How many cases of coronavirus disease 2019 (COVID-19) have been confirmed in the US?

, as of today, October 29, 2020 at 11:24 AM, EDT, there have been:

The 5 states with the highest total confirmed cases are:

 with 33 435 reported fatalities, followed by 

 with 767 905 people who have recovered, followed by 

 California leads in number of persons tested

 with 18 223 596 people tested, followed by 

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

For more COVID-19 coverage for primary care, visit our

Articles

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

COVID-19 Update: US and Global Cases, Deaths, and Recoveries as of October 29, 2020

Rapidly rising obesity rates in the US threaten to reverse decades of effort against cardiometabolic disease. How well do you know what experts recommend for your at-risk patients? 

Guideline-directed Weight Loss: 4 Questions for Primary Care Physicians 

The obesity paradox refers to the situation wherein, despite the known and marked ability of obesity to worsen nearly all cardiovsascular (CV) risk factors, particularly hypertension (HTN), type 2 diabetes, and dyslipidemia, and to increase the prevalance of CVD including HTN, heart failure, coronary heart disease, studies have shown that persons who are overweight or at least mildly obese who have stable CVD have better short- and moderate-term prognosis than do normal weight patients with the same CVD.

Dr Lavie explains the paradox, potential underlying mechanisms, and the critial role of cardiorespiratory fitness to maintain the balance.

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Professor of Medicine, 
Medical Director, Cardiac Rehabilitation and Prevention 
Director, Stress Testing Laboratory, John Ochsner Heart and Vascular Institute, 
Ochsner Clinical School - The University of Queensland School of Medicine

Videos

Carl "Chip" Lavie, MD, author of the original book titled, "The Obesity Paradox" explains the paradox of metabolic health in the obese, how it wanes, and an essential element to maintain it. 

The Obesity Paradox: How Real is It? 

Adults should be screened for colorectal cancer beginning at age 45, according to a new 

 by the US Preventive Services Task Force (USPSTF).

This is the first time the USPSTF has recommended colorectal cancer screening starting at age 45 (B recommendation), but the task force still strongly recommends screening patients aged 50-75 years (A recommendation). For adults aged 76-85 years, the USPSTF recommends that the decision to screen for colorectal cancer be made on an individual basis (C recommendation).

USPSTF Grades and Suggestions for Practice:


The USPSTF recommends the service.
There is high certainty that the net benefit is substantial.


The USPSTF recommends the service.
There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.


The USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences.
There is at least moderate certainty that the net benefit is small.

This new draft recommendation applies to adults without symptoms and who do not have a personal history of colorectal polyps, or a personal or family health history of genetic disorders that increase the risk of colorectal cancer.

“Unfortunately, not enough people in the US receive this effective preventive service that has been proven to save lives,” said USPSTF Chair Alex Krist, MD, MPH, professor of family medicine and population health, Virginia Commonwealth University, in a 

 “We hope that this recommendation to screen people ages 45 to 75 for colorectal cancer will encourage more screening and reduce people's risk of dying from this disease.”

Black adults have the highest incidence of and mortality from colorectal cancer vs other populations, according to the draft recommendation. Because of this, the USPSTF draft recommendation particularly encourages clinicians to offer recommended screening to their Black patients beginning at age 45.

“New science about colorectal cancer in younger people has enabled us to expand our recommendation to screen all adults starting at age 45, especially Black adults who are more likely to die from this disease,” said USPSTF member Michael Barry, MD, director of the Informed Medical Decisions Program, Massachusetts General Hospital, in the same press release.

In addition, the USPSTF recommends direct visualization tests and stool-based tests to screen for colorectal cancer. The draft recommendation does not include serum tests, urine tests, or capsule endoscopy.

“There are many tests available that can effectively screen for colorectal cancer,” said Martha Kubik, PhD, RN, USPSTF member, in the same press release. “We urge primary care clinicians to discuss the pros and cons of the various recommended options with their patients to help decide which test is best for each person.”

For the first time, the USPSTF recommends colorectal cancer screening in adults  beginning at age 45.

New USPSTF Colorectal Cancer Screening Draft Recommendation Includes Adults Aged 45 Years

Waist circumference measures, complementary antihypertensives, appropriate exercise levels for T2D patients--test what you know about cardiometabolic risk and management. 



4 Questions for PCPs on Prevention and Management of Cardiometabolic Diseases

, as of today, October 28, 2020 at 9:24 AM, EDT, there have been:

 with 33 433 reported fatalities, followed by 

 with 763 108 people who have recovered, followed by 

 with 18 127 049 people tested, followed by 

Global confirmed cases of COVID-19 have surpassed 44 million. We summarize more of today's data from the Johns Hopkins COVID-19 interactive map.

COVID-19 Update: US and Global Cases, Deaths, and Recoveries as of October 28, 2020

Approximately 30% of US adults aged <45 years do not know all 5 of the most common stroke symptoms despite rising stroke rates among this population, according to new research published in the journal 

Recent studies suggest that stroke incidence in the US is declining in the general population, however, stroke incidence and hospitalizations have increased by >40% in young adults in the past several decades, wrote study authors led by Khurram Nasir, MD, MPH, MSc, chief of the Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Texas.

“While the medical community has made significant improvements to reduce the severity and complications of strokes with early interventions, these efforts are of limited value if patients do not recognize stroke symptoms,” said Nasir in an 

American Heart Association (AHA) press release

 “Time is critical for treating stroke. The earlier people recognize symptoms, the better their chances are to reduce long-term disability from stroke.”

Researchers used data from the 2017 National Health Interview Survey to examine awareness of 5 of the most common stroke symptoms and response to a perceived stroke among young adults. In this survey, the 5 most common stroke symptoms asked about were:

Difficulty walking/dizziness/loss of balance

The National Health Interview Survey included >24 000 adults, of which 9844 were young adults aged <45 years who were included in the primary analysis (mean age 31.3 years, 50.6% women, 62.2% non-Hispanic white).

Overall, 28.9% of participants were not aware of all 5 stroke symptoms, whereas approximately 3% (representing nearly 3 million young adults) were not aware of 

Also, Hispanic adults and adults not born in the US were approximately twice as likely to be unaware of any of the common stroke symptoms vs non-Hispanic white adults and those born in the US.

Differences were also seen among education levels as participants with a high school diploma or lower education level were about 3-times as likely to be unaware of any stroke symptom vs those with higher education levels.

Nasir and colleagues also found that approximately 3% of participants would not contact emergency medical services if they did see someone experiencing perceived stroke symptoms.

“We hope that highlighting the continued impact of current health disparities may advance focused public health strategies and educational initiatives to increase awareness of and appropriate response to stroke symptoms,” added Nasir in the same AHA press release.

New research shows nearly 30% of US young adults do not know the 5 most common stroke symptoms, almost 3 million are not aware of any symptoms. 

Stroke Rates Rising Among US Young Adults, yet 1 in 3 Don’t Know Common Symptoms

 in the United States and the strong association between excess adiposity and 

 weight loss is recommended by professional societies as part of a heart health plan for at-risk patients. Weight-loss drugs are a valuable part of that plan when used appropriately. How much do you know about dosage, interactions, and safety warnings? Take this quiz and find out!

Weight loss is essential to arrest the cardiovascular disease and metabolic dysfunction linked to obesity. What do you know about the drugs now available that may help?

What do you Know about Weight Loss Medications? 

, as of today, October 27, 2020 at 10:24 AM, EDT, there have been:

 with 33 424 reported fatalities, followed by 

 with 758 192 people who have recovered, followed by 

 with 17 982 829 people tested, followed by 

How many cases of COVID-19 have been confirmed in the US? How many people have been tested? Get your daily COVID-19 update here.

COVID-19 Update: US and Global Cases, Deaths, and Recoveries as of October 27, 2020

Dapagliflozin was found to be renoprotective and cardioprotective in patients with most causes of chronic kidney disease (CKD) with or without type 2 diabetes, according to a secondary analysis of the 

 at the American Society of Nephrology’s virtual Kidney Week, held October 19-25, 2020.

"As we've already seen from this study in patients with chronic kidney disease with and without type 2 diabetes, dapagliflozin reduced the risk of kidney failure, reduced the risk of death from cardiovascular causes or hospitalization for heart failure, and prolonged survival,” said lead author David Wheeler, MD, George Institute for Global Health, Sydney, Australia, during the virtual presentation. "In this pre-specified analysis, we've shown that these renal-cardiovascular mortality benefits are present regardless of the underlying cause of chronic kidney disease and regardless of the presence or absence of type 2 diabetes."

Wheeler and colleagues re-examined the 4304 CKD patients from the 

, who had an estimated glomerular filtration rate (eGFR) of 25-75 mL/min/1.73 m

 and a urine albumin-to-creatinine ratio of 200-5000 mg/g.

The patients were randomized to receive 10 mg of dapagliflozin once daily or placebo and the primary outcome was a composite of sustained decline in eGFR of ≥50%, end-stage kidney disease, or death from cardiovascular or kidney causes.

The results showed that patients treated with dapagliflozin had a significantly reduced risk for the primary endpoint regardless of the underlying cause of kidney disease (hazard ratio [HR] 0.61, 95% CI 0.51-0.72).

Furthermore, when broken down by etiology of kidney disease, dapagliflozin significantly reduced the risk for the primary endpoint in patients whose kidney disease was caused by diabetic nephropathy (HR 0.63, 95% CI 0.51-0.78) and glomerulonephritides (HR 0.43, 95% CI 0.26-0.71) vs placebo.

However, patients whose kidney disease was caused by ischemic/hypertensive CKD (HR 0.75, 95% CI 0.44-1.26) or caused by other or unknown causes (HR 0.58, 95% CI 0.29-1.19) didn't see a significant benefit with dapagliflozin.

In an additional analysis of 270 patients with IgA nephropathy, there was a 71% reduced risk for this primary endpoint with dapagliflozin vs placebo over a 32-month follow-up period (HR 0.29, 95% CI 0.12-0.73).

One limitation to this study was the exclusion of patients with type 1 diabetes, which was due to concerns about safety and the potentially increased risk for diabetic ketoacidosis in this population, noted Wheeler.

Dapagliflozin is renoprotective and cardioprotective in chronic kidney disease patients, suggests a secondary analysis of the DAPA-CKD trial presented at Kidney Week 2020. 