Internal Medicine

Routine ADRD screening in primary care did not benefit family caregivers

This multisite RCT randomized 1,808 older adult–family dyads to dementia screening (with or without facilitated follow-up) versus no screening in primary care. Only 5.1% of patients screened positive, and more than one-third of those assigned to follow-up declined diagnostic assessment. At 24 months, SF-36 physical and mental component scores did not differ between combined screening groups and no-screening controls. Caregiver preparedness, caregiving self-efficacy, and depression or anxiety also showed no improvement with screening, and no clear psychological harms emerged. 1

Prediabetes independently elevated 5-year ASCVD risk, especially in young and obese adults

This Kaiser Permanente cohort included 1,358,882 adults aged 18–90 years without prior ASCVD or diabetes; 50.7% had prediabetes at baseline. Over 4.1 years’ mean follow-up, prediabetes conferred a 21% higher adjusted ASCVD risk versus normoglycemia (HR 1.21; 95% CI 1.18–1.25). Relative risk was greatest in adults aged 18–34 years (HR 1.54; 95% CI 1.18–2.02), identifying a particularly vulnerable group. Prediabetes with obesity carried higher 5-year ASCVD risk (HR 1.32) than prediabetes without obesity (HR 1.22) versus those with neither condition. 2

US use of nonstatin lipid-lowering therapies increased from 2019 to 2024

This cross-sectional study examined national trends in prescribing nonstatin lipid-lowering agents from 2019 to 2024 compared with statins. It characterizes real-world uptake of ezetimibe, PCSK9 inhibitors, and other nonstatins in contemporary US practice. The analysis highlights how clinicians are adding nonstatins to, or substituting them for, statins in ASCVD prevention and treatment. These patterns can help identify where nonstatin use aligns—or misaligns—with guideline-directed lipid management. 3

Adaptive mHealth program modestly reduced gestational weight gain in overweight and obese patients

This cluster-randomized trial enrolled 1,265 pregnant patients with BMI 25.0–<40.0 receiving care in an integrated health system. The intervention combined clinician motivational interviewing with an app delivering automated feedback, connected devices, education, and stepped lifestyle coaching. Weekly gestational weight gain was lower with the intervention versus standard care (0.25 vs 0.28 kg/week; mean difference −0.03 kg/week; 95% CI −0.05 to −0.01). Total gestational weight gain was also reduced (9.7 vs 10.6 kg; mean difference −0.87 kg; 95% CI −1.40 to −0.34). 4