Published March 4, 2023
Morning Report — Not Your Typical Medical Newsletter
We get it, you see a lot of medical newsletters, so hear us out. Once a month, we’ll highlight important medical news sprinkled with witty commentary, fun facts, giveaways, and more… because learning should be fun! Subscribe to receive the Morning Report directly.
The Fairway to Cardiometabolic Health
LIFESTYLE LESSONS
We’re teeing off this month’s newsletter with a small randomized crossover study comparing the acute effects of three activities on older adults’ metabolic health: an 18-hole round of golf (sans cart!), a 6-km walk, and a 6-km Nordic walk (a ski-adjacent form of walking). The scorecard showed golfing on par with Nordic and regular walking when it came to lowering blood pressure, but the grassy game shot to a healthy lead in the lipid profile and glucose metabolism columns. “So, golf’s got that going for it, which is nice.”
It’s in the hole!
We would expect an aerobic exercise to improve the cardiometabolic profile—that’s par for the course—but golfing? Isn’t there a lot of casual leaning on golf clubs as the group ahead of you finishes putting? Well, what golf lacks in aerobic intensity, it makes up for in duration and, therefore, total energy expenditure. A golfer could be strolling the greens for four-plus hours on a good day or navigating water, sand, and forest for much longer on most days.
Key takeaway
As snow shovels give way to golf clubs this spring, you may want to encourage older patients with access to a golf course to give it a swing or continue swinging. Patients who can play a full 18 holes (while eschewing the golf cart!) will reap the same or greater cardiometabolic benefits as those who engage in more rigorous aerobic exercises like Nordic and regular walking. The key to achieving these benefits is to (1) forgo the cart and (2) avoid overindulging at the 19th hole.* Okay, the study didn’t mention number two.
*The “19th hole” is the clubhouse for those of you—like us—whose golf knowledge starts with Caddyshack and ends with Happy Gilmore.
Inconceivable! Proof of Concept for Male Contraception
EMERGING EVIDENCE
Thus far, developing a viable male contraceptive product has been as herculean a task as constructing an artificial heart. But researchers are betting the house on a new contraception strategy—inhibiting the soluble adenylyl cyclase (sAC) enzyme—which recently showed proof of concept. This nonhormonal option could eliminate two main snarls found in previous product development attempts: (1) disruption to sperm development and (2) side effects men weren’t likely to accept when the alternative wasn’t pregnancy.
You shall not pass!
How does a sAC inhibitor work? As you know from med school (or eighth-grade health class), sperm is stored in the epididymis until ejaculation. Then, the sAC enzyme sparks the sperm’s motility, enabling it to swim from the vagina to the uterus. The introduction of a sAC inhibitor blocks that motility and ruins a swim faster than a floating Baby Ruth (that’s three Caddyshack references for those of you playing along).
Of mice and men
In a mouse model, the experimental compound proved 100% effective in preventing pregnancy for two and a half hours. The drug did not disrupt normal mating behavior, and male fertility resumed the next day. But here’s the thing: the lifespan of a human sperm (up to five days) exceeds that of a mouse sperm, so who’s to say that a dormant human sperm won’t start swimming toward the uterus once the inhibitor wears off?
Key takeaway
The long and winding road to a male contraceptive option has pivoted toward a new cell pathway that can temporarily immobilize sperm—at least in male mice. This means that one day men could conceivably switch their fertility on and off and share the burden of birth control with women. We hear your skepticism—we’ve traveled this road before. But this new target may be the game changer. A realistic timeline includes three years to the first human trials plus another five years to a CVS shelf. That’s at least eight years from now, but who’s counting, ladies?
The Bitter Fall of Aspirin for Primary Prevention of ASCVD
CARDIO CORNER
Aspirin once stood tall as a power player—alongside statins—in the primary prevention of atherosclerotic cardiovascular disease (ASCVD), but a tide of unfavorable studies in recent years has prompted guidelines to reduce the drug’s playing time and, in some cases, bench it altogether. A new meta-analysis of aspirin for primary prevention of ASCVD reveals its dodgiest benefit-to-risk profile yet and begs the question “Does prophylactic low-dose aspirin belong in the game—even for patients with higher ASCVD risk?”
In this meta-analysis of >170,000 patients without ASCVD, the use of aspirin did not cut mortality risk. All gains made in lowering the risk of myocardial infarction (a 15% relative reduction) were dwarfed by an increased risk of major bleeding (a 48% relative increase)—ACROSS ALL LEVELS OF ASCVD RISK. Sorry for shouting, but it’s an important note. Also of note, the use of aspirin failed to significantly reduce the risk of stroke.
Key takeaway
Aspirin remains in the starting lineup of ASCVD treatment, but as a prevention tool, it may not be the strongest player. This revelation appears to be reflected in increasingly more conservative guidelines, like the USPSTF’s 2022 recommendation to consider aspirin only for high-risk individuals at low bleeding risk. But this study seems to make the case to further limit its use: “The anticipated absolute risk of major bleeding with aspirin exceeds absolute MI benefits for every level of ASCVD risk.” The researchers suggest focusing instead on lifestyle changes, smoking cessation, physical activity, and, of course, preventive statin therapy. Speaking of statins, the study reaffirmed this versatile drug’s pharmacologic MVP status. When aspirin tag-teamed with statins, the risk of myocardial infarction further dropped while the risk of bleeding remained level. If we listen closely, we can hear the renewed chants to “put statins in the water.” Okay, that’s still a bridge too far.
Rapid-Fire COVID-19 Updates
COVID QUICK HITS
- Physical interventions to interrupt or reduce the spread of respiratory viruses
- Real-world COVID-19 vaccine effectiveness against the Omicron BA.2 variant in a SARS-CoV-2 infection-naive population
- Severe fatigue and persistent symptoms at 3 months following severe acute respiratory syndrome Coronavirus 2 Infections during the pre-Delta, Delta, and Omicron time periods: a multicenter prospective cohort study
Heroic Hue Holds Off Diabetes
DIETARY DIGEST
Purple is strolling into 2023 like a boss, boom box over its shoulder blasting Purple Rain. Why? Because fruits and vegetables of this regal color are finally getting their due as potent protectors against diabetes and other chronic diseases, thanks to a recent review article. Emboldened by the good press, purple is guaranteeing a 2024 Super Bowl victory for its long-suffering Vikings. Easy, purple, you can only do so much.
The secret behind the color purple
The review article plunged into the science behind anthocyanins, the compounds responsible for the pigment and antioxidant power in purple (or red and blue) fruits, vegetables, and tubers. Researchers found that anthocyanins can help lower the risk of type 2 diabetes mellitus (T2DM) by acting on energy metabolism, gut microbiota, and inflammation. But not all anthocyanins are created equal. This latest research splits anthocyanins into two groups: acylated (think purple potatoes, purple radishes, purple carrots, and purple cabbage) and non-acylated (think blueberries and mulberries). Both groups pack a disease-fighting punch, but the acylated group confers substantially greater benefits in reducing the risk of T2DM.
Key takeaway
This review article draws purple produce out from under the shadow of green fruits and vegetables and positions it in a new light. You may want to encourage patients (especially those at risk for T2DM) to make room on their plate for purple food—just not the Red 40 plus Blue 1 variety. As always, patients can’t go wrong tasting the rainbow of real fruits and vegetables (no disrespect, Skittles), and thanks to the power of anthocyanins, purple is an important color in that nutritional spectrum.
Pri-Med’s Primary Care Bootcamp for NPs and PAs
CME ALERT
Calling all newly practicing NPs and PAs (or someone who knows one)! Want to confidently provide care in the exam room from day one? Join Pri-Med’s Primary Care Bootcamp for NPs and PAs and fill that competence gap between the classroom and the real world. With two distinct tracks and over 40 courses, you’ll earn 20+ CME/CE credits upon completion. Topics covered range from the top chief complaints seen in primary care to interpreting lab results to practice management essentials. With a library of downloadable resources and video lessons you can watch from anywhere; it’s like having an on-demand mentor available to answer your questions at any time. Enroll now for one year at $499 and take your skills to the next level!
Interested in more healthcare news? Here are some other articles we don’t want you to miss:
- The use of opioids in the management of chronic pain: synopsis of the 2022 updated U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline
- FDA panel gives unanimous thumbs up to OTC naloxone
- Rethinking menopausal hormone therapy: for whom, what, when, and how long?
- Major clinical trial shows simplified HIV treatment options just as effective
- Circulating chromosome conformation signatures significantly enhance PSA Positive predicting value and overall accuracy for prostate cancer detection
- Serologic screening for genital herpes infection: US Preventive Services Task Force reaffirmation recommendation statement
Morning Report is written by:
- Alissa Scott, Author
- Aylin Madore, MD, MEd, Editor
- Eleni Scott, MD, Editor
Would you like to share your feedback with Morning Report? Drop us an email at morningreport@pri-med.com to let us know how we’re doing.
Please note that the summaries in Morning Report are intended to provide clinicians with a brief overview of an article, and while we do our best to select the most salient points, we ask that you please read the full article linked in each summary for clarification before making any practice-changing decisions.
Enjoying Morning Report? Subscribe & Share It With Your Colleagues!
Is Morning Report for you? It is if . . .
You're someone who needs quick-hitting, accurate medical news and you're a fun and witty healthcare professional who wants your news with some flare.
You don't just need to know about the latest metabolism study–you also need to know how it parallels an Alanis Morissette hit. If you're reading about acupuncture treatment, you need us to skip the needle puns and get right to the point. We keep things simple, but when we do get into the scientific weeds, we always remind you to check for ticks.
Subscribe to receive the Morning Report directly in your inbox the first Saturday of every month.
As a leader in CME/CE for 27+ years, Pri-Med provides evidence-based in-person and online CME/CE for primary care clinicians. Explore our education to earn credits and stay informed on the most current clinical strategies relevant to your daily practice.