Staying #Up2Date 🚨

1. Don’t sleep on this 💤

The SURMOUNT-OSA studies have shown that Tirzepatide, a GIP/GLP-1 receptor agonist, may be a treatment for obstructive sleep apnea (OSA). In both studies, patients had moderate-to-severe OSA with mean of 51.5 events/hour on the apnea-hypopnea index (AHI) and BMI ≧30 kg/m². In trial 1, which included patients not using CPAP, the mean change in AHI at week 52 was −25.3 events per hour (95% confidence interval [CI], −29.3 to −21.2) with tirzepatide and −5.3 events per hour (95% CI, −9.4 to −1.1) with placebo. This ended up being an estimated treatment difference of −20.0 events per hour (95% CI, −25.8 to −14.2) (P<0.001). In trial 2, which included patients using CPAP, the estimated treatment difference was −23.8 events per hour (95% CI, −29.6 to −17.9) (P<0.001). 

2. A new tool 🫀

There’s a new cardiovascular risk calculator in town, aptly called “PREVENT.” How does it differ from the traditional ASCVD risk calculator we have all grown to love/hate? 

• It includes additional metabolic and renal factors such as BMI, eGFR, HbA1c, and uACR.

• Patients’ zip codes can be used to account for risks conferred by social circumstances. 

• Estimates are provided for CV disease, for ASCVD (i.e., coronary disease plus stroke), and for heart failure with 10- and 30-year risks generated for those 30-79 and 30-59 y.o., respectively.

3. A bolus of coffee pls ☕ 

Caffeine can raise your heart rate, but does it raise your blood pressure too? In this Italian cohort study researchers collected office, home, and 24-hour ambulatory blood pressure (BP) readings in 1400 participants - stratified into nonconsumers, moderate- (1–2 cups daily), or heavy-consumers (≥3 cups daily). At baseline and 10-year follow-up, ambulatory and home readings for BP were no different among groups after adjusting for confounders.

Alzheimer Drug Breakthrough💊

A new Alzheimer’s medication has stepped up to the plate with high hopes of combating the illness.

What happened: The FDA approved Eli Lilly’s treatment drug for early Alzheimer’s, making it the second therapy for slowing progression of the disease.

Why it’s interesting: The drug will be sold under the name Kisunla and is meant for patients with mild cognitive impairment or mild dementia stage of the disease. Alzheimer’s currently affects more than 6.5 million Americans, and researchers say having another drug on the market is a huge step forward.

Kisunla is designed to clear an Alzheimer’s-related protein called beta amyloid from the brain. Unlike its rival Leqembi, patients can stop taking Kisunla once brain scans stop showing amyloid plaques. In a late stage trial, the drug slowed the progression of memory and thinking problems by 29% compared with a placebo. Kisunla is priced at $695.65 USD per vial, or about $32,000 for 12 months (for 13 infusions.) 

Lilly’s drug is expected to be used by patients registered with the US government’s Medicare health plan for people 65 and older. Last year Medicare began covering Alzheimer’s drugs that got FDA approved.

Yes, but: Like any new drug, there are side effects patients should be aware of. Kisunla caused a quarter of patients' brains to swell while a third experienced bleeding in the brain. However, Reuters reported that most of the cases were mild. Patients who wish to take Kisunla must get 5 MRI scans to check for side effects, and the FDA has placed its strongest boxed safety warning on the prescribing label.

Postcall’s Take: It’s no secret that this is a huge win for Alzheimer patients (and their loved ones). Postcall will continue to watch for updates as the drug moves into clinical practice.

Hot Off The Press

1:🦿Researchers at MIT have created a prosthetic leg fully driven by the body’s own nervous system. The procedure works by reconnecting muscles in the residual limb, allowing patients to receive “proprioceptive” feedback about the prosthetic. So far 7 patients have had the surgery and they were able to walk faster, avoid obstacles, and climb stairs more naturally than people with a traditional amputation. 

2: 🧠 A new Boston University study has shown that an AI program could predict whether people would develop Alzheimer’s within 6 years of showing signs of mild cognitive impairment. The tool had a 78.5% accuracy rate. Detecting the disease early is crucial to getting patients the care they need.

3: 🐎 Democrats are reportedly talking about replacing Joe Biden as the party’s nominee after a stumbling performance at the first presidential debate last week.

4: 🦠 A clinical trial for a new COVID-19 nasal spray vaccine is underway in the US and some researchers believe the new candidate may provide better protection against the virus than an injection. Scientists say they are taking all the necessary steps to ensure the new vaccine is safe and effective before it’s offered to the public.

5:🧑‍⚖️ The US Supreme Court ruled on Monday that Trump has broad immunity from prosecution for actions that were within his constitutional powers as president. This is a landmark decision recognizing for the first time any form of presidential immunity from prosecution, and will likely hamper several active cases against Trump.

6:📱Eight TikTok creators have sued the US government after they claim banning the app “violates their First Amendment right to free speech.” Despite lack of evidence, the US government said TikTok’s current ownership structure poses a threat since ByteDance operates under the laws of the Chinese government.

Notable Numbers 🔢

99%: the efficiency of a CRISPR-based genetic technique that intends to eliminate primary African malaria vector, Anopheles gambiae mosquitoes, and also reduce malaria transmission.

$300 billion: the value of the global pet industry. Psychologist Hal Herzog has pointed out that research suggesting that owning a pet improves health is fuzzy at best, and propaganda of the pet care industry at worst.

450: the number of people who contracted salmonella poisoning this spring due to untreated water from a farm in Florida. The FDA said fortunately there are no more produce from the farm in grocery stores and the risk of contracting salmonella now is unlikely.

💬 In Our Community

Do you think your specialty choice impacts your longevity? Or maybe it’s your lifestyle that informs your specialty choice?

There’s an interesting study shared on Facebook called “Medical specialties and life expectancy: An analysis of doctors’ obituaries 1997–2019,” published in Lifestyle Medicine.

Here’s what we took away from the study and the online discussion:

1. On average, doctors tend to live longer than the general population in the UK.

2. Different medical specialties seem to be associated with different lifespans:

   1. General practitioners (family doctors), surgeons, and pathologists tended to live the longest, with average ages at death around 80 years.

   2. Emergency medicine doctors had the youngest average age at death at about 59 years.

      1. Other studies show people that work shifts and night hours have a lower life expectancy.

      2. BUT this finding should be interpreted cautiously because emergency medicine is a relatively new specialty, so there may not be enough older emergency doctors yet to give an accurate picture.

   3. Emergency medicine doctors had a higher proportion of accidental deaths compared to other specialties.

      1. Our favourite response to this: "Great news for ER docs. We don't need to save for retirement!"

   4. Radiologists used to incur significantly higher radiation doses. New trainees would not be impacted as much by radiation.

   5. Anesthesiologists also die earlier, but we’re not sure why.

While this study provides interesting insights, it has limitations. For example, not all doctors have obituaries published in the British Medical Journal, so the data might not represent all doctors perfectly.

Relax

First Question: Dr. Fleming discovered what on his petri dish of bacteria when he returned from vacation?

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