Internal Medicine Alert – July 30, 2025

Can Vitamin D Supplementation Slow Cellular Aging?

In a large randomized, double-blind, placebo-controlled trial, vitamin D3 supplementation modestly but significantly slowed the rate of leukocyte telomere shortening over four years.

Benefits of Nudging in Severe Aortic Stenosis

A single health system study of electronic provider notifications when severe aortic stenosis was discovered on echocardiography showed that referrals for aortic valve replacement significantly increased, especially in women and those > 80 years of age.

Restricting Remdesivir in an Immune Era: No Harm, Big Savings

A quasi-experimental, eight-hospital, pre-post restriction of remdesivir to only symptomatic, oxygen-requiring, immunocompromised adults during July 2023 to June 2024 led to a 90% reduction in remdesivir use (37.7% to 4.1%) without any increase in 14- or 28-day all-cause mortality, 30-day readmission, or hospital length of stay. Medium- and high-risk covariate models confirmed no mortality signal, while an intriguing rise in intensive care unit admission and mechanical ventilation use among the few post-intervention recipients was most consistent with residual confounding and confounding by indication (i.e., the sickest patients being channeled to receive therapy). In an era of widespread hybrid immunity from Omicron-descended variants, broad remdesivir formulary restriction can be implemented safely and can yield substantial cost savings without compromising outcomes.

Updated Recommendations for Drug-Susceptible and Drug-Resistant Tuberculosis

The authors provide an update of recommendations for the treatment of tuberculosis, including cases with drug resistance. The recommendations include the use of newer drugs that have undergone clinical trials and shorter durations of therapy.

Does Lipoprotein(a) Improve the Risk Calculation of the PREVENT Equation?

A pooled cohort from the Multi-Ethnic Study of Atherosclerosis and the United Kingdom Biobank study has shown that, overall, the American Heart Association PREVENT risk scores performed well at predicting atherosclerotic cardiovascular disease risk even in those with high lipoprotein(a) levels, but considering lipoprotein(a) in those with low PREVENT scores may help make therapeutic decisions in these individuals.

Lenacapavir Injection and Tablets (Yeztugo)

The U.S. Food and Drug Administration has approved lenacapavir, a potent, first-in-class, capsid inhibitor, for reducing the risk of sexually acquired human immunodeficiency virus type 1.