MEDICAL NEWS BRIEFS #20

Rates of Sudden Death After Heart Attack (Myocardial Infarction): After an acute heart attack (myocardial infarction), sudden death rates have changed over the past 20 years. Current management after MI states that coronary patients should be on a beta blocker, a potassium-sparing diuretic, a statin, and have a high rate of being stented or bypassed. This is the modern, aggressive approach and is quite effective. During the first month after MI, sudden death can still occur, but is less likely than 20 years ago. Sudden death rates later, after the first month, are 2 to 3-fold less frequent than in the past. This is a confirmation of the benefit of an aggressive approach to patients with an acute heart attack. 

Reference: Curtain JP, Pfeffer MA, Braunwald E. Rates of Sudden Death after Myocardial Infarction—Insights from the VALIANT and PARADISE-MI Trials JAMA Cardiol 2024 Aug 7.

Antibiotic Prophylaxis and Infective Endocarditis Incidence Following Invasive Dental Procedures: Patients over 60 or patients with an artificial heart valve, acquired heart valve disease (mitral prolapse, rheumatic heart disease), and congenital valve abnormalities are susceptible (at high risk) for endocarditis. Endocarditis is a bacterial infection of the inner lining of the heart. Invasive dental procedures cause bacteria from the mouth to spill into the bloodstream and collect on the inner lining of the heart (the endocardium). Infection damages the valve. Taking prophylactic antibiotics before invasive dental procedures significantly reduces the chances of acquiring endocarditis and is recommended for all patients with high risk heart conditions.

Reference: Sperotto F, France K, Gobbo M. Antibiotic Prophylaxis and Infective Endocarditis Incidence Following Invasive Dental Procedures. JAMA Cardiol 2024 Apr 6;9(7):599-610.

Treatable Condition Misdiagnosed as Dementia in Almost 13% of Cases: Chronic liver problems, such as cirrhosis, often cause “hepatic encephalopathy”(HE). HE is caused by a build up of ammonia in the blood stream. When a chronically damaged liver is unable to metabolize proteins (which contain nitrogen), ammonia accumulates in the bloodstream causing the person to develop confusion and even coma. The confusion is often misdiagnosed as dementia. It is easily treatable and controllable, but not curable. Chronic liver disease is irreversible so accompanying encephalopathy requires constant monitoring and treatment.

Reference: Larkin M. Treatable Condition Misdiagnosed as Dementia in Almost 13% of Cases. Medscape Medical News 2024 July 23. 

Statins: So Misunderstood: “Statins are bad for the liver.” “Statins cause muscle pain.” Both of these comments are untrue. Multiple studies comparing various statins to placebo have concluded that elevated liver enzymes from statins DO NOT “indicate liver damage or dysfunction,” and that “chronic liver disease and stable cirrhosis are not contraindications to statin use.” The FDA has “removed the recommendation for routine regular monitoring of liver function for patients on statins.” Also “most muscle pain occurring in patients on statins is not due to the statin…muscle pain for any reason is common….trials…of patients on statins had the same amount and degree of muscle pain as patients on placebo.” Symptom scores for statins and placebo were virtually the same. 

Reference: Paauw DS. Statins: So Misunderstood Medscape Medical News 2024 Aug 8.

NO-RX Online Semaglutide Poses Multiple Risks: Semaglutide, the most often prescribed GLP-1 agonist, is available in online pharmacies without a prescription (I did not know this). Investigators learned, however, the “unregistered and falsified products” have problems. There’s a 50-50 chance your order will never come, there may be contaminants added, and the concentration of the drug may be higher than noted on the label (as much as 29%-39%), resulting in overdoses. The cost may be exorbitant as well. These drugs are popular because they work, but “counterfeit, unauthorized versions of Semaglutide…are becoming endemic.” Caution should be exercised.

Reference: Tucker ME. No-prescription online Semaglutide poses multiple risks. Medscape Medical News 2024 Aug 5. 

Regularly Drinking Alcohol After Age 60 Linked to Early Death: Bummer! Researchers in Spain studied 12 years of health outcomes for 135,000 UK residents age 60 or older. Men who had 3 drinks/day, and women who had a drink and a half/day, had a 33% increased risk of early death, a 39% increased risk of dying from cancer, and a 21% increased risk of dying from cardiovascular disease. These folks were compared to people who had one drink or less/day. Drinking wine, or drinking mostly with meals, showed a lower risk overall. “Americans’ attitudes toward the health impacts of alcohol are changing, with 65% of 18-34 year olds saying drinking can have negative health effects. But just 39% of adults 55 or older agreed drinking is bad for a person’s health.”

Reference: O’Mary L. Regularly drinking alcohol after 60 linked to early death. WebMD Health News 2024 August 15. 

GLP-1 Receptor Agonists and Chronic Coronary Disease: Not surprisingly, Glucagon-like peptide-1 (GLP-1) receptor agonists are now recommended by the American College of Cardiology and the American Heart Association for the management of chronic coronary disease. Specific reasons for their use were omitted, but I’m sure weight loss and lower blood sugar are desirable effects for CAD patients.

Reference: What are current guideline recommendations for managing chronic coronary disease in adults? AFP Clinical Answers Am Fam Phys 2024 August;110(2):117.