primary prevention

PMID (1):

40207842

MeSH

cardiovascular diseases

cholesterol

Postexposure Doxycycline to Prevent Bacterial Sexually Transmitted Infections

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

Postexposure Doxycycline to Prevent Bacterial Sexually Transmitted Infections

Aubrey Delammermore — Wed, 26 Apr 2023 05:00:00 +0000

Date Added:

April 26, 2023

Journal/Publication:

New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

April 6, 2023

Issue:

Volume:

388

Pages:

1296-1306

URL:

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1056/NEJMoa2211934

Keywords

sexually transmitted diseases

sexual and gender minorities

Anti-Bacterial Agents / administration & dosage

HIV prevention

doxycycline

PMID (1):

37018493

MeSH

Anti-Infective Agents* / administration & dosage

Chlamydia Infections / prevention & control

Doxycycline* / administration & dosage

Pre-Exposure Prophylaxis

Transgender Persons

Doxycycline prophylaxis after unprotected sex seems to dramatically reduce the incidence of STIs. James W. Mold, MD, MPH

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Background: Interventions to reduce sexually transmitted infections (STIs) among men who have sex with men (MSM) are needed.

Methods: We conducted an open-label, randomized study involving MSM and transgender women who were taking preexposure prophylaxis (PrEP) against human immunodeficiency virus (HIV) infection (PrEP cohort) or living with HIV infection (persons living with HIV infection [PLWH] cohort) and who had had Neisseria gonorrhoeae (gonorrhea), Chlamydia trachomatis (chlamydia), or syphilis in the past year. Participants were randomly assigned in a 2:1 ratio to take 200 mg of doxycycline within 72 hours after condomless sex (doxycycline postexposure prophylaxis) or receive standard care without doxycycline. STI testing was performed quarterly. The primary end point was the incidence of at least one STI per follow-up quarter.

Results: Of 501 participants (327 in the PrEP cohort and 174 in the PLWH cohort), 67% were White, 7% Black, 11% Asian or Pacific Islander, and 30% Hispanic or Latino. In the PrEP cohort, an STI was diagnosed in 61 of 570 quarterly visits (10.7%) in the doxycycline group and 82 of 257 quarterly visits (31.9%) in the standard-care group, for an absolute difference of -21.2 percentage points and a relative risk of 0.34 (95% confidence interval [CI], 0.24 to 0.46; P<0.001). In the PLWH cohort, an STI was diagnosed in 36 of 305 quarterly visits (11.8%) in the doxycycline group and 39 of 128 quarterly visits (30.5%) in the standard-care group, for an absolute difference of -18.7 percentage points and a relative risk of 0.38 (95% CI, 0.24 to 0.60; P<0.001). The incidences of the three evaluated STIs were lower with doxycycline than with standard care; in the PrEP cohort, the relative risks were 0.45 (95% CI, 0.32 to 0.65) for gonorrhea, 0.12 (95% CI, 0.05 to 0.25) for chlamydia, and 0.13 (95% CI, 0.03 to 0.59) for syphilis, and in the PLWH cohort, the relative risks were 0.43 (95% CI, 0.26 to 0.71), 0.26 (95% CI, 0.12 to 0.57), and 0.23 (95% CI, 0.04 to 1.29), respectively. Five grade 3 adverse events and no serious adverse events were attributed to doxycycline. Of the participants with gonorrhea culture available, tetracycline-resistant gonorrhea occurred in 5 of 13 in the doxycycline groups and 2 of 16 in the standard-care groups.

Conclusions: The combined incidence of gonorrhea, chlamydia, and syphilis was lower by two thirds with doxycycline postexposure prophylaxis than with standard care, a finding that supports its use among MSM with recent bacterial STIs. (Funded by the National Institutes of Health; DoxyPEP ClinicalTrials.gov number, NCT03980223.).

Author/s:

Luetkemeyer, A. F., Donnell, D., Dombrowski, J. C., Cohen, S., Grabow, C., Brown, C. E., Malinski, C., Perkins, R., Nasser, M., Lopez, C., Vittinghoff, E., Buchbinder, S. P., Scott, H., Charlebois, E. D., Havlir, D. V., Soge, O. O., Celum, C., DoxyPEP Study Team

A Hitchhiker's Guide to Worldwide COVID-19 Vaccinations: A Detailed Review of Monovalent and Bivalent Vaccine Schedules, COVID-19 Vaccine Side Effects, and Effectiveness Against Omicron and Delta Variants

Aubrey Delammermore — Sun, 09 Oct 2022 05:00:00 +0000

Date Added:

October 9, 2022

Journal/Publication:

Cureus

Publisher:

Cureus

Publication Date:

October 2, 2022

Issue:

Volume:

URL:

A Hitchhiker's Guide to Worldwide COVID-19 Vaccinations: A Detailed Review of Monovalent and Bivalent Vaccine Schedules, COVID-19 Vaccine Side Effects, and Effectiveness Against Omicron and Delta Variants

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.7759/cureus.29837

Keywords

Cost-Benefit Analysis

PMID (1):

36204257

MeSH

Centers for Disease Control and Prevention, U.S.

delivery of health care

A summary of recommended dosing intervals and effectiveness of currently available COVID-19 vaccines. James W. Mold, MD, MPH

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For the primary prevention of coronavirus disease 2019 (COVID-19), there are currently four different vaccines available in the USA. These are Pfizer (messenger RNA [mRNA]), Moderna (mRNA), Novavax (recombinant protein), and Jansen/Johnson & Johnson (adenoviral vector). All individuals should get vaccinated, and the Centers for Disease Control and Prevention (CDC) has provided comprehensive guidelines on recommended doses, their frequency by age group, and vaccine types, all discussed in detail in this article. Vaccines are a critical and cost-effective tool for preventing the disease. Prior to receiving a vaccine, patients should get adequate counseling regarding any potential adverse effects post vaccination. Appropriate safety precautions must be taken for those more likely to experience adverse consequences. Healthcare professionals should be aware of the symptoms, indicators, and treatment of any adverse event post-vaccination. We have provided a comprehensive review of the different characteristics of COVID-19 vaccines available in the United States, including their effectiveness against various variants, adverse effects, and precautions necessary for healthcare professionals and the general population. This article also briefly covers COVID-19 vaccines available worldwide, specifically their mode of action and effectiveness.

Author/s:

Goyal, L., Zapata, M., Ajmera, K., Churasia, P., Pandit, R., Pandit, T.

Individualized approach to primary prevention of substance use disorder: age-related risks

Devin Evans — Wed, 03 Mar 2021 06:00:00 +0000

Date Added:

March 3, 2021

Journal/Publication:

Substance Abuse Treatment, Prevention, and Policy

Publication Date:

August 14, 2020

Issue:

Volume:

URL:

Individualized approach to primary prevention of substance use disorder: age-related risks

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1186/s13011-020-00300-7

Keywords

substance use disorder

PMID (1):

32795372

MeSH

aged

Adverse Childhood Experiences

social determinants of health

substance-related disorders

risk factors

This systematic review documented age-associated risk factors for substance use disorders. James W. Mold, MD, MPH

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Background: The misuse of legal and illegal substances has led to an increase in substance use disorder (SUD) in the United States. Although primary prevention strategies have been successfully used to target chronic physical diseases, these strategies have been less effective with SUD, given misconceptions of SUD, shortages in behavioral health professionals, and the population-based focus on specific substances. A developmental approach to the identification and primary prevention of SUD that does not fully rely upon behavioral health workers is needed. The purpose of this paper was to examine age related risk factors for developing SUD and present a novel individualized approach to SUD prevention.

Methods: A literature search was conducted to identify risk factors for SUD among children, young adults, adults, and older adults. We searched CINAHL, PsycINFO, and PubMed between the years 1989-2019, and extracted data, analyzing similarities and differences in risk factors across life stages. Broader categories emerged that were used to group the risk factors.

Results: More than 370 articles were found. Across all age groups, risk factors included adverse childhood experiences, trauma, chronic health diseases, environmental factors, family history, social determinants, and grief and loss. Despite the similarities, the contextual factors and life challenges associated with these risks varied according to the various life stages. We proposed an approach to primary prevention of SUD based on risk factors for developing the disease according to different age groups. This approach emphasizes screening, education, and empowerment (SEE), wherein individuals are screened for risk factors according to their age group, and screening results are used to customize interventions in the form of education and empowerment. Given that trained persons, including non-healthcare providers, close to the at-risk individual could conduct the screening and then educate and mentor the individual according to the risk level, the number of people who develop SUD could decrease.

Conclusions: The risk factors for developing SUD vary across the various life stages, which suggests that individualized approaches that do not overtax behavioral healthcare workers are needed. Using SEE may foster early identification and individualized prevention of SUD.

Author/s:

Afuseh, Eric, Pike, Caitlin A., Oruche, Ukamaka M.

Aspirin for Primary Atherosclerotic Cardiovascular Disease Prevention as Baseline Risk Increases: A Meta-Regression Analysis

John Bayhi — Thu, 21 May 2020 16:39:36 +0000

Date Added:

May 21, 2020

Journal/Publication:

The American Journal of Medicine

Publisher:

Elsevier Inc

Publication Date:

May 20, 2020

Volume:

Article in Press

URL:

Aspirin for Primary Atherosclerotic Cardiovascular Disease Prevention as Baseline Risk Increases: A Meta-Regression Analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.amjmed.2020.04.028

Keywords

Atherosclerotic Cardiovascular Disease

myocardial infarction

MeSH

cardiovascular diseases

Brain Ischemia

follow-up studies

myocardial infarction

This analysis of 12 RCTs involving almost 1 million patients found that low-dose aspirin prevents major cardiovascular events (RRReduction 14%; ARR/1000 patient years 0.06%) but increases major bleeding events (RRIncrease 40%; ARR/1000 patient years 0.1%) across all levels of baseline risk. The researchers concluded that the absolute risk reduction and the risk: benefit ratio suggest that we should probably not prescribe low-dose aspirin for primary prevention even if the baseline risk of CV events is high and the risk of bleeding is low. James W. Mold, MD, MPH

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Background

Aspirin is often prescribed for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) however, recent randomized trials (RCTs) have challenged this practice. Despite this, aspirin is commonly recommended for high risk primary prevention. We tested the hypothesis that aspirin is more efficacious for the primary prevention of ASCVD, as the baseline risk increases.

Methods

RCTs that compared aspirin to control for primary prevention and evaluated ASCVD (composite of myocardial infarction and ischemic stroke) and major bleeding were included. Rate ratios (RR) and 95% confidence intervals (CI) were calculated. A regression analysis was performed using the ASCVD event rate in the control arm of each RCT as the moderator.

Results

Twelve RCTs were identified with 963,829 patient years of follow-up. Aspirin was associated with a reduction in ASCVD (4.7 versus 5.3 events per 1,000 patient years; RR 0.86; 95% CI 0.79-0.92). There was increased major bleeding among aspirin users (2.5 versus 1.8 events per 1000 patient years, RR 1.41 95% CI, 1.29-1.54). Regression analysis found no relationship between the log rate ratio of ASCVD or major bleeding and incidence of ASCVD in the control arm of each RCT.

Conclusion

Aspirin is associated with a reduction in ASCVD when used for primary prevention; however, it is unlikely to be clinically significant given the increase in bleeding. More importantly, aspirin's treatment effect does not increase as ASCVD risk increases as many hypothesize. There is no suggestion from this data that use of aspirin for higher risk primary prevention patients is beneficial.

Author/s:

Nudy, M, Cooper, J, Ghahramani, M, Ruzieh, M, Mandrola, J, Foy, AJ

Statin Use Over 65 Years of Age and All-Cause Mortality: A 10-Year Follow-Up of 19 518 People

Brian Desmarais — Sat, 14 Mar 2020 20:02:11 +0000

Date Added:

March 14, 2020

Journal/Publication:

Journal of the American Geriatrics Society

Publication Date:

October 1, 2019

Issue:

Volume:

URL:

Statin Use Over 65 Years of Age and All-Cause Mortality: A 10-Year Follow-Up of 19 518 People

Type:

Meta-analyses, Reviews, and Guidelines, Practice Management Reviews and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1111/jgs.16060

Keywords

all-cause mortality

cardiovascular events

hypercholesterolemia

older adults

Hydroxymethylglutaryl-CoA Reductase Inhibitors

MeSH

cardiovascular diseases

Statins appear to significantly reduce all-cause mortality in patients over 65 and in those over 75 as well. James W. Mold, MD, MPH

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Abstract

OBJECTIVES

As life expectancy continues to rise, the burden of cardiovascular disease among older people is expected to increase, making cardiovascular prevention in older people an issue of growing interest and public health importance. We aimed to explore the long‐term effects of adherence to statins on mortality and cardiovascular morbidity among older adults.

DESIGN

A historical population‐based cohort study using routinely collected data.

SETTING

Clalit Health Services Northern District.

PARTICIPANTS

We followed members of Clalit Health Services aged 65 years or older who were eligible for primary cardiovascular prevention for a period of 10 years.

MEASUREMENTS

We fitted Cox regression models to assess the association between the adherence to statin therapy and all‐cause mortality and cardiovascular morbidity, adjusting for cardiovascular risk factors and associated morbidity as time‐updated variables.

RESULTS

The analysis included 19 518 older adults followed during 10 years (median = 9.7 y). All‐cause mortality rates were 34% lower among those who had adhered to statin treatment, compared with those who had not (hazard ratio [HR] = .66; 95% confidence interval [CI] = .56‐.79). Adherence to statins was also associated with fewer atherosclerotic cardiovascular disease events (HR = .80; 95% CI = .71‐.81). The benefit of statin use did not diminish among beyond age 75 and was evident for both women and men.

CONCLUSION

Adherence to statins may be associated with reduced mortality and cardiovascular morbidity among older adults, regardless of age and sex. J Am Geriatr Soc 67:2038–2044, 2019

Author/s:

Eilat-Tsanani, S., Schonmann, Y., Mor, E.

Primary Prevention of Cardiovascular Disease

John Bayhi — Sat, 05 Oct 2019 14:48:41 +0000

Date Added:

October 5, 2019

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

October 4, 2019

URL:

Primary Prevention of Cardiovascular Disease

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2019.15915

Keywords

CAD

coronary artery disease

guidelines

American Heart Association

American College of Cardiology

CVD

cardiovascular disease

2018 Cholesterol Clinical Practice Guidelines: Synopsis of the 2018 American Heart Association/American College of Cardiology/Multisociety Cholesterol Guideline.

PMID (1):

31584604

The most recent ACC/AHA Guideline regarding primary prevention of coronary artery disease. James W. Mold, MD, MPH

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Atherosclerotic CVD remains the leading cause of death for people of most racial/ethnic groups. In 2010, the AHA suggested metrics of ideal cardiovascular health in 7 domains (blood pressure, physical activity, cholesterol, diet, weight, smoking, and blood glucose). There have since been multiple related guideline updates and scientific statements. In 2017, the ACC/AHA Task Force on Clinical Practice Guidelines commissioned an updated guideline integrating existing and new recommendations into a unified and “user-friendly” document on primary prevention of ASCVD.

Author/s:

Jain, A, Davis, AM

2018 Cholesterol Clinical Practice Guidelines: Synopsis of the 2018 American Heart Association/American College of Cardiology/Multisociety Cholesterol Guideline

Tracy Ashby — Wed, 29 May 2019 05:00:00 +0000

Date Added:

May 29, 2019

Journal/Publication:

Annals of Internal Medicine

Publisher:

The American College of Physicians

Publication Date:

May 28, 2019

URL:

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.7326/M19-0365

Keywords

cholesterol

Hydroxymethylglutaryl-CoA Reductase Inhibitors

cardiovascular disease

statin therapy

risk factors

PMID (1):

31132793

MeSH

This is the 2018 version of the AHA/ACC Guideline on cholesterol management. James W. Mold, MD, MPH

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Description:

In November 2018, the American Heart Association and American College of Cardiology (AHA/ACC) released a new clinical practice guideline on cholesterol management. It was accompanied by a risk assessment report on primary prevention of atherosclerotic cardiovascular disease (ASCVD).

Methods:

A panel of experts free of recent and relevant industry-related conflicts was chosen to carry out systematic reviews and meta-analyses of randomized controlled trials (RCTs) that examined cardiovascular outcomes. High-quality observational studies were used for estimation of ASCVD risk. An independent panel systematically reviewed RCT evidence about the benefits and risks of adding nonstatin medications to statin therapy compared with receiving statin therapy alone in persons who have or are at high risk for ASCVD.

Recommendation:

The guideline endorses a heart-healthy lifestyle beginning in childhood to reduce lifetime risk for ASCVD. It contains several new features compared with the 2013 guideline. For secondary prevention, patients at very high risk may be candidates for adding nonstatin medications (ezetimibe or proprotein convertase subtilisin/kexin type 9 [PCSK9] inhibitors) to statin therapy. In primary prevention, a clinician–patient risk discussion is still strongly recommended before a decision is made about statin treatment. The AHA/ACC risk calculator first triages patients into 4 risk categories. Those at intermediate risk deserve a focused clinician–patient discussion before initiation of statin therapy. Among intermediate-risk patients, identification of risk-enhancing factors and coronary artery calcium testing can assist in the decision to use a statin. Compared with the 2013 guideline, the new guideline gives more attention to percentage reduction in low-density lipoprotein cholesterol as a treatment goal and to long-term monitoring of therapeutic efficacy. To simplify monitoring, nonfasting lipid measurements are allowed.

Author/s:

Grundy, Scott M, Stone, Neil J., Guideline Writing Committee for the 2018 Cholesterol Guidelines

Aspirin Use in Primary Care

Tracy Ashby — Fri, 25 Jan 2019 06:00:00 +0000

Date Added:

January 25, 2019

Journal/Publication:

Healthy Hearts for Oklahoma (H2O)

Publisher:

The Oklahoma Cooperative

Publication Date:

January 25, 2019

Type:

Clinical Decision Aids

Format:

Article

Keywords

cardiovascular events

MeSH

disease, cardiovascular

Hydroxymethylglutaryl-CoA Reductase Inhibitors

This is the material used in the Healthy Hearts for OK project to update clinicians on the role of low-dose aspirin for prevention of cardiovascular events.

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An update for clinicians on the role of low-dose aspirin for prevention of cardiiovascular events from the Healthy Hearts for OK project.

Author/s:

Mold, James W.

Cholesterol Management in Primary Care

Jeffrey Wilson — Wed, 05 Sep 2018 15:42:28 +0000

Date Added:

September 5, 2018

Journal/Publication:

Healthy Hearts for Oklahoma

Publisher:

Agency for Healthcare Research and Quality

Type:

Clinical Decision Aids

Format:

Slides

Keywords

MeSH

cholesterol

This is the decision aid for statin use developed for the Healthy Hearts for OK Project.

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Patients with existing disease or major risk factors should be prescribed statins unless contraindicated.

Aspirin Use in Primary Care

Jeffrey Wilson — Wed, 05 Sep 2018 15:37:53 +0000

Date Added:

September 5, 2018

Journal/Publication:

Healthy Hearts for Oklahoma

Publisher:

Agency for Healthcare Research and Quality

Type:

Clinical Decision Aids

Keywords

cardiovascular disease

MeSH

disease, cardiovascular