Physical activity insufficient to counter CV risk associated with sugar-sweetened beverage consumption

Contrary to popular belief, the benefits of physical activity do not outweigh the risks of cardiovascular disease associated with drinking sugar-sweetened beverages, according to a new study led by Harvard T. H. Chan School of Public Health. Jean-Philippe Drouin-Chartier, professor at Université Laval’s Faculty of Pharmacy, was a co-author.

Sugar-sweetened beverages are the largest source of added sugars in the North American diet. Their consumption is associated with a higher risk of cardiovascular disease, the world’s leading cause of death.

“The marketing strategies for these drinks often show active people drinking these beverages. It suggests that sugary drink consumption has no negative effects on health if you’re physically active. Our research aimed to assess this hypothesis,” says Drouin-Chartier.

For the study, the scientists used two cohorts totalling around 100,000 adults, followed for about 30 years. The data show that those who consumed sugar-sweetened beverages more than twice a week had a higher risk of cardiovascular disease, regardless of physical activity levels.

The study found that even if the recommended 150 minutes of weekly physical activity protects against cardiovascular disease, it’s not enough to counter the adverse effects of sugar-sweetened beverages. “Physical activity reduces the risk of cardiovascular disease associated with sugar-sweetened beverages by half, but it does not fully eliminate it,” says Drouin-Chartier.

The frequency of consumption considered in the study-twice a week-is relatively low but still is significantly associated with cardiovascular disease risk. With daily consumption, the risk of cardiovascular disease is even higher.

For this reason, Drouin-Chartier underlines the importance of targeting the omnipresence of sugar-sweetened beverages in the food environment. This category includes soft and carbonated drinks (with or without caffeine), lemonade, and fruit cocktails. The study did not specifically consider energy drinks, but they also tend to be sugar-sweetened.

For artificially sweetened drinks, often presented as an alternative solution to sugar-sweetened beverages, their consumption was not associated with higher risk of cardiovascular diseases. “Replacing sugar-sweetened beverages by diet drinks is good, because it reduces the amount of sugar. But the best drink option remains water,” explains Drouin-Chartier.

“Our findings provide further support for public health recommendations and policies to limit people’s intake of sugar-sweetened beverages, as well as to encourage people to meet and maintain adequate physical activity levels,” added lead author Lorena Pacheco, a research scientist in the Department of Nutrition at Harvard Chan School. 

Reference:

Lorena S Pacheco, Deirdre K Tobias, Yanping Li, Shilpa N Bhupathiraju, Walter C Willett, David S Ludwig, Cara B Ebbeling, Danielle E Haslam, Jean-Philippe Drouin-Chartier, Frank B Hu, Marta Guasch-Ferré, Sugar-sweetened or artificially-sweetened beverage consumption, physical activity, and risk of cardiovascular disease in adults: a prospective cohort study, The American Journal of Clinical Nutrition, 2024, https://doi.org/10.1016/j.ajcnut.2024.01.001.

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Superior Trunk Block Effective Phrenic-Sparing Alternative to Interscalene Block for Shoulder Arthroscopy

Recently published research study reviewed the use of superior trunk block (STB) as an alternative to interscalene block (ISB) for postoperative pain management in patients undergoing shoulder arthroscopy. The study aimed to compare the incidence and degree of hemidiaphragmatic paralysis and the block efficacy of these techniques. The findings were based on a systematic review and meta-analysis of randomized controlled trials (RCTs) that included 359 patients.

Findings and Conclusion of STB versus ISB

The study found that the STB group showed a significantly lower incidence of total hemidiaphragmatic paralysis, subjective dyspnea, and Horner’s syndrome compared to the ISB group. Furthermore, the duration of the block and block efficacy showed no significant difference between the groups. The researchers concluded that STB has a better safety profile than ISB, resulting in lower rates of hemidiaphragmatic paralysis and dyspnea while providing a similar block. They suggested that STB could be preferred over ISB, especially in patients susceptible to phrenic nerve paralysis complications.

Significance of Meta-Analysis and Study Outcome

This meta-analysis is the first to pool the results of RCTs comparing STB with ISB in patients undergoing shoulder arthroscopy. The study included 359 patients and found that STB demonstrated equal effectiveness as ISB in providing analgesia while also showing a higher safety profile with lower incidence of hemidiaphragmatic paralysis and minor complications. The study highlighted that STB may offer advantages over ISB, particularly in patients at increased risk of respiratory insufficiency.

Study Limitations and Implications for Clinical Practice

The researchers acknowledged some limitations, such as the relatively small sample size and heterogeneity in some outcomes among the included studies. They also noted that the publication bias analysis suggested some degree of asymmetry in the data, indicating the possibility of small study effects. However, the study’s findings have significant implications for clinical practice, and the researchers recommended STB as a preferred alternative to ISB, especially for patients at increased risk of respiratory insufficiency.

In conclusion, this meta-analysis of RCTs comparing STB and ISB in patients undergoing shoulder arthroscopy indicates that STB may be a safer alternative with equivalent analgesic efficacy compared to ISB. The study suggests that STB should be considered as a preferred option, particularly for patients at increased risk of respiratory insufficiency.

Reference –

Amaral S, Arsky Lombardi R, Medeiros H, et al. (November 03, 2023) Superior Trunk Block Is an Effective Phrenic-Sparing Alternative to Interscalene Block for Shoulder Arthroscopy: A Systematic Review and Meta-Analysis. Cureus 15(11): e48217. doi:10.7759/cureus.48217.

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Organic compound found in trees could prevent contact lens eye infections

A new study suggests a naturally-occurring material is an effective disinfectant for contact lenses, worn by millions of people worldwide.

Microbial keratitis is one of the most serious potential complications for contact lens wearers. It’s an infection of the cornea that is caused by bacteria; the most common being Pseudomonas aeruginosa.

Previous studies have found that existing disinfecting solutions are not effective for preventing biofilm, which are clusters of bacteria that attach to the surface of lenses.

Hydroquinine, an organic compound found in the bark of some trees, is known to have bacterial killing activity against Pseudomonas aeruginosa and several other clinically important germs, including Staphylococcus aureus, Escherichia coli, and Klebsiella pneumoniae.

The team behind the discovery, from the University of Portsmouth in England and Naresuan and Pibulsongkram Rajabhat universities in Thailand, has now explored the potential use of multipurpose formulas containing hydroquinine as a disinfectant for contact lenses.

They examined the antibacterial, anti-adhesion, and anti-biofilm properties of hydroquinine-formulated multi-purpose solutions (MPSs), and then compared it to two commercial MPSs; Opti-free Replenish and Q-eye. The natural compound killed 99.9 per cent of bacteria at the time of disinfection.

The paper, published in Antibiotics, says these findings may aid in the development of novel disinfectants aimed at combating the P. aeruginosa bacteria.

Dr Robert Baldock from the School of Pharmacy and Biomedical Sciences at the University of Portsmouth, said: “Commercially available disinfecting solutions, which are made up of a number of chemicals, can sometimes cause reactions with painful side-effects.

“We hoped to demonstrate that new agents made from natural products may be an excellent option to limit or reduce the risk of contact lens contamination.

“It is exciting to see how this research has progressed; from discovery to exploring potential applications.”

There are up to 3.5 million reports of corneal infections annually, and in extreme cases it can result in permanent eye damage and vision loss. The risk of microbial keratitis doubles when someone wears contact lenses overnight and or longer than the recommended daily amount.

Corneal blindness resulting from microbial keratitis is emerging as a prominent cause of visual disability, according to the World Health Organisation (WHO). The World Health Organisation (WHO) has also classified multidrug-resistant P. aeruginosa as one of the most concerning pathogens.

Drug-resistant bacteria occur in more than 2.8 million infections and are responsible for 35,000 deaths per year. Antimicrobial resistance happens when germs change over time and no longer respond to medicines, making it difficult to treat infections.

Amoxicillin and Trimethoprim are commonly prescribed antibiotics that certain strains of P. aeruginosa have become resistant to.

Hydroquinine is already known to be an effective agent against malaria in humans, and it is also being used in the Netherlands to treat nocturnal muscle cramps. Until now, there has been little investigation into its drug-resistant properties.

Lead author, Sattaporn Weawsiangsang from the Faculty Of Allied Health Sciences at Naresuan University, is currently a visiting researcher at the University of Portsmouth.

She said: “Our initial findings suggest that soaking contact lenses in a multi-purpose solution containing hydroquinine is possibly helpful to prevent contamination and infection.

“However, further investigation is needed to determine whether hydroquinine itself also has adverse reactions or toxicity.

“We are continuing to test the compound on a number of cells, and so far, the results are really promising. This potential development could contribute to the creation of new disinfectants from natural products, effectively combating P. aeruginosa infections and reducing cases of corneal infections.”

The paper concludes by recommending further research examining the effectiveness of hydroquinine with several different contact lens materials, and against other pathogenic microorganisms. 

Reference:

Weawsiangsang S, Rattanachak N, Ross S, Ross GM, Baldock RA, Jongjitvimol T, Jongjitwimol J. Hydroquinine Enhances the Efficacy of Contact Lens Solutions for Inhibiting Pseudomonas aeruginosa Adhesion and Biofilm Formation. Antibiotics. 2024; 13(1):56. https://doi.org/10.3390/antibiotics13010056.

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Drugs used for treating erectile dysfunction tied to reduced risk of Alzheimer’s disease: Study

UK: Erectile dysfunction drugs, which work by dilating blood vessels to allow more blood to flow through, were first developed to treat high blood pressure. A new study published in Neurology suggests that the drugs may be tied to a reduced risk of Alzheimer’s disease. 

According to the study, the drugs used to treat erectile dysfunction may also be associated with a reduced risk of Alzheimer’s disease. The study does not prove that erectile dysfunction drugs reduce the risk of Alzheimer’s disease. It only shows an association.

“Although we’re making progress with the new treatments for Alzheimer’s disease that work to clear amyloid plaques in the brain for people with early stages of the disease, we desperately need treatments that can prevent or delay the development of Alzheimer’s disease,” said study author Ruth Brauer, PhD, of the University College London in the United Kingdom. “These results are encouraging and warrant further research.”

The study involved 269,725 male participants with an average age of 59 who were newly diagnosed with erectile dysfunction. Participants did not have any memory or thinking problems at the start of the study. They were then followed for an average of five years. The study compared the 55% of the participants who had prescriptions for erectile dysfunction drugs to the 45% who did not have prescriptions.

During the study, 1,119 people developed Alzheimer’s disease.

Among the participants taking erectile dysfunction drugs, 749 developed Alzheimer’s disease, which corresponds to a rate of 8.1 cases per 10,000 person-years. Person-years represent both the number of people in the study and the amount of time each person spends in the study. Among those who did not take the drugs, 370 developed Alzheimer’s disease, which corresponds to a rate of 9.7 cases per 10,000 person-years.

Once researchers adjusted for other factors that could affect the rate of Alzheimer’s disease, such as age, smoking status and alcohol consumption, they found that people who took erectile dysfunction drugs were 18% less likely to develop Alzheimer’s than people who did not take the drugs.

The association was strongest in those who were issued the most prescriptions over the study period.

“More research is needed to confirm these findings, learn more about the potential benefits and mechanisms of these drugs and look into the optimal dosage,” Brauer said. “A randomized, controlled trial with both male and female participants is warranted to determine whether these findings would apply to women as well.”

The study was based on prescription records. A limitation of the study is that researchers did not have information on whether participants actually filled the prescriptions and used the drugs.  

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Intra arterial tirofiban as rescue therapy during mechanical thrombectomy in stroke may improve recanalization rates

Tamil Nadu: Use of intra-arterial (IA) tirofiban with or without adjunct techniques as rescue therapy during mechanical thrombectomy (MT) in large vessel occlusion (LVO) improves recanalization rates without raising the risk of symptomatic haemorrhage, a recent study has shown. The findings were published online in the Journal of Clinical Interventional Radiology.

Stroke is an important cause of disability and morbidity affecting the productive life of an individual with a substantial socioeconomic impact. Acute ischemic stroke (AIS) due to LVO can be in situ occlusion due to underlying intracranial atherosclerotic disease (ICAD) or thromboembolism (cardiac-embolism/artery-to-artery embolism). Recanalizing the acutely occluded vessel as early as possible is the strongest predictor of good clinical outcomes.

Mechanical thrombectomy has become the standard of care in acute LVO since 2015. In the event of unsuccessful recanalization during MT, there are no established guidelines for rescue therapy. MT can cause plaque disruption and endothelial damage, resulting in subsequent platelet activation and occlusion of the initially recanalized vessel.

Tirofiban is approved for use in acute coronary syndrome by the U.S. Food and Drug Administration (FDA), a short-acting inhibitor of the glycoprotein IIb/IIIa receptor (GpIIb/IIIa). Tirofiban blocks platelet aggregation and subsequent thrombus formation. Karthikeyan Muthugounder Athiyappan, Department of Interventional Radiology, Kovai Medical Center and Hospital, Coimbatore, Tami Nadu, India, and colleagues aimed to investigate the safety profile and role of intra-arterial (IA) tirofiban as a rescue therapy in acute ischemic stroke (AIS) patients undergoing MT.

For this purpose, they conducted a retrospective study among AIS patients with LVO eligible for endovascular revascularization and in whom IA tirofiban is given as rescue therapy.

IA tirofiban at a dose of 0.4 μg/kg/min was administered through the microcatheter in the target vessel followed by intravenous (IV) infusion of 0.1 μg/kg/min if the target vessel shows reocclusion following initial recanalization, flow limiting or significant residual stenosis after thrombectomy, or requires balloon angioplasty or stenting. The study’s primary safety measure was the incidence of symptomatic haemorrhage.

There were 82 patients in the study; 36 were in the tirofiban group, and 46 were in the non-tirofiban group.

The study led to the following findings:

  • Immediate successful reperfusion was achieved in 86.1% of patients and 89% of patients in the tirofiban and non-tirofiban groups, respectively.
  • 19.4 and 25% of patients in the tirofiban group required adjunct techniques of angioplasty and stenting, respectively.
  • 2.7% of patients in the tirofiban group had a symptomatic haemorrhage, while 8.7% in the non-tirofiban group had symptomatic intracranial haemorrhage.
  • On multinomial logistic regression, a history of transient ischemic attack, watershed infarct pattern, and truncal occlusion predicted the usage of IA tirofiban during mechanical thrombectomy.

“The findings revealed that using IA tirofiban with or without other adjunct techniques as rescue therapy during MT in LVO improved recanalization rates without raising symptomatic haemorrhage risk,” the researchers concluded.

Reference:

The study titled, “Safety Profile of Intra-Arterial Tirofiban as a Rescue Therapy during Mechanical Thrombectomy in Acute Ischemic Stroke,” was published online in the Journal of Clinical Interventional Radiology. DOI: 10.1055/s-0043-1775981

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Cariprazine Shows High Tolerability and Completion Rates in Major Depressive Disorder Patients

Cariprazine, approved by the FDA as an adjunctive treatment for MDD, has demonstrated positive outcomes in various trials. The analysis focused on its safety profile, leveraging data from five randomized, double-blind, placebo-controlled trials involving patients with inadequate responses to monotherapy antidepressant treatment.

A recent pooled analysis of phase 3 trials has shed light on the safety and tolerability of cariprazine, an adjunctive treatment for major depressive disorder (MDD). This study was published in the International Clinical Psychopharmacology journal. Led by Michael E. Thase, MD, from the Perelman School of Medicine at the University of Pennsylvania, the study aimed to assess the outcomes of patients with MDD receiving cariprazine in conjunction with antidepressant therapy.

A total of 16,825 patients were included in the analysis. 62% of patients were at intermediate or high risk of frailty. In-hospital mortality and any complication rates were primary outcomes. Length of hospital stay and total charges were secondary outcomes. Frailty was assessed using the Hospital Frailty Risk Score, stratified into low, intermediate, and high risk.

  • Patients with high or intermediate frailty had higher in-hospital mortality rates (6.37 and 5.15 times, respectively) compared to those with low frailty.

  • Patients undergoing leadless pacemaker implantation had a 90% completion rate.

  • Only 4.3% discontinued treatment due to mild or moderate treatment-emergent adverse events.

  • PANDO patients showed significant associations with ocular surface, eyelid, upper airway, and systemic inflammatory-related diseases.

  • The Butantan–Dengue Vaccine demonstrated an overall 2-year vaccine efficacy of 79.6% against symptomatic, virologically confirmed dengue.

The pooled analysis underscores the high tolerability and completion rates in MDD patients treated with cariprazine. Despite mild to moderate adverse events, the study supports the safety of cariprazine as an adjunctive therapy for MDD.

Reference:

Thase ME, Yeung PP, Rekeda L, Liu M, Varughese S. Safety and tolerability of cariprazine for the adjunctive treatment of major depressive disorder: a pooled analysis of phase 2b/phase 3 clinical trials. Int Clin Psychopharmacol. Published online January 25, 2024. doi:10.1097/YIC.0000000000000528

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Indiscreet prescribing of antibiotics is key contributor to microbial resistance nationwide: MoS Health

New Delhi: The Union Health Ministry has initiated several initiatives to promote judicious use of antimicrobials, as indiscreet prescribing of antibiotics is one of the major causes of microbial resistance in the country, the Parliament was recently informed.

Concerns related to overprescription of antibiotics in the country were raised during a Rajya Sabha Session by Minister A D Singh, who inquired whether a survey of nearly 10 thousand hospitals by the National Centre for Diseases Control (NCDC), has found that more than half of the patients were given antibiotics to prevent rather than treat the infection.

In response to the question raised, Prof. Satya Pal Singh Baghel, the Minister of State in the Ministry of Health and Family Welfare confirmed that National Centre for Disease Control (NCDC) conducted Point Prevalence Survey (PPS) on antibiotic use at 20 tertiary care government hospitals (NAC-NET sites). This study was conducted amongst 9653 eligible patients admitted in these 20 hospitals. 71.9% of the patients received antibiotics. Of those who were prescribed antibiotics, 54.8% received antibiotics for prophylactic indications (Surgical Prophylaxis 37.3% and Medical prophylaxis 17.5%).

The Minister further said that indiscreet prescribing of antibiotics is one of the major causes of microbial resistance in the country. He further shed light on the efforts being made by Government to control the tendency of overprescription of antibiotics. He said that the Health Ministry has taken steps to promote judicious use of antimicrobials which includes launch of Red Line awareness campaign on Antimicrobials Resistance, urging people not to use medicines marked with a red vertical line, including antibiotics, without a doctor’s prescription.

Furthermore, the Indian Council of Medical Research (ICMR) has released treatment guidelines for antimicrobial use in common syndromes, which contain guidelines for the use of antibiotics for viral bronchitis and low-grade fever antibiotics are included in Schedule H and H1 of the Drugs Rules, 1945. These drugs have specific caution labeling requirements and are sold only under the prescription of a Registered Medical Practitioner.

“The supply of a drug specified in Schedule H1 are recorded in a separate register at the time of the supply and such records are maintained for three years and are open for inspection. Central Drugs Standard Control Organisation (CDSCO) has placed 24 hi-end antimicrobials under schedule H1 by issuing notification,” the Minister added.

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Inhaled antibiotics may reduce exacerbations and improve QoL in bronchiectasis patients

Inhaled antibiotics  may reduce exacerbations and improve QoL in bronchiectasis patients suggests a new study published in the Chest. 

Inhaled antibiotics are conditionally recommended by international bronchiectasis guidelines for the treatment of patients with bronchiectasis but results of individual studies are inconsistent. A previous meta-analysis demonstrated promising results regarding the efficacy and safety of inhaled antibiotics in bronchiectasis. Subsequent publications have further supplemented the existing body of evidence in this area. Systematic review and meta-analysis of randomised controlled trials of inhaled antibiotics in adult patients with bronchiectasis. We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and ClinicalTrials.gov for eligible studies. Studies were included if they enrolled adults with bronchiectasis diagnosed by CT and trials had a treatment duration of at least 4 weeks. The primary endpoint was exacerbation frequency, with additional key efficacy endpoints including severe exacerbations, bacterial load, symptoms, quality of life and FEV1. Data were pooled through random-effects meta-analysis.Results: 20 studies involving 3468 patients were included. Inhaled antibiotics were associated with reduced number of subjects with exacerbations (risk ratio 0.85 95%CI 0.75-0.96), a slight reduction in exacerbation frequency (rate ratio 0.78 95%CI 0.68-0.91), a probable reduction in the frequency of severe exacerbations (rate ratio 0.48 95%CI 0.31-0.74) and a likely slight increase in time to first exacerbation (hazard ratio 0.80 95%CI 0.68-0.94). Inhaled antibiotics likely lead to a slight increase in the Quality of Life-Bronchiectasis Respiratory Symptom Score (2.51, 95%CI 0.44 to 4.31) and may reduce scores on the St. George’s Respiratory Questionnaire (-3.13, 95%CI -5.93 to -0.32). Bacterial load was consistently reduced but FEV1 was not changed with treatment. Evidence suggests little to no difference in adverse effects between groups (odds ratio 0.99 95%CI 0.75-1.30). Antibiotic resistant organisms were likely increased by treatment. Inhaled antibiotics result in a slight reduction in exacerbations, a probable reduction in severe exacerbations and a likely slight improvement in symptoms and quality of life in adults with bronchiectasis.

Reference:

Ricardo Cordeiro, Hayoung Choi, Charles S. Haworth, James D. Chalmers. The efficacy and safety of inhaled antibiotics for the treatment of bronchiectasis in adults: Updated systematic review and meta-analysis, CHEST, 2024,ISSN 0012-3692. https://doi.org/10.1016/j.chest.2024.01.045.

(https://www.sciencedirect.com/science/article/pii/S0012369224001399)

Keywords:

Inhaled antibiotics, exacerbations, improve QoL, bronchiectasis patients, bronchiectasis; therapeutics; antibiotics; inhalation; meta-analysis, CHEST, Ricardo Cordeiro, Hayoung Choi, Charles S. Haworth, James D. Chalmers

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Do JAK-STAT Inhibitors confer increased risk of vascular complications in dermatology patients?

Australia: Evolving evidence suggests that dermatology patients receiving Janus kinase–signal transducer and activator of transcription inhibitors (JAK-STATi) may be at increased risk of venous thromboembolism (VTE) and major adverse cardiovascular events (MACE). Most existing literature focused on indications that may confer a higher risk of MACE and VTE than that among patients with isolated dermatological indications.

A recent meta-analysis of randomized clinical trials did not identify a significant rise in the risk of VTE and MACE in dermatology patients receiving JAK-STATi for a median duration of 16 weeks.

The results of the review published in JAMA Dermatology suggest that the evidence is insufficient regarding an increased risk of cardiovascular complications conferred by JAK-STATi in dermatological patients, particularly when used for short time frames.

JAK-STATi include Janus kinase and tyrosine kinase 2 (TYK2) inhibitors, medications that target the JAK-STAT pathway; a series of intracellular mediators that result in amplification and gene transcription through a secondary messenger pathway. Over the past decade, JAK-STATi has revolutionized the management of several dermatological conditions.

In 2022, the ORAL study, a large open-label randomized clinical trial, suggested that rheumatoid arthritis patients receiving JAK-STATi may be at higher risk of MACE and VTE. This prompted a classwide black box warning counselling against their use in patients above 65 years or with preexisting cardiovascular risk factors. Similarly, dermatological guidelines have recommended against JAK-STATi use in certain population groups, or only in patients who have failed trials of more established therapies, including TNF inhibitors.

Against the above background, Patrick A. Ireland, Prince of Wales Hospital, Randwick, New South Wales, Australia, and colleagues aimed to evaluate the risk of VTE, MACE, serious adverse events (SAEs), and tolerability of systemic JAK-STATi compared with placebo, in those with a dermatologic indication.

For this purpose, the researchers carried out a systematic review of the literature from June 2023 using online databases. The analysis was reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines.

The eligibility criteria of the studies were placebo-controlled randomized clinical trials that compared systemic JAK-STATi with placebo and investigated the safety in patients with atopic dermatitis, vitiligo, psoriasis, alopecia areata, lichen planus or hidradenitis suppurativa. Study selection and data extraction were carried out by two authors working independently using a standardized template.

The main outcomes were the incidence of VTE, SAE, MACE, and study discontinuation due to TEAEs. Analysis of these values was done against person exposure years to determine the incidence rate (IR). Risk ratios (RRs) compared incidence rates among treatment and placebo comparator arms.

The researchers reported the following findings:

  • Forty-five randomized clinical trials were eligible for inclusion, with 12 996 patients receiving active JAK-STATi therapy and 4925 allocated to placebo treatment.
  • There was no significant increase in MACE (I2 = 0.00%; RR, 0.47) or VTE (I2 = 0.00%; RR, 0.46) between placebo and JAK-STATi comparator arms.
  • There was also no significant difference in SAEs (I2 = 12.38%; RR, 0.92) and discontinuations between JAK-STATi and placebo (I2 = 23.55%; RR, 0.94).

“We did not identify a significant increase in the risk of MACE and VTE in dermatology patients receiving JAK-STATi in the short term,” the researchers wrote.

The results aid in reassuring clinicians that prescribing these medications in short intervals to patients with low CV risk profiles appears to be both well tolerated and safe in this cohort.

“Given the limited evidence, clinicians must remain judicious in their use of these medications for long durations and in high-risk patient populations,” the research team concluded.

Reference:

Ireland PA, Jansson N, Spencer SKR, Braden J, Sebaratnam D. Short-Term Cardiovascular Complications in Dermatology Patients Receiving JAK-STAT Inhibitors: A Meta-Analysis of Randomized Clinical Trials. JAMA Dermatol. Published online January 31, 2024. doi:10.1001/jamadermatol.2023.5509

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Predictive Model using AI may detect Hyperuricemia Risk Early among those on low dose Aspirin

Hyperuricemia is primarily attributed to increased serum uric acid (SUA) concentration, considered the primary gout factor. In the US, approximately 38 million adults, up to 16.9% of the population, are affected by hyperuricemia.

According to an original research article published in Frontiers in Pharmacology, researchers concluded that a predictive model established by XGBoost algorithms could help clinicians detect hyperuricemia risk early in people taking low-dose aspirin.
Hyperuricemia is a severe condition related to gout and cardiovascular diseases. Low-dose aspirin was reported to inhibit uric acid excretion, leading to hyperuricemia. To decrease hyperuricemia-related CVD, this study identified the risk of hyperuricemia in people taking aspirin.
The data for this study were collected from the NHANES between 2011 and 2018. The analysis included participants who answered the “Preventive Aspirin Use” questionnaire with positive answers. The study used six machine learning algorithms, and the eXtreme Gradient Boosting (XGBoost) model was selected to predict the risk of hyperuricemia.
Key findings from the study are:
  • Out of 805 participants enrolled, 190 participants had hyperuricemia.
  • The participants were divided into a training set and a testing set (ratio of 8:2).
  • The area under the curve for the training and testing set was 0.864 and 0.811, respectively.
  • The SHapley Additive exPlanations (SHAP) method evaluated the modelling performance.
  • The feature ranking interpretation presented that eGFR, BMI, and waist circumference were the three most essential features for hyperuricemia in those taking aspirin.
  • The factors correlated with the development of hyperuricemia are triglyceride, hypertension, total cholesterol, HDL, LDL, age, race, and smoking.
Study limitations include a cross-sectional study, small sample size, and the duration of people taking low-dose aspirin was not known.
They said we leveraged an ML model trained on NHANES data to develop a hyperuricemia model for those taking aspirin. XGBoost model can p help clinicians detect hyperuricemia risk early.
Reference
Zhu, B. et al. Prediction of hyperuricemia in people taking low-dose aspirin using a machine learning algorithm: a cross-sectional study of the National Health and Nutrition Examination Survey. Frontiers in Pharmacology, 14. https://doi.org/10.3389/fphar.2023.1276149

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