Mayo Clinic proceedings
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Mayo Clinic proceedings · Nov 2024
ReviewAndrogen Society Position Paper on Cardiovascular Risk With Testosterone Therapy.
The Androgen Society is an international, multidisciplinary medical organization committed to advancing research and education in the field of testosterone deficiency and testosterone therapy (TTh). This position paper is written in response to results of the TRAVERSE study, published in June 2023, which reported no increased risk of major adverse cardiovascular events (MACE) in men who received TTh compared with placebo. In 2013-2014, 2 observational studies reported increased cardiovascular (CV) risks with TTh and received wide media attention. ⋯ Review of the prior literature reveals near uniformity of studies reporting no increased MACE with TTh. This includes 2 additional large randomized controlled trials, multiple smaller randomized controlled trials, several large observational studies, and 19 meta-analyses. In view of these findings, it is the position of the Androgen Society that it has now been conclusively determined that TTh is not associated with increased risks of heart attack, stroke, or CV death.
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Mayo Clinic proceedings · Nov 2024
ReviewEvaluation and Management of Female Stress Urinary Incontinence.
Female stress urinary incontinence, the loss of urine with transient increases in abdominal pressure, is a common condition that can profoundly impact a patient's quality of life. The diagnosis is most commonly made via clinical history, including the subjective degree of bother, and physical examination evidence of urinary leakage with cough or Valsalva maneuver. A variety of treatment options exist for stress incontinence, ranging from observation, pelvic floor physical therapy, vaginal inserts, or continence pessaries to procedural interventions. ⋯ Ultimately, shared decision-making between the patient and the physician is used to decide the management strategy. This collaborative approach facilitates alignment of the chosen intervention with the patient's unique circumstances and preferences. We review relevant clinical considerations in the evaluation and management of female stress incontinence.
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Mayo Clinic proceedings · Sep 2024
ReviewBariatric and Metabolic Surgery in the Adult Population: What a Primary Care Provider Needs to Know.
Obesity is a significant public health concern worldwide and a leading cause of preventable death and morbidity, but the management of this condition remains a challenge. Metabolic and bariatric surgery (MBS) is safe and currently has the most consistent and robust data among anti-obesity interventions for ameliorating obesity and its associated complications. Despite the benefits and safety of MBS, it is significantly underused. ⋯ The purpose of this review is to summarize key points of the 2022 American Society for Metabolic and Bariatric Surgery/International Federation for the Surgery of Obesity and Metabolic Disorders guidelines regarding MBS, as well as to discuss indications, benefits and risks, most common types of MBS, and barriers to access, thereby increasing awareness of MBS among primary care physicians. This narrative review was based on articles found by searching PubMed from its inception until April 2024 for the terms sleeve gastrectomy, gastric bypass, and metabolic and bariatric surgery. Our search was confined to English-language publications, with emphasis placed on evidence derived from systematic literature reviews, meta-analyses, and randomized clinical trials whenever available.
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Mayo Clinic proceedings · Sep 2024
Review Practice GuidelineThe Princeton IV Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease.
The Princeton Consensus (Expert Panel) Conference is a multispecialty collaborative symposium dedicated to optimizing sexual function and preserving cardiovascular health. The Fourth Princeton Consensus Conference was convened on March 10-11, 2023, at the Huntington Medical Research Institutes in Pasadena, California. Princeton panels I to III addressed the clinical management of men with erectile dysfunction (ED) who also had cardiovascular disease. ⋯ Mounting evidence supports the need for providers to treat men with ED as being at risk for cardiac events until proven otherwise. Algorithms for the diagnosis and treatment of ED are updated with new recommendations for coronary artery calcium scoring for advanced cardiovascular risk stratification. Optimization of oral phosphodiesterase type 5 inhibitors in the treatment of men with ED and cardiovascular disease is thoroughly explored, including recent evidence of potential cardioprotective effects of these drugs.
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Mayo Clinic proceedings · Sep 2024
ReviewDevelopments and Controversies in Invasive Diagnosis of Coronary Microvascular Dysfunction in Angina With Nonobstructive Coronary Arteries.
Approximately half of all coronary angiograms performed for angina do not show obstructive coronary artery disease, and many of these patients have coronary microvascular dysfunction (CMD). Invasive testing for CMD has increased with the advent and wider availability of thermodilution systems. We review CMD pathophysiology and invasive diagnostic testing using the Doppler and thermodilution systems. We report the results of a PubMed search of invasive microvascular testing and discuss limitations of current diagnostic algorithms in the diagnosis of CMD, including controversies regarding the optimal cutoff value for abnormal coronary flow reserve, use of microvascular resistance indices, and options for increasing sensitivity of testing.