Geriatric Update May 12, 2025

The CDC reports 1001 confirmed measles cases in 31 states, up from 935 in 30 states last week. No new updates on the Ohio Department of Health website.

Hemodialysis patients have been excluded from factor X (FXa) anticoagulant trials, but this meta-analysis looked at 486 dialysis-dependent patients with atrial fibrillation (AF) from 4 RCTs, with a median follow-up of 0.5 to 1.88 years. FXa inhibitors were associated with a reduced risk of major bleeding compared to warfarin (RR = 0.64, 95% CI = 0.42-0.99; p = 0.04), and intracranial bleeding (RR = 0.40, 95% CI = 0.17-0.96; p = 0.04), but no significant difference in stroke or systemic embolism (RR = 0.46, 95% CI = 0.20-1.02; p = 0.06) or other outcomes, including gastrointestinal bleeding, acute coronary syndrome, and mortality.

Over 20-years, 3249 major acute coronary events (MACEs) occurred among 17 087 participants from the EPIC-Norfolk study; Compared with individuals with no biomarker elevations, the hazard ratios (HR) for incident MACE were 1.33, 1.68, and 2.41 for those with one, two, or three biomarkers in the top quintile. Comparing the top to bottom quintile, HR were: 1.78 (95% CI: 1.57-2.00) for LDL cholesterol, 1.55 (95% CI: 1.37-1.74) for hsCRP, and 1.19 (95% CI: 1.07-1.33) for lipoprotein a (Lp(a)), respectively, all were multivariable analysis. For Lp(a), no treatment is approved, and statins are not effective, but abdominal obesity is the biggest risk factor and weight loss reduces Lp(a). Lepodisiran, an extended-duration, small interfering RNA targeting hepatic synthesis lowered Lp(a) by 40% in a recent phase 3 trial.

In patients with minor stroke, dual antiplatelet therapy based on aspirin and clopidogrel offers balanced efficacy and safety, better than aspirin alone (n = 2128; odds ratio [OR], 1.26; 95% CI, 1.04~1.54) and similar to recombinant tissue plasminogen activator (rt-PA; n = 1840; OR, 1.23; 95% CI, 1.00~1.50) based on modified Rankin scale over 3 months. And lower symptomatic intracranial hemorrhage risk than rt-PA (n = 2538; OR, 0.11; 95% CI, 0.04~0.30) and tenecteplase (n = 194; OR, 0.15; 95% CI, 0.03~0.68), as well as a lower mortality than aspirin alone (n = 830; OR, 0.27; 95% CI, 0.10~0.71). In a meta-analysis of 10,665 patients, avg age 66.

The long-term risk of stroke after transient ischemic attack or minor stroke over 5- and 10-year was 12.5% (95% CI, 11.0%-14.1%) and 19.8% (95% CI, 16.7%-23.1%), respectively, in 171,068 patients, avg age, 69 years.

Intensive blood pressure control by community health workers in China, lowered the risk of dementia by 15% (risk ratio: 0.85; 95% CI 0.76 to 0.95; P = 0.0035) and cognitive impairment by 16%. systolic BP was 22.0 mm Hg (95% confidence interval (CI) 20.6 to 23.4; P < 0.0001) and that in diastolic BP was 9.3 mm Hg (95% CI 8.7 to 10.0; P < 0.0001) in the intervention group compared to usual care. Serious adverse events occurred less frequently in the intervention group (risk ratio: 0.94; 95% CI 0.91 to 0.98; P = 0.0006).

A systematic review and meta-analysis of 30 studies with >1.1 million participants with obstructive sleep apnea, age 59.5, positive airway pressure (PAP) reduced all-cause mortality (HR 0·63, 95% CI 0·56-0·72; p<0·0001) and cardiovascular mortality (0·45, 0·29-0·72; p<0·0001) compared to the no-PAP group, and the clinically relevant benefit of PAP therapy increased with use.

Medication classes associated with reduced risk of Alzheimer’s disease in multiple studies included: antibiotics, antihypertensives, lipid-lowering drugs, anti-inflammatories, and vaccines/antivirals, based on systematic review of 14 studies, and is a similar pattern is seen by several machine learning models developed for the early identification of dementia using electronic health record (EHR) or claims data.

Urinary incontinence is not associated with moderate-to-vigorous physical activity, but is associated with cardiovascular disease (CVD) risk factors and comorbidity, in 20,155 women, age 50: increased odds of type 2 diabetes (aOR 1.25, 95 % CI: 1.06–1.48), dyslipidemia (aOR 1.37, 95 % CI: 1.19–1.58), stroke (aOR 1.55, 95 % CI: 1.06–2.25), and coronary artery bypass grafts (aOR 3.17, 95 % CI: 1.45–6.95) after adjustment for age, race, body mass index, and tobacco use.

In women with mixed incontinence who did not respond to conservative treatment, there was no difference between botox (onabotulinumtoxinA) and midurethral sling in Urogenital Distress Inventory score improvement at 6 months. This is good news for our patients who may not be surgical sling candidates.

SGLT2 inhibitors increased the risk of falls 1.80 (1.10–2.92), GLP-1 agonists did not 1.61 (0.88–2.84), but in combination with SGLT-2 did 2.89 (1.27–6.56). The mechanism is felt to be: hypovolemia, nocturia, hypoglycemia and dehydration increased risk. 

Both cinnamon oil and cinnamaldehyde in cinnamon inhibited the catalytic activity of CYP2C9, which metabolizes warfarin, phenytoin, losartan, tolbutamide, glipizide, and several NSAIDs like celecoxib and ibuprofen, and CYP1A2 metabolizes caffeine, antidepressants, antipsychotics, etc. Usual consumption as spice is not thought to have an effect on meds.

In a mouse study, vitamin B-12 directly protects acinar cells from necrosis during the early stages of acute pancreatitis and subsequently reduces T lymphocyte infiltration. Artificially increasing serum B12 levels before and after the induction of pancreatitis not only reduced the severity of the condition but also promoted tissue repair after pancreatic injury. Interestingly, despite vitamin B-12's known role in the one-carbon metabolism pathway, its protective effects in pancreatitis were not mediated through the reduction of homocysteine or the glutathione (GSH) pathways. Instead, vitamin B12 was found to enhance ATP production in pancreatic tissue, thereby reducing acinar cell necrosis and preventing disease progression.  

Diverticulitis was not precipitated by Intake of peanuts, nuts, and seeds (aHR,1.07 [95% CI, 0.91 to 1.25]) and fresh fruits with edible seeds (aHR,1.06 [CI, 0.90 to 1.24]). There was a reduced risk for incident diverticulitis in women in the highest quartile of healthy diets compared with the lowest quartile: the Dietary Approaches to Stop Hypertension diet (aHR, 0.77 [CI, 0.65 to 0.90]), the Healthy Eating Index (aHR, 0.78 [CI, 0.66 to 0.91]), the Alternative Healthy Eating Index (aHR, 0.81 [CI, 0.69 to 0.95]), and the Alternative Mediterranean diet (aHR, 0.91 [CI, 0.78 to 1.06]).

I have reported that vitamin D’s immune modulation helps prevent multiple sclerosis (MS). In this study, oral cholecalciferol 100,000 IU every 2 weeks significantly reduced disease activity in  clinically isolated syndrome (CIS) and early relapsing-remitting MS over 2 years vs. placebo (hazard ratio [HR], 0.66 [95% CI, 0.50-0.87]; P = .004), and median time to disease activity was longer in the vitamin D group (432 vs 224 days; log-rank P = .003). All 3 secondary MRI outcomes reported significant differences favoring the vitamin D group.