Statins associated with decreased risk for CVD and death, even in very old adults

Embargoed for release until 5:00 p.m. ET on Monday 27 May 2024    

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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.    
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1. Statins associated with decreased risk for CVD and death, even in very old adults

Abstract: https://www.acpjournals.org/doi/10.7326/M24-0004   

FREE Summary for patients: https://www.acpjournals.org/doi/10.7326/P24-0004   

URL goes live when the embargo lifts      

A study of adults aged 60 years and older found that the use of statin therapy as primary cardiovascular disease (CVD) prevention was effective for preventing CVD and all-cause mortality, even in adults aged 85 years and older. The study is published in Annals of Internal Medicine.

Researchers from the University of Hong Kong used a target trial emulation design to investigate the relationship between statin therapy and CVD risk using electronic health records (EHRs) from the Hong Kong Hospital Authority. Thes study included adult patients over 60 without preexisting diagnosed CVDs who met indications for statin treatment from January 2008 to December 2015. Patients with prior statin use, lipid-lowering drug use, cancer, myopathies, or liver dysfunction were excluded. Statin therapy was defined as specific statin drugs, and outcomes included major CVDs, all-cause mortality, and adverse events. Follow-up was conducted until outcomes, death, loss to follow-up, or the end of the study.  The data showed that in all age groups, initiating statin therapy was associated with lower incidence of CVD and all-cause mortality, even among the older population aged 85 years or older. In addition, statin use did not increase the risk for adverse events, such as myopathies and liver dysfunction.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Eric Yuk Fai Wan, PhD, please contact Janet Sun at janetsun@hku.hk.

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2. Voluntary circumcision effective for preventing HIV infection among men who have sex with men

Abstract: https://www.acpjournals.org/doi/10.7326/M23-3317  

URL goes live when the embargo lifts     

A randomized controlled trial comprised of 247 men who have sex with men (MSM) found that voluntary medical male circumcision (VMMC) can prevent incident HIV infection. These findings suggest that MSM should be included in VMMC guidelines. The study is published in Annals of Internal Medicine.

Researchers from China enrolled uncircumcised, HIV-seronegative men aged 18 to 49 years who self-reported predominantly practicing insertive anal intercourse and had 2 or more male sex partners in the past 6 months in a trial to assess the efficacy of VMMC in preventing incident HIV infection. Once enrolled, all men received HIV counseling and testing and were then randomly assigned to immediate circumcision (intervention group) or circumcision delayed for 12 months (control group). There were zero seroconversions in the intervention group and five in the control group, and the HIV incidence was lower in the intervention group. Given the context of this sample size and length of follow-up, the incidence rates of syphilis, herpes simplex virus type 2, and penile human papillomavirus were not statistically significantly different between the 2 groups. While VMMC may exhibit high protective efficacy, the authors caution that it is important to offer comprehensive protection against HIV with additional preventive measures. Recommendations include condom use, education to reduce the number of partners, regular HIV testing, and pre-exposure or post-exposure prophylaxis, as appropriate.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Professor Huachun Zou from Fudan University, China, PhD, please contact him at zouhuachun@fudan.edu.cn.

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3. Sepsis covers a broad spectrum of illnesses that vary widely in mortality and cause

Authors suggest “sepsis” may be too broad a term for a large range of disease manifestations

Abstract: https://www.acpjournals.org/doi/10.7326/M24-0400   

URL goes live when the embargo lifts      

An analysis of sepsis presentations and mortality rates observed a 30-fold variation in mortality rates among patients with suspected sepsis depending on infection site, organ dysfunction, and their distinct combinations. According to the authors, their observation of a wide range of disease manifestations and outcomes begs the question whether it is appropriate and helpful to group all these infections together as 1 syndrome with a common descriptor and common treatment plan, especially those at low risk for poor outcomes. The analysis is published in Annals of Internal Medicine.

Researchers from Harvard Medical School and Harvard Pilgrim Health Care Institute conducted an analysis of 74,858 patients with suspected sepsis in 5 Massachusetts hospitals between June 2015 and August 2022 to elucidate the heterogeneity of sepsis by characterizing the breadth of infection sites, organ dysfunctions, and outcomes. The authors found that common comorbidities of suspected sepsis included hypertension (69%), diabetes (35%), heart failure (28%), and chronic lung disease (28%). About 30% of patients were admitted to intensive care, and about 9% died in the hospital. The authors note that there was a 30-fold variation in crude deaths depending on the primary site of infection, ranging from tick or vector-borne infections causing 1% of deaths to 33% from bacteremia. Similarly, there was a 13-fold variation in crude deaths across organ dysfunctions, ranging from 2.2% from decline in systolic blood pressure to 27% from respiratory failure requiring intubation, and mortality rates increased with successively more organ dysfunctions but still varied widely depending on which organs were involved. These findings echo other studies that have also documented divergent sepsis phenotypes but extends them by systematically characterizing the breadth of different sepsis manifestations and their mortality rates.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Michael Klompas, MD, MPH, please contact mklompas@bwh.harvard.edu.

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4. ESWL with ERP helpful in short term but not long term for patients with chronic pancreatitis

Abstract: https://www.acpjournals.org/doi/10.7326/M24-0210   

URL goes live when the embargo lifts      

A randomized trial of persons with chronic pancreatitis found that the use of extracorporeal shockwave lithotripsy (ESWL) endoscopic retrograde pancreatography (ERP) provide modest short-term pain relief. The study is published in Annals of Internal Medicine.

Researchers from the Asian Institute of Gastroenterology and Aalborg University Hospital conducted a sham-controlled randomized trial of 106 persons with chronic pancreatitis to investigate the pain-relieving effect of pancreatic duct decompression. Fifty-two patients were assigned ESWL with ERP and 54 were assigned to the sham group. After 12 weeks, participants receiving ESWL with ERP showed better pain relief compared with the sham group. However, the difference between groups was not sustained at the 24-week follow-up, and no differences were seen for 30% pain relief at 12- or 24-week follow-up.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding authors, please email Rupjyoti Talukdar (rup_talukdar@yahoo.com) or Søren Schou Olesen (soso@rn.dk)