Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
#1 Use of Statins in the Elderly
51 Plays3 years ago
Elderly patients over age 75 have the highest rate of statin use in the United States, but should this be the case? Are elderly patients more likely to be helped or harmed by these medications? Drs. Bobby Scott and Sandy Robertson discuss the evidence in the medical literature surrounding this topic in an attempt to answer these questions and more...
Plus, Dr. Dawn Caviness answers a clinical question about the use of aspirin for pre-eclampsia prevention.
If you liked the episode, please leave a positive review and subscribe! Tell your colleagues and friends!
Comments/Questions/Suggestions? Email us at whatstheproofpodcast@gmail.com or find us on Twitter @theproofpodcast!
Credits:
- Hosts: Bobby Scott, MD, FAAFP; Sandy Robertson, PharmD; Dawn Caviness, MD, BSN
- Production & Cover Art: Bobby Scott, MD, FAAFP
- Music: Twisterium, MondayHopes, Muzaproduction, and SergeQuadrado from Pixabay
Recommended
Transcript
Introduction to Evidence-Based Decision-Making
00:00:00
Speaker
You are listening to the What's the Proof podcast, where we seek to help doctors and other clinicians incorporate the best available evidence into their everyday clinical decision making. The content of this podcast is meant for educational purposes only and should not be construed as personalized medical advice. The views and opinions expressed are those of the host and guest, and no content on this podcast has been approved or sanctioned by Atrium Health.
Hosts and Episode Topic Announcement
00:00:36
Speaker
Welcome everybody to the inaugural episode of What's the Proof podcast. My name is Bobby Scott and I'm a clinical assistant professor at the Cabarrus Family Medicine Residency Program in Concord, North Carolina. With me today, I have one of our amazing hosts, Dr. Sandy Robertson, who's a PharmD and is an associate professor here at Cabarrus Family Medicine.
00:00:56
Speaker
And joining us a bit later would be Dawn Kavanas. She's a wonderful family physician who is assistant professor as well and one of our great faculty at the residency program. She'll be joining us for a special segment we have towards the end of the show.
Rise in Statin Use Among Elderly Patients
00:01:10
Speaker
But today's episode, really excited about talking about the use of statins in the elderly.
00:01:17
Speaker
So Sandy, statins are definitely one of the most frequently used medications in this country and possibly worldwide. Yes, they are. I know I've heard many, many times doctors saying a little statin should be sprinkled in the water supply. So we're very familiar with statins. We're very comfortable with prescribing them.
00:01:37
Speaker
Yes, Bobby, we are. It's very, very commonly prescribed. In fact, the rate of statin use for primary prevention has drastically increased in the past two decades. We know that in 1999, 8.8% of adults were taking a statin for primary prevention, but by 2012, 34% were on a statin.
00:01:58
Speaker
The biggest increase in that is among our elderly patients. We know from the NHANES survey in 2014 that those patients 75 years or older had the highest rate of statin use at 47.6%. When you compare that with age 60 to 74 at 43% and then only 17.4% of those aged 40 to 59, it becomes very apparent that we need to be confident
Evidence Supporting Statin Use in the Elderly?
00:02:25
Speaker
and what our data is surrounding our elderly patients. So Bobby, what is the evidence to support this drastic increase in statin use for the elderly? Yeah, great question. I think by the end, by the early to mid 2000s, we had a pretty good idea from the literature that statins were effective at reducing overall mortality, as well as the risk of cardiovascular events for adults who already had cardiovascular disease or they were high risk for developing cardiovascular disease.
00:02:55
Speaker
However, the clinical trials we had mostly did not include older adults, particularly those above the age of 70. So the evidence for benefit and safety in those patients was pretty limited. So probably the best evidence available at the time
00:03:11
Speaker
regarding the use of statins in older patients was first probably the PROSPER trial, which was a randomized controlled trial. It was published in 2002. Nearly 6,000 patients that were between the age of 70 to 84 with either a history of cardiovascular disease or risk factors for cardiovascular disease, and they followed them for about three years. The primary outcome was a composite outcome, meaning they combined
00:03:36
Speaker
some outcomes including cardiovascular death, MI, stroke, and we're comparing Pravastatin versus placebo. And what they found was there was no difference in overall mortality overall. There was a reduction in the primary outcome, the composite outcome, and a reduction in death from cardiovascular disease. Now these were pretty good benefits. I mean, the number needed to treat for the primary outcome was 48.
00:04:03
Speaker
And a number needed to treat him 107 for reduction in cardiovascular death. So not bad. When you look at the overall all-cause mortality, it's interesting because there was actually no net benefit in all-cause mortality because there was roughly an equivalent increase in death from cancer, which was surprising at the time. And so when you look at these outcomes, they were actually outcomes looking at the whole population in the study. But when they went back and looked at the subgroup that was just for primary prevention,
00:04:32
Speaker
there was actually no significant difference in outcomes for this group. Yes, it's disappointing that when you look at that subgroup analysis, there's no significant differences in the primary prevention group.
00:04:44
Speaker
Yeah. And in 2010, they did a subgroup analysis of another trial called the Jupiter trial, which had another, you know, 6,000 patients, 70 years or older. They were looking at Rosuvastatin versus placebo and looking at very similar outcomes, but they had a different composite. They had the usual kind of three mace outcomes, but they also added in revascularization and the rates of hospitalization for unstable angina.
00:05:10
Speaker
And this did show a statistically insignificant reduction in all-cause mortality. And it did show a reduction of cardiovascular events. But there are some significant limitations in this study. So first, the study population is a little bit unusual because it was made up of adults actually with normal cholesterol levels but had elevated high sensitivity CRP levels.
00:05:33
Speaker
So this is really probably not generalizable and the use of CRP is not really well established in the literature even at this point. Additionally, the reduction in the composite outcome appears to be mostly driven by a reduction in the rates of revascularization and the rates of hospitalization, which may reflect differences in clinical management rather than be purely related to the effects of the statin. Yeah, that's a little disappointing as well.
00:06:01
Speaker
So Sandy, what do you think? Looking back to the beginning of the last decade, do you think that this evidence was strong enough to justify that widespread use of statins in the elderly at the time?
Critique of 2013 ACC Guidelines
00:06:12
Speaker
That's a great question.
00:06:16
Speaker
I have a hard time saying a firm yes or no, but if I'm forced to give the answer, it's going to be no. Unfortunately, I think this appears to be something that we've jumped on a bit prematurely before we have some really concrete data. I get concerned when interventions like this becomes widespread practice without robust evidence to support its use. And this makes it ripe for what's called a medical reversal. Medical reversal. Okay, so that's interesting. What is that?
00:06:47
Speaker
A medical reversal is something that actually is very common in our practices these days. It's when a practice becomes widespread based on promising but ultimately insufficient evidence for its benefit, only to be proven later that it's either ineffective or even harmful.
00:07:05
Speaker
Unfortunately, it happens a lot more than we would like to admit, and as clinicians, it's difficult for us to know that medical reversals happen in our day-to-day practice. If you're interested in really learning more about it, there's a book that I would recommend called Ending Medical Reversal. It's written by Drs. Prasad in Sifu. I wouldn't say it's a nighttime read because it's going to upset you a little, so try not to get your feelings hurt if you read it, but it's worth it.
00:07:33
Speaker
So the interesting thing to ponder is where we are now in terms of statin use in the elderly. When the 2013 ACC guidelines were introduced, that's the first time the ASCVD risk estimator came out. One of the major criticisms of these guidelines was that many more patients would now be recommended to start a statin than they would have been previously.
00:07:54
Speaker
So it stands to reason that the percentage of elderly patients on statins may be even higher today than it was in 2012. Now granted, the 2013 guidelines recommended individualizing the approach when it came to patients 75 and older, but the recommendation stated it was to consider initiating a statin for primary prevention and secondary prevention.
00:08:17
Speaker
So now here we are a decade later, there are likely many more patients that were started on the statin in their late 60s and early 70s who are still taking their statin today and they're 75, 80 years of age. I think a lot of doctors aren't really sure what to do with these patients. I mean, should they keep them on it or should they take them off?
00:08:38
Speaker
Yeah, I know I've asked that question to myself many times. And yeah, I think that's a great segue into discussing what some of the current guidelines say about statins in the elderly.
Divergent Guidelines: ACC vs USPSTF
00:08:50
Speaker
You know, the most current guidelines came out and actually in 2019 from the ACC. And for secondary prevention in patient 75 and older, they actually suggest initiating a moderate or high intensity statin after
00:09:03
Speaker
weighing the risks and benefits, as well as patients' preferences. And they give this a moderate recommendation, and they suggest continuing it as long as it is tolerated in those patients. Now, for primary prevention, the guidelines say, consider initiating a moderate intensity statin
00:09:20
Speaker
if the patient has an LDL between 70 and 189, and then consider stopping it in two different situations. First, if the potential benefit declines significantly. So, for example, someone develops a significant physical or cognitive decline, they become very frail, their life expectancy is greatly reduced. I mean, that's pretty much a no-brainer, I think. I think so. And another suggestion they gave, which is,
00:09:46
Speaker
a little bit, I don't know how useful it is, but they suggest that you can obtain a CAC, a cardiac calcium score in patients between 76 and 80. And if their score is zero, then you can feel comfortable not doing a statin. Bobby, is that standard practice here in Concord? I would not say so, no.
00:10:10
Speaker
And it's important to note that when they give these recommendations, they label them as weak recommendations, so not based on really robust evidence at all. We also have the USPSTF, and they're currently in the process of updating their recommendation, but their most recent recommendation was in 2016. And at that time, they felt that the evidence was insufficient to assess the benefits and harms for starting statins for primary prevention in patients 76 and older.
00:10:40
Speaker
Okay, so these are conflicting recommendations. Yeah.
00:10:46
Speaker
If you follow the more aggressive ACC guideline, you may start and continue statins in the elderly based on the risk benefit ratio, which we all know isn't that easy to assess, right? Or you could follow the USPSTF and come to the conclusion that there's simply not enough evidence to support the use of statins in the elderly, and you probably aren't going to put your patients on them, right? So Dr. Scott, how do you decide which guideline to follow?
00:11:14
Speaker
Yeah, that's a tough question. So yeah, I would say the best that you can do in that situation is really just try to look at the evidence yourself. And then based on that, come to some kind of conclusion as to which organization's recommendation you feel is most trustworthy and most appropriate. But without knowing the evidence, it's really, really hard to do that. And Sandy, I know you're pretty well read on the evidence on this topic. So why don't you tell our listeners a little bit about
00:11:44
Speaker
What's the most recent
Mixed Evidence from Recent Studies
00:11:45
Speaker
evidence? What do we have in the last seven to eight years, 10 years that may inform us a little bit more? Hopefully we've got some more information than we used to. Yeah, I think we're getting some data. But unfortunately, some of our data over the last decade has been inconsistent. It's either observational studies or subgroup analysis from randomized controlled trials that specifically have an elderly demographic. And there's some limitations in these studies.
00:12:12
Speaker
One to note is the all-hat trials published in 2017. It had almost 3,000 patients aged 65 or older with elevated LDLs and hypertension, but no known CVDs. This was primary prevention. It was a private statin 40 milligram a day versus usual care, and most of those patients were not on a statin.
00:12:33
Speaker
And after six years of follow-up, there was no difference in all-cause mortality or cardiovascular event rates. I know in patients aged 65 to 74 and also in patients 75 or older. So that was a little disappointing. So no benefit? No, no benefit. Wow, okay. Right.
00:12:51
Speaker
Another interesting study was published in Lancet of 2019, so fairly recent. So we have a lot of statin trials, a lot of randomized control trials, and subsets of those have the appropriate elderly patients that we're looking for specifically to answer this question.
00:13:07
Speaker
And these researchers actually did a meta-analysis of 28 different randomized controlled trials with statins. They're called the Cholesterol Treatment Trialist Collaboration. They pulled together these 28 randomized controlled trials. Each trial had to have at least a thousand patients over the age of 75 in the trial and were followed for at least two years.
00:13:29
Speaker
They ended up with more than 14,000 patients 75 years or older in order to calculate the benefit or potential benefit. They found that 2.6% of patients on a statin suffered a major coronary event each year compared with 3% in the control group. So that is an NNT of 250, which is a little disappointing.
00:13:53
Speaker
And when you break that down into those who have had a history of cardiovascular disease, meaning secondary prevention, which consisted of 8,000 patients, there was a benefit. It was a reduction from 6.8% down to 6% in major coronary vascular events. So secondary prevention, it proved to be beneficial. However, in the subgroup of patients with no previous history of cardiovascular disease, there was no benefit.
00:14:21
Speaker
Now, there's some limitations to both of these trials, but today this is the best two studies that we have. Wow, okay, so both times, secondary prevention seems to have a benefit, but primary prevention, not so much. Jury's still out, yep. Got it, okay.
00:14:41
Speaker
Well, you know, Sandy, when we were prepping for the show, I came across this really interesting article and it seemed to get a fair amount of media attention when it came out back in 2020. It was a cohort study that was published in JAMA and it used VA data on about 300,000 veterans in the VA health system and patients that were 75 and older but had never been on a statin.
00:15:06
Speaker
And they found that 58,000 or so patients got started on a statin during the study, and it was ultimately associated with a lower risk for cardiovascular and all-cause mortality. Wow, okay. Yeah, and I read a few different media articles where they basically interviewing doctors, cardiologists about this, and mostly they ended up with these very positive conclusions being drawn about how this justifies the use of statins in the elderly.
00:15:32
Speaker
It kind of bothered me to be honest. I know where you're going with this. I think it's important that we look at this study from the proper perspective. It's a cohort study, which is an observational study that basically takes a group of people, you look forward and see how they're exposed to some kind of intervention. In this case, it's a statin.
00:15:53
Speaker
and basically just seeing what happens. And this is lower on the hierarchy of evidence than the gold standard randomized controlled trial. And the main weakness with these type of studies is that they really can't prove causality. They can't control for confounding variables. So you cannot be sure with high certainty that the statin was what made the difference for these people living longer.
00:16:19
Speaker
So not to dog on observational studies too much here, because they do have a benefit. They can be very helpful, for example, in identifying potentially beneficial treatments that we don't have randomized controlled trials to prove that they work. But what really gets me about the study is I'm not really sure I understand why it was done in the first place. We already have plenty of observational data that suggests statins
00:16:42
Speaker
may have some benefit in elderly patients.
The PREVENTABLE Trial
00:16:45
Speaker
So this study really does very little, I think, to help answer the question of whether statins are beneficial in elderly patients. Right. I agree. And unfortunately, I think we waste a lot of time and money on these types of studies that really aren't adding much to the conversation. Yeah, I think we've moved on into the wanting to confirm with randomized controlled trials. That's the stage where I am. You? Yes, very much so. And fortunately,
00:17:09
Speaker
There is a promising ongoing randomized controlled trial right now called the preventable trial. And in this study, the researchers are hoping to enroll 20,000 elderly patients, and they're going to randomize them to either a torvostatin or placebo, and studying multiple outcomes, but whether it helps prevent dementia,
00:17:29
Speaker
disability and preventing negative cardiovascular outcomes. Some of these questions we're trying to get answered right now. Great. So hopefully, after that all is said and done, we'll have some high quality evidence that will help further clarify this question of whether our older patients should be taking statins or not. Okay. Anyway, we've been talking about benefits, but we also need to think about what are the potential harms of statins in our elderly
Potential Risks of Statins
00:17:55
Speaker
patients. Sandy, tell us about that.
00:17:58
Speaker
Sure. I don't think I need to tell the audience of the common side effects that patients complain about with statins or obviously myalgias, myopathies. We know that there's a subset of patients that are more prone to that. And even though the randomized control trials do not show high percentages of myalgias and myopathies, we know that in general about 30% of patients complain about that. And that affects patient outcomes. That isn't an important thing to patients.
00:18:22
Speaker
When we have looked at who complains of myalgias or who has myopathy, we know that elderly patients on high dose statins with concomitant disease states, especially liver and renal dysfunction, are at higher risk of that. We don't know the exact number of patients that are going to complain and have those symptoms, nor do we know with definitive data who is at increased risk of falls because of these complaints. That is something that we still don't know about.
00:18:51
Speaker
The two concerning things that come up when you Google it and patients come in all the time are diabetes and cancer, and I think we need to address both of those. The cancer risk is really controversial. There in the PROSPER trial, the first trial that you talked about earlier in the segment, that was the trial that did show in the elderly population overall an increased risk of cancer.
00:19:12
Speaker
And that is concerning. However, other studies are not showing that. In fact, some site-specific cancer data with statin use shows a decreased risk of cancer. So we cannot definitively answer whether it increases or decreases your risk of cancer. And at this point, we're saying overall, there's no increased risk of cancer.
00:19:33
Speaker
when you look at all age populations. But in the elderly, I'm hoping the preventable trial might do that as a secondary outcome, certainly, to look at that if you have 20,000 patients potentially. The diabetes data is very confusing. There have been multiple meta-analyses that have looked at new onset diabetes in the setting of starting statin therapy.
00:19:56
Speaker
One published in Lancet of 2010 looked at 13 randomized controlled trials and looked at new onset diabetes. And the incidence was 4.9% in those patients taking statins versus 4.5%, which basically breaks down to you have to treat for four years with a statin in 255 patients to have one new case of diabetes.
00:20:18
Speaker
Most conclusions from all of the meta-analyses and all the authors support that overall the benefit outweighs the risk, even if you have diabetes as a diagnosis secondary to a statin. However, as a pharmacist, it's very difficult for me to explain that to a patient that this could potentially be a drug side effect, basically, which is diabetes. So I do find that that's difficult.
00:20:46
Speaker
Yeah. I mean, it's not nausea, right? And it's not even myalgias, which I know is uncomfortable, but it's not diabetes, correct? Typically, we have to treat diabetes with medications, and then that just kind of starts us down a different path. At this point, I don't discredit the data. We don't know for sure. I would recommend monitoring glucose levels and being open-minded and kind of remembering that this is a potential side effect for some patients.
00:21:15
Speaker
In addition, if I have a patient that just has an overwhelming anxiety about this, that is something for individualized shared decision making. And I really take that into account when I'm trying to counsel patients and decide what's best
Stance on Statins for Secondary Prevention
00:21:29
Speaker
for them.
00:21:29
Speaker
Yeah, absolutely. So I think with this area of primary prevention, you have this a whole bunch of uncertainty already. So, you know, the question of diabetes probably shouldn't, you know, shouldn't convince you one way or the other. I mean, there's a lot of uncertainty there as well. I agree. Okay, so we've talked about, you know, what's the evidence behind the benefits? What's the evidence behind the harm? So, Sandy, what would you say, what's your overall bottom line here? What should we do with statins in the elderly?
00:21:57
Speaker
That is a fantastic question, Bobby. How about I split it with you? I'm going to take the easy one and I'm going to let you take the hard one. Okay. All right. Fair enough. Here's my official stance. With a moderate level of certainty, I support the use of statins in the elderly for secondary prevention for those patients with established cardiovascular disease. I do. I support it. Yeah, I'd agree with that. Okay. With as long as they are tolerating it well and they are in support of it.
00:22:26
Speaker
Yes, for primary prevention, I'm going to ask you, how do you feel about initiating a statin for primary prevention in an elderly patient? Yeah, I think right now I would have to say that
00:22:42
Speaker
To me, I don't think there is enough evidence to make me feel confident in a clear benefit in initiating a statin in an elderly patient, particularly by the age of 75 or higher. 60 to 65 to 74 is a little bit, a little less certainty there too. But I'd say 75 and older, I don't feel confident starting a statin. Because I think there's a lot of conflicting limited evidence, but probably the best evidence that we have
00:23:11
Speaker
suggests that there's probably no benefit. So I probably would lean that way. Now if someone is already on a statin, I would suggest going back and looking at the reason why they were started on it in the first place. And if they're tolerating it well, having an individualized discussion, shared decision-making discussion about what the patient desires and
00:23:33
Speaker
of their fears. Right. And if they, you know, if they are having problems, if they just simply don't want to be on anymore, there's not enough evidence that's going to make me feel confident in trying to convince them to stay on it. I agree. I agree.
00:23:49
Speaker
We once again kind of come to the same conclusion, Dr. Scott. Wow. This is a tough one. I wonder how many of our audience members are disagreeing with us. Yeah, I guess we'll find out by the number of emails we get after this. I guess we will. Nothing would make me happier than to have
00:24:07
Speaker
a large study like the preventable trial to give me more confidence. I am trying my best not to fall into this medical reversal subset. And if the data comes out to change my opinion, I'm open for that.
00:24:22
Speaker
Yeah, absolutely. Me too. Gosh, fingers crossed. I know. Me too. Well, thank you so much, Sandy. This has been a really fun experience doing our first episode here. Next time we do this, we're going to look a little bit more into this prevention, cardiovascular disease prevention topic in the elderly when we look at aspirin. So stay tuned. It'll be another robust discussion.
00:24:47
Speaker
Alright, and now we're gonna move on to our new segment, Residents Ask the Darnedest Things with Dr. Dawn Kavaness. I'd like to welcome her onto the show.
00:24:58
Speaker
I'm excited to be here. Thanks for having me. Yeah, absolutely. I'm really excited. So this new segment is called Residents Ask the Darnedest Things. And we thought it would be fun. We all get asked great questions. That's one of the big reasons we enjoy teaching, is getting those hard questions. And the purpose of this segment, I think, is really to take a real question that we've gotten from a resident recently while precepting.
00:25:23
Speaker
talk a little bit about how we answered it, and then maybe some of the evidence that either supports or contradicts what we actually told them. And I think you had a great question recently about an OB patient. Yeah, so I had a resident ask me about an OB patient that had an elevated BMI, had a BMI of 35.
00:25:42
Speaker
and asked me if they should start them on aspirin for preeclampsia prevention. And I would like to say that I was one of those attendings that quickly rattled off the guidelines, but it's hard to keep those tables and guidelines memorized. And so I did what I have found I have done a lot as an attending is great question. Let's look that up together is what I said.
00:26:08
Speaker
And so one of the things that I use a lot is the US Preventive Task Services Task Force app and their website. So me and the resident just look back together and I find that that's a really useful tool that I would say most residents and attendings use, but I
Low-Dose Aspirin for Preeclampsia Prevention
00:26:29
Speaker
do find that sometimes it's not utilized. It's particularly when it comes to OB questions. Sure, yeah, I wouldn't think to do that.
00:26:35
Speaker
Yeah, so when there is good data, which often OB, we kind of have to search, and sometimes we always, sometimes it's expert opinion that we land on, but this is one of those questions that we actually have some pretty good data on. Oh, good. Yeah, let's hear about it.
00:26:49
Speaker
Yeah, so when you pull up in the app, you will see there's a pretty clear guideline about this. So the USPSTF recommends the use of low dose aspirin, 81 milligrams, as preventative medication for preeclampsia after 12 weeks of gestation in persons who are at high risk for preeclampsia. That's a B grade level recommendation.
00:27:13
Speaker
I guess the question is, who is high risk? The other thing I love about the app and their website is they have these lovely tables. If you want to get really into it and dig deeply, you can actually find the research behind it and those things that went into that grade B recommendation.
00:27:32
Speaker
Basically, the table that they have there in the app and on the website goes through risk factors that can be obtained from the patient medical history. And the guideline shows that recommended low-dose aspirin, it's for those patients that have one of these high risk factors, or if the patient has two or more moderate risk factors, they should be started on aspirin.
00:27:57
Speaker
Risk factors that are considered high-level risk factors would be history of preeclampsia, especially when accompanied by adverse outcome, multi-fetal gestation, chronic hypertension, pre-gestational type 1 or type 2 diabetes,
00:28:14
Speaker
kidney disease, autoimmune disease, or combinations of multiple moderate risk factors. That helps me jump over to the moderate risk factors. These factors are more independently associated with moderate risk for preeclampsia, and those are if a patient is nulliparous, obese with a BMI greater than 30, family history of preeclampsia, African American,
00:28:43
Speaker
lower income, age 35 years or older, personal history factors such as low birth weight or small for gestational age, previous adverse pregnancy outcome, or greater than 10 year pregnancy interval, and in vitro conception. And those that don't have those risk factors, there is not a recommendation to do low dose aspirin. So that is a lot, which is why we use the table and reference our tools.
00:29:09
Speaker
So the patient you had had the BMI risk factor and another one as well? Yeah. So that was the question, like what are the risk factors? So this was a nulliferous patient who also had an elevated BMI, meaning she had two of the moderate risks. And so therefore we started on aspirin, 81 milligrams. Wow. And you said this is level B data, meaning some randomized controlled trials?
00:29:34
Speaker
Yes. And I did not, I don't have those pulled right here. I could quickly pull those up. That's okay. I'm not going to have to do that today, but wow. Okay. So aspirin for prevention of preeclampsia and what kind of outcomes are we preventing when we do that? Just recurrent preeclampsia or is there other other outcomes too?
00:29:55
Speaker
Yeah, so it's a great question. So the benefits of taking aspirin as a preventative medication, there was adequate evidence that there is a reduction in the risk for preterm birth, SGA and UGR, and perinatal mortality in those that had this increased risk. And also, of course, there's a decreased risk in preeclampsia, which would lead to improved maternal and perinatal outcomes.
00:30:20
Speaker
Okay, so what is the key take-home point that you taught the resident in that scenario? The recommendation is the use of low-dose aspirin, 81 milligrams, as preventative medication for preeclampsia after 12 weeks of gestation in persons who are at high risk for preeclampsia. And that's a grade B recommendation, which means moderate certainty of substantial benefit.
Conclusion and Call for Engagement
00:30:45
Speaker
And that's going to wrap up our show today. Thank you very much for listening. If you enjoyed the podcast, please leave a review and hit that subscribe follow button in your podcast app of choice. For any questions or comments about today's episode, drop us an email at whatstheproofpodcastatgmail.com. We'll see you next time.