Episode 208: 208. Medical Update- VIP medicine, Pre-Diabetes, Prevent food allergies, PRP

Lindholt JS, Søgaard R, Rasmussen LM, et al. Five-year outcomes of the Danish cardiovascular screening (DANCAVAS) trial. N Engl J Med 2022;387(15):1385-1394.

Study design: Randomized controlled trial (nonblinded)

Looking to see if intensive screening protocol for cardiovascular disease reduce cardiovascular events or mortality in older men?

Danish study, 46,611 men aged 65 to 74 years were randomly assigned to receive an invitation to screening or usual care

The screening program included non-contrast electrocardiographically gated CT to measure coronary artery calcium, look for aneurysms, and detect atrial fibrillation; ankle-brachial index measurements for peripheral arterial disease (PAD) and hypertension; and blood tests for diabetes and hyperlipidemia

Those who accepted screening were more educated, more likely to be employed, and had a somewhat lower rate of hospitalization for cardiovascular events in the previous 5 years. (the rich white gullible ceo male)

The screened group was more likely to be given lipid-lowering drugs and antithrombotics, and they were more likely to have repair of an aortic aneurysm.

In the entire population, stroke was less likely (HR 0.93; 0.86 - 0.99) but there were no significant differences in myocardial infarction, aortic dissection, or aortic rupture.

The authors estimated that 97.4% of men who received preventive therapy of some kind as a result of screening experienced no mortality benefit after almost 6 yrs of follow up.

This is basically a really small absolute benefit which we could also see in just placing a pt on a statin. We don’t need vip medicine we need pcp that have time to calculate risk and place pt on statin when indicated.

Goldberg RB, Orchard TJ, Crandall JP, et al, for the Diabetes Prevention Program Research Group. Effects of long-term metformin and lifestyle interventions on cardiovascular events in the diabetes prevention program and its outcome study. Circulation 2022;145(22):1632-1641.

Study design: Randomized controlled trial (nonblinded)

What is the long-term impact of treating prediabetes on mortality and cardiovascular outcomes?

Go way back

original Diabetes Prevention Program study randomized 3234 overweight or obese adults with impaired glucose tolerance ("prediabetes") to receive metformin 850 mg twice daily, an intensive exercise program, or placebo and followed them for 3 years

Patients were invited to participate in a long-term open-label follow-up study This article reports long-term cardiovascular and mortality outcomes for each group.

Patients in the intervention groups were less likely to have been given a diagnosis of T2DM (55% for metformin and 53% for lifestyle vs 60% for placebo; P = .001; number needed to treat [NNT] = 17)

There was no difference between either intervention group and placebo with regard to the risk of cardiovascular death, nonfatal stroke, or nonfatal myocardial infarction. There was also no significant difference in the composite of all 3 outcomes for the original metformin group versus the placebo group (hazard ratio [HR] 1.03; 95% CI 0.78 - 1.37) or for those in the original lifestyle group versus the placebo group (HR 1.14; 0.87 - 1.50).

More is less or rather more meds is less diagnosis but no difference in things we actually care about

Skjerven HO, Lie A, Vettukattil R, et al. Early food intervention and skin emollients to prevent food allergy in young children (PreventADALL): a factorial, multicentre, cluster-randomised trial. Lancet 2022;399(10344):2398-2411.

Study design: Randomized controlled trial (single-blinded)

Does the early introduction of allergenic foods prevent the development of food allergy?

investigators randomized healthy newborns, singletons or twins, with at least 35 weeks' gestational age (concealed allocation) to receive no intervention (n = 597), a skin intervention (n = 575), a food intervention (n = 642), or a combined intervention (n = 583).

The skin intervention consisted of 5- to 10-minute baths with added petrolatum-based emulsified oil followed by topical cetirizine cream applied to the face. This intervention was to occur at least 4 days per week from age 2 weeks to 8 months,

The food allergy intervention consisted of sequentially adding allergenic foods (peanuts, cow’s milk, wheat, then eggs) to the infants’ regular diet at weekly intervals starting at age 3 months.

Overall, 95% of the infants in each group were breastfed at 3 months

The researchers had final data on 99.9% of the participants!

based on structured parental interviews, skin testing, and oral challenges The researchers classified the development of food allergy at 36 months as probable, none, or unclear.

There was no significant difference, however, between the infants who were exposed to skin interventions and those who were not exposed (2.1% vs 1.6%).

BUT BUT BUT

Food allergy occurred in 1.1% of infants in the interventions using food (food intervention and combination intervention) compared with 2.6% in not using food (no intervention and skin intervention; number needed to treat = 63; 95% CI 37-196).

Lewis E, Merghani K, Robertson I, et al. The effectiveness of leucocyte-poor platelet-rich plasma injections on symptomatic early osteoarthritis of the knee: the PEAK randomized controlled trial. Bone Joint J 2022;104-B(6):663-671.

Study design: Randomized controlled trial (double-blinded)

Allocation: Concealed

recruited adults with at least 4 months of knee pain (with or without swelling) who had mild degeneration on their x-rays (if plain x-rays found no signs of degeneration, they used magnetic resonance imaging to confirm the diagnosis).

The participants were randomized to receive 3 weekly saline injections (n = 28), or

a single PRP injection followed by 2 weekly saline injections (n = 47), or

3 weekly PRP injections (n = 27).

. The clinician performing the injections was unmasked but had no other involvement in the study procedures.

the participants were evaluated at 6 weeks, 12 weeks, 6 months, and 12 months after enrollment

Using intention-to-treat analysis looking at pain, function, and quality of life, at no point in the study were PRP injections, singly or serially, superior to saline injections.