Obesity should be managed in older adults. However, challenges in this age group include multimorbidity, polypharmacy, limited mobility and sensation, and, in particular, sarcopenia, a natural consequence of aging exacerbated by weight loss. Lifestyle recommendations should emphasize adequate protein intake and exercise, particularly strength training, adapted to mobility. Antiobesity medications and metabolic-bariatric surgery are useful in select patients.
Elevated lipoprotein(a) is an independent risk factor for atherosclerotic cardiovascular disease and aortic valve stenosis. Current lipid-lowering treatments have a minimal impact on lipoprotein(a) levels, but emerging therapies show promise, and ongoing phase 3 trials are evaluating their effect on cardiovascular outcomes. This review summarizes evidence on risk, screening strategies, and evolving therapies for elevated lipoprotein(a).
Although withholding these drugs before noncardiac surgery reduces the risk of intraoperative hypotension, recent trials suggest that it leads to harm in sicker patients. An individualized approach is safest, particularly in patients with heart failure. This review examines the emerging evidence regarding the impact of pausing vs continuing these drugs on intraoperative hypotension, myocardial injury, acute kidney injury, and postoperative outcomes.
Melanoma differentiation-associated gene 5 (MDA5) dermatomyositis, characterized by antibodies targeting MDA5, has recently emerged as a distinct subset of the idiopathic inflammatory myopathies. It is identified by distinctive clinical manifestations, including fever, characteristic skin lesions, nonerosive symmetrical polyarthritis, and rapidly progressive interstitial lung disease (ILD); often there is minimal to no muscle involvement. Classifying the disease into rapidly progressive ILD, rheumatic, and vasculopathic subtypes, as reported in some studies, may help predict prognosis. Prompt recognition of its unique clinical manifestations and initiation of aggressive immunosuppressive therapy are vital to improve outcomes in this potentially life-threatening condition.
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