VA/DoD recommend a nuanced approach to management of dyslipidemia for CVD risk reduction

VA/DOD guidelines differ from ACC/AHA guidelines in several aspects

Free abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-0840
URL goes live when embargo lifts

The U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) approved a joint clinical practice guideline for the management of dyslipidemia for cardiovascular disease (CVD) risk reduction in adults. A synopsis of the guideline is published in Annals of Internal Medicine.

The synopsis summarizes key features of the guideline in five areas: elimination of treatment targets; additional tests for risk prediction; primary and secondary prevention; and laboratory testing. According to the authors, the guidelines differ from the American College of Cardiology and American Heart Association (ACC/AHA) guidelines in several aspects.

Both the ACC/AHA and VA/DoD guidelines recommend the elimination of treatment targets. However, the VA/DoD guidelines include an extended review of the research through February 2014. With regard to additional tests to refine risk prediction, the VA/DoD guidelines are more conservative, recommending these tests only when the rationale is clear. Once the patient's 10-year risk has been calculated, the VA/DoD recommends shared decision-making to determine whether the potential benefits of medications outweigh the potential harms for each patient, which is a more nuanced approach than that of the ACC/AHA. The VA/DoD recommends that patients be treated with a moderate-dose statin first, then titrate to a high dose in patients at the highest risk. The authors cite safety concerns as the rationale for this recommendation. The VA/DoD recommendations call for nonfasting laboratory tests, and once a statin is initiated, they do not recommend routine monitoring of lipids. Finally, the authors of the VA/DoD guideline say their group contained members with no conflicts of interest.

Notes: For an embargoed PDF, please contact Angela Collom. To reach Dr. John Downs from the VA, please contact Nenette Madla at 210-978-2002 or stxmedia@va.gov.

Free abstract: http://www.annals.org/article.aspx?doi=10.7326/M14-2368
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A review 2001 - 2009 data from the Fatality Analysis Reporting System (FARS) found that states with primary seatbelt laws, or laws that allow vehicle occupants to be ticketed solely for not wearing seatbelts, had a 17 percent reduction in the incidence rate of motor vehicle fatalities compared to states with secondary seatbelt laws. Secondary seatbelt laws only allow citations within the context of other traffic violations. The findings are published in Annals of Internal Medicine.

Editorialists from the Centers for Disease Control and Prevention (CDC) call the prevention of motor vehicle injuries a "winnable battle" because interventions have an immediate positive effect. They say that four additional evidence-based interventions could further increase seatbelt use: 1) apply existing seatbelt laws to all positions in the vehicle; 2) increase fines for noncompliance with seatbelt laws; 3) expand high-visibility enforcement at night; and 4) bolster communication campaigns, such as "Click It or Ticket."

Notes: For an embargoed PDF, please contact Angela Collom. To reach the lead author of the paper, please contact Bethany Tripp at Bethany.tripp@childrens.harvard.edu or 617-919-3656. The editorialists can be reached through the CDC, National Center for Injury Prevention and Control media relations line at 770-488-4902.

3. Pregnancy safer than previously believed for women with stable lupus

Free abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-0443
URL goes live when embargo lifts

Most women with systemic lupus erythematosus (SLE) that become pregnant when lupus is inactive or stable, are unlikely to flare or experience complications, according to a study published in Annals of Internal Medicine.

Researchers studied 385 patients with SLE enrolled in the PROMISSE (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus) study to identify predictors of adverse pregnancy outcomes in patients with inactive or stable active disease. Pregnancy outcomes were uncomplicated in 81 percent of the women studied, but varied by ethnicity and other patient characteristics. Most white non-Hispanic patients had favorable pregnancy outcomes, while African and Hispanic Americans had a higher rate of fetal complications. In addition to ethnicity, antihypertensive use at baseline, presence of lupus anticoagulant, any clinical flare during pregnancy, and thrombocytopenia, were all associated with negative outcomes.

The author of an accompanying editorial suggest that clinicians use these findings to counsel patients with SLE who are contemplating pregnancy or those who are already pregnant.

Notes: For an embargoed PDF, please contact Angela Collom. To speak with one of the authors, please contact Ryan Jaslow at Ryan.Jaslow@nyumc.org or 212-404-3511.

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Also in this issue:

Enhancing Cognitive Aging: Clinical Highlights of a Report From the Institute of Medicine

Sharon K. Inouye, MD, MPH

Ideas and Opinions

M15-1228

http://www.annals.org/article.aspx?doi=10.7326/M15-1228

Orchestrated Scientific Collaboration: Critical to the Control of MERS-CoV

Trish M. Perl, MD, MSc, and Connie Savor Price, MD

Ideas and Opinions

M15-1395

http://www.annals.org/article.aspx?doi=10.7326/M15-1395