Dual antiplatelet therapy is not more effective than aspirin alone after CABG: ESC Study

Dual antiplatelet therapy (DAPT) was not more effective than aspirin alone for the prevention of major adverse cardiovascular events and increased major bleeding in patients with acute coronary syndrome (ACS) who underwent coronary artery bypass grafting (CABG), according to late-breaking research presented in a Hot Line session today at ESC Congress 20251 and simultaneously published in New England Journal Medical.

ESC Guidelines recommend DAPT with aspirin plus a P2Y12 inhibitor over single antiplatelet therapy for patients with ACS (heart attacks or unstable angina) who have undergone CABG.2 “These recommendations are mainly based on extrapolation of data from non-CABG studies, sub-studies of ACS trials and smaller randomised studies with surrogate endpoints. Data from larger randomised trials with clinically relevant endpoints are lacking. We conducted the TACSI trial to investigate whether 12 months of DAPT with ticagrelor and aspirin would reduce the risk of all-cause death and cardiovascular events compared with aspirin alone in ACS patients after CABG,” explained Principal Investigator, Professor Anders Jeppsson from Sahlgrenska University Hospital, Gothenburg, Sweden.

The TACSI trial was an investigator-initiated pragmatic, open-label, registry-based randomised trial conducted in all 22 cardiothoracic surgery centres in Sweden, Denmark, Norway, Finland and Iceland. Patients undergoing their first isolated CABG were randomised 1:1 within 3–14 days to either DAPT (ticagrelor 90 mg twice daily plus aspirin 75 mg once daily) or aspirin only (75–160 mg daily according to local protocols) for 12 months. The primary efficacy endpoint of major adverse cardiovascular events (MACE) was a composite of all-cause death, myocardial infarction, stroke or new coronary revascularisation within 12 months. The primary safety endpoint was major bleeding.

The 2,201 patients included had a mean age of 66 years and 14.4% were women. The primary endpoint of MACE occurred in a similar proportion of patients in each group: 4.8% of patients in the DAPT group and 4.6% in the aspirin only group (hazard ratio [HR] 1.09; 95% confidence interval [CI] 0.74 to 1.60; log rank p=0.77). Major bleeding was more frequent in the DAPT group (4.9% vs. 2.0%; HR 2.50; 95% CI 1.52 to 4.11).

A key secondary endpoint of net adverse clinical events (the primary endpoint plus major bleeding) was higher in the DAPT group than in the aspirin group (9.1% vs. 6.4%; HR 1.45; 95% CI 1.07 to 1.97). A total of 0.7% of patients with DAPT and 0.2% with aspirin only died during the first year after randomisation (HR 4.01; 95% CI 0.85 to 18.9).

Concluding, Professor Jeppsson said: “Our 12-month data do not support the use of DAPT over aspirin alone in ACS patients after CABG, given the lack of improvement in MACE and the increased risk of major bleeding. However, further long-term follow-up is needed.” 

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Gout Significantly Impairs Hand Function, Comparable to Rheumatoid Arthritis, suggests study

Researchers have found in a new study that gout severely affects hand function, reducing grip strength, endurance, and dexterity due to joint and tissue changes. The level of manual impairment is nearly as significant as that seen in rheumatoid arthritis.

The aim of the study was to compare the hand function (grip strength and grip endurance, manual dexterity, and perceived hand functional disability) of participants with gout, rheumatoid arthritis, and healthy control. Grip strength and grip endurance were assessed using a hand dynamometer, while manual dexterity was evaluated through the Nine-Hole Peg Test. Perceived hand functional disability was measured using the Duruöz Hand Index. Results: The grip strength was similar between gout and healthy control (p>0.05). Dominant and non-dominant grip endurance in gout were lower than healthy control (p=0.008, p=0.001). The dominant placing, removing, and total Nine-Hole Peg Test time of gout compared to healthy control were higher (p=0.001, p<0.001, and p<0.001). The non-dominant placing, removing, and total Nine-Hole Peg Test time of gout were higher than healthy control (p=0.002, p=0.004, and p=0.002). The Duruöz Hand Index in gout was higher than healthy control (p=0.002), but lower than rheumatoid arthritis (p=0.008). The findings indicate that individuals with gout experience impairments in grip strength, manual dexterity, and perceived hand function. Assessing hand function during clinical examinations of patients with gout should be considered.

Reference:

Mete O, Apaydin H, Varol F, Gülöksüz EGA, Pamukcu M. Hand function in gout: a comparative study with rheumatoid arthritis and healthy. Rev Assoc Med Bras (1992). 2025 Jul 7;71(6):e20250054. doi: 10.1590/1806-9282.20250054. PMID: 40638474; PMCID: PMC12245048.

Keywords:

Hand, function, gout, comparative, study, rheumatoid arthritis, healthy, Mete O, Apaydin H, Varol F, Gülöksüz EGA, Pamukcu M, Revista da Associação Médica Brasileira

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Happy music could help you recover from motion sickness

Scientists studying ways of improving motion sickness have found that playing different types of music may help people recover more effectively. Using a specially calibrated driving simulator, they induced car sickness in participants and then played different types of music while they tried to recover. Soft and joyful music produced the best recovery effects, while sad music was less effective than doing nothing at all.

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Dad’s childhood passive smoking may confer lifelong poor lung health onto his kids

A father’s exposure to passive smoking as a child may impair the lifelong lung function of his children, putting them at risk of COPD—a risk that is heightened further if they are childhood passive smokers themselves—finds research published online in the respiratory journal Thorax.

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People with learning disabilities seem to progress faster to severe type 2 diabetes

People with learning disabilities progress faster to severe type 2 diabetes and are at greater risk of dying from their condition than people without these disabilities, suggests research published in the journal BMJ Open Diabetes Research & Control.

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Early aspirin discontinuation linked to benefits in low-risk MI patients undergoing PCI: ESC Study

Madri: Among low-risk patients with acute MI who underwent early complete revascularisation and received one month of dual antiplatelet therapy (DAPT), P2Y12 inhibitor monotherapy was noninferior to continued DAPT for adverse cardiovascular and cerebrovascular events, while reducing bleeding risk.

These late-breaking findings were presented in a Hot Line session today at ESC Congress 2025 and simultaneously published in New England Journal of Medicine.

Current ESC Guidelines recommend 12 months of DAPT − aspirin plus a potent P2Y12 inhibitor − after percutaneous coronary intervention (PCI) for MI.2 Principal Investigator of the TARGET-FIRST trial, Professor Giuseppe Tarantini from the University of Padua, Italy, explained: “No randomised trials have previously assessed early aspirin discontinuation in acute MI patients who achieve early, complete revascularisation with modern stents. In such cases, bleeding risk may outweigh residual ischaemic risk, making antiplatelet therapy de-escalation attractive.”

In this open-label randomised controlled trial conducted at 40 European centres, eligible adults with an ST-segment elevation MI (STEMI) or non-STEMI underwent complete revascularisation within seven days using a contemporary drug-eluting stent and completed one month of DAPT without adverse events.

They were randomised 1:1 to continue DAPT or switch to P2Y12 inhibitor monotherapy for 11 months. The primary endpoint was a composite of all-cause death, MI, stent thrombosis, stroke or Bleeding Academic Research Consortium (BARC) type 3/5 bleeding at 11 months. Noninferiority was defined as an absolute difference ≤1.25 percentage points in the upper bound of the two-sided 95% CI.

The mean age of the 1,942 randomised patients was 61 years and 21.6% were women.

The primary endpoint occurred in 2.10% of the P2Y12 inhibitor monotherapy group and 2.18% of the continued DAPT group (difference –0.09 percentage points; 95% CI –1.39 to 1.20; p=0.021 for noninferiority). MI occurred in 0.7% vs. 1.1%, definite/probable stent thrombosis in 0.1% vs. 0.0% and ischaemic stroke in 0.3% vs. 0.2%, respectively. BARC type 3/5 bleeding occurred in 0.7% in each group.

The main secondary endpoint (BARC type 2/3/5 bleeding) was significantly lower with P2Y12 inhibitor monotherapy (2.65% vs. 5.57%; hazard ratio [HR] 0.46; 95% CI 0.29 to 0.75; p=0.002).

The patient-oriented composite outcome (all-cause death, MI, stent thrombosis, stroke, repeat ischaemia-driven revascularisation or BARC type 2/3/5 bleeding) occurred in 4.5% in the monotherapy group and 7.2% in the DAPT group (HR 0.61; 95% CI 0.42 to 0.89). Therapy adherence at 11 months was high in both groups (86.9% with monotherapy and 88.6% with DAPT).

Professor Tarantini concluded: “In low-risk acute MI patients with early complete revascularisation and no complications after one month of DAPT, switching to P2Y12 inhibitor monotherapy-maintained protection from ischaemic events and reduced bleeding. These results reflect the benefits of modern stents, high procedural success and optimal medical therapy, making early aspirin discontinuation feasible in this selected population.”

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Medicaid is crucial to access treatment for opioid addiction, researchers find

Medicaid plays a key role for giving people with opioid-use disorder access to treatment, according to a Rutgers Health study. Progress in life-saving treatment for opioid-use disorder with the medication has stalled in the past several years. While some states were able to achieve substantial improvement, others lost ground.

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Multimodal deep learning model improves risk prediction for cervical cancer radiotherapy decisions

Standard concurrent chemoradiotherapy (CCRT) for cervical cancer achieves disease-free survival (DFS) in approximately 70% of patients with locally advanced disease; however, nearly 30% still experience recurrence or metastasis.

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People with learning disabilities seem to progress faster to severe type 2 diabetes

People with learning disabilities progress faster to severe type 2 diabetes and are at greater risk of dying from their condition than people without these disabilities, suggests research published in the open access journal BMJ Open Diabetes Research & Control.

This is despite having better overall blood glucose control and similar risks of vascular complications, the findings indicate.

Around 1.5 million people (950,000 adults) in the UK have a learning disability, which includes conditions such as Down syndrome and cerebral palsy, note the researchers.

Type 2 diabetes in those with learning disabilities can be challenging as it requires a substantial amount of monitoring and management, which they may not always be able to do, potentially compromising their blood glucose control, explain the researchers.

But there’s been no large study on the potential impact of learning disabilities on the outcomes of type 2 diabetes, including blood glucose control, progression to microvascular and macrovascular complications, initiation of insulin therapy (proxy for severe disease), and risk of death, they add.

Macrovascular complications refer to stroke, coronary heart disease, heart failure, peripheral vascular disease, or amputation more than 6 months after diagnosis of type 2 diabetes. Microvascular complications refer to diabetic nephropathy, retinopathy, or neuropathy.

In a bid to plug this knowledge gap, the researchers extracted anonymised medical records for 352,215 adults newly diagnosed with type 2 diabetes in primary care between January 2004 and January 2021 from the UK Clinical Practice Research Datalink (CPRD) GOLD.

Of these, 280,300 met the eligibility criteria for inclusion in the study, 2074 of whom had a learning disability when they were diagnosed.

They tended to be younger (average age 51 vs 64) and have a shorter monitoring period. And they included higher proportions of men, people of White ethnicity, people living with severe obesity and in areas of greatest deprivation than those without learning disabilities.

They were also more likely to be taking medication for diabetes and high blood pressure and to have more complications related to diabetes at the time of their diagnosis.

Even after adjusting for these potentially influential risk factors they were 19% less likely to have poor blood glucose control than those without learning disabilities 5 years after diagnosis.

But they were 20% more likely to progress faster to severe disease and the need for insulin therapy than those who didn’t have learning disabilities.

And they were around twice as likely to die from any cause and specifically from diabetes despite having similar risks of vascular complications as those who didn’t have learning disabilities.

This is an observational study, and as such, can’t establish cause and effect, and the researchers acknowledge that large numbers of values for the outcome variables for blood glucose control were missing among those with learning disabilities. Complication rates may therefore have either been underdiagnosed or under-recorded, they suggest.

“Our finding of higher rates of insulin initiation in those with learning disabilities warrants further investigation into whether this is due to poorer glycemic control at presentation (and therefore faster advancing type 2 diabetes) or due to having a greater degree of clinical surveillance,” say the researchers.

“Future research into the mechanisms behind this could help reduce health disparities for people with [type 2 diabetes] and learning disabilities,” they add.

Reference:

https://drc.bmj.com/lookup/doi/10.1136/bmjdrc-2024-004879

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Colchicine may slow blood mutation, related CVD risk, reveals study

Taking low-dose colchicine daily may slow the progression of a common acquired gene mutation found in the blood of older adults that can lead to certain blood cancers and increased risk of cardiovascular disease, according to a subanalysis of the LoDoCo2 trial published in JACC, the flagship journal of the American College of Cardiology, and simultaneously presented at ESC Congress 2025.

Clonal hematopoiesis (CH) is an acquired mutation in blood stem cells that is linked to risk of developing leukemia and other blood cancers. It is also associated with a more than 1.5-fold increased risk of cardiovascular disease, including coronary heart disease, heart failure and arrhythmias. The most common driver genes that can lead to CH are DNMT3A, TET2 and ASXL1, which represent about 80% of CH cases. Research has shown that over 10% of people 70 years old and older carry one or more of these mutations and the risk increases with age.

In this study, researchers looked at a subset of participants in the LoDoCo2 Trial, which previously found that 0.5 mg daily of colchicine reduced the risk of cardiovascular disease by 31% in people with chronic coronary disease, to determine if colchicine also modified CH growth in the same individuals. Colchicine is a medication commonly used to treat gout and other inflammatory conditions.

Participants provided four blood samples: at the beginning of the study, after 30 days, one-year post randomization and at the end of the study. Their blood DNA was sequenced to detect and quantify CH mutations and analyze changes over time. Also, two blood biomarkers of inflammation were measured at the first three timepoints.

Those randomized to colchicine had a non-significant 6.3% annual increase in the number of overall mutated CH cells compared to a significant 14.9% increase in those taking placebo. Colchicine was associated with significantly attenuated clonal growth in TET2 CH, specifically, with a 9.1% annual increase in TET2 clone size in the colchicine group, compared with a 29.6% increase in the placebo group.

“These findings are striking in part because larger CH clones have been more strongly linked to both cardiovascular disease and cancer, and TET2 CH in particular has been consistently associated with increased cardiovascular risk,” said Michael Honigberg, MD, MPP, FACC, cardiologist at Massachusetts General Hospital and the study’s senior author. “Our study suggests that individuals with CH, especially TET2-mutated CH, may derive particular benefit from colchicine, including for cardiovascular risk reduction.”

In a second study published in JACC and being presented at ESC Conference 2025, researchers looked at whether CH’s relevance to cardiovascular disease risk decreased as women got older. Older adults have the highest risk of cardiovascular disease, and some previous studies have failed to demonstrate an association between CH and CVD after age 70.

Researchers in this study looked at over 6,600 women in the Women’s Health Initiative Long Life Study who had a median age of 80. They found that several CH subtypes (TET2, ASXL1, and JAK2) were associated with incident CVD, suggesting that CH remains associated with cardiovascular health into later life.

“Clonal hematopoiesis is emerging as a key link between aging, cardiovascular disease and cancer,” said Harlan Krumholz, MD, FACC, JACC Editor-in-Chief and Harold H. Hines Jr Professor of Medicine, Yale University School of Medicine. “This study advances our understanding of how inflammation and genetic changes in blood cells may shape cardiovascular risk, pointing to new opportunities for prevention and treatment.”

Reference:

Common inflammation drug may slow blood mutation, related CVD risk, Meeting: ESC Congress 2025.

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