The edition · Internal Medicine
Shingles may briefly raise stroke risk; a ward-run rehab unit shortens discharge delays; a VA/DoD lipid guideline adds lipoprotein(a) testing
A systematic review links herpes zoster to a short-lived rise in vascular risk, a hospitalist-led rehabilitation unit cut waits for post-acute care, GDF-15 predicts death better than it diagnoses coronary disease, and an updated US lipid guideline changes how risk is estimated.
The edition in brief
A systematic review of observational evidence (five epidemiological studies in the primary synthesis) found that herpes zoster is associated with a transient rise in vascular risk, most consistently for stroke, peaking about three to four weeks after onset and larger after herpes zoster ophthalmicus; evidence for myocardial infarction was less consistent. A single-centre report from a US Veterans hospital described a hospitalist-led short-stay rehabilitation unit that cut mean referral-to-discharge time from 6.89 days to 3.35 days over two years, without extra post-acute beds. In 3,379 patients with suspected functionally relevant coronary disease, growth differentiation factor 15 had modest diagnostic accuracy (AUC 0.598) but high prognostic accuracy for death (time-dependent AUC about 0.82 to 0.83 at 2 years). A small study of a hybrid continuous glucose monitoring protocol in 54 inpatients found a mean absolute relative difference of 10.0% after protocol-guided exclusions and replaced 53% of fingerstick tests. A synopsis of the 2025 VA/DoD lipid guideline recommends the PREVENT calculator, suggests coronary calcium testing when risk is uncertain, recommends one-time lipoprotein(a) testing and favours combination lipid lowering in very-high-risk secondary prevention.
Herpes zoster as a short-term vascular trigger, most clearly for stroke
Consider shingles a short-term marker of vascular risk, and check risk factors and symptoms in the weeks that follow.
A hospitalist-led rehabilitation unit shortened waits for post-acute care
Consider measuring discharge delays by destination, and whether physician-led step-down care could shorten them locally.
GDF-15 predicts death far better than it diagnoses obstructive coronary disease
Do not rely on GDF-15 to diagnose coronary disease; it may be a useful risk marker, but it should not change management on its own.
Continuous glucose monitoring replaced about half of inpatient fingersticks in a small protocol study
Consider inpatient continuous glucose monitoring only within a written protocol that specifies when to confirm with a fingerstick.
Before attributing a fall in a ward patient to age, review the medicines
Review the medicine list and check postural blood pressure and glucose when an older inpatient falls or becomes confused.
The 2025 VA/DoD lipid guideline adds PREVENT, lipoprotein(a) and calcium scoring
Consider adding one-time lipoprotein(a) testing and, where risk is uncertain, calcium scoring to your risk assessment, while following your own institution's guideline.
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