The Curbsiders: CBD Liver Injury, IV Iron in HF, Bedtime BP Meds, RA & Carpal Tunnel, Finerenone for HFpEF

CBD-Induced Liver Injury

• 💡 A study in JAMA Internal Medicine investigated the effect of intermediate-dose CBD on liver enzymes and hormones in healthy individuals.
• ⚠️ Results showed elevated liver enzymes in more patients receiving CBD compared to placebo, suggesting a potential for drug-induced liver injury even in a healthy population.
• 🔬 Limitations include short-term follow-up and the need for further research on long-term liver function changes.
• 🗣️ The discussion highlighted the importance of directly asking patients about CBD use due to its widespread consumption.

IV Iron for Heart Failure with Reduced Ejection Fraction (HFrEF)

• 💔 The FAIR-HF2 trial investigated high-dose IV iron (ferric carboxymaltose) in ambulatory patients with HFrEF and iron deficiency.
• 📉 Topline results indicated a negative trial, with no significant reduction in cardiovascular death or heart failure hospitalization compared to placebo.
• 📊 The study's primary outcome was changed due to the COVID-19 pandemic, and a Hotchberg procedure was used to account for multiple comparisons, leading to a more stringent p-value criterion.
• 🤔 Despite the negative findings, investigators and editorialists suggest that IV iron may still benefit certain subgroups, and further research is warranted, potentially with different IV iron formulations.

Bedtime Blood Pressure Medication Timing

• ⏰ The BedMed trial aimed to definitively answer whether taking antihypertensives at bedtime is superior to morning dosing for cardiovascular risk reduction.
• 📊 The trial, stopped early due to funding constraints, found no significant difference in all-cause death or hospitalization for stroke, MI, or heart failure between bedtime and morning dosing groups.
• 📈 While prior studies suggested a benefit to nighttime dosing, this large, pragmatic trial did not replicate those findings, increasing confidence that there is likely no large benefit.
• ✅ The study concluded that it is safe to take blood pressure medications at night, and patients can take them whenever makes the most sense for adherence, though morning dosing may be easier for some.

Carpal Tunnel Syndrome and Rheumatoid Arthritis (RA)

• 📌 A population-based study explored the occurrence of carpal Tunnel Syndrome (CTS) before and after an incident diagnosis of Rheumatoid Arthritis (RA).
• 📈 The study found a twofold increased risk of CTS in the years prior to an RA diagnosis and a 1.8-fold increased risk after diagnosis, suggesting an association.
• 🔍 This association was slightly more pronounced in seronegative RA patients, though not statistically significant.
• 💡 While not compelling enough to warrant routine screening for RA in all CTS patients, the findings suggest it's important to consider RA in patients with worsening or atypical CTS symptoms.

Finerenone for Heart Failure with Preserved Ejection Fraction (HFpEF)

• 🚀 Finerenone, a non-steroidal mineralocorticoid receptor antagonist, is now FDA approved to treat heart failure with an ejection fraction at or above 40% (HFpEF).
• ✅ This approval is based on the FINEARTS-HF trial, which demonstrated a reduction in worsening heart failure events, though not cardiovascular death.
• ⚖️ Finerenone offers an alternative to spironolactone for HFpEF, with potential benefits in balanced heart and kidney distribution, though cost may be a factor.
• 🏥 Current guidelines suggest a weaker recommendation (2B) for MRAs in HFpEF, but this is expected to be upgraded following the FINEARTS-HF trial results.