In the News

NEJM Original Investigation Article The New England Journal of Medicine, September 21, 2023 A randomized, controlled trial in 529 patients with heart failure and obesity, assigned to receive medication or placebo, and followed for one year.

What’s Interesting about this article?

• Heart failure with preserved ejection fraction is increasing in prevalence and is associated with high symptom burden and functional impairment, especially in persons with obesity.
• The weekly dose of semaglutide (2.4 mg) resulted in larger reductions in symptoms, greater improvements in exercise function and greater weight loss than placebo.
• In an accompanying editorial, Yigal Pinto, MD, PhD speculates that heart failure with preserved ejection fraction may be a metabolic disease.

JournalDoc Comments:

• The class of incretin mimetics is gaining recognition as “new miracle drugs” for weight loss. This article suggests that they may have an effect on cardiovascular disorders as well as obesity.
• It is not clear whether the improvement in symptoms is due to a change in intracardiac pressures or weight loss.
• This study offers a new treatment option for a condition that has, in the past, been difficult to treat.

Link to Article in PubMed Disclaimer: Article of the Week selections by JournalDoc physicians are independent, unbiased and have no commercial conflict of interest. JournalDoc does not support or endorse the findings or opinions expressed in the article. Findings in the article may need to be supported by further research and/or the consensus of experts.

JAMA Original Investigation Article

Journal of the American Medical Association, September 12, 2023

Retrospective Study from the UK Biobank, including 49,841 adults > 60 years without an initial diagnosis of dementia.

What’s Interesting about this article?

• Individuals in the study wore a wrist accelerometer to measure sedentary (sitting) time each day.
• These older adults resided in England, Scotland or Wales and were followed for 6.72 years. During this time 414 individuals were diagnosed with dementia.
• More time spent in sedentary behavior was significantly associated with a higher incidence of dementia.

JournalDoc Comments:

• This is an extraordinarily large study group from one of the most respected data registries in the world.
• The retrospective study design does not allow a determination of whether this relationship is causal – i.e., that increased sitting time results in increased risk of dementia. However, it may be “associated with” the diagnosis of dementia.
• This study may add further weight to the adage that “sitting is the new smoking” in preventive medicine.

Link to Article in PubMed

Disclaimer: Article of the Week selections by JournalDoc physicians are independent, unbiased and have no commercial conflict of interest. JournalDoc does not support or endorse the findings or opinions expressed in the article. Findings in the article may need to be supported by further research and/or the consensus of experts.

JAMA Original Investigation Article

Journal of the American Medical Association, September 5, 2023

A randomized, Phase 2 clinical trial at 11 research sites with 104 participants aged 21 to 65 with a diagnosis of major depressive disorder.

What’s Interesting about this article?

• A single 25 mg dose of synthetic psilocybin, with psychological support, resulted in a clinically significant and sustained reduction in depressive symptoms and functional disability.
• A placebo effect was excluded because controls received a vitamin capsule identical in appearance to the psilocybin pills.
• There were no serious adverse effects.

JournalDoc Comments:

• As pointed out in an accompanying editorial by Rachel Yehuda, PhD and Amy Lehrner, PhD, psychedelic therapy may represent “A New Paradigm of Care for Mental Health.”
• Most psychedelic compounds are illegal under federal law, therefore research with these compounds must be conducted under close supervision by trained individuals in accredited institutions.
• The psychedelic approach focuses on revealing the causes of depression through new insights during the induced visions or hallucinations, rather than suppression of symptoms through traditional antidepressants.
• As with most new treatments, we need to proceed slowly and carefully in evaluating the potential of psychedelics through additional experiments.

Link to Article in PubMed

Disclaimer: Article of the Week selections by JournalDoc physicians are independent, unbiased and have no commercial conflict of interest. JournalDoc does not support or endorse the findings or opinions expressed in the article. Findings in the article may need to be supported by further research and/or the consensus of experts.

JAMA Insights Commentary

Journal of the American Medical Association, September 26, 2023

Commentary by David Carr, MD, and Ganesh Muneshwar Babulal, PhD

What’s Interesting about this article?

• The older adult (>65 years) population in the US will increase to 88 million by 2050 and represent at least 23% of all drivers.
• Compared with younger drivers, older adults experience decreases in visual, cognitive, and motor functions, resulting in a 2.5 times higher risk of a crash death for those aged 75-79 years old, and a 5-times higher risk for those 80 years or older.
• More than 90% of crashes are due to human error. Innovations in electronic automotive technologies may increase the safety of older drivers.
• Autonomous/driverless cars may represent the ultimate solution to unsafe older drivers.

JournalDoc Comments:

• “Taking away the car keys” is one of the most dreaded and difficult challenges for children of older drivers.
• Clinicians have an ethical “duty to warn” and notify state license agencies if they are aware of impairments or medications of older patients who refuse to stop driving.
• Loss of driving privileges affects the independence of older adults and may result in increased loneliness and depression.
• Mandatory cognitive and motor skills assessment prior to license renewal may be one possible solution.

Link to Article in PubMed

Disclaimer: Article of the Week selections by JournalDoc physicians are independent, unbiased and have no commercial conflict of interest. JournalDoc does not support or endorse the findings or opinions expressed in the article. Findings in the article may need to be supported by further research and/or the consensus of experts.

The New England Journal of Medicine, August 17, 2023

Study Design: Randomized controlled Study (RCT) with 604 patients

What’s Interesting about this article?

• The MIND diet is a hybrid of the Mediterranean and DASH diets with some modifications to include foods thought to reduce the risk of Alzheimer’s disease.
• This was a 3-year two site study involving older adults without cognitive impairment but with a family history of dementia.
• There was no significant difference in cognition or MRI outcomes in the MIND group and the control group at three years.

JournalDoc Comments:

• 94% of the trial participants completed the study, which indicates an exceptionally high level of adherence.
• It would be wonderful to have a dietary option for prevention of cognitive decline or Alzheimer’s, but dietary studies are difficult to complete because of lack of adherence or reliable food diaries. The MIND diet represents the best attempt to date, combining the proven benefits of both the Mediterranean and DASH diets.

Link to article in PubMed

Disclaimer: Article of the Week selections by JournalDoc physicians are independent, unbiased and have no commercial conflict of interest. JournalDoc does not support or endorse the findings or opinions expressed in the article. Findings in the article may need to be supported by further research and/or the consensus of experts.