Episode 428: 435. Evolocumab, Statin and CKD, PCN allergy, MRI vs Rotator Cuff

we unpack whether rivaroxaban followed by aspirin improves thromboprophylaxis after hip and knee arthroplasty, put oral GLP-1 therapy orforglipron head-to-head with dapagliflozin for type 2 diabetes, and examine new evidence on venous thromboembolism after mechanical restraint in psychiatric hospitals. We also translate updated pediatric functional-constipation guidance, the newest ACG recommendations for colonic diverticulitis, and real-world data on blood-pressure control and mortality among U.S. veterans—then finish with a practical look at whether a lumbar belt can truly ease nonspecific low-back pain.Shivakumar S, et al. Rivaroxaban then aspirin vs. aspirin alone after total hip or knee arthroplasty. N Engl J Med 2026 Jul 12; [e-pub]. DOI: 10.1056/NEJMoa2603649. PubMed https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00800-7/abstract https://pubmed.ncbi.nlm.nih.gov/42393373/ Welch M, et al. Orforglipron compared with dapagliflozin in adults with type 2 diabetes and inadequate glycaemic control with metformin (ACHIEVE-2): A multicentre, randomised, non-inferiority, open-label, phase 3 trial. Lancet 2026 Jul 11; 408:125. DOI: 10.1016/S0140-6736(26)00800-7. PubMed Viuff JH, et al. Venous thromboembolism after mechanical restraint in psychiatric hospitals: Population based cohort and self-controlled case series study. BMJ 2026 Jul 1; 394:e100016. DOI: 10.1136/bmj-2026-100016. PubMed Gordon M, et al. European Society for Paediatric Gastroenterology, Hepatology and Nutrition/North American Society for Pediatric Gastroenterology, Hepatology and Nutrition guidelines for treatment of functional constipation in children aged 0–18 years. J Pediatr Gastroenterol Nutr 2026 May 20; [e-pub]. DOI: 10.1002/jpn3.70447. PubMed Peery AF, et al. ACG clinical guideline: Colonic diverticulitis. Am J Gastroenterol 2026 Jul; 121:1549. DOI: 10.14309/ajg.0000000000004047.  Yamada M, et al. Blood pressure control and mortality among US veterans. Hypertension 2026 Apr 7; [e-pub]. DOI: 10.1161/HYPERTENSIONAHA.125.25787.  Grange L, et al. Lumbar belt for nonspecific low back pain: A randomized clinical trial. JAMA Netw Open 2026 Aug 3; 9:e2629793. DOI: 10.1001/jamanetworkopen.2026.29793. PubMed

Does a Coronary Artery Calcium (CAC) scan still earn its place in modern cardiovascular prevention? This podcast cuts through the headlines to examine the recent research, challenge overconfident conclusions, and put CAC testing under the microscope alongside the PREVENT risk equation.Each episode brings a sharp, evidence-first look at what calcium scoring can—and cannot—tell us about heart-attack risk. We unpack study methods, question the assumptions behind new publications, and ask the practical questions clinicians and patients actually need answered: When does CAC meaningfully change care? Who benefits most? And in an era of PREVENT, does a scan add actionable information beyond the numbers?Clear-eyed, clinically grounded, and never afraid to interrogate the data, this is the podcast for anyone who wants the real value of CAC—not just the latest claim.

OMED lecture on how to understand medical stats

CME

OMED lecture

Xin X, et al. Optimal exercise modalities and dosages for blood pressure reduction in adults with prehypertension and established hypertension: A network meta-analysis and dose–response relationship study. J Am Heart Assoc 2026 May 14; 15:e044003. DOI: 10.1161/JAHA.125.044003. Vosooney A, et al. Screening for Cervical Cancer: A Recommendation From the Women’s Preventive Services Initiative. Obstet Gynecol 2026 Jul; 148:e3. DOI: 10.1097/AOG.0000000000006315. Castells A, et al. Effect of invitation to colonoscopy versus faecal immunochemical test screening on colorectal cancer mortality (COLONPREV): A pragmatic, randomised, controlled, non-inferiority trial. Lancet 2025 Apr 12; 405:1231. DOI: 10.1016/S0140-6736(25)00145-X.Castells A, et al. Colonoscopy versus biennial FIT screening: A post hoc sustained-strategy analysis of the COLONPREV Trial. Gut 2026 Jun 10; [e-pub]. DOI: 10.1136/gutjnl-2026-338896.  Diercks D, et al. Evaluation and management of chest pain from cardiovascular causes in female patients. BMJ 2026 Jan 30; 392:e086177. DOI: 10.1136/bmj-2025-086177.  https://www.sciencedirect.com/science/article/pii/S0140673626008767?via%3Dihub   Lancet. 2026 May 23;407(10543):2015-2026. Yanik EL, et al. Associations of sleep and shift work with osteoarthritis risk. Arthritis Care Res (Hoboken) 2026 Jan 22; [e-pub]. DOI: 10.1002/acr.70040.  Noma H, et al. Angiotensin receptor blockers versus calcium channel blockers for first-line antihypertensive therapy and survival in adults aged 75 years or older. J Am Geriatr Soc 2026 Apr 26; [e-pub]. DOI: 10.1111/jgs.70463. https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/215256s029lbl.pdf

Xin X, et al. Optimal exercise modalities and dosages for blood pressure reduction in adults with prehypertension and established hypertension: A network meta-analysis and dose–response relationship study. J Am Heart Assoc 2026 May 14; 15:e044003. DOI: 10.1161/JAHA.125.044003. Vosooney A, et al. Screening for Cervical Cancer: A Recommendation From the Women’s Preventive Services Initiative. Obstet Gynecol 2026 Jul; 148:e3. DOI: 10.1097/AOG.0000000000006315. Castells A, et al. Effect of invitation to colonoscopy versus faecal immunochemical test screening on colorectal cancer mortality (COLONPREV): A pragmatic, randomised, controlled, non-inferiority trial. Lancet 2025 Apr 12; 405:1231. DOI: 10.1016/S0140-6736(25)00145-X.Castells A, et al. Colonoscopy versus biennial FIT screening: A post hoc sustained-strategy analysis of the COLONPREV Trial. Gut 2026 Jun 10; [e-pub]. DOI: 10.1136/gutjnl-2026-338896.  Diercks D, et al. Evaluation and management of chest pain from cardiovascular causes in female patients. BMJ 2026 Jan 30; 392:e086177. DOI: 10.1136/bmj-2025-086177.  https://www.sciencedirect.com/science/article/pii/S0140673626008767?via%3Dihub   Lancet. 2026 May 23;407(10543):2015-2026. Yanik EL, et al. Associations of sleep and shift work with osteoarthritis risk. Arthritis Care Res (Hoboken) 2026 Jan 22; [e-pub]. DOI: 10.1002/acr.70040.  Noma H, et al. Angiotensin receptor blockers versus calcium channel blockers for first-line antihypertensive therapy and survival in adults aged 75 years or older. J Am Geriatr Soc 2026 Apr 26; [e-pub]. DOI: 10.1111/jgs.70463. https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/215256s029lbl.pdf

Jafari K, et al. Risk factors for pediatric deep neck infection revisit after emergency department discharge for pharyngitis or localized neck symptoms. Ann Emerg Med 2026 May; 87:605. DOI: 10.1016/j.annemergmed.2025.10.007. In a “look-back” analysis of some 800 children admitted with deep neck infection, 18% had at least one ED discharge before admission. The most common discharge diagnoses were fever, pharyngitis/tonsillitis, and localized neck symptoms. In a “look-forward” analysis, 0.01% of about 400,000 children diagnosed with pharyngitis/tonsillitis and 0.07% of almost 60,000 children presenting with nontraumatic neck symptoms were subsequently admitted with a deep neck infection.  Klausen MK, et al. Once-weekly semaglutide versus placebo in patients with alcohol use disorder and comorbid obesity: A randomised, double-blind, placebo-controlled trial. Lancet 2026 May 2; 407:1687. Heavy drinking decreased from 17 days per month at baseline to 13 with placebo and 10 with semaglutide — a significant 3-day difference. Days without any alcohol use in the past month increased from 9 at baseline to 11 with placebo and 12 with semaglutide, though this difference was not significant (P=0.051).  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2848777Conclusions and Relevance  In this RCT of 651 AWS, varenicline sampling was efficacious, with potentially superior outcomes compared with NRT.    https://jamanetwork.com/journals/jama/fullarticle/2848997Conclusions and Relevance  Among childbearing physicians in training, a parental support package significantly mitigated postpartum burnout. https://pubmed.ncbi.nlm.nih.gov/42120723/. These data demonstrate orforglipron's potential as a globally scalable option for minimizing weight changes after injectable therapy. Trial limitations include the absence of a comparator arm involving continued use of injectable obesity-management medications and the trial's 1-year duration. https://pubmed.ncbi.nlm.nih.gov/42104164/mong 263 clinicians (107 residents, 156 specialists), specialists scored higher than residents (median, 46 [IQR, 42-50] vs 41 [IQR, 36-46]; P < .001; r = 0.32). ChatGPT correctly diagnosed 53 of 61 cases (86.9%), Gemini 50 (82.0%), and Copilot 44 (72.1%). Both ChatGPT and Gemini exceeded the upper bound of the specialist population median 95% CI (47.17).  https://www.nejm.org/do/10.1056/NEJMdo008444/full/Among patients with noncardioembolic ischemic stroke or high-risk TIA treated with antiplatelet therapy, asundexian at a daily dose of 50 mg resulted in lower risks of ischemic stroke and major cardiovascular events than placebo, without a higher risk of major bleeding.

https://pubmed.ncbi.nlm.nih.gov/41903215/  Evolocumab to Reduce First Major Cardiovascular Events in Patients Without Known Significant Atherosclerosis and With Diabetes: Results From the VESALIUS-CV Trial https://pubmed.ncbi.nlm.nih.gov/41769754/  Association between statin therapy as primary prevention and mortality in adults 50 years and older with chronic kidney disease without other indications https://pubmed.ncbi.nlm.nih.gov/41921035/  Direct Oral Challenge for Penicillin Allergy: The International Network of Antibiotic Allergy Nations (iNAAN) Study https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2844659  Incidental Rotator Cuff Abnormalities on Magnetic Resonance Imaging  https://www.acpjournals.org/doi/10.7326/ANNALS-25-02772   Rapid Evaluation of Artificial Intelligence Technology Used for Ambient Dictation in Primary Care: Comparing the Quality of Documentation of Artificial Intelligence–Generated and Human-Produced Clinical Notes

https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.70463  Angiotensin Receptor Blockers Versus Calcium Channel Blockers for First-Line Antihypertensive Therapy and Survival in Adults Aged 75Years or Older  https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0140673626003673?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0140673626003673%3Fshowall%3Dtrue&referrer=https:%2F%2Fpubmed.ncbi.nlm.nih.gov%2F Pharmacological blood-pressure lowering for the prevention of cardiovascular disease and death across the full spectrum of chronic kidney disease severity: an individual-participant data meta-analysis  https://pubmed.ncbi.nlm.nih.gov/42033454/   Overdiagnosis in atrial fibrillation screening with wearables  https://pubmed.ncbi.nlm.nih.gov/41766353/   Patients' perspectives on deprescribing in swedish primary care: an exploratory survey study  https://pubmed.ncbi.nlm.nih.gov/41627785/   Reducing short-acting beta-agonist overprescribing in general practice: Evaluation of a quality improvement programme in East London  https://pubmed.ncbi.nlm.nih.gov/42024880/   Screening for Cervical Cancer: A Recommendation From the Women's Preventive Services Initiative