The US Preventive Services Task Force (USPSTF) on May 5 posted a draft recommendation statement indicating that evidence is insufficient to determine the benefits and harms of taking most vitamin, mineral, and multivitamin supplements to prevent heart disease and cancer. 

However, while the benefit or harm of most supplements is unclear, the task force found specifically no benefit associated with taking vitamin E (I recommendation) and that harms outweigh benefits associated with taking beta-carotene (D recommendation). There is no evidence that either of them reduces the risk of heart disease and cancer.

“The Task Force recommends against the use of vitamin E or beta-carotene for the prevention of heart disease and cancer,” said Task Force member John Wong, MD in a Task Force 

. “The evidence shows there is no benefit to taking vitamin E and that beta-carotene can be harmful because it increases the risk of lung cancer in people already at risk, such as those who smoke, and also increases the risk of dying from heart disease or stroke.”

 is based on review of 14 180 unique citations and 351 full-text articles drawn from common medical databases for the period between January 2013 and August 2020. Surveillance continued for relevant literature through January 22, 2021.

“Because heart disease and cancer are the two leading causes of death in the US, we want to look at whether taking vitamins and minerals help [sic] prevent these important diseases,” said Chyke Doubeni, MD, MPH, a task force member and inaugural director of the Mayo Clinic Center for Health, Equity and Community Engagement Research, in the statement. “However, there is not enough evidence to know if taking vitamin, mineral and multivitamin supplements prevent these conditions, so the task force is calling for more research.”

The draft recommendation does not apply to people who are or who may become pregnant, according to the recommendation statement. For these individuals, the task force previously issued a separate statement that recommends folic acid supplements.

"We conclude that most vitamin and mineral supplements provide no clinically important protective effects for CVD, cancer, or all-cause mortality in healthy adults without known nutritional deficiencies , with vitamin E having the strongest body of evidence demonstrating no benefit for most outcomes relevant to this review. These conclusions are generally consistent with those of the previous review for the USPSTF on this topic."

The Task Force states in the draft, also, that because the focus of the review on CVD and cancer, it does not address other potential benefits of supplemental vitamins and minerals on other outcomes. In addition, the studies reviewed are in predominantly healthy populations without known deficiencies and so the review does not cover therapeutic supplementation in those with medical conditions or nutritional deficits.

Authors wrote that more research is needed on the effects of vitamin D, vitamin C, and folic acid administered with other B vitamins on CVD and cancer prevention.

“The evidence base demonstrating no benefit of vitamin E on cancer and CVD is robust and does not warrant resource investment in major new de novo studies,” wrote review authors. “Given the risks identified for beta-carotene, we see no need for further research on the role of beta-carotene in CVD and cancer prevention, nor, by extension, for vitamin A.”

The public can comment on the draft recommendation on 

Articles

The USPSTF states that evidence is insufficient to determine benefits and harms of most supplements for prevention of the diseases but warns against vitamin E and beta-carotene. 

USPSTF: Vitamin E, Beta-carotene Supplementation Not Recommended for CVD, Cancer Prevention 

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

Centers for Disease Control and Prevention

, as of today, May 5, 2021, at 1:29 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, May 5, 2021 at 1:08 PM, EDT, there have been:

The 5 states with the highest total confirmed cases are:

 with 61 967 reported fatalities, followed by 

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

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 May 5, 2021

In mid-April, researchers at the Kaiser Family Foundation (KFF) 

 the US as a whole "...will likely reach a tipping point on COVID-19 vaccine enthusiasm in the next 2 to 4 weeks." The "COVID-19 vaccine tipping point" is described as the point at which vaccine supply may begin to outstrip demand.

We are now approaching mid-May and KFF just published 

 to reveal how the states compare to the US national average on the spectrum of vaccine coverage. Identifying where these differences are greatest, says KFF, is essential to understanding how to focus efforts to increase coverage throughout the country. 

The slides below summarize the KFF findings as of April 29, 2021.  

Images ©Sebastien Garcia/stock.adobe.com

A number of US states fall below the national average of ~50% adults having received at least 1 dose of COVID-19 vaccine and could be at risk of future virus spread.  

COVID-19 Vaccine Tipping Points: KFF Data on States at Risk  

 A 52-year-old man presents to the emergency department complaining of fever, body aches, and urinary frequency. He denies any abdominal or flank pain, dysuria, unprotected sex, polydipsia, or other complaints and has never had these symptoms before.

Vital signs are normal except for temperature of 102°F.

 Physical exam is otherwise normal with no abdominal or flank tenderness.

Initial diagnostic testing

Lab results: 

Find many more puzzling presentations in our collection of Dr Pregerson's

The patient is a 52-year-old man and he has never had these symptoms before. Review lab results and CT findings. What's your diagnosis? 

Seen in the ED: Urinary Frequency, Body Aches, Fever

, as of today, May 3, 2021, at 2:00 PM, EDT:

, as of today, May 4, 2021 at 11:57 AM, EDT, there have been:

 Deaths due to COVID-19 are highest in California 

with 61 967 reported fatalities, followed by 

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 May 4, 2021

The Kidney Disease: Improving Global Outcomes (KDIGO) 

 for Diabetes Management in Chronic Kidney Disease, published in mid-2020, is the first KDIGO guideline on the subject of CKD in the diabetes population. 

The new guideline provides evidence-based best practices for care of patients with diabetes and CKD, including integrating new therapies with existing management strategies. 

The full guideline is important reading for primary care clinicians. For a start, click through these 10 take-home points, from KDIGO. 

The 2020 Kidney Disease: Improving Global Outcomes Clinical Practice Guideline integrates new treatments and practices with existing management strategies for CKD patients with diabetes. 

Diabetes Management in CKD: 10 Top Takeaways from KDIGO 2020

How do you gauge a patient's "DOAC Hate Factor" and why is it important?



In his presentation "DOAC Dos and Don'ts" at the American College of Physicians Internal Medicine Meeting 2021: Virtual Experience, Stephan Moll, MD, spoke first about dosing and duration of treatment for venous thromoboembolism (VTE) using the "new" direct oral anticoagulants (DOACs) and then reviewed the approach to anticoagulant therapy in a range of special populations, including patients with obesity, with cancer, and renal compromise. He finishes his talk with a quick review of the evidence on perioperative anticoagulation.

Quantifying the "DOAC Hate Factor," he explains, is important when discussing continuation or discontinuation of anticoagulation therapy because patient preference has to be considered here. Once you know, on a scale from 0 to 10, how much hate there is, you can ask questions and try to accommodate where it's possible. 

The slide show that follows is based on Dr Moll's presentation and includes links to many of the studies he mentions. 

Stephan Moll, MD is Professor of Medicine in the Department of Medicine, Division of Hematology, at the University of North Carolina School of Medicine, in Chapel Hill, NC.

ACP 2021: Dr Stephan Moll covers the basics of DOAC duration for VTE, use of anticoagulation in special populations, and perioperative use of DOACs 

ACP: DOAC Dos and Don'ts Primer with Stephan Moll, MD

The US Food and Drug Administration (FDA) has approved dapagliflozin (Farxiga

, AstraZeneca) oral tablets for the treatment of chronic kidney disease (CKD) among adults with CKD who are at risk for disease progression, regardless of diabetes status.

More specifically, dapagliflozin—a sodium-glucose cotransporter 2 inhibitor—has been approved to reduce the risk of kidney function decline, kidney failure, cardiovascular (CV) death, and hospitalization for heart failure among patients with CKD, according to the April 30, 2021, 

“Chronic kidney disease is an important public health issue, and there is a significant unmet need for therapies that slow disease progression and improve outcomes,” said Aliza Thompson, MD, MS, deputy director of the Division of Cardiology and Nephrology in the FDA’s Center for Drug Evaluation and Research, in the agency’s press release. “Today’s approval of Farxiga for the treatment of chronic kidney disease is an important step forward in helping people living with kidney disease.”

The approval was based on results from the 

. In this multicenter, double-blind study, 4304 patients with CKD stages 2-4, with and without diabetes, were randomly assigned to receive either dapagliflozin 10 mg or a placebo.

Researchers then compared the 2 groups for the number of patients whose disease progressed to a composite endpoint that included at least a 50% reduction in kidney function, progression to kidney failure, or CV or kidney death.

The results showed that 197 of the 2152 patients who received dapagliflozin had at least 1 of the composite endpoint events compared to 312 of the 2152 patients who received a placebo. Also, 100 patients in the dapagliflozin group were hospitalized or died compared to 138 patients in the placebo group.

“Based on the unprecedented results of the DAPA-CKD trial, dapagliflozin is now the first SGLT2 inhibitor approved for the treatment of chronic kidney disease regardless of diabetes status. This transformational milestone provides patients and physicians with a new and effective treatment option for this often debilitating and life-threatening disease,” said Hiddo L. Heerspink, PhD, lead author of the DAPA-CKD trial, in an 

Dapagliflozin was not studied, nor is it expected to be effective, in treating CKD among patients with autosomal dominant or recessive polycystic kidney disease or patients who require or have recently used immunosuppressive therapy for kidney disease, noted the FDA press release.

Dapagliflozin was originally approved in 2014 to improve glycemic control in adults with type 2 diabetes (T2D) in addition to diet and exercise. It has since been granted indications to reduce the risk of hospitalization for heart failure (hHF) in adults with T2D and established CV disease or multiple CV risk factors and to 

 and hHF in adults with heart failure (NYHA class II-IV) with reduced ejection fraction with and without T2D.

Dapagliflozin is the first SGLT-2 inhibitor to receive FDA approval for the treatment of CKD, regardless of diabetes status.

FDA Approves Dapagliflozin to Treat Chronic Kidney Disease in Adults at Risk of Progression, Regardless of Diabetes Status

Rochelle Walensky, MD MPH, Director of the US Centers for Disease Control and Prevention (CDC), was a featured presenter at the recent American College of Physicians Internal Medicine Meeting 2021: Virtual Experience. In her presentation, titled "COVID-19: Lessons Learned," Dr Walensky discussed racial/ethnic inequities in COVID-19 impact, breakthrough infections, what happened with the Johnson & Johnson vaccine, and variants of concern in the US. 

The slide show that follows is based on Dr Walensky's presentation and includes links to all of the primary studies that she discusses.

COVID-19: Lessons Learned

CDC Director Rochelle Walensky, MD MPH, was a featured presenter at the recent ACP Internal Medicine Meeting 2021: Virtual Experience, where she spoke about lessons learned during COVID-19. 

ACP: Lessons Learned during COVID-19 Pandemic

, as of today, May 3, 2021 at 11:20 AM, EDT, there have been:

 with 61 939 reported fatalities, followed by 

Data from the Johns Hopkins COVID-19 interactive map and the CDC on COVID-19 cases, mortalities, vaccinations, and more.