The edition · Internal Medicine
Where haemoglobin sits matters, and what a fall can hide
A half-million-person cohort finds mortality lowest a little above the anaemia threshold and raised both below and above it, alongside a cautious cardiovascular signal for timely menopausal hormone therapy and the occult harms that follow a fall in an older adult.
The edition in brief
Today's internal medicine edition leads with a UK cohort of over 500,000 adults showing a U-shaped relationship between haemoglobin and 13-year mortality: risk was lowest 1 to 3 g/dL above the WHO anaemia threshold, and clearly raised below it (more than 2 g/dL below: hazard ratio 2.87) and modestly even just below it (hazard ratio 1.18 for 0 to 1 g/dL above). The authors stress these are interpretive, not new thresholds. A target-trial emulation from SWAN estimates that menopausal hormone therapy started for vasomotor symptoms within 10 years of menopause was associated with lower cardiovascular risk (hazard ratio 0.78 overall), but the authors caution against using this to justify hormone therapy for prevention. A clinic pearl covers structured deprescribing in polypharmacy. The edition closes on a narrative review arguing that harm after an older adult's fall extends well beyond fractures and head injury, across thoracic, abdominal, vascular, viral-reactivation and psychological domains that are easily missed.
Mortality is lowest just above the anaemia threshold, and rises each way
Interpret a borderline or mildly abnormal haemoglobin in context rather than dismissing it because a threshold was not crossed.
A cardiovascular signal for timely hormone therapy, with caveats
Treat this as reassurance that symptom-driven hormone therapy near menopause is not cardiovascularly harmful, not as a reason to prescribe it for prevention.
Make deprescribing a deliberate step, not an afterthought
Schedule deprescribing as its own task in polypharmacy, stopping one drug at a time and documenting the reason.
After a fall in an older adult, look beyond the fracture
After a fall in an older adult, assess beyond fractures and head injury and plan follow-up that includes the psychological impact.
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