Internal Medicine Alert – December 30, 2025

Total Steps vs. How You Get Them and the Risk of Cardiovascular Events

In a large U.K. Biobank study of subjects who performed a one-week determination of steps/day, those who achieved < 8,000 steps/day were categorized by the duration of their step acquisition periods and were followed for a mean of eight years. All-cause mortality and the development of cardiovascular disease (CVD) were greater in those with short step acquisition periods (< 5 minutes) as compared to those with longer periods (> 15 minutes). Thus, longer step acquisition bouts are more effective in reducing mortality and CVD in those with less-than-ideal total daily step counts.

Who Needs Antithrombotic Therapy After Atrial Fibrillation Ablation?

An international trial of rivaroxaban vs. low-dose aspirin started one year or more after successful atrial fibrillation catheter ablation has shown no significant differences in a composite outcome of stroke, systemic embolism, or covert cerebral emboli determined by head magnetic resonance imaging and no differences in major bleeding but shows an increase in clinically relevant minor bleeding with rivaroxaban.

Vertigo and Altered Postural Perception: Overlapping Symptoms, Distinct Mechanisms

Two distinct vestibular disorders, persistent postural-perceptual dizziness (PPPD) and vestibular migraine (VM), both involve vertigo as a primary symptom. Nearly half of chronic migraine patients also experience vertigo, especially those with aura and allodynia. Since PPPD is seen as a functional maladaptation and VM is associated with cortical hyperexcitability, treatment for vertigo in these two conditions should be tailored to their unique pathophysiological mechanisms.

COVID-19 Vaccine Receipt Was Associated with Better Clinical Outcomes in U.S. Veterans

An observational study from the Department of Veterans Affairs found that individuals who received the 2024-2025 COVID-19 vaccine and the influenza vaccine on the same day had fewer emergency department visits, COVID-19-associated hospitalizations, and deaths related to COVID-19 compared to a group that only received the influenza vaccine.

Nerandomilast Tablets (Jascayd)

The U.S. Food and Drug Administration has approved nerandomilast for the treatment of idiopathic pulmonary fibrosis (IPF). It is the first preferential inhibitor of phosphodiesterase 4B (PDE4B).