geoffrey modest medical blogs

  A recent systematic review and individual participant-level meta-analysis of clinical trials found that prescribing ACE-inhibitors or ARBs to patients with advanced chronic kidney disease (stage 4 or 5) was beneficial: see ckd ACE ARB good for advanced CKD AnnIntMed2024 in dropbox or doi:10.7326/M23-3236)   Details : -- 18 completed randomized controlled trials were found in a literature search from 1946 to 2024 -- 1739 participants were included, mean age 55, 52% female, 15% Black -- median eGFR by creatinine was 23 (IQR 18-27), 32% had eGFR below 20; median albumin-creatinine ratio 1215mg/g (range 527-2463 mg/g) but 84% had “severe albuminuria” (which they did not define, >1000mg???) -- mean systolic BP 155 mmHg -- the issue of determining the overall demographics/comorbidities/etc is difficult given the huge differences in the individual studies, including year study done (varies from 1992 to 2007), different meds used (perindopril-ind...

  There has been a concerted effort to improve the cardiovascular risk calculator by the American Heart Association. Their new calculator, called PREVENT (Predicting Risk of CVD EVENTS) was just published (see cardiac risk factor PREVENT circ2024  in dropbox, or DOI: 10.1161/CIRCULATIONAHA.123.067626):   Details : -- derivation cohort (from which the calculator was derived): 3,281,919 individuals with individual-level participant data from 25 data sets, between 1992 and 2017 -- primary outcome: CVD (cardiovascular disease), which included clinical ASCVD (atherosclerotic cardiovascular disease) plus heart failure -- assessment included traditional risk factors (smoking, systolic blood pressure, cholesterol, antihypertensive or statin meds taken, and diabetes) and estimated GFR (eGFR)     -- optional predictors assessed included urine albumin-to-creatinine ratio (UACR), hemoglobin A1c, and a “social deprivation index” (SDI, a measure of the indivi...

A recent article confirmed that about 7% of US adults who have had Covid infection develop long Covid (see  covid long covid frequency in US JAMA2024  in dropbox, or doi:10.1001/jama.2024.11370)   Details : -- new data from the Medical Expenditure Panel Survey (MEPS), a representative household survey of the US civilian non-institutionalized population sponsored by the Agency for Healthcare Research and Quality (AHRQ) -- 17,418 adults were surveyed, a statistical representation of 259 million adults -- 8275 adults reported having Covid, 1202 adults reported having long Covid symptoms (defined as symptoms lasting three months), which translates to:     -- 14.5% of those who reportedly had had Covid subsequently reported symptoms of long Covid     --  6.9% of the whole group surveyed had long Covid, which would translate to a total of 17.9 million adults in the US -- females were more likely to have reported Covid than males...