Archive for category: News

MI care pathways should adopt early combination therapy with statins and ezetimibe as standard practice. Delaying this approach or relying solely on high-intensity statin monotherapy has been linked to avoidable harm, underscoring the need for timely and effective lipid-lowering treatment (LLT).

Patients who receive an add-on medication soon after a heart attack have a significantly better prognosis than those who receive it later, or not all.

This is according to a new study from researchers at Lund University in Sweden and Imperial College London. The findings suggest that treating patients earlier with a combination of statins and the cholesterol-lowering drug ezetimibe could prevent thousands of new heart attacks over a decade.

Cardiovascular disease is by far the most common cause of death worldwide, with heart attack (‘myocardial infarction’) being the most common acute event. For those who survive a heart attack, the risk of a new heart attack is greatest in the first year after the initial event because the blood vessels are more sensitive, making it easier for blood clots to develop.

Reducing LDL or “bad” cholesterol in the blood can stabilise changes in the vessels, decreasing the risk for new events. The current treatment guidelines for patients are high-potency statins immediately after a heart attack, to lower their cholesterol levels. However, the majority of patients do not reach recommended cholesterol levels using only statins, and so need an add-on treatment, such as ezetimibe.

“Today’s guidelines recommend stepwise addition of lipid-lowering treatment. But it’s often the case that this escalation takes too long, it’s ineffective and patients are lost to follow-up,” says Margrét Leósdóttir, Associate Professor at Lund University and senior cardiology consultant at Skåne University Hospital in Malmö, Sweden. “By giving patients a combination treatment earlier, we could help to prevent many more heart attacks.”

Co-investigator Professor Kausik Ray, from Imperial College London’s School of Public Health, said: “This study shows that we could save lives and reduce further heart attacks by giving patients a combination of two low-cost drugs. But at the moment patients across the world aren’t receiving these drugs together. That’s causing unnecessary and avoidable heart attacks and deaths – and also places unnecessary costs on healthcare systems. Our study shows the way forward; care pathways must now change for patients after this type of heart event.”

In the latest study, the international team examined outcomes for heart attack patients if they received a combination of statins with the add-on therapy ezetimibe (within 12 weeks after a heart attack), statins with ezetimibe added later (between 13 weeks and 16 months), or just statins with no ezetimibe at all.

Based on Swedish registry data from 36,000 patients who had a heart attack between 2015 and 2022, the researchers used advanced statistical models to emulate a clinical trial. The results show that patients who received a combination treatment of statins and ezetimibe within 12 weeks of a heart attack and were able to lower cholesterol to the target level early, had a better prognosis and less risk of new cardiovascular events and death than those who received the add-on treatment later, or not at all.

From the analysis, the researchers believe many new heart attacks, strokes and deaths could be prevented every year internationally if the treatment strategy were to be changed. Under a scenario in which 100% of patients would receive ezetimibe early, they estimate 133 heart attacks could be avoided in a population of 10,000 patients in 3 years.

The researchers suggest that in the UK, which records an estimated 100,000 hospital admissions from heart attacks a year,[1] this would equate to an estimated 5,000 heart attacks being prevented over a ten year period.[2]

Dr Leósdóttir said: “Combination therapy is not applied up-front for two main reasons. General recommendations are not included in today’s guidelines and a precautionary principle is applied to avoid side effects and overmedication. However, there are positive effects from applying both medicines as soon after the infarction as possible. Not doing this entails an increased risk. In addition, the drug we have examined in the study causes few side effects and is readily available and inexpensive in many countries.”

Margrét Leósdóttir hopes that the research results will in time provide support for changes in the recommendations. A treatment algorithm has already been introduced at her hospital in Sweden to help doctors to prescribe appropriate lipid-lowering treatment for patients who have had a myocardial infarction. It has been noted that patients achieve their treatment goals earlier and two months after the infarction twice as many patients have reduced their bad cholesterol to the target level, compared with previously.

“Several other hospitals in Sweden have also adopted the algorithm and there are similar examples from other countries that have produced as good results. My hope is that even more will review their procedures, so that more patients will get the right treatment in time, and we can thereby prevent unnecessary suffering and save lives.”

Professor Ray added: “Our findings suggest that a simple change in treatment guidelines could have a huge impact on patients and reduce the demand on the NHS. Ezetimibe is already widely available and prescribed for relatively low cost. This add on therapy could be rolled out for around £350 a year per patient, which is a huge cost saving compared to the lasting impacts of treating heart attacks and the impact they have on patients’ lives.”

Reference:

Margret Leosdottir, Jessica Schubert, Julia Brandts, Stefan Gustafsson, Thomas Cars, Johan Sundström, Tomas Jernberg, Kausik K. Ray, Emil Hagström,, Early Ezetimibe Initiation After Myocardial Infarction Protects Against Later Cardiovascular Outcomes in the SWEDEHEART Registry,, Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2025.02.007.

Vitamin A deficiency has been observed to be associated with diabetic retinopathy. However, only a limited number of studies have explored this link in individuals with type 2 diabetes.

The purpose of this study was to examine the relationship between serum vitamin A levels and diabetic retinopathy in patients diagnosed with type 2 diabetes. Between the years 2019 and 2024, data were retrospectively collected from a total of 470 healthy individuals and 1,020 individuals with type 2 diabetes. Among those with diabetes, 500 had no signs of diabetic retinopathy, while 520 were diagnosed with the condition.

Participants were required to be over the age of 30 and to have undergone retinal examinations to determine the severity of diabetic retinopathy, as well as blood tests to measure serum vitamin A levels. Findings revealed that a substantial portion of participants had low levels of vitamin A in their blood.

Individuals with diabetic retinopathy had significantly lower vitamin A levels compared to healthy participants. After accounting for various influencing factors, the study found that individuals with diabetic retinopathy were more likely to have vitamin A deficiency. Furthermore, the likelihood of vitamin A deficiency increased in relation to the severity of diabetic retinopathy. When the participants were further divided according to the severity of their diabetic retinopathy, it became evident that lower levels of vitamin A were associated with more advanced stages of the disease.

This relationship appeared to be influenced by whether the individuals smoked or had a history of high blood pressure. Additionally, over a two-year period of follow-up, individuals with lower vitamin A levels were more likely to develop diabetic retinopathy, suggesting a progressive link between declining vitamin A status and disease progression. This study indicates that reduced levels of vitamin A in the blood are associated with both the presence and severity of diabetic retinopathy in people with type 2 diabetes. A deficiency in vitamin A may therefore serve as a potential biological risk factor for the development and worsening of diabetic retinopathy.

Researchers have found in a new study that diabetes was linked to increased oral health risks in elderly. The findings of the study revealed that women and urban residents were more prone to caries, while rural populations had greater periodontal issues. The study emphasizes the importance of managing oral health in diabetic individuals. The study was published in BMC Oral Health journal by Subhojit Shaw and Junaid Khan.

New research led by scientists at the University of Birmingham suggests that treating psoriasis with a tripeptide-composed of three amino acids-may help relieve symptoms when delivered through a topical, emollient-based cream.

The researchers, whose study is published in Pharmacological Research, identified the smallest part of a peptide (small protein) called PEPITEM, which occurs naturally in the body and regulates inflammation.

The study also showed that both PEPITEM and the three amino acid (tripeptide) sequence delivered a significant reduction in the severity of psoriasis, that is comparable to a steroid cream.

Psoriasis is a long-term disease with no cure, where the skin cells multiply too quickly, resulting in raised scaly patches of dry skin that can be itchy, painful, interfere with sleep, or make it hard to concentrate, and may crack, bleed, or ooze. It is caused by an over-active immune system, and tends to go through cycles, becoming more intense during ‘flares’, which may last weeks or months.

It is usually treated in the first instance with emollients, or creams containing vitamin D analogues (such as calcipotriol), vitamin A (retinoids) or corticosteroids.

These therapies can only be used for short periods due to side effects that occur with continuous use, but as a natural molecule, PEPITEM, and the tripeptide sequence that is derived from it are less likely to show these ‘off target’ effects.

In its native state, PEPITEM consists of a chain of 14 amino acids, but in this most recent study, researchers led by Professor Ed Rainger from the University of Birmingham and Professor Francesco Maione from the University of Naples Federico II, looked for, and identified the smallest parts of the PEPITEM molecule that influence immune cells and inflammation in psoriasis.

Work by the Birmingham scientists identified two sequences of three amino acids that showed biological activity comparable to the full-length PEPITEM molecule.

The scientists then optimised these tripeptides to improve their stability in the body, and tested their ability to reduce immune cell activation and migration, which are hallmarks of inflammatory disease. Their findings showed these two sequences had at least the same activity as the original PEPITEM molecule.

They then selected the sequence with the greatest biological activity and researchers from the University of Naples Federico II trialled its effectiveness in psoriasis, using an animal model of disease.

They found that topical application directly to the skin every day for seven days in an emollient cream resulted in a clear reduction in disease compared to untreated animals, and their findings were confirmed using PASI (Psoriasis Area and Severity Index) scoring, which is used in clinical practice to measure the extent and severity of psoriasis.

Importantly, the study also showed that both PEPITEM and the tripeptide sequence reduced the PASI score by 50%, making it comparable to the steroid cream Clobetasol Proprionate 0.05%.

Professor Ed Rainger said: “While there are a number of therapies for psoriasis, there is a clear need for new therapeutic agents that can be used continuously, and without the risk of excessive side effects, to prevent psoriasis flares. Our findings raise the possibility of using PEPITEM derived peptides for the treatment of psoriasis.”

“This study also raises the interesting possibility that PEPITEM derived peptides could be used in combination with other psoriasis therapies, allowing lower dosing for longer durations, for example, a ‘steroid sparing’ approach, to reduce the side effects associated with prolonged use of such agents.”

Further investigation showed both the whole PEPITEM molecule and the tripeptide sequences are powerful regulators for the synthesis of signalling molecules that promote inflammation, leading to the recruitment of immune cells and proliferation of other cell types in skin tissue involved in disease, with some tripeptide sequences showing an order of magnitude increase in efficacy compared to the parent PEPITEM sequence.

Professor Rainger added: “We have identified the parts of the PEPITEM molecule that are responsible for its biological action, and delivered peptides that mimic PEPITEM, and dramatically influence the skin’s inflammatory processes. Their significantly smaller size, and higher efficacy should result in substantial advantages in synthesis, formulation, and use in therapeutics.”

The study is part of a wider research programme on PEPITEM and its potential use in therapies for diseases such as rheumatoid arthritis (RA), diabetes, lupus, and psoriasis, and many others, which feature chronic inflammation as an underlying causative factor.

University of Birmingham Enterprise has filed several patent families related to PEPITEM and the components of the PEPITEM molecule responsible for maintaining a normal immune response.

Reference:

Anella Saviano, Bonita Apta, Samantha Tull, Laleh Pezhman, Areeba Fatima, Mustafa Sevim, Antonio Mete, Myriam Chimen, Anna Schettino, Noemi Marigliano, Helen M. McGettrick, Asif J. Iqbal, Francesco Maione, G. Ed Rainger, PEPITEM, its tripeptide pharmacophores and their peptidomimetic analogues regulate the inflammatory response through parenteral and topical dosing in models of peritonitis and psoriasis, Pharmacological Research, https://doi.org/10.1016/j.phrs.2025.107624. 

Researchers have found in a cohort study of extremely preterm infants that respiratory outcomes were comparable between those undergoing transcatheter closure and surgical ligation for patent ductus arteriosus (PDA), despite a longer PDA exposure in the transcatheter group. Further research is needed to determine the optimal timing for transcatheter intervention.