As I wrote in a previous column, health care professionals scour 100 medical journals a month and compile a list each year of the 20 studies most likely to change the care that you receive from your primary physician or other health care provider. We covered half of them in the previous column, and now here are the other half.
Three of these articles deal with heart problems and how to prevent them. The first deals with semaglutide, brand name Wegovy, which is effective for weight loss in patients with and without diabetes, but also decreases the risk of a heart attack in patients with known coronary artery disease.
Unfortunately, we don’t yet have evidence that semaglutide reduces heart disease risk in patients with obesity who don’t have known coronary disease. But ongoing studies may eventually show this protective effect, and that would be really great — especially when the cost of the drug comes down.
The second article on heart disease deals with the use of SGLT-2 inhibitors (sold as Jardiance, Farxiga and others) in older adults with diabetes and heart failure. A meta-analysis of 20 studies using one of the drugs on frail older adults with heart failure and type 2 diabetes showed fewer deaths and fewer hospitalizations for heart failure.
These articles paint a picture of heart and kidney effects from these meds that are so strong that they can be safely used, even in older and frail patients.
The third article changes the longstanding use of a beta-blocker (metoprolol, timolol and many others with names ending in -lol) to treat patients who have had a heart attack but with preserved heart function, also called ejection fraction. Beta-blockers were thought to prevent death from any cause or from a new heart attack.
This well-conducted study with a large patient population showed no benefit from the use of a beta-blocker drug. So it’s not necessary for patients after a heart attack.
The next group of articles deals with problems in addiction and mental health.
What is the best strategy for smoking cessation when initial treatment with varenacline, or Chantix, or nicotine replacement therapy fails? The study gave patients either varenacline or nicotine replacement therapy. After six weeks of treatment, the patients who had not quit were either continued on the same dose or switched to a higher dose of the same medicine, or switched to the other therapy.
What happened? Those who were switched to a higher dose of varenacline, from 2 milligrams a day to 3 milligrams a day, were much more likely to quit than those who stayed on the same dose or who were switched to nicotine replacement. Those who were on nicotine replacement were much more likely to quit if the dose was doubled at six week or they were switched to varenacline.
The second study dealt with the use of electronic nicotine delivery systems. Adult smokers who were given e-cigarettes and smoking cessation counseling were significantly more likely to quit cigarettes at six months than those given smoking cessation counseling and a $50 voucher to buy a nicotine-replacement product.
In the study, the cost of the e-cigarettes was paid by the study. In the real world, results may be different when patients have to buy their own e-cigarettes. In addition, a significant number of patients treated with e-cigarettes became long-term vapers. Long-term vaping has other potentially negative breathing effects, but it is still better than continuing to smoke tobacco.
The next important question to be answered by recent research is: What medications are effective and safe for treatment of alcohol use disorder? In conjunction with counseling, naltrexone or Vivitrol and acamprosate have the strongest evidence for effective treatment, based on a systematic review of the literature. The authors of the research add that naltrexone and acamprosate can be used even if counseling is not available or refused by the patient.
If you are concerned about your use of alcohol, or know someone who is, the Alcohol Use Disorder Identification Test can be used to make the diagnosis of alcohol use disorder. It is available at: https://nida.nih.gov/sites/default/files/files/AUDIT.pdf
The last issue in mental health deals with care for patients with long COVID, defined as severe fatigue lasting months after initial symptoms. A trial compared the effect of cognitive behavioral therapy delivered by psychologists with the patient’s usual care. Cognitive behavioral therapy was delivered in 20 weekly hourlong sessions.
Six weeks after completing the therapy, 63 percent of patients no longer had severe fatigue compared to only 26 percent of those having had their usual care. So if you think you have long COVID, it is worth considering cognitive behavioral therapy as it more than doubles the likelihood of getting better.
The last two top research articles dealt with treatment of patients with Alzheimer’s disease and the preferred method to deliver bad news.
New monoclonal antibodies for Alzheimer’s patients (lecanemab, or Leqembi, and donanemab, or Kisunla) target amyloid removal from the brain. But patient-oriented evidence matters, that is, significant improvement in symptoms is absent. In addition, they are associated with risks of harm, specifically swelling and bleeding into brain tissue. In short, they are minimally effective, frequently harmful and very expensive — not a good combination for our patients.
The last top research article studied whether delivering bad news by a telephone call or in person made any difference in patient satisfaction. This was another meta-analysis, looking at more than 20 articles. They found no difference between the two methods in level of psychological stress, anxiety, depression or post-traumatic stress.
The authors suggest that “in an increasingly online world, patients will help us choose the best method, and knowing may be preferable to waiting for many patients.” Let your doctor know what your preference is.
Your comments, questions and suggestions are welcome at: agingforamateurssimpson@gmail.com.