Archive for category: News

USA: In a recent study published in Circulation, the researchers have described a two-step screening protocol that combines clinical risk assessment with biomarker testing for more effective identification of patients with type 2 diabetes who need medication to prevent heart failure. A

According to the study led by UT Southwestern Medical Center researchers, the new strategy is the best approach for predicting heart failure in patients with diabetes-even in those deemed low-risk following clinical risk assessment only. 

“Diabetes often leads to cardiovascular disease, with heart failure being one of the most common manifestations,” said Ambarish Pandey, M.D., Associate Professor of Internal Medicine in the Division of Cardiology at UT Southwestern and corresponding author of the study. “In recent years, many physicians have relied on one-step screening approaches, like clinical risk scores, biomarker tests, or echocardiography, to identify those at high risk for developing heart failure. But even patients considered low-risk by these single-step risk assessment tools sometimes develop heart failure. Furthermore, testing all individuals with diabetes with often expensive biomarker or echo assessments is often not feasible or cost-effective.”

Dr. Pandey and his colleagues found that combining these risk assessment strategies sequentially by adding a second step – such as giving low-risk patients by clinical risk score a blood test for natriuretic peptide levels, a biomarker for cardiovascular disease – is the most efficient and potentially cost-effective strategy for screening for heart failure. Natriuretic peptides are proteins produced by the heart when there is stressful stretching of the heart muscle. The research could lead to more patients being accurately screened and receiving proven preventive therapies, such as sodium-glucose cotransporter 2 inhibitors (SGLT2i), to protect their heart health.

The study included data from 6,293 diabetes patients who had taken part in seven cohort studies. Of those, 4,889 had no signs of atherosclerotic cardiovascular disease (ASCVD). All patients had undergone screening to determine their level of risk for heart failure. By comparing screening methods and downstream risk of heart failure episodes at a five-year follow-up, researchers were able to determine the methods and sequence that best predicted those at risk.

“Our study found that 30% to 50% of the total heart failure events in the population without prevalent ASCVD occurred in individuals marked low-risk with a single screening strategy,” Dr. Pandey said. “But when a second step was added, approximately 85% of the actual heart failure cases were identified. This suggests a substantial percentage of patients with diabetes who could benefit from more aggressive preventive treatment are being overlooked.”

Different two-step screening strategies were evaluated incorporating WATCH-DM, blood tests including natriuretic peptides, and echocardiography. “We found that assessing the WATCH-DM risk score in all individuals, followed by natriuretic peptides only among individuals who were considered low-risk based on the WATCH-DM risk score, was the most efficient of the two-step screening strategies to assess heart failure risk and target preventive therapies,” said study first author Kershaw Patel, M.D., Assistant Professor of Cardiology at the Houston Methodist Academic Institute.

Although echocardiographic screening can be a beneficial risk determinant after clinical assessment, it is more expensive and time-consuming than a natriuretic peptide blood test. That makes the echocardiogram less likely to be checked unless a patient is already considered high-risk or has another indication for testing.

“The key to improving our ability to identify those most in need of preventive treatment is using cost-effective screening tools that can be easily implemented in the clinic,” Dr. Pandey said. “Our finding advances the field by demonstrating an efficient and effective approach that gives physicians a better idea of their patients’ actual risk. We hope that further study of this two-step strategy will enable us to evaluate both its clinical success and its cost-effectiveness to develop a consistent approach for patients.”

Reference:

Kershaw V. Patel, Matthew W. Segar, David C. Klonoff, Muhammad Shahzeb Khan, Muhammad Shariq Usman, Carolyn S.P. Lam, Subodh Verma, Andrew P. DeFilippis, Optimal Screening for Predicting and Preventing the Risk of Heart Failure Among Adults With Diabetes Without Atherosclerotic Cardiovascular Disease: a Pooled Cohort Analysis, https://doi.org/10.1161/CIRCULATIONAHA.123.067530

USA: A mortality follow-up study of a cross-sectional cohort study has shed light on the association between hearing aid use and mortality in adults with hearing loss in the USA. 

Tne new study from Keck Medicine of USC published in The Lancet Healthy Longevity revealed that adults with hearing loss who regularly used hearing aids had a 24% lower risk of mortality than those who never wore them. 

Hearing loss affects approximately 40 million American adults, yet only one in 10 people who need hearing aids use them, research shows.

According to the study, those who don’t use hearing aids but should want to make wearing them one of their New Year’s resolutions, the study showed. 

“We found that adults with hearing loss who regularly used hearing aids had a 24% lower risk of mortality than those who never wore them,” said Janet Choi, MD, MPH, an otolaryngologist with Keck Medicine and lead researcher of the study. “These results are exciting because they suggest that hearing aids may play a protective role in people’s health and prevent early death.”

Previous research has shown that untreated hearing loss can result in a reduced life span (as well as other poor outcomes such as social isolation, depression and dementia). However, until now, there has been very little research examining if the use of hearing aids can reduce the risk of death. The study represents the most comprehensive analysis to date on the relationship between hearing loss, hearing aid use and mortality in the United States, according to Choi.

Choi and her fellow researchers used data compiled by the National Health and Nutrition Examination Survey between 1999-2012 to identify almost 10,000 adults 20 years and older who had completed audiometry evaluations, a test used to measure hearing ability, and who filled out questionnaires about their hearing aid use. Researchers followed their mortality status over an average follow-up period of 10 years after their evaluations.

A total of 1,863 adults were identified as having hearing loss. Of these, 237 were regular hearing aid users, which were characterized as those who reported wearing the aids at least once a week, five hours a week or half the time, and 1,483 were identified as never-users of the devices. Subjects who reported wearing the devices less than once a month or less frequently were categorized as non-regular users.

Researchers found that the almost 25% difference in mortality risk between regular hearing aid users and never-users remained steady, regardless of variables such as the degree of hearing loss (from mild to severe); age, ethnicity, income, education and other demographics; and medical history. There was no difference in mortality risk between non-regular users and never users, indicating that occasional hearing aid use may not provide any life-extending benefit.

While the study did not examine why hearing aids may help those who need them live longer, Choi points to recent research linking hearing aid use with lowered levels of depression and dementia. She speculates that the improvements in mental health and cognition that come with improved hearing can promote better overall health, which may improve life span.

Choi hopes this study will encourage more people to wear hearing aids, even though she acknowledges that factors, including cost, stigma and difficulty finding devices that fit and function well, are barriers to use.

Choi can personally relate to these challenges. She was born with hearing loss in her left ear, but did not wear a hearing device until her 30s. It then took her several years to find ones that worked effectively for her.

She is currently working on an AI-driven database that categorizes hearing aid choices and tailors them to individual patient needs. She also advocates for larger studies to further understand the link between regular hearing aid use and a lower mortality risk and to promote hearing care. 

Reference:

Janet S Choi, Meredith E Adams, Eileen M Crimmins, Frank R Lin, Jennifer A Ailshire, Association between hearing aid use and mortality in adults with hearing loss in the USA: a mortality follow-up study of a cross-sectional cohort, The Lancet Healthy Longevity, DOI:https://doi.org/10.1016/S2666-7568(23)00232-5.

The fibrinogen-to-albumin ratio (FAR), a new inflammatory marker, is a potential prognostic indicator for vascular diseases.

A comprehensive population-based study conducted over nearly three decades has shed light on a potential link between clinically apparent Helicobacter pylori infection (CAHPI) and the risk of developing Alzheimer’s disease (AD). This study was published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association journal. The study, utilizing the United Kingdom’s Clinical Practice Research Datalink (UK CPRD), aimed to investigate whether there exists an association between CAHPI and the onset of AD in individuals aged 50 years and above.

Denmark: Findings from a parallel-design, double-blind trial published in JAMA Dermatology have offered a potential new therapeutic option for treating hidradenitis suppurativa (HS). The study suggests the feasibility of HSP90 inhibition as a novel mechanism of action in HS treatment.