(Press-News.org) Embargoed for release until 5:00 p.m. ET on Monday 31 July 2023
Annals of Internal Medicine Tip Sheet
@Annalsofim
Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
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1. ACP issues updated guidance for colorectal cancer screening of asymptomatic adults
Abstract: https://www.acpjournals.org/doi/10.7326/M23-0779
Editorial: https://www.acpjournals.org/doi/10.7326/M23-1695
FREE Summary: https://www.acpjournals.org/doi/10.7326/P23-0004
URL goes live when the embargo lifts
The American College of Physicians (ACP) issued updated guidance for colorectal cancer screening for asymptomatic, average-risk adults that suggests starting screening at age 50. The guidance is based on a critical review of existing clinical guidelines and evidence reviews and modeling studies used to develop those guidelines. The guideline is published in Annals of Internal Medicine.
Colorectal cancer (CRC) is the fourth highest in incidence and second in mortality among cancers in the U.S. The goal of this ACP guidance statement is to help guide physicians on when to start and stop screening, and on the selection of type and frequency of screening tests in asymptomatic, average-risk adults. ACP’s guidance is for adults at average risk for CRC who do not have symptoms. It does not apply to adults with a family history of colorectal cancer, a long-standing history of inflammatory bowel disease, genetic syndromes such as familial cancerous polyps, a personal history of previous colorectal cancer or benign polyps, or other risk factors. Physicians should perform an individualized risk assessment for CRC in all adults.
In this updated guidance, ACP suggests that clinicians:
Start screening for colorectal cancer in asymptomatic average-risk adults at age 50 years.
Consider not screening asymptomatic average-risk adults between the ages of 45 to 49. Clinicians should discuss the uncertainty around benefits and harms of screening in this population.
Stop screening for colorectal cancer in asymptomatic average-risk adults older than 75 years or in asymptomatic average-risk adults with a life expectancy of 10 years or less.
Select a screening test for colorectal cancer in consultation with their patient based on a discussion of benefits, harms, costs, availability, frequency, and patient values and preferences.
Select among screening tests for colorectal cancer: a fecal immunochemical or high-sensitivity guaiac fecal occult blood test every 2 years, colonoscopy every 10 years, or flexible sigmoidoscopy every 10 years plus a fecal immunochemical test every 2 years.
Should not use stool DNA, computed tomography colonography, capsule endoscopy, urine, or serum screening tests for colorectal cancer.
The net benefit of colorectal cancer screening is much less favorable in average-risk adults between ages 45 to 49 years than 50 to 75 years. Although there has been a small increase in CRC incidence among individuals aged 45 to 49 years, the incidence is much lower than in individuals aged 50 to 64 years and 65 to 74 years. Harms associated with CRC screening include cardiovascular and gastrointestinal events (e.g., serious bleeding, perforation, myocardial infarction, angina), unnecessary follow-ups, and costs for findings deemed clinically unimportant.
Media contacts: For an embargoed PDF, please contact Addison Dunlap at adunlap@acponline.org. To speak with someone from ACP, please contact Andrew Hachadorian at ahachadorian@acponline.org.
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2. Age is a significant independent predictor of LDL-C response to statin treatment initiation
Use of low- to moderate-intensity statins associated with greater reduction of LDL-C in older persons
Abstract: https://www.acpjournals.org/doi/10.7326/M22-2643
URL goes live when the embargo lifts
A study of more than 80,000 persons found that age is a significant independent predictor of low-density lipoprotein cholesterol (LDL-C) response to statin treatment initiation. The initiation of low- to moderate-intensity statins was associated with a greater reduction of LDL-C in older persons than younger persons, regardless of whether the statin was prescribed for primary prevention, for secondary prevention, or among patients with diabetes. The findings are published in Annals of Internal Medicine.
Patient-to-patient LDL-C response varies widely in statin treatment. The reduction in LDL-C may depend on the age of the patient treated. Persons older than 75 years have been underrepresented in randomized clinical trials, which limits evidence about the effects of statin treatment in this age group. While current guidelines recommend statin use for secondary prevention in older adults, the recommendation is less strong for primary prevention.
Researchers from Statens Serum Institut, the Danish Cancer Society Research Center, Copenhagen University Hospital – Bisbebjerg and Frederiksberg and Stanford University conducted a nationwide cohort study of 82,958 persons initiating simvastatin or atorvastatin, including 10,388 persons aged 75 years and older. The authors found that initiators aged 75 years or older had higher mean LDL-C percentage reductions than initiators younger than 50 years. For example, they note that older persons initiating 20 mg simvastatin experienced a mean reduction of 39.0 percent compared with younger persons, who only experienced a mean reduction of 33.8 percent. Similarly, older persons initiating 20 mg atorvastatin experienced a mean reduction of 44.2 percent compared with younger persons, who experienced a mean reduction of 40.2 percent. According to the study authors, these findings suggest that low- to moderate statins may be more appealing as initial treatment in older adults who are at increased risk for adverse events.
Media contacts: For an embargoed PDF, please contact Addison Dunlap at adunlap@acponline.org. To speak with the corresponding author Giulia Corn, MSc, PhD, please contact Nanna Martensen at presse@ssi.dk.
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3. Simple score helps to identify inflammatory arthritis risk in at-risk individuals
Abstract: https://www.acpjournals.org/doi/10.7326/M23-0272
URL goes live when the embargo lifts
A set of scores to identify inflammatory arthritis (IA) in at-risk persons have been developed and may be useful in both clinical care and trial settings for the identification of low- or high-risk IA cases. The scores and their development processes are published in Annals of Internal Medicine.
IA is an immune-related condition defined by the presence of clinical synovitis. Its most common form is rheumatoid arthritis (RA). Several biomarkers associated with RA may be present for years before the development of clinical synovitis onset. Further characterization of this preclinical continuum should improve our knowledge of RA and its biomarkers, leading to better prevention strategies.
Researchers from Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Leeds Biomedical Research Centre-NIHR developed simple and comprehensive scores to predict IA in at-risk persons. They developed the scores using an observational cohort study of 455 persons with new musculoskeletal symptoms, a positive test for anticitrullinated protein antibodies, and no clinical synovitis and followed for 48 weeks or more, or until IA occurred. The authors found that their simple score identified 249 low-risk participants with a false negative rate of 5 percent. They also found that their comprehensive score identified 119 high-risk participants with a false-positive rate of 29 percent. The authors clarify that the simple score is reproducible, economical, and practical for use in primary care with good negative predictive value of the low-risk group, who may not require referral to secondary care. They add that in comparison, the comprehensive scores identify a high-risk population for intervention studies and for clinical management.
Media contacts: For an embargoed PDF, please contact Addison Dunlap at adunlap@acponline.org. To speak with the corresponding author, Paul Emery, MA, MD, MBBChir, please contact p.emery@leeds.ac.uk
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4. Guideline-recommended diabetes care exceedingly lacking in China
URL goes live when the embargo lifts
Abstract: https://www.acpjournals.org/doi/10.7326/M23-0442
A cross-sectional survey of persons with self-reported diabetes in China found that guideline-recommended diabetes care targets have not been met. The findings highlight the need for immediate national health actions to improve care. The findings are published in Annals of Internal Medicine.
China has the largest population of persons with diabetes--25 percent of all persons with diabetes reside there. Proper management of diet, lifestyle, weight, and clinical risk factors in diabetes is integral to reducing complications, improving quality of life, and reducing costs. However, a meta-analysis of people with type 2 diabetes from 20 countries revealed poor achievement of guideline-recommended hemoglobin A1c, blood pressure, and low-density lipoprotein cholesterol (LDL-C), also known as “ABC” targets.
Researchers from School of Public Health, Shanghai Jiao Tong University School of Medicine and the Chinese Center for Disease Control and Prevention conducted a cross-sectional survey of a sample of 8,401 adults with self-reported diabetes and a subset of 3,531 with dietary data. The authors found that only one-third of survey participants achieved a body mass index (BMI) of 24 kg/m2 or less. Only 4.4% achieved all 3 ABC targets. While 2 in 3 adults met the individualized HbA1c target, only slightly more than 1 in 5 adults met the BP and LDL-C targets and 5.1% met all 4 primary lifestyle targets, mainly because fewer than 1 in 5 adults achieved the recommended leisure time activity level. Few people achieved all dietary targets. According to the authors, national health care policies for supporting accessible and affordable diabetes care need to be better designed and more effectively implemented in China.
Media contacts: For an embargoed PDF, please contact Addison Dunlap at adunlap@acponline.org. To speak with the first author, Victor W. Zhong, PhD, please email wenze.zhong@shsmu.edu.cn.
END
ACP issues updated guidance for colorectal cancer screening of asymptomatic adults
2023-07-31
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