The eight survival secrets
Eat better, be more active, quit tobacco, get healthy sleep, manage weight, control cholesterol, manage blood pressure, and manage blood sugar: the American Heart Association’s “Life’s Essential 8” sounds a lot like my long abandoned list of New Year’s resolutions.
A cohort study from the UK Biobank finds that those who manage to adhere to the Essential 8 and have better cardiovascular health live longer: women with high cardiovascular health (according to a score based on the Essential 8) aged 50 years lived 9.4 years longer than women with low cardiovascular health, for instance. That’s hardly surprising, but more intriguing is the finding that, among those with a high level of cardiovascular health, there was no difference in disease-free life expectancy between participants with low socioeconomic status and other socioeconomic groups.
JAMA Intern Med doi:10.1001/jamainternmed.2023.0015
Rooting for the antivenom
This week’s most exciting piece of research among the leading general medical journals was about scorpion stings. It’s not just the topic—the idea of being stung by a scorpion is pretty terrifying—but the research letter in the New England Journal of Medicine offered a gripping story with a nail-biting finale, keeping us in suspense about the fate of the 252 bite victims until the very last sentence. We heard that severe toxic effects of a scorpion sting include “a rapid onset of a dramatic neuromotor syndrome, with agitation, nystagmus, opisthotonos, hypersalivation, bronchorrhea, fasciculations, and flailing limbs.” Of those given the antivenom, 45% didn’t actually need it, according to local guidelines—given that list of possible symptoms, I can see why. And what became of the 252 recipients of the F(ab′)2 antibody antivenom in emergency departments in Arizona? They all survived.
N Engl J Med doi:10.1056/NEJMc2029813
A sound idea for treating hypertension?
Is ultrasound renal denervation ever likely to join the menu of treatments for hypertension? A new trial found that ultrasound renal denervation reduced daytime ambulatory systolic blood pressure compared with a sham procedure in patients with high blood pressure that was not controlled despite taking up to two hypertensives. However, this greater reduction in daytime ambulatory systolic blood pressure after two months seen in the treatment group was a rather modest 6.3 mm Hg. Early safety monitoring found no adverse events, but the procedure, which involves inserting a catheter into the renal arteries and zapping nerves with ultrasound, took an average of 77 minutes to perform. Longer follow-up from this and other studies will tell us more.
JAMA doi:10.1001/jama.2023.0713
Thiazide study leaves no stone left unturned
The 2019 NICE guideline on renal and ureteric stones recommends considering thiazides for adults “with a recurrence of stones that are predominantly (more than 50%) calcium oxalate and hypercalciuria, after restricting their sodium intake to no more than 6 g a day.”
A randomised control trial, whose eligibility criteria mirrored that of NICE’s recommendation, aimed to determine the efficacy and dose-response effect of hydrochlorothiazide in preventing recurrence of kidney stones, which are still unclear given methodological limitations of previous studies. Using symptomatic or radiological recurrence of kidney stones as the primary end point, the study found no benefit in taking hydrochlorothiazide at doses up to 50 mg once daily after a median follow-up of 2.9 years. However, adverse events of gout, hypokalaemia, and diabetes were more common in those taking thiazides than those receiving placebo.
N Engl J Med doi:10.1056/NEJMe2300120
Pituitary rhymes
Oh the grand old team of researchers in Boston, they had the medical records of 414 men and women (with pituitary microadenomas, which have a prevalence of 10-38.5% on radiological studies), they followed them up to 17 years (as part of a retrospective cohort study to see if these incidentalomas need close monitoring or not), and they wrote down their sizes again: and when they went up they went down, and when they went down they went up, and when they went only half way up they were neither up nor down (as in, over the study period, two thirds didn’t change in size or got smaller, and any growth seen was small and slow).
Ann Intern Med doi:10.7326/M22-1728
Footnotes
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Competing interests: None declared.
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Provenance and peer review: Not commissioned, not peer reviewed.