The Clinical Moment: What's Happening...
A recently published article in the journal Neurology: Cardiovascular risk factors and accelerated cognitive decline in midlife | Neurology found that cardiovascular risk factors such as Diabetes, Hypertension and smoking, increase the risk of accelerated cognitive decline in midlife. As these are modifiable risk factors, pharmacists can play a key role in helping our patients to control them and to prevent future cognitive impairment.
Eat Your Veggies!!! A large prospective cohort study was published in July in the JAMA Association Between Plant and Animal Protein Intake and Overall and Cause-Specific Mortality | Cardiology | JAMA Internal Medicine | JAMA Network found that increasing the intake of plant protein over egg/red meat protein in particular, was significantly associated with lower overall mortality and cardiovascular mortality.
Before you drink…. or eat…. The American Cancer Society recently updated their Cancer Prevention Guidelines, advising against drinking alcohol altogether. American Cancer Society Guideline for Diet and Physical Activity for Cancer Prevention “Alcohol is one of the most important preventable risk factors for cancer, along with tobacco use and excess body weight. Alcohol use accounts for about 6 % of all cancers and 4 % of all cancer deaths in the USA. Yet many people don’t know about the link between alcohol use and cancer.” To learn more about the types of cancers and links to alcohol consumption, follow the hyperlink: Alcohol Use and Cancer. This is another way a pharmacist can educate to prevent future disease in our patients.
Have you watched the show on Netflix called “The Game Changers” which introduces you to scientists and athletes who discuss the optimal diet for human performance and health? This weekend in your downtime, why not take a look?
Now on to something pharmacists can have a big impact on: The proper prescribing of Direct Oral Anticoagulants (DOACs) in Atrial Fibrillation for stroke prevention. Turns out more than one quarter of all patients get a non-recommended dose, and this can increase their risk of death. Pay close attention to the prescribed dosing, and ensure your patients are getting the approved recommended dosing. A study published in September 2020 Journal of the American College of Cardiology Mortality in Patients With Atrial Fibrillation Receiving Nonrecommended Doses of Direct Oral Anticoagulants | JACC: Journal of the American College of Cardiology, followed 10,000 patients on DOACs over two years, to determine the impact of dosing according to recommended guidelines. Patients were mostly prescribed lower dosing (likely in an attempt to reduce bleeding risk), but on occasion higher dosing (likely in higher risk patients). Although under-dosing did decrease bleeding risk numerically, non-recommended dosing (under and over-dosing) resulted in a significant increase in all-cause mortality over 2 years, mostly attributed to cardiovascular reasons (myocardial infarction and congestive heart failure). The risk of major bleeding and of stroke/systemic embolism didn’t differ significantly in the over or under-dosed. Let’s go, and make an impact here!
Take a look at the American Gastroenterological Association (AGA)’s new evidence-based AGA Clinical Practice Guidelines on the Management of Moderate to Severe Ulcerative Colitis - Gastroenterology. This offers a step-by-step management strategy to ensure that patients achieve remission, and a decreased likelihood of colectomy, while limiting the use of corticosteroids, in patients who meet the criterion of disease severity for initiation of a immunomodulators, biologics or advanced therapy.
Check out the newly released a scientific statement concerning Cardiorenal Protection With the Newer Antidiabetic Agents in Patients With Diabetes and Chronic Kidney Disease: A Scientific Statement From the American Heart Association | Circulation. Sodium glucose cotransporter 2 (SGLT2) inhibitors and glucagon like peptide-1 (GLP-1) receptor agonists should be considered for people with type 2 diabetes and chronic kidney disease (CKD) to protect their heart and kidneys. Results from relevant trials, show that these classes of medications safely and significantly reduce the risk of cardiovascular events, death and slow the progression of chronic kidney disease to end-stage kidney disease (including risk for dialysis, transplantation and death). Watch out for opportunities to intervene in patients with chronic kidney disease or those at risk for cardiovascular disease.