Empowering Primary Care Through Evidence

Tools for Practice #347 Chlorthali-D’OH!: What is the best thiazide diuretic for hypertension?

Which thiazide diuretic is best at reducing cardiovascular events in hypertension?

Tools for Practice #346 – Stress Urinary Incontinence: Pelvic floor exercises or pessary?

How effective are pelvic floor exercises or pessaries for stress urinary incontinence?

Pelvic floor exercises increase the proportion of women with symptom improvement (74% versus 11%) and patient satisfaction (71% versus 13%) compared to control over 1-6 months. Pessaries may reduce incontinence episodes compared to no treatment based on one small, 2-week study. Exercise may be slightly better than pessary at three months (example: more patients without bothersome symptoms) with less vaginal discharge at 12 months. Read More

Tools for Practice #345 – Fancy Creams for Scaly Skin: Topical calcineurin inhibitors for atopic dermatitis

What are the risks and benefits of topical calcineurin inhibitors for atopic dermatitis?

For improvement of atopic dermatitis, tacrolimus 0.1% is at least equivalent to moderate-potency topical corticosteroids. Pimecrolimus 1% is better than placebo, but likely inferior to tacrolimus 0.1% and moderate potency corticosteroids. Burning skin sensation is common early (30-50% of users) but tapers off for most (<10% at 6 months). Read More

Tools for Practice #344 Statins in Older Adults

In patients ≥65 years old, do the benefits of statins outweigh harms?

For primary prevention patients aged 65-75 years, statins likely result in a 16-39% relative reduction in major adverse cardiac events (MACE). For primary prevention patients aged >75, the benefit of initiating statins is unclear. However, there is no evidence to support stopping statins when primary prevention patients age over 75 (just because of age). For secondary prevention patients over 65 years (and over 75), statins result in ~20% relative reduction in MACE. Adverse events are similar to placebo. Read More

Tools for Practice #343 Less is More Unless it’s Sleep or Toilet Paper: Non-traditional lipoproteins for cardiovascular risk

In patients without established cardiovascular disease (CVD), can lipoprotein(a) or apolipoprotein B meaningfully improve standard CVD risk estimation?

Adding lipoprotein(a) or apolipoprotein B does not meaningfully improve cardiovascular risk prediction above standard risk factors (age, sex, blood pressure, total cholesterol/HDL, diabetes, smoking). Assess risk with CVD risk calculators and offer proven therapies as appropriate. Read More