Dehydration in elderly may increase risk of intracerebral hemorrhage and stroke: Study

A new study published in the Journal of Stroke and Cardiovascular Diseases showed that dehydration was associated with an increased risk of stroke in a large sample of persons aged 80 and over.

Stroke is still a major cause of morbidity and death globally, and early clinical status and modifiable risk factors have a significant impact on outcomes. It is becoming more widely acknowledged that dehydration, a prevalent but sometimes disregarded ailment in hospitalized and elderly patients, may have a role in the severity and recovery of stroke.

Dehydration can exacerbate ischemia damage by increasing blood viscosity, promoting thrombus formation, and impairing brain perfusion. This study looked through a sizable database to see whether dehydration and stroke are related. Adults 80 years of age and older who had medical visits prior to the pandemic, from January 1, 2018, to December 31, 2019, made up the research population.

Laboratory test data and ICD-10 diagnostic codes were used to identify the dehydration cohort. Based on ICD-10 codes, outcome measurements included one of 3 stroke types: transient ischemic attack, ischemic stroke, or intracerebral hemorrhage. A subanalysis was conducted on people with diabetes.

This study found a total of 563,476 of the 3,125,610 people aged 80 and above were dehydrated. There were 443,450 diabetics and 101,661 dehydrated people. In both groups, the dehydration cohorts were somewhat older (82.7 vs. 82.4, p <0.001), slightly more female, and non-Hispanic white.

Dehydrated people had 1.98–3.99 times the risk of stroke after adjusting for common covariates in propensity score matching: ischemic stroke (OR=1.98, 95% CI=1.9-2.07), TIA (OR=2.88, 95% CI=2.74-3.28), and intracerebral hemorrhage (OR=3.99, 95% CI=3.41-4.67). The diabetic group experienced ischemic stroke (OR=1.97, 95% CI=1.81-2.16), TIA (OR=2.81, 95% CI=2.33-3.39), and intracerebral hemorrhage (OR=6.76, 95% CI=4-11.42).

Overall, in this sizable sample of 3 million people, as well as in a subset with diabetes, a substantial correlation between dehydration and stroke was discovered. The risk of dehydration in older persons is increased by both the physiological changes associated with natural aging and drugs used to address cardiovascular stroke risk factors. Blood viscosity may account for the link between ischemic stroke and TIA, but the intracerebral hemorrhage correlation is unexpected. Future research ought to assess if better hydration results in fewer strokes.

Source:

Hamrick, I., Tuan, W.-J., Harker, P., Adogwa, O., & Hyacinth, H. I. (2025). Association between dehydration and stroke, a retrospective cohort study of a large database. Journal of Stroke and Cerebrovascular Diseases: The Official Journal of National Stroke Association, 108430, 108430. https://doi.org/10.1016/j.jstrokecerebrovasdis.2025.108430

Powered by WPeMatico

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.” 

Powered by WPeMatico

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

Powered by WPeMatico

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.

Powered by WPeMatico

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.

Powered by WPeMatico

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.

Powered by WPeMatico

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.”

Powered by WPeMatico

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.

Powered by WPeMatico

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.

Powered by WPeMatico

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

Powered by WPeMatico