#441 More Clinical Pearls (New antibiotics, syphilis, heart disease, cirrhosis, lots more!) from ACP #IM2024
May 27, 2024
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Experts Nora Taranto, Beth Garbitelli, and Chris Chiu share insights on new antibiotics, syphilis resurgence, cirrhosis management, HFpEF, SGLT2i for gout, and CAR T-cells. Topics range from tropical diseases to autoimmune conditions, offering a diverse medical perspective.
Emerging infectious diseases in the US require vigilance and monitoring for effective management.
Aggressive risk factor management is crucial for patients with peripheral arterial disease to prevent cardiovascular events.
SGLT2 inhibitors are emerging as primary therapy for heart failure with preserved ejection fraction, with ongoing research shaping future guidelines.
Deep dives
Updates in Cardiology and Risk Stratification
Dr. Clyde Yancy discusses Cardiovascular Kidney Metabolic Syndrome and introduces the PREVNT equation incorporating various risk factors like age, race, smoking, blood pressure, statin use, diabetes, EGFR, urine albumin to creatinine ratio, and hemoglobin A1c. He also highlights RNA interference therapy significantly lowering blood pressure and LP Little A drugs' potential benefits.
Peripheral Arterial Disease Insights
Dr. Anurh Shkupta emphasizes the high prevalence of PAD, with 2 million diagnosed and 10 times more with asymptomatic disease. Tobacco is a major risk factor. The connection between intermittent claudication and cardiovascular diseases, such as cerebrovascular and coronary artery disease, underscores the importance of aggressive risk factor management.
Critical Aspects of PAD and Clinical Implications
PAD patients with claudication exhibit high rates of concurrent heart attacks and strokes. Even mild PAD increases the risk of MI significantly. Critical limb ischemia, though rare, leads to a high one-year mortality rate. The overall prognosis for PAD, even asymptomatic, includes substantial cardiovascular morbidity and mortality.
Benefits of Tobacco Cessation in Peripheral Artery Disease
Tobacco cessation plays a vital role in reducing the severity of claudication and chest discomfort in patients. Progression of peripheral artery disease (PAD) shows a dose-dependent relationship with tobacco use, emphasizing the importance of quitting smoking to prevent clinical limb ischemia. By quitting smoking, patients can significantly reduce their risk of progressing to PAD, making tobacco cessation a crucial factor alongside age, diabetes, and high blood pressure.
Impact of SGLT2 Inhibitors in Heart Failure with Preserved Ejection Fraction (HeFF PEF)
Recent guidelines suggest that SGLT2 inhibitors are now considered primary therapy for heart failure with preserved ejection fraction (HeFF PEF), with additional potential therapies like loop diuretics, MR antagonists, ARBs, or ARNIs depending on individual patient factors. New trials like the DELIVER and EMPEROR-Preserved trials have influenced these guideline updates. Controlling blood pressure remains crucial in managing HeFF PEF, with ongoing research, like the STEP Heart Failure trial on samagletide, likely to influence future guideline recommendations.
More clinical pearls from ACP #IM2024, including emerging infectious diseases in the US (malaria, dengue, super gonorrhea, and a resurgence of syphilis), new C. diff treatments, coagulopathy and cirrhosis, fatty liver disease, HFpEF, peripheral arterial disease, Lp(a) and ApoB, CAR T-cells for autoimmune disease, SGLT2i for gout, and hematology updates. Paul and Watto are joined by Drs. Nora Taranto, Beth Garbitelli, and of course Chris “The Chiu Man” Chiu.
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