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Round Up Email August 2023

In this month's email highlights include the SYMPLIFY study is highlighted which provides evidence of improvements in diagnostic accuracy for cancer, a review of the evidence of use of colchicine in coronary heart disease; and evidence relating to statin treatment in the elderly.

Question 1
Low dose colchicine in coronary heart disease – the evidence regarding the use of colchicine in coronary heart disease is reviewed on GPnotebook: COLchicine Cardiovascular Outcomes Trial (COLCOT) - Efficacy and Safety of low-dose colchicine after myocardial infarction
1) With respect to use of colchicine in patients at high cardiovascular risk, which statement is false?
- the COLCOT trial showed that among patients with a recent myocardial infarction, daily colchicine led to a significantly lower risk of ischemic cardiovascular events than placebo
- the dose of colchicine used in the LoDoCo2 trial was 1.5mg per day
- the US Food and Drug Administration (FDA) has approved colchicine to reduce the risk of myocardial infarction (MI), stroke, coronary revascularization, and cardiovascular (CV) death in adult patients with established atherosclerotic disease or with multiple risk factors for CV disease
Question 2
Sexual HIV transmission risk if low viral load – can sexual HIV transmission occur if a patient has a low viral load? This question is addressed in this page on GPnotebook.: Sexual HIV transmission risk if low viral load
2) With respect to sexual transmission of HIV if the viral load is low, which statement is false?
- a review of 8 studies (7762 serodiscordant couples) found, of the 323 transmission events, none were in patients considered stably suppressed on anti-retroviral therapy
- a review of 8 studies (7762 serodiscordant couples) found, of the 323 transmission events, found sexual HIV transmission to be absent in cases involving less than 600 copies per mL
- commentary states that this study provides strong support against the global undetectable equals untransmittable (U=U) campaign
Question 3
Pubic symphysis dysfunction – what is the definition of this condition? How common is pubic symphysis dysfunction? Are multiparous more, or less, at risk of pubic symphysis dysfunction? Is pubic symphysis dysfunction more prevalent in Scandinavian countries?: Symphysis pubis dysfunction
3) With respect to pubic symphysis dysfunction, which statement is false?
- pubic symphysis separation of up to 9 mm is considered physiological in pregnancy
- multiparous women are at reduced risk of pubic symphysis dysfunction
- pubic symphysis dysfunction is more prevalent in Scandinavian countries
Question 4
SYMPLIFY trial – this important trial is summarised on GPnotebook.: SYMPLIFY - evaluation of methylation-based multicancer early detection (MCED) diagnostic test
4) With respect to the SYMPLIFY trial, which statement is false?
- blood-based multicancer early detection (MCED) tests measure cancer biomarkers, such as genetic and epigenetic changes in circulating tumour DNA or proteins produced by cancer cells
- the SYMPLIFY trial investigated the performance of a targeted methylation-based MCED test in symptomatic patients referred from primary care
- the SYMPLIFY trial showed a positive predictive value of about 50% (i.e. about 50% of patients referred with a positive test in this trial were found to have a cancer)
Question 5
Aspartame and cancer risk – this is summarised on GPnotebook.: Aspartame and cancer risk
5) With respect to aspartame and cancer risk, which statement is true?
- the International Agency for Research on Cancer (IARC) have classified aspartame as "possibly carcinogenic to humans"
- the International Agency for Research on Cancer (IARC) have classified aspartame as "probably carcinogenic to humans"
- the International Agency for Research on Cancer (IARC) have classified aspartame as "definitely carcinogenic to humans"
Question 6
Statin treatment in the elderly – more evidence regarding the age when statin treatment has evidence of benefit. The evidence relating to this area is summarised on GPnotebook.: Age and primary prevention of CHD
6) With respect to the use of statin treatment in the elderly, which statement is false?
- use the QRISK3 tool to calculate the estimated CVD risk within the next 10 years for people aged between 25 and 84 without CVD
- a review of the evidence by Marcellaud et al suggests that benefit of statins in primary prevention for patients older than 80 years is not certain
- the Copenhagen General Population Study (CGPS) concluded that people aged less than 70 years with elevated LDL cholesterol had the highest absolute risk of myocardial infarction

Round Up Email August 2023

Question 1

Question 2

Question 3

Question 4

Question 5

Question 6