Internal Medicine
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Type of Provider and Opioid Use in New-Onset Low Back Pain
When compared to an initial visit with a primary care physician, patients who initially received care for new-onset low back pain from a chiropractor, physical therapist, or acupuncturist were at lower odds for early and long-term opioid use.
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Disability After Minor Stroke and TIA — Secondary Analysis of the POINT Trial
Although the data from this analysis suggest disability might be less with dual antiplatelet therapy, differences between the groups were small, did not show robust findings, and did not reach statistical significance in most of the analyses.
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Benefits of Targeting LDL Cholesterol Below 70 mg/dL
After an ischemic stroke of atherosclerotic origin, targeting low-density lipoprotein cholesterol to less than 70 mg/dL resulted in a significant reduction in subsequent major vascular events and no increase in intracranial hemorrhage.
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Making Healthy Lifestyle Choices, Living Longer Without Chronic Diseases
The authors found improving each of four “healthy lifestyle choices” added approximately one year of disease-free life between ages 40 and 75 years. Adopting all four “optimal” lifestyles was associated with nine years of life gained vs. adopting zero optimal lifestyles.
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Is Exercise ECG Testing Dead?
A post-hoc analysis of the SCOT-HEART trial demonstrated exercise ECG is predictive of future coronary heart disease events and mortality. However, coronary CT angiography is more accurate for the detection of coronary artery disease and is more strongly associated with future coronary events.
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Clinical vs. Genetic Risk for Coronary Disease
A study of the utility of a polygenetic score for coronary artery disease risk was compared to the pooled cohort equation (PCE) for determining which primary prevention patients would benefit from statin use. Only at the top 5% risk stratum did the genetic score exceed an odds ratio for coronary disease of 2. Using these data would increase statin recommendations by 4% vs. the PCE.
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Coronary Calcium to Guide Aspirin Primary Prevention
Researchers analyzed the MESA study to determine the comparative value of the pooled risk equation vs. CT coronary artery calcium score for determining which aspirin-naïve patients < age 70 years without overt coronary artery disease would benefit most from primary prevention with aspirin. They found a calcium score of > 100 was superior for this determination.
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Subclinical Leaflet Thrombosis: Not Just a TAVR Phenomenon
Imaging-defined leaflet thrombosis was common and similar between transcatheter aortic valve replacement and surgical aortic valve replacement bioprosthetic valves. These findings showed no apparent relationship to valve hemodynamics or to clinical outcomes, including stroke.
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Where Does Vericiguat Fit into the Heart Failure Medication Algorithm?
Vericiguat reduced cardiovascular death and heart failure hospitalization, although no reduction in overall mortality was observed over a short follow-up period.
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COVID-19 Lockdown Measures May Have Prevented 530 Million Additional Infections
Researchers studied actions taken in six countries and the resulting outcomes.