Internal Medicine Alert – February 28, 2025

Modifiable Cardiovascular Risk Factors and Late-Life Brain Health

The major modifiable risk factors for cardiovascular diseases are delineated in Life’s Essential 8 (LE8), developed by the American Heart Association. These risk factors are blood pressure, glucose, cholesterol, body mass index, smoking, physical activity, diet, and sleep duration. The investigators in this analysis of two large databases in the United Kingdom and the United States demonstrated that cardiovascular health, as defined by the LE8, will also predict brain health later in life.

Combustible vs. Electronic Cigarettes Post-PCI

A large, nationwide South Korean study of smokers undergoing percutaneous coronary intervention (PCI) has shown that electronic cigarette use and smoking cessation resulted in similarly lower subsequent major adverse cardiac events compared to continued smoking.

Migraine and Ischemic Vascular Disease: The Search for the Missing Link

The presence of traditional vascular risk factors does not explain the increased incidence of ischemic stroke and myocardial infarction in patients with migraine. The use of nonsteroidal anti-inflammatory drugs does not increase the risk of ischemic stroke or myocardial infarction in migraineurs.

Procalcitonin-Guided Care Leads to Shorter Duration of Antibiotics in Sepsis

In this multicenter, intervention-concealed, randomized clinical trial of 2,760 critically ill patients hospitalized with sepsis, the use of a daily procalcitonin-guided protocol resulted in shorter antibiotic duration as compared with standard care, without a significant difference in 28-day all-cause mortality. There was no significant difference in antibiotic duration between patients managed with a daily C-reactive protein-guided protocol and standard care, and the difference in all-cause mortality between these two groups was inconclusive.

Noninferiority of Seven vs. 14 Days of Antibiotic Therapy for Bloodstream Infections

In this multinational, noninferiority trial that included more than 3,600 hospitalized patients with bloodstream infections from various pathogens and infectious syndromes, seven days of antibiotic therapy was noninferior to 14 days with respect to death from any cause by 90 days. Patients were excluded if they had severe immunosuppression or foci requiring prolonged treatment, or if their blood cultures yielded Staphylococcus aureus or possible contaminants. Various secondary outcomes were similar between the two groups.

Olezarsen Injection (Tryngolza)

The U.S. Food and Drug Aministration has approved olezarsen, a first-in-class drug to reduce triglycerides in adults with familial chylomicronemia syndrome. Olezarsen is an antisense oligonucleotide-directed inhibitor of apolipoprotein C-III messenger ribonucleic acid.