016

Keywords

Proliferating Cell Nuclear Antigen

PMID (1):

41824590

MeSH

Proliferating Cell Nuclear Antigen

Updated (2026) Guidelines for management of dyslipidemia. James W. Mold, MD, MPH

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Aim: The "2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia" retires and replaces the "2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol."

Methods: A comprehensive literature search was conducted from October 2024 to December 2024 to identify clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline.

Structure: The focus of this clinical practice guideline is to address the evaluation, management, and monitoring of individuals with dyslipidemias, including high blood cholesterol, hypertriglyceridemia, and elevated lipoprotein(a).

Keywords: ACC/AHA clinical practice guideline; HDL; LDL; anticholesteremic agents; atherosclerosis; atherosclerotic disease; cardiovascular disease; cardiovascular diseases; cholesterol; drug interactions; dyslipidemia(s); hydroxymethylglutaryl-CoA reductase inhibitors; hypercholesterolemia; hyperlipid(a)emia/s; hyperlipoproteinemia type II; hypertriglyceridemia; hypolipidemic agents; lipids; lipoprotein(a); primary prevention; risk adjustment; risk assessment; risk factors; simvastatin; statin(s); triglycerides.

Author/s:

Roger S. Blumenthal, Pamela B. Morris, Mario Gaudino, Heather M. Johnson, Timothy S. Anderson, Vera A. Bittner, Ron Blankstein, LaPrincess C. Brewer, Leslie Cho, Sarah D. de Ferranti, Eugenia Gianos, Ty J. Gluckman, Kristen F. Gradney, Ijeoma Isiadinso, Donald M. Lloyd-Jones, Joel C. Marrs, Seth S. Martin, Kellie H. McLain, Laxmi S. Mehta, Samia Mora, Wudeneh M. Mulugeta, Pradeep Natarajan, Ann Marie Navar, Carl E. Orringer, Tamar S. Polonsky, Harmony R. Reynolds, Joseph J. Saseen, Michael D. Shapiro, Daniel E. Soffer, Sheila A. Tynes, Chloé D. Villavaso, Salim S. Virani, John T. Wilkins

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

Secondary Prevention after Ischemic Stroke

Megan George — Wed, 04 Mar 2026 18:17:01 +0000

Date Added:

March 4, 2026

Journal/Publication:

New England Journal of Medicine

Publication Date:

February 18, 2026

URL:

Secondary Prevention after Ischemic Stroke

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1056/NEJMcp2415601

Keywords

Acute Ischemic Stroke

prevention

Strokes

PMID (1):

41707139

MeSH

A review of the causes of ischemic stroke and the risk reduction strategies available to prevent recurrences. James W. Mold, MD, MPH

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The risk of recurrent ischemic stroke can be reduced by managing modifiable risk factors and instituting a regimen of mechanism-specific secondary stroke prevention. Strategies for secondary prevention should be instituted as early as possible. Poststroke monitoring of risk metrics, lifestyle behaviors, and medication recommendations is of key importance.

Author/s:

Karen L. Furie, Peter J. Kelly

Female pattern hair loss

Megan George — Wed, 04 Mar 2026 18:14:15 +0000

Date Added:

March 4, 2026

Journal/Publication:

Canadian Medical Association Journal

Publication Date:

March 2, 2026

URL:

Female pattern hair loss

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.251058

Keywords

Female Pattern Hair Loss

Hair Loss

Alopecia

PMID (1):

41771564

MeSH

Female Pattern Hair Loss

Polycystic Ovary Syndrome

Adrenal Gland Neoplasms

Alopecia

A concise summary of the key features and management of female pattern hair loss. James W. Mold, MD, MPH

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Female pattern hair loss (FPHL) is a common, nonscarring hair-loss disorder. Prevalence of FPHL increases with age; 12% of females will have symptoms by age 29 years, 25% by age 50 years, and 41% to 50% at age 70 years and older. Risk factors include genetics and endocrinological diseases (e.g., polycystic ovarian syndrome, adrenal hyperplasia, ovarian or adrenal tumours).

Author/s:

Eric McMullen, Ammar Saed Aldien, Cathryn Sibbald, Jeffrey Donovan

IgA Nephropathy in Adults: A Review

Megan George — Wed, 04 Mar 2026 18:10:22 +0000

Date Added:

March 4, 2026

Journal/Publication:

JAMA

Publication Date:

January 26, 2026

URL:

IgA Nephropathy in Adults: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

doi:10.1001/jama.2025.25020

Keywords

Antigen-Antibody Complex

IgA Nephropathy

Renal Insufficiency

Angiotensin Receptor Antagonists

renin-angiotensin system

MeSH

Glomerulonephritis

IGA

Antigen-Antibody Complex

Inflammation

Scarring

renal insufficiency

Angiotensin Receptor Antagonists

renin-angiotensin system

blood pressure

Adults

Humans

A comprehensive review of what we know about IgA nephropathy. James W. Mold, MD, MPH

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Importance IgA nephropathy (IgAN) is a chronic kidney disease involving deposition of IgA-containing immune complexes in the glomerulus, causing glomerular inflammation and scarring. It is the most common immune-mediated glomerular disease worldwide, and affects an estimated 198 887 to 208 184 persons in the US. Up to 50% of patients with IgAN develop kidney failure within 10 years of diagnosis.

Observations IgAN typically presents with nephritic syndrome and usually occurs in younger adults, with a mean age at diagnosis of 34 to 45 years. Incidence is highest in East Asia. Approximately 60% of cases are detected incidentally with hematuria or proteinuria on urinalysis. Up to 30% of patients present with episodic visible hematuria, often concomitantly with an upper respiratory or gastrointestinal tract infection (synpharyngitic hematuria). Less common presentations include nephrotic syndrome (<5%) and rapidly progressive glomerulonephritis (<5%). When IgAN is suspected (due to hematuria, proteinuria, or reduced kidney function), initial workup should include quantification of proteinuria and assessment for other causes of nephritic syndrome (eg, lupus nephritis). Adults with suspected IgAN and proteinuria greater than or equal to 0.5 g per day should undergo kidney biopsy. The diagnosis of primary IgAN is based on presence of IgA-dominant immune deposits in the glomerular mesangium after excluding other causes of this histologic appearance, ie, IgA vasculitis, IgA-dominant infection-related glomerulonephritis, and secondary IgAN from diseases such as cirrhosis, inflammatory bowel disease, celiac disease, infection (eg, viral hepatitis), and autoimmune diseases (eg, axial spondyloarthritis). Based on the Kidney Disease: Improving Global Outcomes 2025 clinical practice guideline for the management of IgAN, treatment for patients with proteinuria greater than 0.5 g per day includes behavioral modifications (eg, dietary sodium <2 g/d, smoking cessation, weight control, exercise), antihypertensive medications for goal blood pressure less than 120/70 mm Hg, and therapies to reduce the formation of IgA-containing immune complexes (eg, targeted-release budesonide), decrease glomerular injury (eg, systemic glucocorticoids, iptacopan), and manage existing IgAN-induced nephron loss (eg, renin-angiotensin system inhibitor or dual endothelin angiotensin receptor antagonist [eg, sparsentan] alone or in combination with a sodium-glucose cotransporter 2 inhibitor).

Conclusions and Relevance IgAN is the leading cause of immune-mediated glomerular disease worldwide. Patients with suspected IgAN and proteinuria greater than or equal to 0.5 g per day should undergo kidney biopsy to confirm the diagnosis. Treatment of IgAN includes behavioral modifications, blood pressure management, and therapies to decrease formation of IgA-containing immune complexes (eg, targeted-release budesonide), reduce immune complex–mediated glomerular injury (eg, systemic glucocorticoids, iptacopan), and manage IgAN-induced nephron loss (eg, renin-angiotensin system inhibitor, dual endothelin angiotensin receptor antagonist, and sodium-glucose cotransporter 2 inhibitor).

Author/s:

Sinead Stoneman, Jia Wei Teh, Michelle Marie O’Shaughnessy

Does This Patient Have Volume Overload? The Rational Clinical Examination

Megan George — Tue, 03 Mar 2026 15:47:01 +0000

Date Added:

March 3, 2026

Journal/Publication:

JAMA

Publication Date:

February 23, 2026

URL:

Does This Patient Have Volume Overload? The Rational Clinical Examination

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2026.0446

Keywords

Intravascular Volume Overload

Venous Pressure

Natriuretic Peptides

Auscultation

PMID (1):

41729549

MeSH

A review of the evaluation of patients with possible volume overload. James W. Mold, MD, MPH

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Importance: Accurate assessment of intravascular volume facilitates management decisions about fluid management in patients with volume overload.

Objective: To identify the most accurate clinical examination, radiographic, and laboratory findings for assessing volume overload in nonintubated patients.

Data sources and study selection: MEDLINE was searched (1946 to January 6, 2026) to identify peer-reviewed English-language studies about the diagnostic accuracy of the clinical examination of spontaneously breathing patients with intravascular volume overload.

Data extraction and synthesis: Three authors independently extracted data for each finding and calculated sensitivity, specificity, and likelihood ratios (LRs). A 2-level mixed logistic regression model was used to pool estimates.

Results: Forty studies, involving 11 490 adult patients, were included, with a prevalence of volume overload of 35% to 69%. Thirty-three of those studies evaluated patients with dyspnea. Prevalence of volume overload was more likely when the physical examination revealed jugular venous distention with the highest point of pulsation more than 3 cm in a vertical line above the sternal angle (LR, 4.1 [95% CI, 2.9-5.6]; specificity, 92%), lower extremity edema (LR, 2.2 [95% CI, 1.5-3.1]; specificity, 80%), or crackles on auscultation (LR, 2.7 [95% CI, 1.7-4.5]; specificity, 81%). Vascular congestion on chest radiography increased the likelihood of intravascular volume overload (LR, 5.9 [95% CI, 2.9-12.0]; specificity, 91%). Point-of-care ultrasonography that identified bilateral pulmonary B-lines suggested volume overload (LR, 4.0 [95% CI, 2.6-6.1]; specificity, 77%), and absence of pulmonary B-lines made volume overload unlikely (LR, 0.09 [95% CI, 0.04-0.23]; sensitivity, 93%). Inferior vena cava collapsibility index of less than 50% increased the likelihood of volume overload (LR, 3.9 [95% CI, 2.5-6.1]; specificity, 79%), and a collapsibility index of at least 50% made it less likely (LR, 0.22 [95% CI, 0.11-0.45]; sensitivity, 82%). Point-of-care ultrasonographic measurement of jugular venous pressure (JVP; >8 cm) also increased the likelihood of volume overload (LR, 2.8 [95% CI, 2.2-3.5]; specificity, 71%), although JVP of 8 cm or less identified patients less likely to have volume overload (LR, 0.26 [95% CI, 0.20-0.33]; sensitivity, 81%). A plasma brain-type natriuretic peptide (BNP) level of 100 ng/mL or higher was the single best test to identify those most likely to have volume overload (LR, 6.9 [95% CI, 2.4-20.4]; specificity, 87%), and a normal value made it less likely (LR, 0.14 [95% CI, 0.08-0.24]; sensitivity, 87%).

Conclusions and relevance: A BNP level of 100 ng/mL or higher and presence of vascular congestion on chest radiography may be the most useful tests to identify patients with volume overload. Absence of pulmonary B-lines using point-of-care ultrasonography or BNP levels of less than 100 ng/mL may be most useful to exclude volume overload.

Author/s:

Benjamin Drum, Bryce La Course, Mark Kelly, Audrey York, Emily Worrall, Jennifer Martins, Stacy Johnson, Edmund A Liles Jr

Pertussis Infection in Adults

Megan George — Fri, 27 Feb 2026 01:31:28 +0000

Date Added:

February 26, 2026

Journal/Publication:

JAMA

Publication Date:

February 18, 2026

URL:

Pertussis Infection in Adults

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.26153

Keywords

Pertussis

Bordetella pertussis

whooping cough

PMID (1):

41706481

MeSH

A concise review of pertussis infection in adults. (Much more common than you might think.) James W. Mold, MD, MPH

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Pertussis, or whooping cough, is a highly contagious respiratory illness caused by Bordetella pertussis, a fastidious gram-negative coccobacillus that is a human pathogen without known animal or environmental reservoirs. There are 8 additional known Bordetella species, 3 of which can cause respiratory illness in humans: B parapertussis (which causes infection clinically indistinguishable from pertussis), B bronchiseptica, and B holmesii.

Author/s:

Paul B. Cornia, Benjamin A. Lipsky