Background and objectives The calcimimetic cinacalcet reduced the risk of death or cardiovascular (CV) events in older, but not younger, patients with moderate to severe secondary hyperparathyroidism (HPT) who were receiving hemodialysis. To determine whether the lower risk in younger patients might be due to lower baseline CV risk and more frequent use of cointerventions that reduce parathyroid hormone (kidney transplantation, parathyroidectomy, and commercial cinacalcet use), this study examined the effects of cinacalcet in older ($65 years, n=1005) and younger (,65 years, n=2878) patients.Design, setting, participants, & measurements Evaluation of Cinacalcet HCl Therapy to Lower Cardiovascular Events (EVOLVE) was a global, multicenter, randomized placebo-controlled trial in 3883 prevalent patients on hemodialysis, whose outcomes included death, major CV events, and development of severe unremitting HPT. The age subgroup analysis was prespecified.Results Older patients had higher baseline prevalence of diabetes mellitus and CV comorbidity. Annualized rates of kidney transplantation and parathyroidectomy were .3-fold higher in younger relative to older patients and were more frequent in patients randomized to placebo. In older patients, the adjusted relative hazard (95% confidence interval) for the primary composite (CV) end point (cinacalcet versus placebo) was 0.70 (0.60 to 0.81); in younger patients, the relative hazard was 0.97 (0.86 to 1.09). Corresponding adjusted relative hazards for mortality were 0.68 (0.51 to 0.81) and 0.99 (0.86 to 1.13). Reduction in the risk of severe unremitting HPT was similar in both groups. ConclusionsIn the EVOLVE trial, cinacalcet decreased the risk of death and of major CV events in older, but not younger, patients with moderate to severe HPT who were receiving hemodialysis. Effect modification by age may be partly explained by differences in underlying CV risk and differential application of cointerventions that reduce parathyroid hormone.

Acute Idiopathic Scrotal Edema (AISE) is an uncommon cause of bilateral scrotal swelling encountered in primary care. AISE is usually seen in children; however, several case reports have shown that AISE can occur in adult males. We present an active duty adult male who presented with AISE while deployed in Afghanistan. The clinical course of AISE is usually benign with labs and ultrasound being unremarkable. Besides swelling, the most common symptom tends to be intense scrotal puritis. Treatment for AISE is watchful waiting and conservative therapy. Full symptom resolution usually occurs within 24 hours.

Sarcoidosis is a multisystem granulomatous disease that affects 10 to 20 people per 100,000 in the United States. Hypercalcemia is a known side effect of the disease and in rare instances has been shown to cause ST-segment elevation on electrocardiogram testing that mimics myocardial infarction. Herein, we present a rare case of a 55-year-old, asymptomatic African-American male with sarcoidosis and hydrochlorothiazide usage presenting with ST-segment elevation of the anterior leads secondary to hypercalcemia. Urgent cardiac catheterization showed normal coronary arteries without blockage. The patient's hypercalcemia was corrected with intravenous fluids and the ST-segment elevation resolved. The exact mechanism of ST-segment elevation induced hypercalcemia is unknown. Treatment of the underlying cause of the hypercalcemia is the mainstay of therapy.

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