prevention

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

Hypertension and alcohol: a cross-sectional study comparing PEth with AUDIT and AUDIT-C in primary care

Megan George — Mon, 16 Feb 2026 17:36:14 +0000

Date Added:

February 16, 2026

Journal/Publication:

Family Practice

Publication Date:

February 1, 2026

URL:

Hypertension and alcohol: a cross-sectional study comparing PEth with AUDIT and AUDIT-C in primary care

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1093/fampra/cmaf097

Keywords

alcohol use disorder

cardiovascular disorders

PMID (1):

41511884

MeSH

Alcohol Drinking* / epidemiology

Antihypertensive Agents / therapeutic use

lycerophospholipids* / blood

Hypertension* / drug therapy

Hypertension* / epidemiology

Alcoholism* / diagnosis

primary health care

The results of this study suggest that patients with poorly controlled BP should be further evaluated for alcohol use disorders even if the brief screening questions are negative. James W. Mold, MD, MPH

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Background: This cross-sectional study aimed to describe proportions of patients with indications of alcohol consumption using phosphatidylethanol (PEth), the Alcohol Use Disorders Identification Test (AUDIT), and its consumption-focused version (AUDIT-C), in relation to blood pressure (BP) control, overall and by sex.

Methods: A total of 270 hypertensive primary care patients (ICD-10: I10.9) were stratified into BP control groups: controlled (<140/90 mmHg), uncontrolled (≥140/90 mmHg), and apparent treatment-resistant hypertension (aTRH; ≥140/90 mmHg with ≥3 antihypertensive drugs). A randomized sample from each stratum was invited, baseline data were collected. Alcohol consumption using predefined categories for PEth and AUDIT, and hazardous use (PEth ≥ 0.122 µmol/L; AUDIT ≥ 8; AUDIT-C ≥ 5 for men, ≥4 for women), were analyzed in relation to BP control groups.

Results: Mean age was 67 ± 11 years; 42% were women. PEth indicated high and regular alcohol consumption in 6.4% of controlled, 5.3% of uncontrolled, and 19.2% of aTRH patients (controlled vs. aTRH, P = .027; uncontrolled vs. aTRH, P = .013). AUDIT showed no significant differences in hazardous use between BP groups (P = .865). AUDIT-C identified slightly higher proportions of hazardous use than PEth, across BP groups and sexes. No significant differences were found between BP groups for hazardous use by PEth (P = .339) or AUDIT-C (P = .150).

Conclusions: PEth revealed significantly higher alcohol use in the aTRH group, undetected by AUDIT. AUDIT-C and PEth identified more hazardous use than AUDIT, suggesting their potential to prompt alcohol-related discussions and support evidence-based hypertension care. PEth correlated more strongly with AUDIT-C than with AUDIT.

Clinical trial registration: Retrospectively registered in Clinical Trials, SLSO2022-0143, 2022-12-10.

Keywords: alcohol use disorder; cardiovascular disorders (hypertension/DVT/atherosclerosis); hypertension (high blood pressure); prevention; primary care; screening.

Author/s:

Åsa Thurfjell, Maria Hagströmer, Charlotte Ivarsson, Anders Norrman, Johanna Adami, Lena Lundh, Jan Hasselström

Risedronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women

Saige Blanchard — Tue, 07 Jun 2022 05:00:00 +0000

Date Added:

June 7, 2022

Journal/Publication:

Cochrane Database of Systematic Reviews

Publisher:

John Wiley & Sons, Ltd.

Publication Date:

May 3, 2022

URL:

Risedronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1002/14651858.CD004523.pub4

Keywords

PMID (1):

35502787

MeSH

Risedronic Acid

spinal fractures

osteoporotic fractures

calcium

Drug Approval

A concise summary of a Cochrane Collaboration review of evidence of the effectiveness of risedronate for primary and secondary prevention of fractures. James W. Mold, MD, MPH

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Background: Osteoporosis is an abnormal reduction in bone mass and bone deterioration leading to increased fracture risk. Risedronate belongs to the bisphosphonate class of drugs which act to inhibit bone resorption by interfering with the activity of osteoclasts. This is an update of a Cochrane Review that was originally published in 2003.

Objectives: We assessed the benefits and harms of risedronate in the primary and secondary prevention of osteoporotic fractures for postmenopausal women at lower and higher risk for fractures, respectively.

Search methods: With broader and updated strategies, we searched the Cochrane Central Register of Control Trials (CENTRAL), MEDLINE and Embase. A grey literature search, including the online databases ClinicalTrials.gov, International Clinical Trials Registry Platform (ICTRP), and drug approval agencies, as well as bibliography checks of relevant systematic reviews was also performed. Eligible trials published between 1966 to 24 March 2021 were identified.

Selection criteria: We included randomised controlled trials that assessed the benefits and harms of risedronate in the prevention of fractures for postmenopausal women. Participants must have received at least one year of risedronate, placebo or other anti-osteoporotic drugs, with or without concurrent calcium/vitamin D. Major outcomes were clinical vertebral, non-vertebral, hip and wrist fractures, withdrawals due to adverse events, and serious adverse events. In the interest of clinical relevance and applicability, we classified a study as secondary prevention if its population fulfilled more than one of the following hierarchical criteria: a diagnosis of osteoporosis, a history of vertebral fractures, low bone mineral density (BMD)T score ≤ -2.5, and age ≥ 75 years old. If none of these criteria was met, the study was considered to be primary prevention.

Data collection and analysis: We used standard methodology expected by Cochrane. We pooled the relative risk (RR) of fractures using a fixed-effect model based on the expectation that the clinical and methodological characteristics of the respective primary and secondary prevention studies would be homogeneous, and the experience from the previous review suggesting that there would be a small number of studies. The base case included the data available for the longest treatment period in each placebo-controlled trial and a >15% relative change was considered clinically important. The main findings of the review were presented in summary of findings tables, using the GRADE approach. In addition, we looked at benefit and harm comparisons between different dosage regimens for risedronate and between risedronate and other anti-osteoporotic drugs.

Main results: Forty-three trials fulfilled the eligibility criteria, among which 33 studies (27,348 participants) reported data that could be extracted and quantitatively synthesized. We had concerns about particular domains of risk of bias in each trial. Selection bias was the most frequent concern, with only 24% of the studies describing appropriate methods for both sequence generation and allocation concealment. Fifty per cent and 39% of the studies reporting benefit and harm outcomes, respectively, were subject to high risk. None of the studies included in the quantitative syntheses were judged to be at low risk of bias in all seven domains. The results described below pertain to the comparisons for daily risedronate 5 mg versus placebo which reported major outcomes. Other comparisons are described in the full text. For primary prevention, low- to very low-certainty evidence was collected from four studies (one to two years in length) including 989 postmenopausal women at lower risk of fractures. Risedronate 5 mg/day may make little or no difference to wrist fractures [RR 0.48 ( 95% CI 0.03 to 7.50; two studies, 243 participants); absolute risk reduction (ARR) 0.6% fewer (95% CI 1% fewer to 7% more)] and withdrawals due to adverse events [RR 0.67 (95% CI 0.38 to 1.18; three studies, 748 participants); ARR 2% fewer (95% CI 5% fewer to 1% more)], based on low-certainty evidence. However, its preventive effects on non-vertebral fractures and serious adverse events are not known due to the very low-certainty evidence. There were zero clinical vertebral and hip fractures reported therefore the effects of risedronate for these outcomes are not estimable. For secondary prevention, nine studies (one to three years in length) including 14,354 postmenopausal women at higher risk of fractures provided evidence. Risedronate 5 mg/day probably prevents non-vertebral fractures [RR 0.80 (95% CI 0.72 to 0.90; six studies, 12,173 participants); RRR 20% (95% CI 10% to 28%) and ARR 2% fewer (95% CI 1% fewer to 3% fewer), moderate certainty], and may reduce hip fractures [RR 0.73 (95% CI 0.56 to 0.94); RRR 27% (95% CI 6% to 44%) and ARR 1% fewer (95% CI 0.2% fewer to 1% fewer), low certainty]. Both of these effects are probably clinically important. However, risedronate's effects are not known for wrist fractures [RR 0.64 (95% CI 0.33 to 1.24); three studies,1746 participants); ARR 1% fewer (95% CI 2% fewer to 1% more), very-low certainty] and not estimable for clinical vertebral fractures due to zero events reported (low certainty). Risedronate results in little to no difference in withdrawals due to adverse events [RR 0.98 (95% CI 0.90 to 1.07; eight studies, 9529 participants); ARR 0.3% fewer (95% CI 2% fewer to 1% more); 16.9% in risedronate versus 17.2% in control, high certainty] and probably results in little to no difference in serious adverse events [RR 1.00 (95% CI 0.94 to 1.07; six studies, 9435 participants); ARR 0% fewer (95% CI 2% fewer to 2% more; 29.2% in both groups, moderate certainty).

Authors' conclusions: This update recaps the key findings from our previous review that, for secondary prevention, risedronate 5 mg/day probably prevents non-vertebral fracture, and may reduce the risk of hip fractures. We are uncertain on whether risedronate 5mg/day reduces clinical vertebral and wrist fractures. Compared to placebo, risedronate probably does not increase the risk of serious adverse events. For primary prevention, the benefit and harms of risedronate were supported by limited evidence with high uncertainty.

Author/s:

Wells, G. A., Hsieh, S., Zheng, C., Peterson, J., Tugwell, P., Liu, W.

Midodrine for the Prevention of Vasovagal Syncope : A Randomized Clinical Trial

Saige Blanchard — Fri, 06 Aug 2021 05:00:00 +0000

Date Added:

August 6, 2021

Journal/Publication:

Annals of Internal Medicine

Publisher:

ACP

Publication Date:

August 3, 2021

URL:

Midodrine for the Prevention of Vasovagal Syncope : A Randomized Clinical Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

https://doi.org/10.7326/m20-5415

Keywords

PMID (1):

34339231

MeSH

Hospitals, University

Midodrine can be a helpful treatment for patients with recurrent vasovagal syncope. James W. Mold, MD, MPH

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Background: Recurrent vasovagal syncope is common, responds poorly to treatment, and causes physical trauma and poor quality of life. Midodrine prevents hypotension and syncope during tilt tests in patients with vasovagal syncope.

Objective: To determine whether midodrine can prevent vasovagal syncope in usual clinical conditions.

Design: Randomized, double-blind, placebo-controlled clinical trial. (ClinicalTrials.gov: NCT01456481).

Setting: 25 university hospitals in Canada, the United States, Mexico, and the United Kingdom.

Patients: Patients with recurrent vasovagal syncope and no serious comorbid conditions.

Intervention: Patients were randomly assigned 1:1 to placebo or midodrine and followed for 12 months.

Measurements: The primary outcome measure was the proportion of patients with at least 1 syncope episode during follow-up.

Results: The study included 133 patients who had had a median of 6 syncope episodes in the prior year (median age, 32 years; 73% female). Compared with patients receiving placebo, fewer patients receiving midodrine had at least 1 syncope episode (28 of 66 [42%] vs. 41 of 67 [61%]). The relative risk was 0.69 (95% CI, 0.49 to 0.97; P = 0.035). The absolute risk reduction was 19 percentage points (CI, 2 to 36 percentage points), and the number needed to treat to prevent 1 patient from having syncope was 5.3 (CI, 2.8 to 47.6). The time to first syncope was longer with midodrine (hazard ratio, 0.59 [CI, 0.37 to 0.96]; P = 0.035; log-rank P = 0.031). Adverse effects were similar in both groups.

Limitation: Small study size, young and healthy patients, relatively short observation period, and high proportion of patients from 1 center.

Conclusion: Midodrine can reduce the recurrence of syncope in healthy, younger patients with a high syncope burden."

Author/s:

Sheldon, R., Faris, P., Tang, A., Ayala-Paredes, F., Guzman, J., Marquez, M., Morillo, C. A., Krahn, A. D., Kus, T., Ritchie, D., Safdar, S., Maxey, C., Raj, S. R.

Dog Bites in Children Surge during COVID-19: A Case for Enhanced Prevention

Brian Desmarais — Mon, 29 Jun 2020 16:26:15 +0000

Date Added:

June 29, 2020

Journal/Publication:

Journal of Pediatrics

Publication Date:

June 25, 2020

URL:

Dog Bites in Children Surge during COVID-19: A Case for Enhanced Prevention

Type:

Clinical Research Results

Format:

Article

DOI (1):

https://doi.org/10.1016/j.jpeds.2020.06.071

Keywords

At first, this study may not seem relevant, but take a look anyway. You recommend safe storage of poisons and keeping a supply of ipecac, right? Here’s another chance to practice prevention.

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Not available.

Author/s:

Dixon, C.A., Mistry, R.D.

Prevention, Diagnosis, and Management of Chronic Wounds in Older Adults

Brian Desmarais — Thu, 09 Apr 2020 00:38:07 +0000

Date Added:

April 8, 2020

Journal/Publication:

Mayo Clinic Proceedings

Publication Date:

October 1, 2020

URL:

Prevention, Diagnosis, and Management of Chronic Wounds in Older Adults

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1016/j.mayocp.2019.10.014

Keywords

MeSH

A nice review of chronic wound prevention and care principles from Mayo. James W. Mold, MD, MPH

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Chronic wounds are common, disproportionately affect older adults, and are likely to be encountered by providers across all specialties and care settings. All providers should be familiar with basic wound prevention, identification, classification, and treatment approach, all of which are outlined in this article.

Author/s:

Hoversten, K.P., Kiemele, L.J., Stolp, A.M., Verdoorn, B.