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The Top Trending Clinical Topics of 2018

Ryan Syrek, MA | December 10, 2018 | Contributor Information

The Top Trending Clinical Topics of 2018

Each week, Medscape selects a search term or key phrase that increased in popularity to be that week's top trending clinical topic. We then identify the news or new study that may have captured the interest of healthcare professionals on the subject and combine that with an infographic on key related information.

What follows is a collection of the top trending clinical topics for all of 2018. Everything from a study involving the Mona Lisa to potentially practice-changing information on one of the most commonly administered drugs helped place these terms into the annual top 10. You may be surprised what made the list and why.

The Top Trending Clinical Topics of 2018

Ryan Syrek, MA | December 10, 2018 | Contributor Information

Trend 10: Restless Legs Syndrome

In early February, three studies appeared to inspire interest in our 10th overall top trending clinical topic for 2018.

Initially, a report described 13 new risk loci for restless legs syndrome (RLS) and confirmed six previously identified loci. The findings verified that MEIS1 is indeed the strongest genetic risk factor for the syndrome. Alarmingly, a separate study in Neurology found that women with RLS had a higher cardiovascular disease mortality rate compared with women without the condition. This increased risk was not fully attributable to comorbid disorders associated with RLS.

Finally, a study in Mayo Clinic Proceedings explored the use of opioids in patients with RLS. The findings suggest that opioids may be life-transforming, because effective doses were considerably lower than those used for patients with chronic pain. The risk for opioid use disorder was determined to be low, although caution in prescribing and monitoring was recommended.

From the risk factors both for and associated with RLS to the potential treatments for the condition, these studies helped push this search term to the top.

For more information on RLS, read here.

The Top Trending Clinical Topics of 2018

Ryan Syrek, MA | December 10, 2018 | Contributor Information

Trend 9: Migraine

An important association and several new findings about treatment and prevention options for migraine, as presented at the American Headache Society (AHS) Annual Meeting, led to the increased popularity of our ninth overall trending clinical topic of 2018.

Initially, study results indicating an association between chronic migraine and cognitive impairment were reported at the meeting. Unlike previous research, which had indicated a potential role for the anticonvulsant topiramate as well as a possible role for depressive disorder, anxiety disorder, and nonreparative sleep in cognitive impairment, migraine was the only relevant factor in this study associated with worse performance.

A separate study presented at the meeting found that the oral calcitonin gene-related peptide (CGRP) rimegepant performed well compared with placebo in a phase 3 trial in treating a single, acute migraine attack. Freedom from pain was reported by 20% of participants in the active treatment group 2 hours after dosing, compared with 12% of the placebo group. Treatment of photophobia was even more pronounced, with 38% of those receiving rimegepant reporting relief compared with 25% of the placebo group.

Another presentation at the meeting reported findings suggesting that the CGRP antagonist fremanezumab is associated with increased efficacy, better tolerance, and greater functional improvement in the prevention of chronic migraine compared with topiramate. Topiramate was also found to be inferior to onabotulinumtoxinA in the prevention of chronic migraine in a separate head-to-head, prospective, open-label study. The AHS Annual Meeting clearly provided plenty of material that resulted in migraine becoming the top trending clinical topic in late July and one of the top topics of the year.

For more information on migraine headache, read here.

The Top Trending Clinical Topics of 2018

Ryan Syrek, MA | December 10, 2018 | Contributor Information

Trend 8: Mediterranean Diet

Last year's annual ranking of the healthiest plans for weight loss—combined with countless New Year's resolutions—inspired the top trending clinical topic in early January.

This year's U.S. News & World Report ranking of diets revealed a tie for the top spot, between the DASH (Dietary Approaches to Stop Hypertension) diet and the Mediterranean diet. Both emphasize fruits, vegetables, whole grains, lean proteins, and moderate alcohol intake. The two diets also tied for first place as the best diet for people with diabetes. However, the Mediterranean diet was ranked as the easiest to follow. In addition to weight loss, the Mediterranean diet has been linked to a reduction in the incidence of various diseases, including heart disease and certain cancers. As healthcare professionals looked to provide the best advice to patients seeking to improve their dietary health, "Mediterranean diet" wound up being one of the top trending clinical topics of 2018.

For more information on diet and weight loss in overweight and obese individuals, read here.

The Top Trending Clinical Topics of 2018

Ryan Syrek, MA | December 10, 2018 | Contributor Information

Trend 7: Gout

New treatment information, insight into risk factors, and news about potentially serious comorbidities helped increase the popularity of our seventh overall trending clinical topic of 2018.

In September, results of a new study revealed that canakinumab, an interleukin (IL)1beta blocker, significantly reduced the risk for gout attacks. However, it did not alter serum uric acid levels. Several other studies have demonstrated a benefit in blocking IL-1beta during acute gout attacks, but this was the first such study to indicate a role in prevention. Most notably, this drug may be useful for patients who did not benefit from other therapies.

A separate study that examined allopurinol found that use of the drug to manage gout may also protect against chronic kidney disease (CKD). Because CKD affects 20% of people with gout, compared with only 5% of individuals without, this finding may be particularly helpful. The American College of Radiology has suggested that patients with advanced kidney disease and gout begin treatment with low starting doses, because allopurinol hypersensitivity syndrome that affects renal function is a concern.

In terms of prevention, a new study suggests that the assumption that gout is mainly caused by diet may not be accurate. A study of more than 16,000 patients found that 24% of variance in serum uric acid levels was attributed to genetic factors, whereas only 1% of variance was attributed to food and diet. However, patients are still advised to follow guideline recommendations regarding diet modifications to avoid high-risk foods.

Lifestyle changes are still indicated to help prevent acute gout attacks. This is especially important, considering a new survey that found that more than one fifth (22%) of adults with arthritis have anxiety. What's more, 12% of patients with arthritis report depression. Those seeking to help patients avoid these serious comorbidities no doubt helped gout become the top trending clinical topic in mid-October.

For more information on gout, read here.

The Top Trending Clinical Topics of 2018

Ryan Syrek, MA | December 10, 2018 | Contributor Information

Trend 6: Sleep

A study revealing a potentially concerning association and a new drug approval helped push a basic component of daily health to become the top trending clinical topic in late August.

Although the Centers for Disease Control and Prevention recommends that adults aged 18-60 years get 7 or more hours of sleep per night, a new study found that more sleep isn't necessarily better. New research suggests that people who sleep longer than 8 hours each night may be at higher risk for premature death and development of cardiovascular disease. The study found that sleeping for 9 hours increased the risk of dying from any cause by 14%, sleeping 10 hours increased the risk by 30%, and sleeping for 11 hours increased the risk by 47%. The researchers also found that poor sleep quality was associated with a 44% increased risk for coronary heart disease.

Meanwhile, the US Food and Drug Administration approved Jornay PM, a methylphenidate formulation intended to help control symptoms of attention-deficit/hyperactivity disorder (ADHD) in children. The drug is administered before sleep, between 6:30 PM and 9:30 PM, to provide early-morning control of ADHD symptoms in children aged 6 years and older. The drug has two functional film coatings; the first delays the initial release of the drug for as long as 10 hours, and the second controls the rate of the active ingredient's release throughout the day.

Although sleep is often on the mind of most healthcare professionals, concern about too much of it and a novel drug helped make the term one of the year's top trending subjects.

For more information on normal sleep and sleep physiology, read here.

The Top Trending Clinical Topics of 2018

Ryan Syrek, MA | December 10, 2018 | Contributor Information

Trend 5: Carpal Tunnel Syndrome

An interesting occupational hazard contributed to the popularity of the top trending clinical topic in early April.

In March, the Centers for Disease Control and Prevention released a report suggesting that workers who harvest and process cannabis should be aware of carpal tunnel syndrome symptoms. Specifically, the findings showed that individuals who perform highly repetitive work, most notably "hand trimming activities," such as clipping cannabis leaves, are at increased risk for such conditions as carpal tunnel syndrome. The study may have garnered attention for its eye-catching association with marijuana cultivation, but carpal tunnel syndrome is a concern of workers in many different fields.

For more information on carpal tunnel syndrome, read here.

The Top Trending Clinical Topics of 2018

Ryan Syrek, MA | December 10, 2018 | Contributor Information

Trend 4: Aspirin

Two major trials presented at this year's European Society of Cardiology Congress are largely responsible for our fourth overall trending clinical topic of 2018.

A Study of Cardiovascular Events in Diabetes (ASCEND) included more than 15,000 middle-aged patients with diabetes but without evident heart disease. Results indicated that aspirin (100 mg daily) significantly reduced the risk for serious vascular events by 12% but raised the risk for major bleeding by 29%. However, the use of aspirin had no effect on overall mortality and did not increase fatal bleeding. The findings also revealed no effect on the rate of gastrointestinal cancer.

The Aspirin to Reduce Risk of Initial Vascular Events (ARRIVE) trial included 12,500 adults with presumed moderate risk for heart disease but without any evident heart disease. The results indicated that a daily dose of aspirin (100 mg) did not reduce the long-term risk for cardiovascular or cerebrovascular events or the risk for stroke. Although daily aspirin was associated with more gastrointestinal bleeding, such events were few (< 1%). As with the ASCEND trial, aspirin did not affect overall mortality or increase fatal bleeding incidents.

The results of these studies have combined to challenge the common practice of putting certain at-risk patients on daily aspirin. As experts reevaluate the role of this medication, they are emphasizing other strategies to reduce risks, such as weight loss, exercise, blood pressure management, and nicotine cessation.

For more information on cardiovascular disease prevention, read here.

The Top Trending Clinical Topics of 2018

Ryan Syrek, MA | December 10, 2018 | Contributor Information

Trend 3: Atrial Fibrillation

An important statement about screening, as well as several revealing studies, led to this trending clinical topic in mid-August.

The US Preventive Services Task Force (USPSTF) issued a final statement concluding that evidence is insufficient to warrant screening for atrial fibrillation in asymptomatic adults. The recommendation was made after the USPSTF performed a detailed review of available evidence on screening for previously undiagnosed atrial fibrillation, along with the benefits and harms of stroke prevention. With regard to diagnosing the condition, a new study found that using a home-based, wearable ECG sensor patch for continuous cardiac monitoring may aid in early detection among high-risk patients. The results showed that asymptomatic atrial fibrillation can be easily detected using a self-applied ECG patch.

This is welcome news, as a separate study determined that atrial fibrillation is associated with a higher risk for ischemic stroke than atrial flutter. In that study, patients with atrial fibrillation also had a higher risk for heart failure hospitalization and all-cause mortality compared with patients with atrial flutter and control participants. Given that an estimated 2.7-6.1 million Americans have atrial fibrillation—and that number is expected to rise—this week's top search term is likely to stay popular for quite some time.

For more information on atrial fibrillation, read here.

The Top Trending Clinical Topics of 2018

Ryan Syrek, MA | December 10, 2018 | Contributor Information

Trend 2: Hypothyroidism

News about an artistic diagnosis, an important annual meeting, a potential new diet, and surprising treatment recommendations resulted in our second overall trending clinical topic for 2018.

In a letter published in Mayo Clinic Proceedings, two experts suggest that the appearance of the Mona Lisa may be attributable to hypothyroidism. Pointing not only to visual evidence but dietary patterns of the time, the authors suggest that "the enigma of the Mona Lisa can be resolved by a simple medical diagnosis of a hypothyroidism-related illness."

In more clinically applicable news, the 2018 Annual Meeting of the American Thyroid Association held its 88th conference in October. An overview of hypothyroidism treatments was covered in the annual Clark T. Sawin historical presentation. Advanced thyroid cancer was a key focus, because the condition has remained a challenge despite improved outcomes associated with many other cancer types. Two studies on novel RET oncogene-targeted therapies for metastatic medullary thyroid cancer were presented, and various symposiums on thyroid surgeries and molecular markers were eagerly received.

Recent discussion has also focused on a potential "thyroid diet." For conditions ranging from hypothyroidism to hyperthyroidism and thyroid nodules, nutrition is a significant concern. Consumption of iodine; cruciferous vegetables; soy; various trace minerals; and other dietary products, such as coffee and alcohol, has an impact on various thyroid conditions. In terms of specific treatment, a recent meta-analysis concluded that treatment of subclinical hypothyroidism with levothyroxine is not associated with improvements in quality of life or thyroid-related symptoms. Although common, the treatment may be unnecessary for those with symptoms that may not actually be caused by hypothyroidism. Although some guidelines do suggest treatment in this patient population, the results of this meta-analysis have prompted much discussion.

For more information on hypothyroidism, read here.

The Top Trending Clinical Topics of 2018

Ryan Syrek, MA | December 10, 2018 | Contributor Information

Trend 1: ACE Inhibitors

A study that found a worrisome association, new guidance for disease treatment among younger patients, and medication behaviors in pregnant women resulted in the top trending clinical topic for 2018.

A recent large, population-based cohort study found that the use of angiotensin-converting enzyme (ACE) inhibitors to lower blood pressure was associated with an increased risk of developing lung cancer. Given the widespread use of ACE inhibitors to treat patients with hypertension, this association may mean that a large number of patients are at risk. The analysis of almost 1 million patients found that those who took ACE inhibitors for more than 5 years were at increased risk for lung cancer compared with those who took angiotensin-receptor blockers, but those who used ACE inhibitors for less than 5 years were not at increased risk.

ACE inhibitors were also included in a recent guideline released by the International Society for Pediatric and Adolescent Diabetes. The drugs are recommended for use in children with diabetes and hypertension, because they were proven safe in short-term studies.

Meanwhile, new data revealed that many women with chronic hypertension stop taking antihypertensive medications, including ACE inhibitors, when they become pregnant. The study found that many women never filled prescriptions for antihypertensive medications during pregnancy, even those with evidence of poorly controlled blood pressure. Researchers suggest that additional studies are needed to understand the impact of this finding on women's long-term health. Given the popularity of this year's top trending clinical topic, many will be eagerly awaiting further findings.

For more on ACE inhibitor dosing, read here.


Clinical Trends

This page contains all the weekly trending clinical topics from throughout the year and is updated every Friday with a new infographic.
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