How many people in the US have been vaccinated against COVID-19?

Centers for Disease Control and Prevention

, as of today, June 23, 2021, at 3:44 PM, EDT:

The 5 states with the highest percentage of population fully vaccinated are:

How many cases of COVID-19 have been confirmed in the US?

, as of today, June 23, 2021 at 3:21 PM, EDT, there have been:

The 5 states with the highest total confirmed cases are:

 with 63 409 reported fatalities, followed by 

How many cases of COVID-19 have been confirmed globally?

Articles

Data from the Johns Hopkins COVID-19 interactive map and the CDC on COVID-19 vaccinations, cases, and deaths in the US and on cases and deaths worldwide.

COVID-19 Updates: US Vaccinations and Global Cases and Deaths as of June 23, 2021

, as of today, June 22, 2021, at 6:12 PM, EDT:

, as of today, June 22, 2021 at 5:21 PM, EDT, there have been:

 with 63 365 reported fatalities, followed by 

COVID-19 Updates: US Vaccinations and Global Cases and Deaths as of June 22, 2021

The use of statin therapy in adults aged ≥65 years may not be associated with incident dementia or a decline in neurocognitive health, according to a new observational study published in the 

Journal of the American College of Cardiology

“With statins being increasingly prescribed to older adults, their potential long-term effects on cognitive decline and dementia risk have attracted growing interest,” lead author Zhen Zhou, PhD, Menzies Institute for Medical Research, University of Tasmania, Australia, said in a 

 “The present study adds to previous research by suggesting that statin use at baseline was not associated with subsequent dementia incidence and long-term cognitive decline in older adults.”

With the use of statins among older adults expected to rise, it is important to determine the effects of statin therapy on cognition in this patient population to help physicians weigh their benefits against associated risks, according to study authors.

To investigate the potential neurocognitive effects of statin use, Zhou and colleagues analyzed data from the ASPirin in Reducing Events in the Elderly (ASPREE) trial.

The ASPREE trial was a large prospective, randomized, placebo-controlled trial of daily low-dose aspirin among 19 114 eligible participants aged ≥65 years with no prior cardiovascular disease event, dementia, or major physical disability. Inclusion also required a score of ≥78 on the Modified Mini-Mental State Examination test. The trial was conducted between 2010 and 2014 in Australia and the US.

For the current analysis, Zhou and colleagues excluded adults with missing values for cognitive test scores and/or covariates at baseline, resulting in 18 846 participants. Researchers grouped participants by their baseline statin use vs non-statin use, with approximately 31% (n=5898) of patients taking statins.

Outcome measures included dementia and its subclassifications (ie, probable Alzheimer disease and mixed presentations), mild cognitive impairment (MCI), and changes in domain-specific cognition.

After a median follow-up of 4.7 years, there were 566 incident cases of dementia, including probable Alzheimer disease and mixed presentations. Compared with no statin use, statin use was not associated with dementia, MCI, or changes in cognitive function scores over time.

Also, researchers found 380 incident cases of MCI over the median follow-up. Compared to no statin use, statin use was not associated with risk of MCI, MCI consistent with Alzheimer disease, or other MCI.

There was no statistically significant difference in the change of composite cognition and any individual cognitive domains between statin users and non-statin users.

In addition, there were no differences found in any of the outcomes between hydrophilic and lipophilic statin users. Researchers did find, however, interaction effects between baseline cognitive ability and statin therapy for all dementia outcomes.

Study limitations included observational study bias, lack of data on the length of prior use of statins, and the dose of statins was not recorded in the ASPREE trial, so researchers could not fully explore their effects.

Zhou and colleagues concluded that the study must be interpreted with caution, and they are awaiting confirmation from ongoing randomized trials designed specifically to explore neurocognitive effects of statins in older adults.

A new analysis of the large ASPREE trial found statin use in older adults is not associated in the incidence of dementia or a decline in neurocognitive health. 

Study: No Link Found between Statin Use and Cognitive Decline, Dementia in Older Adults

Higher body mass index (BMI) in late childhood through adolescence may lead to increased risk of cardiometabolic disease in adulthood, regardless of adult BMI, according to investigators from the University of California San Francisco (UCSF).

 Journal of the American College of Cardiology

, researchers point to an increased risk of diabetes, hypertension, heart attack, and poorer health in adults in the third and fourth decade for each incremental increase in BMI z-score among adolescents. The study, led by Jason M. Nagata, MD, MSc, assistant professor of pediatrics in the Division of Adolescent and Young Adult Medicine at UCSF, is the first to demonstrate the adverse relationship in younger adults, according to an American College of Cardiology 

"The finding that adolescent BMI is a risk factor for poor health outcomes in adulthood, regardless of adult BMI, has significant implications for our understanding of cardiovascular disease onset," said lead author Nagata in the statement. "Considering these findings, health care providers should consider BMI history when assessing for cardiovascular and chronic disease risk."

To learn more about the impact of elevated adolescent BMI on the risk for poorer health in adulthood, Nagata et al analyzed data spanning 24 years from the National Longitudinal Study of Adolescent to Adult Health, which recorded data from more than 20 000 adolescents from 1994-1995 to 2016-2018. In the final cohort of 12 300 participants, age was between 11 and 18 years; 51.4% were women and 34.2% identified as a racial/ethnic minority. Average baseline BMI was 22.4 kg/m

Authors report that at the 24-year follow-up each 1-unit higher BMI z-score in adolescence was associated with a 4.17 kg/m

In adjusted analyses, investigators found a prospective association of BMI z-score with

 overall poor self-reported general health

 (adjusted odds ratio [aOR], 1.49; 95% confidence interval [CI], 1.31-1.70; P<.001) and development of:

Elevated BMI in adolescence was associated with a 2.6% increase in overall poor health, an 8.8% increased risk for type 2 diabetes, and 0.8% increased risk for early heart attack in adults in their 30s and 40s, independent of adult calculated BMI.

           (aOR, 2.35; 95% CI, 2.11-2.63; P<.001)

     (aOR, 1.55; 95% CI, 1.45-1.64; P<.001)

   (aOR, 1.24; 95% CI, 1.15-1.34; P<.001)

    (aOR, 1.77; 95% CI, 1.41-2.24; P<.001)

      (aOR, 1.81; 95% CI, 1.37-2.40; P<.001)

               (aOR, 1.12; 95% CI, 1.07-1.18; P<.001)

                   (aOR, 1.64; 95% CI, 1.53-1.77; P<.001)

After adjustment for adult BMI, adolescent BMI z-score was independently associated with poor general health (aOR, 1.23; 95% CI, 1.05-1.445; P=.010), development of diabetes (aOR, 1.56; 95% CI, 1.36-1.79; P <.001), and premature myocardial infarction (aOR, 1.66; 95% CI, 1.25-2.22; P <.001) in adulthood.

Their findings, the researchers said, support the hypothesis not only the age of onset of obesity but also the cumulative obesity exposure contribute to insulin resistance and atherosclerosis. Greater focus on guidance to and support for young patients from pediatricians will be needed to combat poor health outcomes, they said.

In addition to suggesting that health care providers consider BMI history in adult patients as part of an assessment for risk of CV and other chronic disease, Nagat and colleagues emphasize that "adolescence is an important time period to optimize health and prevent early heart attacks." They call on pediatricians to "encourage teens to develop healthy behaviors including physical activity and balanced meals." 

REFERENCE: Jason M. Nagata, Kyle T. Ganson, Jingyi Liu, et al. 

Adolescent body mass index and health outcomes at 24-year follow-up: a prospective cohort study.

 J Am Coll Cardiol. 2021;77:3229–3231. 

Adults in their 30s and 40s who had high BMI in adolescence were at highest risk for type 2 diabetes and early MI, regardless of adult BMI, after 24 years of follow-up, a new study finds.  


 Elevated BMI in Adolescence Increases Risk for Diabetes, Stroke in Young Adulthood, Regardless of Adult BMI 

The American Diabetes Association Virtual 81st Scientific Sessions kick off on Friday, June 25 and run through Tuesday, June 29, 2021.



The topics to be covered this year include many focused on the impact of COVID-19 on persons with diabetes and on their care. There are hundreds of poster presentations and updates on both ongoing and published clinical trial programs studying drug classes that might once have targeted only hyperglycemia but now are proving effective in cardiovascular and renal disease. 

The following slides provide a brief look at 6 clinical trial updates our editors think will be of particular interest to clinicians in primary care. (Note: All times are EST)

Slideshows

The American Diabetes Association 2021 Scientific Sessions run from June 25 to 29. This short slide show highlights 6 clinical trial updates that are a "must see"  for primary care clinicians. 

Clinical Trial Updates at the ADA Scientific Sessions 2021: A few primary care musts 

The US Centers for Disease Control and Prevention (CDC) has rescheduled a special meeting to review cases of myocarditis and pericarditis reported in adolescents and young adults after receiving COVID-19 vaccination.

“The June 18, 2021 COVID-19 meeting is being rescheduled due to the observation of the Juneteenth National Independence Day holiday,” stated the 

 on its website about the online meeting of its Advisory Committee on Immunization Practices (ACIP).

 released today, June 21, 2021, the discussion will now take place during 2 sessions held on the first day of the ACIP meeting: June 23, 2021 at 11:30 am.

The first session, “Overview of myocarditis and pericarditis,” will be presented by Matthew Oster, MD, MPH, who is a medical officer at the CDC’s National Center on Birth Defects and Developmental Disabilities. Directly following the first session will be “Update on COVID-19 vaccine safety, including myocarditis after mRNA vaccines,” presented by Tom Shimabukuro, MD, MPH, who is the deputy director of the CDC’s Immunization Safety Office.

Since April 2021, increased cases of myocarditis and pericarditis have been reported in US adolescents and young adults after receiving an mRNA COVID-19 vaccine, with attention focused on those manufactured by Pfizer-BioNTech and Moderna primarily.

 to the Food and Drug Administration’s vaccine advisory group, where he highlighted over 700 cases of myocarditis/pericarditis that have been reported across all age groups after the Pfizer-BioNTech and Moderna vaccines, most commonly after the second dose. These cases were mostly reported in men, and the median age for a case of myocarditis after a second dose was 24 years.

Dr Shimabukuro also discussed the 475-preliminary myocarditis/pericarditis cases reported to the CDC’s 

Vaccine Adverse Event Reporting System (VAERS)

 in persons aged ≤30 years as of May 31, 2021. Among the 475 reported cases, 226 met the CDC’s “working case definition” of myocarditis and pericarditis and 285 had a known outcome.

Among the 285 cases with a known outcome, 270 were discharged (most to their homes), 15 were still hospitalized, and 3 were in the intensive care unit. Approximately 81% had full recovery of symptoms, according to Shimabukuro.

Among patients aged 16-17 years, there were 79 cases of myocarditis/pericarditis reported after a second dose of vaccine, while the expected number was 2-19 cases, according to Shimabukuro. There were 196 cases in young adults aged 18-24 years, while 8-13 were expected. The case rates per million doses for those age groups were 35 and 21, respectively.

Given the greater risk of other serious COVID-19-related complications, the CDC still 

 that all patients aged ≥12 years be vaccinated against COVID-19. Physicians should consider myocarditis and pericarditis in adolescents or young adults with acute chest pain, shortness of breath, or palpitations.

The special meeting to review cases of myocarditis in the US following COVID-19 vaccination, will now take place this Wednesday during the ACIP online meeting.

CDC Reschedules Meeting on Reports of Myocarditis Following COVID-19 Vaccination

, as of today, June 21, 2021, at 6:36 PM, EDT:

, as of today, June 21, 2021 at 2:22 PM, EDT, there have been:

 with 63 274 reported fatalities, followed by 

COVID-19 Updates: US Vaccinations and Global Cases and Deaths as of June 21, 2021

, as of today, June 18, 2021, at 1:51 PM, EDT:

, as of today, June 18, 2021 at 2:22 PM, EDT, there have been:

COVID-19 Updates: US Vaccinations and Global Cases and Deaths as of June 18, 2021

"If you look at people with type 2 diabetes, unquestionably the group that struggles the most is the group on insulin - and it's a relatively big group," said Thomas Martens, MD, lead investigator for the MOBILE study. "Insulin is hard."

found that in adults with poorly controlled type 2 diabetes (T2D) treated with basal, but not prandial, insulin, use of real time continuous glucose monitoring (CGM) significantly improved glycemic control and time in target glucose range compared to standard blood glucose monitoring. All MOBILE participants were recruited from and cared for in primary care during the study.

In an interview with Patient Care

Online, Dr Martens discussed the challenges to wider adoption of CGM technology in primary care of T2D, including primary care time constraints and clinician training, professional society review and recommendation, and payer reluctance.  

is a director at the Park Nicollet International Diabetes Center, an affiliate of Health Partners Institute in Minneapolis, Minnesota.

For additional interviews with Dr Martens on the MOBILE Study, please see:

CGM vs SMBG in Primary Care: What Does the T2D Evidence Say?

Thomas W. Martens, MD: MOBILE Study Findings on CGM vs BGM in T2 Diabetes

Videos

MOBILE study lead author Tom Martens, MD, talks about the inherent benefits of CGM for T2D patients on basal insulin treated in primary care and also the challenges to this vision of patient care.   

Tom Martens, MD, Talks about the Vision for CGM as Part of Primary Care for Type 2 Diabetes 

On June 10, 2021, the US Occupational Safety and Health Administration (OSHA) issued its long-awaited 

 (ETS) that is aimed at protecting individuals working in hazardous health care settings where patients with suspected or confirmed COVID-19 are treated. This includes employees in hospitals, nursing homes, and assisted living facilities; emergency responders; home health care workers, and employees in ambulatory care facilities. 

What are the key requirements of the ETS? In the slides below, find information on developing a COVID-19 plan, personal protective equipment, patient screening and management, physical distancing, and more. 

OSHA issued its long-awaited COVID-19 Emergency Temporary Standard for health care workers. Find key takeaways in part 1 of our 2-part series.