Questioning Medicine

Episode 428: 435. Evolocumab, Statin and CKD, PCN allergy, MRI vs Rotator Cuff

https://pubmed.ncbi.nlm.nih.gov/41903215/ [https://pubmed.ncbi.nlm.nih.gov/41903215/]  Evolocumab to Reduce First Major Cardiovascular Events in Patients Without Known Significant Atherosclerosis and With Diabetes: Results From the VESALIUS-CV Trial   https://pubmed.ncbi.nlm.nih.gov/41769754/ [https://pubmed.ncbi.nlm.nih.gov/41769754/]  Association between statin therapy as primary prevention and mortality in adults 50 years and older with chronic kidney disease without other indications   https://pubmed.ncbi.nlm.nih.gov/41921035/ [https://pubmed.ncbi.nlm.nih.gov/41921035/]  Direct Oral Challenge for Penicillin Allergy: The International Network of Antibiotic Allergy Nations (iNAAN) Study   https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2844659 [https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2844659]  Incidental Rotator Cuff Abnormalities on Magnetic Resonance Imaging     https://www.acpjournals.org/doi/10.7326/ANNALS-25-02772 [https://www.acpjournals.org/doi/10.7326/ANNALS-25-02772]   Rapid Evaluation of Artificial Intelligence Technology Used for Ambient Dictation in Primary Care: Comparing the Quality of Documentation of Artificial Intelligence–Generated and Human-Produced Clinical Notes

Episode 427: 434. 6 Articles From Arb to Patient Perspective to Cervical Cancer Screening

https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.70463 [https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.70463]  Angiotensin Receptor Blockers Versus Calcium Channel Blockers for First-Line Antihypertensive Therapy and Survival in Adults Aged 75Years or Older     https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0140673626003673?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0140673626003673%3Fshowall%3Dtrue&referrer=https:%2F%2Fpubmed.ncbi.nlm.nih.gov%2F [https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0140673626003673?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0140673626003673%3Fshowall%3Dtrue&referrer=https:%2F%2Fpubmed.ncbi.nlm.nih.gov%2F] Pharmacological blood-pressure lowering for the prevention of cardiovascular disease and death across the full spectrum of chronic kidney disease severity: an individual-participant data meta-analysis     https://pubmed.ncbi.nlm.nih.gov/42033454/ [https://pubmed.ncbi.nlm.nih.gov/42033454/]   Overdiagnosis in atrial fibrillation screening with wearables     https://pubmed.ncbi.nlm.nih.gov/41766353/ [https://pubmed.ncbi.nlm.nih.gov/41766353/]   Patients' perspectives on deprescribing in swedish primary care: an exploratory survey study     https://pubmed.ncbi.nlm.nih.gov/41627785/ [https://pubmed.ncbi.nlm.nih.gov/41627785/]   Reducing short-acting beta-agonist overprescribing in general practice: Evaluation of a quality improvement programme in East London     https://pubmed.ncbi.nlm.nih.gov/42024880/ [https://pubmed.ncbi.nlm.nih.gov/42024880/]   Screening for Cervical Cancer: A Recommendation From the Women's Preventive Services Initiative

Episode 426: 433. Salt, Statins, and Stents

Donato J, et al. Things We Do For No Reason™: Low salt diets for patients with acute heart failure. J Hosp Med 2026 Feb 4; [e-pub]. DOI: 10.1002/jhm.70278 [https://doi.org/10.1002/jhm.70278]. Some guidelines now recommend "normal sodium intake" for patients with acute and chronic HF, which means avoiding excessive sodium intake and staying under 4 to 5 g daily. https://academic.oup.com/eurjhf/article-abstract/26/4/730/8328801?redirectedFrom=fulltext&login=true [https://academic.oup.com/eurjhf/article-abstract/26/4/730/8328801?redirectedFrom=fulltext&login=true] Luo Y, et al. Measuring public preferences for statin therapy: Using the smallest worthwhile difference. JAMA Intern Med 2026 Feb 16; [e-pub]. DOI: 10.1001/jamainternmed.2025.7958 [https://doi.org/10.1001/jamainternmed.2025.7958].  It's honestly kind of beautiful - and a little frustrating. But it's also a reminder that medicine isn't math; it's human. People don't just want statistics; they want clarity, control, and context. A one-percent drop means one thing on paper, and something very different when you're trying to remember if you already took today's pill.   Kang J, et al. Aspirin versus clopidogrel for chronic maintenance monotherapy after percutaneous coronary intervention: 10-year follow-up of the HOST-EXAM trial. Lancet 2026 Apr 11; 407:1439. DOI: 10.1016/S0140-6736(26)00422-8 [https://doi.org/10.1016/S0140-6736(26)00422-8]. Over ten years, about 25 out of 100 patients on clopidogrel had one of these events, compared to about 29 out of 100 on aspirin. Statistically, that’s a hazard ratio of 0.86, with a p value of 0.005, and it translates into an absolute risk reduction of just over 3 percent and a number needed to treat of about 33. In other words, if you treat 33 stable post‑PCI patients with clopidogrel rather than aspirin for ten years, you prevent one net adverse event. Looking only at thrombotic events—cardiovascular death, non‑fatal MI, ischemic stroke, ACS readmission, or stent thrombosis—clopidogrel again came out ahead: roughly 17 percent vs 20 percent, hazard ratio 0.82, p around 0.002. This difference was largely driven by fewer strokes and fewer rehospitalizations for acute coronary syndromes. Now for bleeding. You might worry that better antithrombotic protection would mean more bleeding. In fact, the opposite happened. Any clinically relevant bleeding, BARC type 2 or higher, occurred in about 9 percent of clopidogrel patients versus almost 11 percent on aspirin, with a hazard ratio of 0.81. Major bleeding—BARC type 3, including haemorrhagic stroke—was also lower on clopidogrel: about 5.6 percent vs 7.7 percent. Haemorrhagic stroke itself was cut roughly in half.

Episode 425: 432. CME LECTURE- Under Pressure, Blood Pressure

432.  CME LECTURE-  Under Pressure, Blood Pressure

Episode 424: 431. Gout should we treat to a number? Is Co-testing needed?

https://www.sciencedirect.com/science/article/abs/pii/S2665991326000342?via%3Dihub [https://www.sciencedirect.com/science/article/abs/pii/S2665991326000342?via%3Dihub] lancet rheumatology   A treat-to-target strategy versus symptom-driven management of gout in the Netherlands (GO TEST Overture): a multicentre, open-label, pragmatic, superiority, randomised controlled trial     The question on the table: Is chasing a serum urate level below six milligrams per deciliter worth the effort? Or are we just torturing our patients with more lab draws and dose titrations than they actually need?  What’s the Real Takeaway? So — is it worth chasing six? Probably yes, but let's keep expectations realistic. Think of it like aiming for LDL targets in dyslipidemia — specific numbers keep us intentional, The bottom line: when your gout patient agrees to start urate-lowering therapy,  don’t expect miracles overnight. Lower urate just tilts the odds for fewer flares — it doesn’t guarantee smooth sailing for every patient. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2846208 [https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2846208]   HPV, Cytology, and Cotest Cervical Cancer Screening and the Risk of Precancer     Let’s start with the basics. For years the Pap test, or cytology, has been the main tool for catching early changes on the cervix. More recently, we’ve added tests that look directly for HPV, the virus that actually causes most cervical cancers. Some places now do both at the same time, called “cotesting.” It sounds like more must be better, right? A big study out of British Columbia followed over eight thousand women for up to ten years after they had both tests done at the same visit. The researchers wanted to know: if your HPV test is negative, does adding that extra Pap result actually help keep you safer in the long run? Here’s what they found. If a woman’s HPV test was positive and her Pap looked abnormal, her chance of developing a significant precancer over time was pretty high, more than 40%. If the HPV test was positive but the Pap looked normal, the risk was lower, but still real—over 20%. Those are the folks we definitely want to follow closely. But once the HPV test was negative, the story changed. Whether the Pap looked normal or a bit off, the risk of serious precancer over the following years stayed very low—well under 5%, and for most women under 1%. In fact, women who were HPV‑negative had almost the same low risk as women whose HPV and Pap were both negative, but adding that Pap test made screening more complicated and more expensive for very little extra benefit. So what does this mean in plain language? If your HPV test is negative, you’re in a very low‑risk group for cervical precancer for many years, even if your Pap result isn’t perfectly pristine. Doing both tests on everyone, every time, doesn’t buy much extra safety, but it does add cost and can lead to more follow‑up procedures that many women don’t actually need.