The edition · Top Clinical Updates
A statin in the over-70s prevented heart attacks but did not extend disability-free life
STAREE randomised nearly 10,000 community-dwelling older adults to atorvastatin or placebo and split its two primary endpoints, an ECG algorithm flags treatable cardiac amyloidosis before echocardiography, and a text message beats a portal message for nobody in particular.
The edition in brief
STAREE randomised 9,971 Australians aged 70 and over with no cardiovascular disease, diabetes or dementia to atorvastatin 40 mg or placebo. Over a median 5.9 years, major cardiovascular events fell from 15.5 to 10.9 per 1000 person-years (HR 0.70, 95% CI 0.61-0.82, p<0.001). The second primary endpoint - death, dementia or persistent physical disability - did not differ (21.6 vs 23.0 per 1000 person-years; HR 0.94, 0.84-1.05, p=0.25). Serious adverse events were 2.7% in both arms, with more musculoskeletal, hepatobiliary and diabetes-related events on atorvastatin. A locally deployable AI model reading routine ECG images discriminated transthyretin amyloid cardiomyopathy with an internal area under the curve of 0.84 (0.79-0.89), sensitivity 0.72 and specificity 0.86, holding between 0.78 and 0.89 across five external cohorts and 0.76-0.91 in three screening cohorts. Adding AI-enabled echocardiography raised positive predictive value from 0.24 to 0.66 while dropping sensitivity from 0.84 to 0.68. In the Shanghai Preconception Cohort, higher preconception parental vitamin B12 was associated with fewer birth defects: predicted prevalence fell from 49.6 to 16.2 cases per 1000 pregnancies across maternal B12 categories, with an attenuated paternal pattern. Postconception red-cell folate of 906-1131 nmol/L was associated with 16.5 versus 25.7 cases per 1000 compared with levels under 453, with little further benefit above that. A JAMA systematic review of 155 publications reports updated COVID-19 vaccines were associated with 53% lower hospitalisation risk in adults 65 and over, 58% fewer emergency encounters after maternal vaccination, and 76% fewer paediatric emergency visits in children aged 9 months to 4 years. Digital outreach raised 14-day statin refills from 12.0% to 14.4% in 20,604 patients; switching the message channel added nothing.
STAREE answered both of its questions, and the answers point different ways
In healthy adults over 70, atorvastatin cut major cardiovascular events by 30% but did not extend disability-free survival, so the decision turns on which of those the patient is trying to buy.
An algorithm reading a photographed ECG can put cardiac amyloidosis on the list
An AI model reading photographed ECGs identified transthyretin amyloid cardiomyopathy with an area under the curve of 0.78 to 0.89 across cohorts, making it a plausible first filter where cardiac imaging is scarce - but not yet a test to order.
Fathers' vitamin B12 before conception tracked with birth defects too
Higher periconception vitamin B12 was associated with substantially fewer birth defects, and the benefit of red-cell folate plateaued above about 1100 nmol/L, so check B12 preconceptionally rather than escalating folate.
The season's COVID-19 vaccine evidence, summarised for the people who have to answer for it
Updated COVID-19 vaccines were about 53% effective against hospitalisation in adults over 65 and 76% against emergency visits in young children, with maternal vaccination protecting infants for two months whatever the trimester.
Ask what they stopped, not what they take
Before concluding a drug has failed, ask what the patient stopped and why - a medication never taken has not been tried.
A digital nudge raised statin refills, and changing the channel did nothing
Automated digital outreach raised 14-day statin refills by about 2 percentage points and a second message to non-responders added the same again, but switching the message channel achieved nothing.
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