New Angina Study: Only Fools Rush In?

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New Angina Study: Only Fools Rush In?

Bear with us as we kick off the newsletter with an untimely reference. The movie Caddyshack struck comedy gold in 1980, so when Caddyshack II hit theaters eight years later, anyone looking for a belly laugh was faced with an important choice: sprint to the nearest theater or hold off and wait for some word-of-mouth feedback. Those who went with the “wait and see” approach ultimately saved themselves $4.11 and 98 minutes of their time. Sometimes, it pays to wait and see.

Is “wait and see” the right approach for angina as well?

A multinational observational study analyzed data from 32,691 patients with stable coronary artery disease (CAD), 22% (7,212) of whom reported angina at baseline. Among those patients with stable angina at baseline, the angina disappeared in almost 40% at one year without coronary revascularization. About 2% to 4% of patients without angina at baseline developed angina each year, but at five-year follow-up of all patients with angina, 7,773 had controlled angina. Approximately 84% of these patients had their angina controlled with no medication changes or revascularization at all. A small subset (11.1%) required increased anti-anginal medication, and only 4.5% required coronary revascularization during this period.

More good news!

Those patients whose angina resolved within the first year with conservative management (eg, no medication changes or revascularization) were not at higher risk of cardiovascular death or myocardial infarction than those who never experienced angina in the first place. However, those patients whose angina occurred or persisted beyond year one did show worse outcomes.

Given the fact that angina affects about a quarter of patients with stable CAD, take heart in this news. Waiting and watching may be a reasonable gameplan for many patients. If only Chevy Chase had waited to see if he could get a better script.

An Outbreak of Olympic Fever

We’ve waited four five long years for a glimpse of the Olympic flame, and it’s now burning brightly! Let’s not dwell on athletes’ positive COVID tests, controversial cardboard beds, or the inaccuracy of the “Tokyo 2020” branding. Instead, let’s focus on the grit and determination that catapulted these athletes to the pinnacle of their sport—the same grit and determination that undoubtedly carried you through medical or nursing school. Although your late-night fuel may have involved a little less protein powder and a little more caffeine.

That got us thinking. Surely, on a Venn diagram of Olympians and clinicians, a hearty overlap exists. We can confirm anecdotally that it does! Here are a few Olympians-turned-clinicians:

Amy Chow, MD

This key member of the famed 1996 “Magnificent Seven” Olympic gymnastics team earned an Olympic medal of every color and was the first American woman to land “a double-twisting Yurchenko vault and a tucked double-double bars dismount” in an international competition. We don’t pretend to know what that is, but it sounds perilous. After hanging up her leotard, Dr. Chow earned her medical degree from Stanford Medical School and is now a general pediatrician with a thriving private practice in California.

Bill Baker, MD

Hockey defenseman Bill Baker and the rest of the 1980 US men’s hockey team skated into Olympic immortality at the Lake Placid Winter Games. They won gold by way of a semi-final upset of the powerhouse Russian team, whose victory was as guaranteed as a bad decision on The Bachelor. Dr. Baker transferred his dexterity with a hockey stick to a scalpel, successfully performing countless major jaw surgeries as an oral surgeon in Minnesota.

Tara Mounsey, NP 

Speaking of making ice hockey history, Tara Mounsey and her teammates won gold at the first women’s Olympic ice hockey competition, held in 1998. A string of athletic injuries led her into a career as an orthopedic nurse practitioner at New England Baptist Hospital in Boston, Massachusetts, where she is undoubtedly helping the next generation of Olympic hopefuls.

Dot Richardson, MD

In 1996, shortstop Dorothy “Dot” Richardson led her team to the first ever Olympic women’s softball victory and followed it up with another gold-medal performance in 2000. Off the field, she earned her medical degree at the University of Louisville School of Medicine. She took a leave of absence from her orthopedic residency program at the University of Southern California to win the first of her gold medals—you know, the classic residency story.

Another thing these Olympians-turned-clinicians have in common? They all played team sports, and according to a study from 2012, the dedication needed to excel in team sports may be a predictor of future success in the medical field, at least in otolaryngology.

As you’re watching the Olympians’ grit and determination on full display this week, consider that you may have more in common with these athletes than you once thought!

What Makes Your Heart Flutter?

Public speaking, calls from unknown numbers, Harry Styles, too much caffeine? New research published in JAMA Internal Medicine calls into question that last one.

The idea that caffeine consumption increases cardiac arrhythmias is common, and you may have even counseled your patients to avoid too much caffeine for this reason. However, a recent prospective cohort study examined 12 years of longitudinal data from the UK Biobank, including more than 380,000 people. The study looked at the effect of coffee intake and genes that impact caffeine metabolism on any cardiac arrhythmia.

What they found might make you add an extra shot to your venti shaken iced espresso with almond milk cold brew foam with a sugar-free caramel drizzle (just kidding, we know none of our readers’ drink orders are that high maintenance). After adjusting for demographics, comorbidities, and lifestyle, each added cup of habitual coffee was associated with a 3% relative risk reduction in incidents of arrhythmia.

You might be thinking, “Well, this won’t hold true for me—I don’t have a fully functioning CYP1A2 gene.” If you are thinking that, we are very impressed with your knowledge of your genetics and how they apply to coffee metabolism. Researchers performed a mendelian randomization analysis looking at caffeine metabolism and an analysis examining the interaction between coffee intake, caffeine, metabolism, and arrhythmia risk. They did not find any significant association between impaired coffee metabolism and arrhythmia risk, suggesting that regardless of caffeine-related genetics, more coffee will not increase arrhythmia risk.

Of note, this study evaluated “habitual” caffeine consumption, so this does not mean that if you down three energy drinks after reading this you won’t be in trouble. So, please advise patients against that.

Healthcare Humor

A man goes to the ophthalmologist for his eye test and is asked what he can see. “I see empty airports, empty football fields, closed theaters, and closed bars,” he says.

To which the ophthalmologist replies, “Perfect—you’ve got 2020 vision!”

Teach a Man to Fish and Extend His Lifetime?

“Not Eating Enough of This Nutrient May Be as Deadly as Smoking, Says New Study.” This alarming article title grabbed our attention. And when we learned that the “nutrient” was omega-3, we skidded into the fish section of the grocery store while googling “flax-seed encrusted salmon recipes.”

The original study compared a combination of red blood cell (RBC) long-chain omega-3 fatty acid levels with tried-and-true risk factors for cardiovascular disease to help predict all-cause mortality. The study included 2,240 community-based participants in their mid-60s, who were part of the Framingham Offspring Cohort. After an 11-year follow-up, researchers noticed that RBC fatty acid patterns were as predictive of risk for death as standard risk factors (smoking, diabetes status, blood pressure, cholesterol, etc.), and the higher the omega-3 index, the lower the risk.

Study co-author William S. Harris, PhD, FAHA, summed it up best: “… all things being equal—and of course they never are—people with an omega-3 index in the highest 20% of the population lived about 4.7 years longer, or after age 65, than people with an omega-3 index in the lowest 20%.” So, how does this compare to smoking, as the article title alluded? It turns out that being a regular smoker also reduces life expectancy by about 4.7 years.

Okay. So, let’s recap: a high level of omega-3 in blood erythrocytes is good. Got it. And fish is a great source of omega-3s. Got it. “But what about the mercury, polychlorinated biphenyls, dioxins, and pesticide residues?” asked Debbie Downer. At the end of the day, fish is still a good bang for your buck, so advise patients to take everything in moderation and with a grain of salt—feel free to throw in your own clichés as well.

Did You Know?

Your grandmother was right! Stress really can give you gray hair. With the help of high-resolution scanners, scientists confirmed a link between stress and loss of hair pigment.

“I could’ve told you that,” said everyone who experienced 2020.

Fear not, researchers also confirmed that pigment will return after the stress subsides.

So, before investing in Clairol to remove your stress highlights, maybe try out goat yoga.

We hear it’s not as baaaad as this joke.

Science Does It Again!

We’re geeking out over how incredible and life-changing science can be. A 36-year-old man with quadriparesis and anarthria due to a brain stem stroke 16 years prior was able to communicate with the help of an amazing new technology that can decode words right from the cerebral cortical activity.

A subdural electrode array was implanted over the left temporal lobe while deep-learning algorithms created computational models that, combined with a natural-language model, were trained to decipher words and sentences as the man tried to articulate speech. Mind blown.

But how well did it actually work? Surprisingly well! Eighty-one weeks and 50 training sessions after implantation, sentence decoding yielded a median accuracy of 75%. The error rate was superior to what is considered acceptable in everyday communication.

If only we had used this technology 20 minutes ago when asking Google for information on “goat yoga” and got results for goat Yoda—sound similar they do.

Rapid-Fire COVID-19 Updates

CDC weighs J&J vaccine risks vs benefits

The CDC’s Advisory Committee on Immunization Practices convened to discuss the possible link between Johnson & Johnson’s COVID-19 vaccine and Guillain-Barre syndrome. The verdict? They strongly recommend continued use of the vaccine, given that the risk is “very low.”

New mask mandate

On July 27, the CDC offered new guidance on mask wearing:

  1. 1) Everyone in areas of “substantial or high transmission” should wear a mask in public indoor settings—regardless of vaccination status!
  3. 2) Anyone in a school this fall should wear a mask—again, regardless of vaccination status.

Statins and COVID-19 severity

Patients taking statins have a 41% lower relative risk of in-hospital death from COVID-19, according to a new study. These findings support the continued use or initiation of statins when indicated for patients with underlying conditions.

Interested in more healthcare news? Here are some other articles we don’t want you to miss (subscription or payment may be required for abstract/full text):

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Please note that the summaries in Morning Report are intended to provide clinicians with a brief overview of an article, and while we do our best to select the most salient points, we ask that you please read the full article linked in each summary for clarification before making any practice-changing decisions.

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Not your typical medical newsletter… We get it, you see a lot of medical newsletters, so hear us out. This newsletter is intended to be fun, refreshing, and informative!

Every other week, we’ll highlight important medical news, sprinkled with some witty commentary, fun facts, giveaways, and more… because learning should be fun! Subscribe to receive the Morning Report directly.