geoffrey modest medical blogs

A recent article assessed the threshold values of serum uric acid (SUA) associated with increased total and cardiovascular mortality over a 20-year period (see uric acid cad mortal hth2020 in dropbox, or DOI: 10.1161/HYPERTENSIONAHA.119.13643), the URRAH study (Uric Acid Right for Heart Health) from a working group of the Italian Society of Hypertension Details: --multicenter retrospective observational study collecting data from several large population-based longitudinal studies in Italy --22,714 people included in analysis     --mean age 57, 49% male, 25% smokers, BMI 27, waist circumference 90cm, BP 143/85, SUA 4.9 mg/dL, total chol 212/HDL 55/TG 108     --gout 1%, diabetes 11%, CKD 17%/mean eGFR 83, htn 64%     --meds: allopurinol 1%, ACE-I 15%, ARB 11% (?which), CCB 9%, b-blocker 9%, diuretic 17%, statin 5% --primary endpoints: total mortality (death from any cause) and cardiovascular mortality (CVM: death from fatal MI, stroke, sudden cardiac death, heart

SGLT2s decrease gout risk?? G      Geoff A. Modest, M.D. Wed 1/29/2020 7:44 AM Geoff A. Modest, M.D.    A large population-based cohort study found that sodium-glucose co-transporter-2 inhibitors (SGLT2) in patients with diabetes decrease the risk for gout (see  dm  sglt2  dec  gout AIM2020  in  dropbox , or doi:10.7326/M19-2610) Details: -- data from IBM MarketScan, a US nationwide commercial insurance database of healthcare claims, largely reflecting those people with health coverage through an employer-based health plan -- people with type II diabetes who were prescribed an SGLT2 inhibitor were compared with those prescribed a GLP-1 agonist, from 2013-2018     -- 295,907 adults with diabetes were newly prescribed one of these medications (151,949 on SGLT2 inhibitors, 143,958 on GLP-1 agonists)     -- 52% women, mean age 54, mean A1c 8.7, mean creatinine 0.89, 11% with di

From: Geoff A. Modest, M.D. Sent: Tuesday, January 28, 2020 7:45 AM To: Geoff A. Modest, M.D. <GModest@uphams.org> Subject: gabapentin and baclofen overdoses the US Poison Centers have experienced a dramatically increased rate of reports of gabapentin and baclofen exposures (see gabapentin OD clintox2019 in dropbox, or doi.org/10.1080/15563650.2019.1687902 )  Details: -- retrospective review of the US Poison Centers info (and entered in the National Poison Data System) assessed cases of exposure to gabapentin (2013 to 2017) and baclofen (2014-2017) in those over 18 years old -- isolated exposures were highlighted in this report, since they included only the single substance involved, and it would be difficult to disentangle the effects of one substance vs its combination with other drugs . Many people, however, do have exposures to multiple substances , and these were reported as the total number of exposures below --they define “misuse