During a mean 11 years of follow-up, current smokers' risks for cardiovascular-, cancer-, and respiratory-related deaths were 2, 3, and 13 times higher, respectively, than never smokers' risks. Former smokers who had quit <10 years before enrollment avoided roughly 50% to 60% of these excess risks. By 30 years after quitting, excess mortality was virtually eliminated. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2811807 ..read more

The primary cardiovascular end point was a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke in a time-to-first-event analysis. Improvement in nonfatal stroke was not statistically significant death from cardiovascular causes was no significant but hold on it does appear nonfatal MI was significant and is what really drove the entire composite outcome All the way down to the discussion to find “An important limitation of this trial is that we included only patients with preexisting cardiovascular disease. The effects of semaglutide on primary pr ..read more

Bottom line (ZTLido 1.8%) is a brand name lidocaine patch currently approced for postherpetic neuralgia and will stay that why for now as it did not beat placebo for the treatment of patients with chronic nonspecific neck pain For both pain scores the pain decreased by 1.0 point with lidocaine and by 0.5 points with placebo. These differences were neither statistically significant nor deemed to be clinically important! https://pubs.asahq.org/anesthesiology/article/140/3/513/139530/Multicenter-Randomized-Placebo-controlled ..read more

 patients who have new-onset transient AF detected during a hospitalization for noncardiac surgery or medical illness and are discharged in sinus rhythm, approximately 1 in 3 have AF detected in the year after hospital discharge. Those that did not have afib only had a 5% risk (1 in 20) -- we dont know what this means for rates of patient oriented outcomes https://www.acpjournals.org/doi/10.7326/M23-1411?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed ..read more

Bottom line   Omalizumab does seem to improve allergic reactions to peanuts but comes at a steep price tag. Likely only allergist will prescribe this drug but it is worth know about If you know or take care of anyone with severe peanut allergy. After 16 weeks, 67% of patients who took omalizumab could tolerate a 600-mg peanut protein challenge (≈2 peanuts) versus 7% of controls. Variability among patients was large: 44% of omalizumab patients could tolerate 25 peanuts whereas 14% of patients could not tolerate even 1/10 of a peanut. https://www.nejm.org/doi/10.1056/NEJMoa2312382 ..read more

At ~24 weeks, ~80-90% of females report improvement in their acne with COCs, compared to 50-80% placebo, and 30-50% will have clear-almost clear skin versus 10-40% on placebo. Efficacy appears similar between individual COCs. Limitations: Most COC RCTs unblinded, many COC RCTs prohibited concurrent topical agents, no RCTS comparing COCs to topical agents, many industry-funded. https://cfpclearn.ca/tfp362 ..read more

QM on Spring Break-- but do you like the new format? Andrewbuelt@gmail.com ..read more

Diabetic patient- Empagliflozin prevents death from cardiovascular causes: NNT 46 per 3.1 yrs ($600 a month, 1 million dollars per life saved) -HFpEF- SGLT2 inhibitors do not prevent death and cost roughly $364,000 to prevent one hospitalization -HFrEF -Using Cox models, only Dapagliflozin has mortality benefit (NNT 53) and comes at a cost of $229,914 prevent one cardiovascular death. (117,126$$$ dap for hospitalization ..read more

Primary Outcome: Composite of deaths from cardiovascular causes or hospitalizations and urgent visits for heart failure Death was not improved! NNT of 5 for hospitalizations and urgent visits -- However, results are not reported separately for hospitalizations and urgent visits, which are not equal events  https://www.nejm.org/doi/full/10.1056/NEJMoa2030183 ..read more

NNT of 20 to prevent 1 hospitalization at 16 months of follow up They composite outcome was driven by decrease hospitalizations NOT death https://www.nejm.org/doi/full/10.1056/NEJMoa2022190 ..read more