Anticoagulation helped at intermediate AF stroke risk, and kidney benefit from newer diabetes drugs tracked albuminuria

The edition in brief

SINGLE-AF randomised 1,803 patients with atrial fibrillation at intermediate stroke risk to a direct oral anticoagulant or none; at 24 months the composite of stroke, embolism, major bleeding or cardiovascular death occurred in 0.5% vs 1.5% (HR 0.31, 0.10 to 0.94), from small event numbers. In 75,455 people with type 2 diabetes starting second-line treatment after metformin, GLP-1 receptor agonists or SGLT2 inhibitors were associated with less kidney deterioration than DPP-4 inhibitors when albuminuria was present (five-year risk ratio 0.60) but not when it was absent (1.10). An American College of Physicians evidence review of 90 trials found oestrogen reduced the frequency and severity of menopausal hot flushes and was of high economic value; SSRIs, SNRIs and neurokinin receptor antagonists reduced frequency but not severity. A BMJ network meta-analysis of 124 trials found brisk walking or jogging and combined aerobic-resistance training improved bone density in adults over 40, with clinically meaningful gains at about two to three hours of brisk walking a week. An Ontario study of 2.3 million older adults prioritised 24 prescribing cascades, led by iron to laxative and statin to analgesic. Only SINGLE-AF is randomised outcome evidence; its event counts were small.