geoffrey modest medical blogs

      The Endocrine Society just published new guidelines on vitamin D assessment and treatment for the general population of adults, basically negating the need to perform vitamin D monitoring or therapy (see vit d endocrine soc guidelines2024 in dropbox, or doi.org/10.1210/clinem/dgae322 ). This document was actually written at a “guideline communication” by the Endocrine Society’s Guideline Development Panel. quotes below are from the guidelines or the more extensive systematic reviews published to support their findings   Details/Commentary: -- the new guidelines suggest the following major changes to their prior guidelines of 2011:     -- they no longer endorse the concept of vitamin D “sufficiency”, previously defined as 25(OH)D levels at least 30 ng/mL, nor vitamin D “insufficiency” as being a 25(OH)D levels of 20-30 ng/mL, nor vitamin D “deficiency” as being a 25(OH)D <20 ng/mL, for the following reasons:  ...

  a recent article found that patients sustaining a myocardial infarction who have preserved LV ejection fraction did not benefit from beta-blockers (see   MI bblockers longterm not help NEJM2024  in dropbox, or DOI: 10.1056/NEJMoa2401479), in the REDUCE-AMI trial Details : -- 5020 patients from 45 centers in Sweden, Estonia, and New Zealand (95% from Sweden) who had an acute MI who had coronary angiography revealing obstructive coronary artery disease with a left ventricular ejection fraction (LVEF) of at least 50% were randomized to metoprolol or bisoprolol vs placebo for 3.5 years, in a study from 2017-2023     -- metoprolol was first choice with goal of at least 100 mg/d; bisoprolol was second choice with goal of  at least 5 mg/d     -- hypertension control: recommendation that no b-blockers be used in the placebo group. those already on b-blockers were encouraged to be tapeed off them over 2-4 weeks -- median age 65, 23% women,  -- ...