Dispense As Written

For years, orthopedic surgeons have been sending patients home on aspirin alone after hip and knee replacement— and most of us in primary care and hospital medicine have been quietly uncomfortable with it. EPCAT III is a 5,000-patient double-blind RCT that finally puts the question to rest. The answer might surprise the skeptics. 📊Symptomatic VTE: 0.48% aspirin alone vs. 0.45% rivaroxaban-aspirin...

The Cochrane data is in: nicotine e-cigarettes beat nicotine replacement therapy for smoking cessation -- high-certainty evidence across 80 randomized controlled trials andnearly 30,000 patients. But there's a number buried in the results that the headlines missed, and your patients deserve to hear it.   In this episode, I break down the 2026 update of the Cochrane Living Systematic Review on...

For years, guidelines have told clinicians to target an LDL below 55 mg/dL in patients with established cardiovascular disease. There was just one problem: no randomized trial had ever directly compared that target to the previous goal of less than 70. The 2026 ACC/AHA Dyslipidemia Guideline recommended the stricter number on March 13th. Ez-PAVE published in the New England Journal two weeks later...

SURPASS-CVOT made headlines for proving tirzepatide is non-inferior to dulaglutide for cardiovascular outcomes. But before you let that result drive your clinical decisions, there's a question nobody asked: what exactly was dulaglutide's CV evidence built on? The REWIND trial — the landmark Lancet 2019 RCT that put dulaglutide on the CV map — is the foundation. And when you look closely, t...

Your patient has type 2 diabetes, established cardiovascular disease, and has been on tirzepatide for two years. Their A1c is down, their weight is down, and their triglycerides are better than they've been in a decade. The question every clinician should be asking: is any of that metabolic improvement actuallytranslating into fewer heart attacks and strokes? SURPASS-CVOT is the first randomiz...

A single 25 mg dose of psilocybin. One supervised session. And then — for the next six weeks — a clinically substantial reduction in depression scores, with no pill to refill and no daily adherence to manage. That's the claim from a Phase 2 RCT published in JAMA, and the numbers are hard to dismiss. The question isn't whether the signal is real. The question is whether you can trust it. Th...

Intermittent fasting has been one of the most hyped dietary interventions of the past decade — promoted on podcasts, social media, and wellness blogs as a metabolic cure-all. But what does the highest-quality evidence actually say? In this episode, Gregory Castelli, PharmD, FCCP, BCPS, BC-ADM, CDCES, breaks down a 2026 Cochrane systematic review and meta-analysis that analyzed 22 randomized contro...

Four episodes. One guideline. One honest answer to the question nobody asks at the end of a guideline review: what do we actually do now? This finale recaps the four key takeaways from the 2026 ACC/AHA Dyslipidemia series, addresses the non-statin evidence gap, and closes with the argument that matters most — the one about the patient sitting across from you. 📊 Four Takeaways: • COR 1 + LOE C-EO...

The new 2026 cholesterol guideline just replaced the national heart risk calculator — and 17 million Americans no longer qualify for a statin because of it. 4.1 million of them are currently taking one. Here's what makes this worth examining closely: ↳ The new PREVENT calculator cuts mean 10-year ASCVD risk nearly in half nationally (8.0% → 4.3%) ↳ Black adults saw the largest drop: 10.9% → 5....

The new 2026 ACC/AHA Dyslipidemia Guideline issued a Class 1 Recommendation for every adult in the US to get their Lipoprotein(a) measured once in a lifetime. But here is the catch: if you find it elevated, the guideline’s core recommendation is simply to optimize modifiable risk factors—the exact same care we should already be providing. With no completed outcomes trials yet proving that lowering...

The 2026 ACC/AHA Dyslipidemia Guideline sets LDL targets of less than 70 mg/dL for high-risk patients and less than 55 mg/dL for very high-risk patients. Those numbers will drive prescribing decisions for the next decade. Has anyone ever run a randomized trial where one group was treated to a target of 70 and another to 55, and compared what happened? When the guideline was published on March 13,...

The newly released 2026 ACC/AHA Dyslipidemia Guideline represents a massive collaborative effort across eleven co-signing societies, introducing critical updates like new LDL targets and universal Lp(a) screening. It is a vital playbook for primary care. However, implementing these updates effectively requires us to look closely at how recommendations are categorized. As clinicians, it is easy to...

Nearly 20 years after HPV vaccines were introduced, fewer than one in three eligible adolescent girls worldwide has ever been vaccinated. The barrier isn’t the science — it’s supply, access, and multi-dose schedules. If a single shot delivers the same protection as two, the public health implications are enormous. The ESCUDDO trial (Kreimer et al., NEJM 2025) enrolled over 20,000 girls across Cost...

Should I stop drinking coffee? For years, we’ve said yes — or at least probably. But that advice was built on zero randomized evidence. Observational data had been leaning the other way for years. Nobody actually ran the trial. Until now. The DECAF trial — Does Eliminating Coffee Avoid Fibrillation? — is the first randomized clinical trial to directly test caffeine in AFib patients after cardiover...

Your patient is still not at blood pressure goal after 1–3 months on a medication. Do you double the current dose — or add a second drug? Most clinicians double the dose. A 2025 Lancet meta-analysis of 484 double-blind, placebo-controlled randomized controlled trials has a definitive answer. And the math is not close. Doubling the dose buys you ~1.5 mmHg on average. Beta-blockers? Half a millimete...

Title: Tirzepatide vs Semaglutide: Which GLP-1 Wins? | SURMOUNT-5 TrialDescription:Head-to-head comparison: tirzepatide 15mg vs semaglutide 2.4mg for weight loss. SURMOUNT-5 trial breakdown in under 5 minutes. Evidence-based medicine, no fluff.📊 KEY FINDINGS:Tirzepatide: -20.2% weight loss at 72 weeksSemaglutide: -13.7% weight loss at 72 weeks48.4% vs 27.3% achieving ≥20% weight lossSimilar toler...