Morning Report: Not Your Typical Medical Newsletter

We get it, you see a lot of medical newsletters, so hear us out. Twice a month, we’ll highlight important medical news sprinkled with witty commentary, fun facts, giveaways, and more… because learning should be fun! Subscribe to receive the Morning Report directly.

We’re back! You may or may not have noticed that you haven’t heard from us in a while. Morning Report has switched to a monthly cadence. Look for us in your inbox the first Saturday of every month. We pair well with that first cup of coffee.

“Wonder Drug” Not So Wonderful for Aspiring Fathers?


Some things we didn’t see coming: the Red Wedding, Tide PODS as a snack, a face slap at the Academy Awards, and certainly not bad press for metformin. This go-to medication has boasted an efficacy and safety profile that are the envy of most drugs, but a new study cautions against its use in would-be fathers.

In Denmark, an observational study of more than one million births looked for an association between preconception paternal use of diabetes medications and birth defects. Seven thousand of the offspring had fathers who had been exposed to metformin, insulin, and/or sulfonylureas. Major birth defects occurred in 3.3% of the original study group.

Unfortunately, researchers did identify a statistically significant increase in birth defects with diabetes medication use (a 40% odds increase), but only when it came to metformin. Those odds rose to 75% when the future fathers took metformin within three months of conception. Fortunately, researchers saw no difference in rates of birth defects with metformin use one year before or after conception. The predominant birth defect was genital defects, occurring only in boys.

Key takeaway

Despite this being an observational study in one non-US country, it’s the best data we have, and, unfortunately, it casts a pall over this wonder drug. While we wait for further studies, you may want to counsel aspiring fathers taking metformin to pause their intake for several months before conception. In general, discussing medication options in the context of reproductive goals with both men and women is invariably a good idea. And as always, encourage would-be parents to make smart overall health choices—like not consuming Tide PODS.

An Avocado a Day Keeps the Cardiologist Away?


We know things about avocados. They elevate any sandwich, salad, or dip. They’re a sure-fire Instagram “like” when pictured on toast. And somewhere, someone is eating one while quipping, “They’re high in fat—but it’s the good fat.” But what we haven’t known is how consumption of this fleshy fruit links with long-term cardiovascular (CV) outcomes—until now.

A large prospective study involving women from the Nurses’ Health Study and men from the Health Professionals Follow-Up Study explored the effect of avocado intake (assessed via a questionnaire every four years) on the risk of cardiovascular disease (CVD). After 30 years of follow-up (and a million tubs of guacamole—we’re guessing), the analysis showed the following:

  • Consuming two or more avocados each week may reduce CVD risk by 16% and coronary heart disease (CHD) by 21% in comparison with no consumption
  • The risk of CVD further decreases with each half-serving increase
  • There is no apparent association between avocado intake and stroke risk
  • Substituting avocado for dairy or processed meats yielded a 16% to 22% reduction in CVD risk

Key takeaway 

To these findings, we say, “Holy guacamole!” (Sorry, that was pit-iful). This study offers evidence that a fatty, delectable fruit that most (all?) patients enjoy may also confer cardiovascular protection—at least against CVD and CHD. Win-win! You may want to encourage patients to indulge in some form of avocado at least twice a week, ideally as a replacement for other fatty foods. However, patients should beware of pairing guacamole with an endless bowl of chips. That’s like exercising while drinking a beer. But otherwise, patients should feel free to indulge in avocados/guacamole. It’s worth the extra two bucks at Chipotle.

And the Winner Is…

Thank you all for posting your cartoon caption contest ideas. We were impressed! It was a tough call, but the Pri-Med team agreed that the following caption gave us the heartiest chortle.

“Unfortunately, it only worked for facial hair.”

Congratulations to Marilyn Gately, a physician associate from Fishers, Indiana, for penning this excellent caption!

Check out future issues of Morning Report for more cartoon caption contests.

A Guideline, a Scientific Statement, and a Recommendation Walked into a Newsletter…


Since we last emailed you, medical societies have been busier than Will Smith’s publicist. Here are three updates from the AHA, ACC, HFSA, and USPSTF we don’t want you to miss.

AHA/ACC/HFSA update guidelines for the management of heart failure

The new guidelines focus on preventing heart failure in patients exhibiting early signs of “pre-heart failure.” To that end, the societies redefined the stages of heart failure (A to D), emphasizing the need for treatment in stage A, when at-risk patients have not yet experienced structural changes or diminished heart function. Another important update: SGLT-2 inhibitors got promoted. This drug class joins the ranks of treatment options for patients with symptomatic heart failure. Unfortunately, this bump doesn’t come with a raise—just a corner office.

AHA issues first scientific statement on NAFLD and cardiovascular risk

At least one in four adults worldwide has non-alcoholic fatty liver disease (NAFLD), and it’s often missed in routine medical care. That’s the salient message from the AHA’s recently published scientific statement, meant to raise awareness of the disease and highlight its connection with atherosclerotic cardiovascular disease (ASCVD). The statement urges increased screening and a focus on lifestyle interventions to mitigate the risk for NAFLD and ASCVD.

USPSTF publishes updated recommendation on aspirin for primary prevention

Do not initiate aspirin intake for the primary prevention of cardiovascular disease in adults older than 60, recommends the USPSTF (D recommendation). However, adults aged 40 to 59 with a 10% or greater 10-year CVD risk may see a modest net benefit when taking a daily aspirin, so consider treatment for individual patients (C recommendation). Note the drop in starting age—40 is the new 50.

Rapid-Fire COVID-19 Updates


Reductions in Dementia Risk Within Sight?


Data have shown that vision impairment is a risk factor for dementia and that the majority of vision loss can be prevented or corrected. Armed with this knowledge, we could reasonably conclude that dementia prevention models should include vision impairment in their list of potentially modifiable risk factors. But no matter how hard you look, you won’t find it in important models like the one developed by The Lancet Commission, which is used to direct policy and care.

Should dementia prevention, intervention, and care models address vision loss? 

Researchers set their sights on answering that question in a large cross-sectional study of adults 50 years and older. They calculated the percentage of dementia cases in the United States that would potentially be prevented with the elimination of The Lancet Commission’s existing modifiable risk factors plus vision impairment.

Here’s the breakdown of potentially modifiable dementia risk factors and their population attributable fractions:

  • All risk factors: 62%
  • Hypertension: 12.4%
  • Obesity: 9.2%
  • Depression: 9.1%
  • Hearing loss: 7.0%
  • Traumatic brain injury: 6.1%
  • Diabetes: 5.1%
  • Smoking: 3.2%
  • Physical inactivity: 3.1%
  • Less education: 3.1%
  • Social isolation: 1.9%
  • Vision loss: 1.8%
  • Excessive alcohol consumption: 0.3%

Vision loss may fall toward the bottom of the list, but 1.8% represents a potentially substantial decrease in dementia cases (assuming vision correction can reduce the number of dementia cases in at-risk individuals). How many? More than 100,000 people would potentially avoid dementia, estimates the study’s authors. Given these findings, medical organizations may one day incorporate vision impairment into their dementia prevention models. Hindsight is 20/20.

Key takeaway

While we can’t say for sure whether vision loss leads to dementia, this study suggests that the association between vision impairment and dementia is real. These findings serve as a reminder to clinicians to routinely discuss vision concerns with patients, assess vision in all patients but especially older adults, and encourage patients to seek routine eye care. The message is clear: vision impairment should not be overlooked, so dust off that Snellen chart.

Interested in more healthcare news? Here are some other articles we don’t want you to miss:

Morning Report is written by:

  • Alissa Scott, Lead Author
  • Aylin Madore, MD, MEd, Author and Editor
  • Shira Page, RN, NP, Author and Editor

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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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