By: Dr. Geoffrey Modest There was a recent article looking at statins and fibrates in the primary prevention of vascular events in elderly patients. I will also add to this review a meta-analysis of statin use as primary prevention in the elderly. A French cohort study reviewed a random sample of patients comparing those on […]
Category: Archive
Primary Care Corner with Geoffrey Modest MD: Implantable defibrillators post-MI
By: Dr. Geoffrey Modest A lead article in JAMA was a study of Medicare patients who had an MI with a low ejection fraction (EF) to see what % actually had a cardioverter-defibrillator (ICD) implanted and how the patients did (see JAMA. 2015;313(24):2433-2440). This was a retrospective observational study. Details: –10,381 patients had an MI with EF<35% from 441 US hospitals, […]
Primary Care Corner with Geoffrey Modest MD: Medical use of marijuana
Medical use of marijuana […]
Primary Care Corner with Geoffrey Modest MD: Metformin, CKD, and death
By: Dr. Geoffrey Modest A rather unusual quick-and-dirty study was just published looking at the relationship between metformin use and mortality, as well as lactic acidosis, in those with severe chronic kidney disease, CKD. This study was based on a window of time until 2009, when metformin was used in Taiwan without restriction in those with renal disease (See doi.org/10.1016/S2213-8587(15)00123-0). The […]
Primary Care Corner with Geoffrey Modest MD: Tenofovir nephrotoxicity
Tenofovir nephrotoxicity […]
Primary Care Corner with Geoffrey Modest MD: Atrial fibrillation incidence in Framingham Study
Atrial fibrillation incidence in Framingham Study […]
Primary Care Corner with Geoffrey Modest MD: PPIs associated with MIs???
By: Dr. Geoffrey Modest There was a recent article published online and hitting the press regarding a possible association between the use of proton-pump inhibitors (PPIs) and subsequent MIs (see DOI:10.1371/journal.pone.0124653). The article was unusual in that it used a new technique for medical research: data-mining. The bottom line is that if there were a real association between PPI use […]
Primary Care Corner with Geoffrey Modest MD: Tight diabetes control and cardiovasc disease– followup of the VA study
By: Dr. Geoffrey Modest The Veterans Affairs Diabetes Trial (VADT) was one of the triumvirate published around 2009, along with the ACCORD and ADVANCE trials, which looked at intensive glycemic control and cardiovascular outcomes. These trials basically found that intensive control did not help and perhaps hurt: the ACCORD trial achieved an A1c of 6.4% in the […]
Primary Care Corner with Geoffrey Modest MD: NYTimes – more drug company shenanigans
By: Dr. Geoffrey Modest There was a rather poignant editorial in the NY Times on June 8th, pointing out 2 clever (though, incidentally, illegal) ways the drug companies help boost their profits by preventing/delaying the transition to generics: Buying off the competition — the example of Provigil: the drug company (Cephalon) first sued 4 generic […]
Primary Care Corner with Geoffrey Modest MD: DPP-4 inhibitors and cardiovascular outcomes
By: Dr. Geoffrey Modest New Engl J of Med just had a large study on the cardiovascular effects of sitagliptin (see DOI: 10.1056/NEJMoa1501352). Background: sitigliptin is a DPP-4 inhibitor (dipeptidyl peptidase 4 inhibitor), which functions by decreasing the degradation of incretins (and thereby increasing glucose-mediated endogenous insulin secretion and suppressing glucagon levels). But there were concerning […]