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Family Medicine - Prevention
Health benefits of strength training in adults (September 2022)
Evidence for the health benefits of strength training continues to grow. In a systematic review and meta-analysis of 16 studies involving over 250,000 participants, strength training was inversely associated with the risk for cardiovascular disease, cancer, diabetes, and all-cause mortality independent of aerobic exercise.2 The review was limited to prospective studies of individuals >=18 years without severe health conditions at baseline and a minimum two-year follow-up, and it likely underestimates these associations as not all studies involved robust training methods. These findings support the importance of incorporating strength training into exercise programs for everyone, particularly older adults.
Cardiovascular Medicine - Coronary Heart Disease, Stable
Improved outcomes and adherence with a polypill in older patients with myocardial infarction (September 2022)
In patients with recent myocardial infarction (MI), a polypill strategy may simplify treatment and improve treatment adherence, but its efficacy in preventing a secondary cardiovascular event is uncertain. In a trial that randomly assigned nearly 2500 older patients with an MI in the prior six months to either a polypill (containing aspirin, ramipril, and atorvastatin) or usual care, those receiving a polypill had a lower rate of a composite of cardiovascular events (death, nonfatal MI, nonfatal ischemic stroke, or urgent revascularization; 9.5 versus 12.7 percent) over a mean of 36 months.3 Blood pressure, low-density lipoprotein cholesterol levels, and adverse events were similar between the two groups, and medication adherence was higher in the polypill group. While these results are promising, further studies are needed to confirm these findings.
Cardiovascular Medicine - Lipid Disorders
Novel gene variant associated with familial combined hypocholesterolemia (September 2022)
A number of rare genetic variants cause low levels of low-density lipoprotein cholesterol (LDL-C) and are associated with a reduced risk of atherosclerotic cardiovascular disease (ASCVD). Recently, a novel gain-of-function genetic variant in hepatic lipase (called LIPC-E97G) was identified in a family with combined hypocholesterolemia (low LDL-C, low high-density lipoprotein cholesterol, normal triglyceride and apolipoprotein B concentrations).4 The index case developed ASCVD at age 61 despite having low LDL-C levels (40 mg/dL or 1 mmol/L); other affected family members did not have ASCVD. Additional studies are needed to better understand the biological and clinical significance of this genetic variant.
Family Medicine - Immunizations
New ACIP recommendations for seasonal influenza vaccination (September 2022)
In August 2022, the Advisory Committee on Immunization Practices (ACIP) issued new recommendations for seasonal influenza vaccination in the US.1 The ACIP now recommends that adults aged >=65 years preferentially receive any one of the following higher dose or adjuvanted influenza vaccines: quadrivalent high-dose inactivated influenza vaccine (HD-IIV4), quadrivalent recombinant influenza vaccine (RIV4), or quadrivalent adjuvanted inactivated influenza vaccine (aIIV4). In addition, the approved age indication for the cell culture-based inactivated influenza vaccine has been changed from >=2 years to >=6 months. We are in agreement with this guidance.
1. Grohskopf LA, Blanton LH, Ferdinands JM, et al Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices - United States, 2022-23 Influenza Season. MMWR Recomm Rep. 2022;71(1):1. Epub 2022 Aug 26. [Context Link]
2. Momma H, Kawakami R, Honda T, Sawada SS. Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies. Br J Sports Med. 2022;56(13):755-763. Epub 2022 Feb 28. [Context Link]
3. Castellano JM, Pocock SJ, Bhatt DL, et al Polypill Strategy in Secondary Cardiovascular Prevention. N Engl J Med. 2022;387(11):967. Epub 2022 Aug 26. [Context Link]
4. Dijk W, Di Filippo M, Kooijman S, et al Identification of a Gain-of-Function LIPC Variant as a Novel Cause of Familial Combined Hypocholesterolemia. Circulation. 2022;146(10):724. Epub 2022 Jul 28. [Context Link]
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