(HealthDay News) — In a synopsis of the 2020 updated clinical practice guideline from the U.S. Department of Veterans Affairs and the U.S. Department of Defense, published online Sept. 22 in the Annals of Internal Medicine, recommendations are presented for the management of dyslipidemia to reduce cardiovascular disease (CVD) risk.

Patrick G. O’Malley, M.D., M.P.H., from the Uniformed Services University of the Health Sciences in Bethesda, Maryland, and colleagues developed key questions, evaluated the literature, and developed 27 recommendations and a simple algorithm for managing dyslipidemia to reduce CVD in adults.

The recommendations address targeting of statin dose, additional tests for risk prediction, primary and secondary prevention, laboratory testing, physical activity, and nutrition. The authors suggest against offering a CVD risk assessment more frequently than every five years for primary prevention in patients aged younger than 40 years who are not receiving statins and have not developed new CVD risk factors. A 10-year risk calculator is suggested for CVD risk assessment in primary prevention. Moderate-dose statin therapy is recommended for primary prevention for patients with a 10-year CVD risk ≥12 percent, a low-density lipoprotein cholesterol level ≥4.9 mmol/L, or diabetes. At least moderate statin doses are recommended for secondary prevention. Recommended lifestyle interventions include an exercise-based cardiac rehabilitation program for patients with recent coronary heart disease.


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“We present a pragmatic, patient-centered approach to managing lipid levels to reduce CVD risk, applying evidence for treatment that is concordant with the risk in the populations studied,” the authors write.


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Clinical Practice Guideline Synopsis

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During the worst of the COVID-19 pandemic, when hospitals reported dwindling ICU space, social distancing and virtual schooling were a necessity. And while those methods likely did limit the spread of the virus, they created their own deleterious effects. For developing eyes in school-age children, converting from a 7-hour in-person school day to a 7-hour screen-based school day may have played a role in growing rates of asthenopia and convergence insufficiency, according to a report presented at the American Academy of Ophthalmology 2021 meeting in New Orleans, held November 12-15. 

Researchers asked 110 students (ages 10-17) with no history of ocular pathology, to complete a modified convergence insufficiency symptom survey (CISS), and an asthenopia survey both before and after a virtual school session. 

The report shows that 61% of the participants experienced an increase in symptoms of convergence insufficiency after a virtual school day, with 17% of children categorized as having severe symptoms. The average sum of the CISS scores increased from 5.17 before school, to 9.82 after school (P ≤.0001). 

Computer-based asthenopia, also called ocular fatigue, symptoms also increased in the study, from a score of 1.58 before school, to 2.74 after school (P ≤.0001), with more than half of the participants (53%) recording an increase in asthenopia symptoms.

According to the researchers, the usefulness of virtual schooling may have either run its course, or the measure could benefit from a strategy to protect developing eyes. 

“Healthy children are experiencing acute ocular symptoms from virtual school,” they reported. “Digital education needs to be restructured to reduce ocular symptoms and create a better environment for children’s learning.”

(HealthDay News) — For individuals with type 2 diabetes, sodium glucose cotransporter 2 (SGLT2) inhibitors are associated with a reduced risk for cardiovascular events during short-term follow-up, according to a study published online Sept. 23 in The BMJ.

Kristian B. Filion, Ph.D., from the Lady Davis Institute at the Jewish General Hospital in Montreal, and colleagues conducted a multi-database retrospective cohort study involving 209,867 new users of an SGLT2 inhibitor matched to 209,867 users of a dipeptidyl peptidase-4 (DPP-4) inhibitor on time conditional propensity score. Participants were followed for a mean of 0.9 years for a primary outcome of major adverse cardiovascular events (MACE).

The researchers found that SGLT2 inhibitors were associated with reduced risks for MACE compared with DPP-4 inhibitors (incidence rate per 1,000 person-years, 11.4 versus 16.5; hazard ratio, 0.76). In addition, SGLT2 inhibitors were associated with reductions in the rates of myocardial infarction, cardiovascular death, heart failure, and all-cause mortality (hazard ratios, 0.82, 0.60, 0.43, and 0.60, respectively). For ischemic stroke, the benefit of SGLT2 inhibitors was not statistically significant. For MACE, similar benefits were seen for canagliflozin, dapagliflozin, and empagliflozin (hazard ratios, 0.79, 0.73, 0.77, respectively).

“These findings suggest that SGLT2 inhibitors offer cardioprotective benefits among people with type 2 diabetes in a real world setting, although additional studies are needed to determine if these benefits persist long term,” the authors write.


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Several authors disclosed financial ties to the pharmaceutical industry.

Abstract/Full Text

Reference

Hamburger JL, Lavrich JB, Rusakevich A, et al. The visual consequences of virtual school: acute eye symptoms in healthy children. Paper presented at: The American Academy of Ophthalmology 2021 Annual Meeting; November 12-15; New Orleans. Abstract PA016.

This article originally appeared on Ophthalmology Advisor