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According to the study, E-cigarette use was associated with increased risk for incident heart failure compared with never use. The association was significant even after adjustment for concomitant substance use and other risk factors.

Heart failure is a condition that affects more than 6 million US adults in which the heart becomes too stiff or too weak to pump blood as effectively as it should. It can often lead to debilitating symptoms and frequent hospitalizations as people age. Electronic nicotine products, which include vape pens, e-cigarettes, personal vaporizers and mods, hookah pens, e-cigars, e-pipes, and e-hookahs, deliver nicotine in aerosol form without combustion.

Since their first introduction in the US in the late 2000s, electronic nicotine products have often been portrayed as a safer alternative to smoking, but a growing body of research has suggested increased concern about potential adverse health effects.

Surveys indicate that about 5% to 10% of US teens and adults use e-cigarettes. In 2018, the US Surgeon General called youth e-cigarette use an epidemic and warned about the health risks associated with nicotine addiction.

“More and more studies are linking e-cigarettes to harmful effects and finding that it might not be as safe as previously thought,” Yakubu Bene-Alhasan, a resident physician at MedStar Health in Baltimore and the study’s lead author, said in a press release.

“The difference we saw was substantial. It’s worth considering the consequences to your health, especially about heart health.”

For the study, the researchers aimed to analyze associations between e-cigarette use and new diagnoses of heart failure in 175,667 study participants (an average age of 52 years and 60.5% female). For this purpose, they used data from surveys and electronic health records in All of Us, a large national study of US adults run by the National Institutes of Health.

Following were the study’s key findings:

• Of this sample, 3,242 participants developed heart failure within a median follow-up time of 45 months.
• People who used e-cigarettes at any point were 19% more likely to develop heart failure compared with people who had never used e-cigarettes. In calculating this difference, a variety of demographic and socioeconomic factors, other heart disease risk factors, and participants’ past and current use of substances, including alcohol and tobacco products, were accounted for.
• There was no evidence that participants’ age, sex, or smoking status modified the relationship between e-cigarettes and heart failure.
• The increased risk associated with e-cigarette use was statistically significant for heart failure with preserved ejection fraction (HFpEF)—in which the heart muscle becomes stiff and does not fill with blood between contractions. However, this association was not significant for heart failure with reduced ejection fraction (HFrEF)—in which the heart muscle becomes weak, and the left ventricle does not squeeze as hard as it should during contractions.

The findings align with previous studies conducted in animals, which signaled e-cigarette use can affect the heart in ways that are relevant to the heart changes involved in heart failure.

Other studies in humans have also shown links between e-cigarette use and some risk factors associated with developing heart failure. However, previous studies attempting to assess the direct connection between e-cigarette use and heart failure have been inconclusive, which Bene-Alhasan said is due to the inherent limitations of smaller sample sizes, cross-sectional study designs, and the smaller number of heart failure events seen in previous research.

Researchers said the new study findings point to a need for additional investigations of the potential impacts of vaping on heart health, especially considering the prevalence of e-cigarette use among younger people.

“I think this research is long overdue, especially considering how much e-cigarettes have gained traction,” Bene-Alhasan said. “We don’t want to wait too long to find out eventually that it might be harmful, and by that time a lot of harm might already have been done. With more research, we will get to uncover a lot more about the potential health consequences and improve the information to the public.”

Bene-Alhasan also said e-cigarettes are not recommended as a tool to quit smoking since many people may continue vaping long after they quit smoking. The U.S. Centers for Disease Control and Prevention recommends a combination of counseling and medications as the best strategy for quitting smoking.

Hypertension guidelines recommend diagnosing and treating obstructive sleep apnea in patients with hypertension. MAD is an oral appliance therapy option for patients who decline or cannot tolerate CPAP. The effectiveness of MAD versus CPAP in reducing 24-hour ambulatory blood pressure (BP) was the focus of the study.

In an investigator-initiated, randomized, non-inferiority trial, researchers enrolled 321 participants aged over 40 with hypertension and increased cardiovascular risk from three public hospitals. A total of 220 participants with moderate-to-severe OSA (apnea–hypopnea index ≥15 events/hour) were randomized to either MAD or CPAP (1:1 ratio). The primary outcome was the difference between the 24-hour mean arterial BP at baseline and six months.

The key findings of the studu were:

• In the MAD group, the 24-hour mean arterial BP decreased by 2.5 mmHg (P = 0.003) at six months compared to baseline.

• In the CPAP group, no significant change was observed (P = 0.374).

• The between-group difference in 24-hour mean arterial BP was -1.6 mmHg (95% confidence interval: -3.51 to 0.24), indicating non-inferiority (P < 0.001).

• The MAD group showed a larger reduction in all secondary ambulatory BP parameters compared to the CPAP group, with the most pronounced effects observed in asleep BP parameters.

• Both treatments improved daytime sleepiness, with similar between-group differences (P = 0.384).

• There were no significant between-group differences in cardiovascular biomarkers.

The study concludes that MAD is non-inferior to CPAP for reducing 24-hour mean arterial BP in patients with hypertension and increased cardiovascular risk. Given its effectiveness, MAD may provide an alternative treatment option for patients who cannot tolerate CPAP.

Reference:

Ou, Y.-H., Colpani, J. T., Cheong, C. S., Loke, W., Thant, A. T., Shih, E. C., Lee, F., Chan, S.-P., Sia, C.-H., Koo, C.-Y., Wong, S., Chua, A., Khoo, C.-M., Kong, W., Chin, C. W., Kojodjojo, P., Wong, P. E., Chan, M. Y., Richards, A. M., … Lee, C.-H. (2024). Mandibular advancement vs CPAP for blood pressure reduction in patients with obstructive sleep apnea. Journal of the American College of Cardiology. https://doi.org/10.1016/j.jacc.2024.03.359

“Artificial intelligence can detect interval breast cancer that may often be overlooked,” the researchers from Turkey wrote in their study.

Prof. Levent Çelik, MD, from Maltepe University Hospital and Erkin Aribal, MD, from Acibadem University, both in Istanbul, Turkey, found that AI was implemented into breast cancer screening in a middle-income country, it achieved high specificity and sensitivity in detecting interval cancers that were labeled initially as BI-RADS 1 or 2.

Previous studies have shown the efficacy of AI in reducing interval cancers, identifying between 12% and 50% of these cancers. The level of success depends on the thresholds chosen for the technology’s implementation.

Middle-income countries comprise 108 countries with a gross national income per capita ranging from $1,136 to $13,845. These countries contribute about 30% to the global gross domestic product (GDP) and constitute about 75% of the world’s population.

Against the above background, the study was conducted to investigate the accuracy and efficiency of an AI algorithm (Transpara v1.6, ScreenPoint Medical) in detecting interval cancers in a middle-income country national screening program.

The study included data from 2,129,486 mammograms reported as BI-RADS 1 or 2. These were matched with the national cancer registry for interval cancers. The interval group comprised 406, while a control group comprised 446 women with two negative consequent mammograms, defined as time-proven normal.

The cancer risk scores were issued on a one-to-10 scale, with 10 indicating extremely elevated risk. The researchers also employed specificity thresholds of 90% and 95% for the system.

The study led to the following findings:

· AI labeled 53% of ICs with the highest score of 10. The sensitivity of AI in detecting ICs was 53.7% and 38.5% at specificities of 90% and 95%, respectively.

· AUC of AI in detecting major signs was 0.93 with a sensitivity of 81.6% and 72.4% at specificities of 90% and 95%, respectively and minor signs were 0.87 with a sensitivity of 70% and 53% at a specificity of 90% and 95%, respectively.

· In subgroup analysis for time to diagnosis, the AUC value of the AI system was higher in the 0-6 month period than in later periods.

In conclusion, AI has the potential to enhance screening mammogram outcomes, specifically in countries with limited resources, by reducing human errors and detecting more undepictable cancers with the expense of a possible higher recall rate.

“It is necessary to conduct additional real-life studies to determine the appropriate approach for using suitable AI algorithms in national screening programs,” the researchers wrote. “Such studies can help optimize strategies utilizing AI and human readers.”

Reference:

DOI: https://doi.org/10.1016/j.crad.2024.03.012