Baricitinib not linked to increased VTE Risk in Alopecia Areata Patients: Study

A new study published in the International Journal of Dermatology revealed that alopecia areata patients treated with baricitinib had no reported thrombotic events over 6 months, indicating no increased risk of venous thromboembolism (VTE) in this population.

Based on post-marketing data from patients with rheumatoid arthritis (RA) receiving tofacitinib, the European Medicines Agency (EMA) released an advisory in January 2023 on the risk of VTE associated with Janus kinase inhibitors (JAKi) in chronic inflammatory disorders. Given that RA is a recognized independent risk factor for VTE, this might be biased.

Additionally, the effects of JAKi differ due to differences in enzyme selectivity. In this investigation, VTE risk factors were examined in a cohort of AA patients who were eligible for baricitinib therapy. Additionally, any changes in laboratory VTE markers following 6 months of baricitinib treatment were evaluated.

The patients with moderate-to-severe AA who were ≥ 18 years old, suitable for therapy with baricitinib 4 mg, and who presented to the department consecutively between July 2023 and July 2024 were included in a prospective observational research. During the screening appointment, baseline clinical and demographic information was gathered.

Patients with major (a prior VTE episode) or minor (smoking status, active malignancies, family history of VTE, prior thrombophlebitis, recent trauma or fractures, prolonged immobilization, major recent surgeries, use of estrogen-progestin contraceptives, and recurrent miscarriages) clinical risk factors for VTE were also identified through a comprehensive medical history check. Additionally, baseline and 6-month therapy levels were assessed for antiphospholipid antibodies (lupus anticoagulant, anti-cardiolipin, and anti-β2 glycoprotein I), protein C, antithrombin III, homocysteine, protein S, and factor VIII.

After being evaluated for baricitinib therapy eligibility, 47 individuals with moderate-to-severe AA were included to the trial. Based on the previously published criteria, none of the screened patients showed a contraindication to the therapy. In terms of clinical VTE risk factors at baseline, 1 patient (2.1%) had a history of superficial thrombophlebitis, 5 women (10.6%) were taking combination estrogen-progestin contraceptives, and 8 out of 47 patients (17%) were heavy smokers.

There were no significant risk factors in any of the patients. Although two patients (4.2%) had bone fractures, which are recognized clinical risk factors for VTE, there were no thrombotic events while on baricitinib. Laboratory tests conducted on 37 out of 47 patients after 6 months of continuous medication revealed no changes in the majority of patients. Overall, these results imply that the risk of experiencing adverse events from VTE might be decreased for individuals who are eligible for baricitinib therapy.

Source:

Caldarola, G., Ferretti, A., Pinto, L. M., Di Gennaro, L., De Luca, E., Falco, G. M., De Simone, C., De Cristofaro, R., & Peris, K. (2025). No increased risk of thromboembolic events during 6-month treatment with baricitinib in patients with alopecia areata. International Journal of Dermatology, ijd.70051. https://doi.org/10.1111/ijd.70051

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Extensive Gastric Atrophy Linked to Higher Risk of Esophageal Cancer: Study

Researchers have established in a new study that extensive gastric atrophy (GA) greatly increases the risk of esophageal squamous cell carcinoma (ESCC) development. This new large Japanese cohort study yields more compelling evidence, demonstrating that open-type GA independently elevates the risk of ESCC, even after risk factor adjustment for established risk factors including age, sex, alcohol, and smoking. The study was published in Digestive Endoscopy journal by Kenta W. and colleagues.

The investigation was a retrospective nationwide cohort study that involved 17 health check-up centers in Japan. There were 33,461 participants who received endoscopy from 2013 to 2017 and had at least one follow-up endoscopy up to December 2022. GA was assessed endoscopically and was classified into three groups: atrophy-free, closed-type GA, and open-type GA. The incidence of ESCC was evaluated by Kaplan-Meier survival analysis and Cox regression models by the researchers. Multivariable adjustment was done by considering key confounders such as age, gender, drinking, and smoking.

Results

  • Of the 33,461 participants, 17,398 (52.0%) were atrophy-free, 8257 (24.7%) had closed-type GA, and 7804 (23.3%) had open-type GA.

  • During a median follow-up duration of 6 years, 77 new ESCC cases were newly diagnosed.

The incidence rates were shown to vary significantly among the groups:

  • Atrophy-free group: 24 cases (0.024% per year)

  • Closed-type GA group: 15 cases (0.031% per year)

  • Open-type GA group: 38 cases (0.089% per year)

  • Statistical analysis showed that open-type GA had a strong correlation with increased ESCC risk (p < 0.001).

  • In a model adjusted for known risk factors, open-type GA was an independent risk factor with an adjusted hazard ratio of 2.72 (95% CI: 1.58–4.69).

  • Closed-type GA did not correlate with ESCC after adjustment.

This huge Japanese cohort study presents new evidence that severe gastric atrophy of the open-type is causally associated with a higher risk of esophageal squamous cell carcinoma. Closed-type GA was not associated with such risk, suggesting that atrophy severity is crucial. The results highlight the need to recognize GA, especially open-type, as a possible marker of ESCC risk and stress the necessity for strict long-term follow-up in this group.

Reference:

Watanabe K, Fukuda S, Kubota D, et al. Potentially Causal Associations Between Extensive Gastric Atrophy and Esophageal Squamous Cell Carcinoma: A Nationwide Retrospective Cohort Study in Japan. Dig Endosc. Published online August 26, 2025. doi:10.1111/den.70019

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Worse outcomes with aspirin in high-risk chronic coronary syndrome patients who require long-term anticoagulation: ESC Study

Adding aspirin increased the risk of cardiovascular events, death and major bleeding in high-risk patients with chronic coronary syndrome (CCS) who had prior stenting and were receiving long-term chronic oral anticoagulation (OAC), according to late-breaking research presented in a Hot Line session today at ESC Congress 2025 and simultaneously published in New England Journal of Medicine.

Explaining the rationale of the AQUATIC trial, its Principal Investigator, Professor Martine Gilard from Hospital Cavale Blanche, Brest, France, said: “After stent implantation, many patients with CCS (stable coronary artery disease) are at high risk for future cardiovascular events due to conditions including diabetes, chronic kidney disease and diffuse multivessel disease, and some require long-term anticoagulation, particularly due to atrial fibrillation (AF). Managing the risk of further cardiovascular events in these patients is challenging and there is limited trial evidence to guide the optimal antithrombotic strategy. We designed the AQUATIC trial to formally test the efficacy and safety of adding aspirin to OAC, a combination that is commonly used for this high-risk population in clinical practice.”

This was a double-blind, placebo-controlled, parallel-group, randomised trial conducted at 51 centres in France. Eligible patients had CCS and stent implantation (>6 months before), were at high atherothrombotic risk and required long-term OAC for any reason (mainly AF). High atherothrombotic risk was defined as either a history of percutaneous coronary intervention (PCI) during an acute coronary syndrome (ACS) (with ≥1 stent(s) >6 months) or history of PCI (>6 months) outside the context of ACS but with high-risk features such as diabetes, chronic kidney disease, diffuse multivessel disease (involvement of three coronary vessels), history of complex PCI or peripheral artery disease. Patients were randomised 1:1 to aspirin or placebo on top of OAC (either a direct OAC or vitamin K antagonists). The primary efficacy endpoint was a composite of cardiovascular death, myocardial infarction, stroke, systemic embolism, coronary revascularisation and acute limb ischaemia. The key secondary safety endpoint was major bleeding according to the International Society on Thrombosis and Haemostasis (ISTH) definition.

The trial was stopped early on the advice of the independent Data Safety Monitoring Board after a median follow-up of 2.2 years due to an excess of all-cause mortality in the aspirin group. The 872 patients randomised had a mean age of 72 years and 14.5% were male.

The primary efficacy outcome occurred in significantly more patients in the aspirin group than the placebo group (16.9% vs. 12.1%; adjusted hazard ratio [HR] 1.53; 95% confidence interval [CI] 1.07 to 2.18; p=0.019). All-cause death also occurred in significantly more patients with aspirin vs. placebo (13.4% vs. 8.4%; adjusted HR 1.72; 95% CI 1.14 to 2.58; p=0.010).

The risk of major bleeding was more than three-fold higher in the aspirin group than the placebo group (10.2% vs. 3.4%; HR 3.35; 95% CI 1.87 to 6.00; p<0.0001).

A total of 467 and 395 serious adverse events were reported in the aspirin and placebo groups, respectively.

In conclusion, Professor Gilard said: “Among patients with CCS at high atherothrombotic risk who require OAC therapy, aspirin significantly increased the risk of major cardiovascular events, all-cause mortality and major bleeding, and its use should be discouraged. Other studies have investigated antithrombotic therapy for stable coronary artery disease and AF, 2,3 but this is the first randomised trial to include patients who had prior stenting and with high atherothrombotic risk − event rates were around seven times higher in AQUATIC than in previous trials. Our findings can now be considered in future ESC Guidelines to build on current recommendations, which are based on expert consensus.”

Reference:

Gilles Lemesle, Romain Didier, Aspirin in Patients with Chronic Coronary Syndrome Receiving Oral Anticoagulation, New England Journal of Medicine, DOI: 10.1056/NEJMoa2507532.

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Uterine Manipulators Enhance Laparoscopic Rectal Surgery Outcomes: Study

A recent study published in BMC Surgery found that uterine manipulators improve surgical exposure in laparoscopic rectal procedures in women without compromising oncological or perioperative outcomes.

The research analyzed female patients undergoing laparoscopic rectal resection for benign and malignant conditions, comparing those in whom uterine manipulators were used with those operated on without them. Surgeons reported enhanced visualization of the deep pelvis, which is often restricted in women due to uterine mobility and narrower pelvic dimensions. Improved access allowed for precise dissection around critical structures such as the rectum, ureters, and neurovascular bundles, facilitating safer and more efficient surgery. Importantly, the use of uterine manipulators did not significantly increase operative time, intraoperative blood loss, or postoperative complications. Oncological parameters—including total mesorectal excision quality, lymph node harvest, and circumferential resection margin—remained consistent across both groups, confirming that manipulator use does not compromise cancer-related outcomes. Functional outcomes, such as urinary and sexual function, were similarly unaffected, reinforcing the safety of this approach.

The authors emphasize that uterine manipulators can be particularly beneficial in challenging pelvic dissections, such as low rectal tumors or in patients with obesity or a narrow pelvis. While the findings support routine consideration of manipulators in female laparoscopic rectal surgery, they also highlight the importance of surgeon experience and familiarity with the device to maximize benefits. The study concludes that uterine manipulators serve as a valuable adjunct, providing enhanced exposure and operative confidence while maintaining safety and oncological integrity. Further randomized trials and long-term follow-up studies are suggested to assess additional outcomes, including patient-reported quality of life and potential impacts on postoperative recovery. Overall, this research underscores the potential for uterine manipulators to improve technical feasibility and precision in minimally invasive rectal surgery for women.

Reference:
Zhu, Y., Wang, X., Liu, H., & Chen, L. (2025). Uterine manipulators enhance surgical exposure in laparoscopic rectal cancer surgery in women without affecting oncological or perioperative outcomes. BMC Surgery, 25, 189. https://doi.org/10.1186/s12893-025-03078-2 [API]

Keywords: uterine manipulator, laparoscopic rectal surgery, female pelvic anatomy, surgical exposure, pelvic dissection, oncological outcomes, BMC Surgery

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’12k too low’: FMGs urge UP govt for stipend hike

New Delhi: The foreign medical graduates have urged the Uttar Pradesh Government to increase the stipend for medical graduates from abroad who are undergoing internship in the State.

Currently, the FMGs undergoing internship get Rs 12,000 per month as their stipend. Pointing out that the stipend for FMG interns in Bihar was recently raised to Rs 27,000 per month, the All FMGs Association (AFA) has demanded an increase in the stipend amount in Uttar Pradesh as well.

Highlighting the issue, AFA mentioned in an X post, “I respectfully request @CMOfficeUP @myogiadityanath @brajeshpathakup ji to consider increasing the stipend for intern doctors in Uttar Pradesh, as it is currently lower than the daily wage for laborers and neighbor states.”

Medical Dialogues had earlier reported that, offering respite to the MBBS, BDS, and AYUSH interns in Bihar, the State Government announced a stipend hike. The State Government announced that the MBBS, BDS, Ayurvedic, Unani, and Homoeopathy Interns in the government medical colleges, Patna Dental College and other institutes across the State would get Rs 27,000 per month. Previously, they used to get Rs 20,000 per month as their stipend.

Also Read: Bihar Govt approves stipend hike: MBBS, BDS, AYUSH, FMG interns to get Rs 27k per month

Apart from this, the State had also announced to give a Rs 27,000 monthly stipend to the Foreign Medical Graduates (FMGs) undergoing mandatory internship in the State’s Government Medical Colleges.

Referring to this, Dr. Kaushal from All FMGs Association (AFA) told Medical Dialogues, “Although Uttar Pradesh is more developed than Bihar and some neighbouring states, they still offer only 12k to their MBBS interns, which includes FMGs and IMGs interns. Recently, Bihar has raised the stipend from 20 to 27k. Delhi is already paying a nearly 30k stipend. States like Odisha, Assam, and West Bengal pay nearly 40k. But interns in Uttar Pradesh are getting such a low stipend.”

“AFA urges CM and the health minister sir to respond on this matter and understand the need of interns doctors who work tirelessly and increase the stipend in Uttar Pradesh,” he added.

Meanwhile, the Indian Medical Graduates in Uttar Pradesh have also been demanding a stipend hike. Medical Dialogues had earlier reported that MBBS interns in Uttar Pradesh recently protested against this on the social media platform X. Currently, the medical interns in Uttar Pradesh receive Rs 12,000 per month as their stipend, which, the students have claimed, is the lowest stipend in the country.

Also Read: UP MBBS interns launch protest storm on X demanding stipend hike

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Death of 2 newborns at Indore Hospital: NHRC seeks Action Taken Report

Bhopal: Taking cognisance of the deaths of two newborns allegedly bitten by rats at Indore’s government-run Maharaja Yeshwantrao (MY) Hospital, the National Human Rights Commission (NHRC) has issued notices to the Principal Secretary, Public Health and Medical Education Department, Madhya Pradesh government, and Indore District Collector, seeking an action taken report within 10 days.  

Medical Dialogues had reported that two newborns were bitten by rats inside the Neonatal Intensive Care Unit (NICU). One of the newborns, bitten over the weekend, passed away on Tuesday. The second infant admitted to the same neonatal intensive care unit (NICU) reportedly died after suffering injuries believed to be caused by a rat.

However, hospital authorities stated that the cause of death of the two infants was their critical medical condition, not the rat bite. They attributed their deaths to pneumonia and septicaemia, respectively. According to hospital officials, the reported rat bite resulted only in “minor scratches” on two fingers and was not a contributing factor in the fatality.

Also read- Another newborn dies amid rat bite allegations at Indore Hospital

While hospital authorities claimed that both newborns died due to pre-existing medical conditions, including congenital deformities, families and civil society groups have alleged gross negligence, as they claimed that the deaths are linked to alleged rat bites inside the hospital’s neonatal intensive care unit (NICU).

In support of the deceased infant’s families, a non-profit organisation, Network for Access to Justice, filed a complaint before the commission and sought immediate action against the responsible individuals and the urgent need for accountability, alleging that the families of the children have suffered irreparable loss.

While considering the matter, the commission in the notice said, “The complainant stated that this horrifying event highlights gross medical negligence and a complete failure to ensure basic hygiene and patient safety. Such a lapse not only breaches the trust of citizens in public healthcare but also constitutes a serious violation of the Right to Life and Health under Article 21 of the Constitution.”

In its notice, the NHRC has directed authorities that the allegations levelled in the complaint be inquired into, and asked to submit an “action taken report within 10 days” for perusal of the commission.

The Commission further stated, “Immediate measures must be taken to improve sanitation, pest control, and overall safety standards in government hospitals across the State. The allegations made in the complaint prima facie seem to be serious violations of the human rights of the victims.”

Speaking to The Hindu, NHRC member Priyank Kanoongo said, “Such incidents revealed a pathetic state of affairs at government hospitals in the State, while also pointing out that no action has been taken against any senior official in the matter.

“If the action is only taken against a company that provides manpower and some nursing staff, nothing is going to improve. For the system to be fixed, accountability has to be fixed from the top,” he added. 

More serious accusations

The Jai Adivasi Yuva Shakti (JAYS), a tribal organisation, on Monday claimed rats had gnawed four fingers of one of the deceased infants and accused the medical facility’s administration of lying and misleading everyone. They demanded suspension of the hospital superintendent and other senior officials, along with registration of a case of culpable homicide not amounting to murder.

If the demand is not met by Monday evening, the tribal community would launch a major agitation, JAYS national president Lokesh Mujalda warned.

Two newborn girls, who had been bitten by rats in the hospital’s ICU, died recently, raising questions about the institution’s functioning.

One of them, the daughter of Devram from Dhar district, who was admitted to the hospital with congenital deformities, died after the rat attack, Mujalda claimed while talking to PTI. The body was handed over to the family in a plastic bag after the post-mortem on Saturday evening, he said.

When the packing was removed before the funeral, the family was devastated and enraged to notice that four fingers on one hand of the baby had allegedly been gnawed by rats, Mujalda said.

He accused the MYH administration of misleading everyone by initially claiming the baby had only suffered minor injuries to her fingers due to rat bites.

On Saturday, JAYS functionaries staged a protest at the hospital with the bereaved parents seeking compensation of Rs 1 crore each for the families of the two infants, as well as registration of a culpable homicide case against senior officials.

“The district administration has assured us that the necessary steps will be taken to suspend senior officials of MYH and register an FIR against them. If this demand is not fulfilled within 10 days, another protest will be staged by us at MYH,” Mujalda had said.

The hospital administration has so far taken disciplinary action against six officials, including suspension and removal from posts, in connection with the deaths.

Also read- Rahul Gandhi slams PM Modi, State Govt over newborns’ death at Indore Hospital

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Massive MBBS Seats Vacant Across Indian Medical Colleges, reveals four-year report

Altogether 11,966 UG medical seats remained vacant in the last four years (starting from the academic year 2021-2022), revealed the data shared by the Union Minister of State for Health, Smt. Anupriya Patel in the Lok Sabha.

As per the data shared by the Union MoS Health, the highest number of vacancies was recorded during the academic year 2022-2023 when altogether 4,146 UG medical seats remained unfilled.

In 2021-2022, the total number of vacant seats was a minimum- altogether 2,012 seats remained vacant that year. Thereafter, the number of vacant seats doubled. The following year i.e. in 2023-2024, the number dropped to 2,959 and in 2023-2024, the number of vacant UG medical seats further got reduced to 2,849.

For more details, check out the full story on the link below:

Four-Year Report: Massive MBBS Seat Vacancies Across Indian Medical Colleges

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Black youth, especially Black girls, use mental health services less than their white peers, study finds

Black adolescents with mental distress are less likely to use mental health services than their white peers, and Black girls are the least likely to access care, according to new research published in the Canadian Medical Association Journal.

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Canada must protect youth from sports betting advertising, say specialists

Canada must enact strong, effective legislation to protect youth from gambling advertising. Minors are suffering harms from problem gambling despite age restrictions, argue authors in an editorial in CMAJ (Canadian Medical Association Journal).

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ESC/EAS 2025 Update Brings New Recommendations on Cholesterol Management and Risk Assessment

Belgium: The European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) have released a 2025 Focused Update to their 2019 Guidelines for the management of dyslipidaemias, introducing crucial revisions and new recommendations based on recent scientific evidence. The update, published in the European Heart Journal, aims to refine approaches to cardiovascular (CV) risk assessment and lipid-lowering therapies, particularly ahead of the next comprehensive guideline revision.

The Task Force, composed of experts from various European countries and the United States, meticulously reviewed new evidence published up to March 31, 2025, to ensure the guidelines reflect the latest advancements in patient care.
Here are 10 important points or key takeaways from this significant update:
1. Revised Cardiovascular Risk Estimation: The update recommends the use of SCORE2 for apparently healthy individuals under 70 years old and SCORE2-OP (Systematic Coronary Risk Evaluation 2-Older Persons) for those aged 70 to 89 years, to estimate the 10-year risk of both fatal and non-fatal cardiovascular disease (CVD). These new algorithms replace the older SCORE algorithm and consider non-HDL cholesterol, offering a more comprehensive risk assessment.
2. Subclinical Atherosclerosis as a Risk Modifier: The presence of subclinical coronary atherosclerosis, identified through imaging or an increased Coronary Artery Calcium (CAC) score (e.g., >300), should now be considered to improve risk classification. This is particularly relevant for individuals at moderate risk or those around treatment decision thresholds, as it can indicate a higher risk than calculated by SCORE2/SCORE2-OP alone.
3. Bempedoic Acid for LDL-C Lowering: Bempedoic acid is now recommended for patients who are unable to tolerate statin therapy to achieve their low-density lipoprotein cholesterol (LDL-C) goals. It can also be considered as an add-on therapy to the maximally tolerated statin dose, with or without ezetimibe, for high or very high-risk patients. Bempedoic acid typically reduces LDL-C by approximately 23% as monotherapy and by 18% when added to statin therapy.
4. Evinacumab for Homozygous Familial Hypercholesterolaemia (FH): For patients aged 5 years or older with homozygous FH who have not reached their LDL-C goal despite receiving maximum doses of other lipid-lowering therapies, evinacumab should be considered to significantly lower LDL-C levels, with observed reductions close to 50%.
5. Intensified Lipid-Lowering in Acute Coronary Syndromes (ACS): The guidelines emphasize a strategy of early, intensive LDL-C lowering during index hospitalization for ACS. This involves immediate initiation of statin therapy and, when necessary, combination treatment with one or more non-statin therapies with proven CV benefit. This approach supports the principle of “the sooner, the lower, the better” to prevent recurrent CV events in this vulnerable patient population.
6. Lipoprotein(a) [Lp(a)] as a Cardiovascular Risk Enhancer: Lp(a) levels above 50 mg/dL (105 nmol/L) should be considered a cardiovascular risk-enhancing factor in all adults, with higher levels correlating with a greater increase in risk. Measurement of Lp(a) is recommended at least once in an adult’s lifetime, especially in younger patients with FH or premature ASCVD, or in moderate-risk individuals to refine risk classification.
7. High-Dose Icosapent Ethyl for Hypertriglyceridaemia: For high-risk or very high-risk patients with elevated triglyceride levels (fasting triglyceride level 135–499 mg/dL or 1.52–5.63 mmol/L) despite statin therapy, high-dose icosapent ethyl (2 × 2 g/day) should be considered in combination with a statin to reduce the risk of cardiovascular events.
8. Volanesorsen for Severe Hypertriglyceridaemia due to Familial Chylomicronemia Syndrome (FCS): Volanesorsen (300 mg/week) should be considered in patients with severe hypertriglyceridaemia (levels >750 mg/dL or >8.5 mmol/L) specifically attributed to FCS, to lower triglyceride levels and reduce the risk of acute pancreatitis.
9. Statin Therapy for Primary Prevention in People with HIV (PWH): Statin therapy is now recommended for PWH aged ≥40 years in primary prevention, irrespective of their estimated cardiovascular risk and LDL-C levels. This recommendation, based on the REPRIEVE trial, aims to reduce cardiovascular events, with careful consideration of potential drug interactions with antiretroviral therapy.
10. Statins for Cardioprotection in Cancer Therapy: Statins should be considered in adult patients at high or very high risk of developing chemotherapy-related cardiovascular toxicity, such as anthracycline-induced cardiac dysfunction. This reflects growing evidence supporting their cardioprotective role in this specific patient group.
François Mach, Department of Cardiology, Geneva University Hospital, Geneva, Switzerland, and colleagues note that while new recommendations for risk estimation and specific therapies have been introduced, the LDL-C treatment goals and therapeutic guidance based on cardiovascular risk categories have not changed from the 2019 ESC/EAS Guidelines. The intensity of recommended LDL-C lowering continues to be determined by an individual’s level of risk.
Furthermore, the update reiterates that dietary supplements or vitamins without documented safety and significant LDL-C-lowering efficacy are generally not recommended to lower the risk of atherosclerotic cardiovascular disease, with the exception of high-dose, purified icosapent ethyl in the context of hypertriglyceridaemia.
Reference:
Mach, F., Koskinas, K. C., E, J., Tokgözoğlu, L., Badimon, L., Baigent, C., Benn, M., Binder, C. J., Catapano, A. L., De Backer, G. G., Delgado, V., Fabin, N., Ference, B. A., Graham, I. M., Landmesser, U., Laufs, U., Mihaylova, B., Nordestgaard, B. G., Richter, D. J., . . . Shek, A. 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias: Developed by the task force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). European Heart Journal. https://doi.org/10.1093/eurheartj/ehaf190

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