ACC Issues Vaccination Guidelines for Adults with Cardiovascular Disease

The American College of Cardiology (ACC) has released new vaccination recommendations for adults with cardiovascular disease, advising immunization against COVID-19, influenza, RSV, pneumonia, and shingles. Published in JACC, the guidelines provide evidence-based support for each vaccine and include FAQs to guide discussions between patients and clinicians as part of routine prevention and treatment.

The guidance also provides detailed evidence for each vaccine recommendation and answers to frequently asked questions to guide conversations between clinicians and patients.

“Vaccination against communicable respiratory diseases and other serious diseases is critical for people with heart disease, but barriers exist to ensuring people are educated on which vaccines to get, how often to get them and why they are important,” said Paul Heidenreich, MD, FACC, chair of the CCG writing committee. “With this document, we want to encourage clinicians to have these conversations and help their patients manage vaccination as part of a standard prevention and treatment plan.”

People with heart disease have a higher risk of infection when exposed to a respiratory virus and a higher risk of adverse outcomes, including hospitalization and death. Studies have shown that vaccines are highly effective in reducing these risks; however, a recent study showed only 30% of primary care physicians are assessing their patients’ vaccination status at clinic visits.

The ACC issued this CCG to consolidate vaccine-specific recommendations made by ACC/American Heart Association guidelines and the Centers for Disease Control and Prevention. The guidance mainly focuses on respiratory vaccines but also offers guidance based on emerging evidence that other vaccines-such as the herpes zoster (shingles) vaccine-may offer cardiovascular protective benefits.

Vaccine specific guidance includes:

• Influenza – An annual flu vaccine is recommended for all adults to reduce cardiovascular morbidity, cardiovascular mortality and all-cause death. Nasal versions of the vaccine are not recommended in patients over 50.

• Pneumococcal – recommended for adults 19 or older with heart disease to get this one-time vaccine to protect against pneumonia, bacteremia and meningitis and related risk of hospitalization and death. Following CDC/Advisory Committee on Immunization Practices recommendation, the guidance advises a single dose of PCV20 or PCV21, or PCV15 followed by PPSV23 depending on prior vaccination history.

• COVID-19 – For the 2024–25 season, all adults with heart disease were recommended to receive the seasonal COVID-19 vaccine. Future vaccination frequency may change, but it is likely vaccination will remain beneficial for those with heart disease. Benefits include reduced risk of infection, severe infection, death, heart attack, COVID-19 induced pericarditis/myocarditis, COVID-19 induced stroke and atrial fibrillation, and long COVID symptoms.

• RSV – recommended for adults 75 or older and for adults aged 50–74 with heart disease to protect against lower respiratory disease that can result in hospitalization and death. Current guidance recommends a single dose, rather than annual vaccination.

• Shingles – recommended for adults 50 or older to receive two doses to protect against increased risk of stroke and heart attack when infected. People with heart disease are at an increased risk of shingles infection.

The document outlines strategies to improve vaccination rates, address hesitancy and overcome barriers to access, noting that clinician-patient discussions about vaccination during cardiology visits can be an important opportunity to integrate vaccination into a cardiovascular care plan.

Reference:

A. Heidenreich, P, Bhatt, A, Nazir, N. et al. 2025 Concise Clinical Guidance: An ACC Expert Consensus Statement on Adult Immunizations as Part of Cardiovascular Care: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. Published online Aug. 26, 2025. doi:10.1016/j.jacc.2025.07.003.

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Rheumatoid arthritis linked to increased risk of degenerative valvular heart disease: AHA

A new study published in the Journal of American Heart Association showed that degenerative valvular heart disease has been linked to an increased risk of rheumatoid arthritis (RA).

Degenerative valvular heart disease (VHD) is a prevalent subtype of VHD that mostly affects people over 50 in high-income nations and is caused by age-related degenerative pathogeneses. There is growing evidence that degenerative VHD, including aortic stenosis (AS) and mitral regurgitation (MR), is influenced by immunological dysregulation and chronic inflammation.

Despite the growing evidence that RA and degenerative VHD share comparable inflammatory processes and risk factors, little is known about how they relate to one another. Thus, this study was set to examine the relationship between the risk of various forms of degenerative VHD and the prevalence of RA.

Cox proportional hazards models, with sequential adjustments for demographics, lifestyle factors, and comorbidities, were used to evaluate the relationship between prevalent RA and new-onset degenerative VHD.

Among 492 745 UK Biobank individuals who did not have VHD at baseline. 8 subtypes of degenerative VHD were identified in this study: tricuspid stenosis, tricuspid regurgitation, mitral stenosis, aortic regurgitation, aortic stenosis, pulmonary stenosis, and pulmonary regurgitation.

Over a median follow-up of 13.71 (interquartile range: 12.71–14.55) years, 359 instances of degenerative VHD were reported among individuals with RA (n=6673), whereas 13 518 cases were reported among people without RA (n=486–072) over a median follow-up of 13.78 (interquartile range: 12.96–14.51) years. 

Aortic stenosis (hazard ratio [HR], 1.64 [95% CI, 1.40–1.92]), aortic regurgitation (HR, 1.69 [95% CI, 1.34–2.13]), and mitral regurgitation (HR, 1.54 [95% CI, 1.32–1.81]) were the three types of new-onset degenerative VHD that were significantly associated with RA after full adjustment. 

No significant association was found between RA and other subtypes of degenerative VHD. Additionally, sex subgroup analysis showed that RA and sex interacted to increase the risk of aortic stenosis (P for interaction=0.02) and mitral regurgitation (P for interaction=0.04) in women.

Overall, while there was no significant correlation between RA and incident degenerative MS, TR, or PR, the results of this cohort analysis suggested that RA was linked to the development of degenerative AS, AR, and MR.

Furthermore, incident AS and MR may be more likely to occur in women with RA. In order to incorporate these findings into primary prevention in high-risk groups, more research is required.

Source:

Wang, Z., Lv, J., Qian, X., Li, Z., Yin, Z., Wang, C., Zhao, S., Gao, X., & Wu, Y. (2025). Association between rheumatoid arthritis and the risk of incident degenerative valvular heart disease: Evidence from a prospective cohort study. Journal of the American Heart Association,. https://doi.org/10.1161/JAHA.125.042025

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College drinking linked to poor academics and mental health for those around the drinker

It’s well known that alcohol misuse can harm not only drinkers themselves but also those around them. Now, a new report in the Journal of Studies on Alcohol and Drugs shows that, among college students, harms such as lower grades, mental distress and even suicidal thoughts are linked to being exposed to a drinker’s poor behavior.

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Leveraging food delivery services to provide rapid cardiac arrest response could save lives

Inspired by an urgent need to improve timely defibrillation for out-of-hospital cardiac arrests (OHCA) in dense urban settings, a team of investigators developed a simulation that explored the potential of leveraging an existing food delivery network in Taipei City, Taiwan, to help address this challenge.

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Risk of a second cancer after early breast cancer is low, say new findings

For women diagnosed with early breast cancer, the long-term risk of developing a second primary cancer is low (around 2–3% greater than women in the general population), finds a study published in The BMJ.

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Data science uncovers patterns in health service use linked to child mortality

Children in sub-Saharan Africa have the world’s highest rates of under-5 mortality at 74 deaths per 1,000 live births, which is 14 times higher than the risk for children in North America and Europe. In 2021, sub-Saharan Africa accounted for more than 80% of under-5 mortality worldwide. Sadly, the causes of death, such as diarrhea, malaria and preterm birth, are mostly preventable or treatable.

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Parkinson’s disease drug candidates induce unexpected damaging effects

Parkinson’s disease is the second most common neurodegenerative disease, affecting over 10 million people worldwide. Some forms of Parkinson’s disease are characterized by an inability of cells to clean up dysfunctional mitochondria, particularly in neural cells of the brain. Like batteries, the mitochondria provide energy for a cell to function, but also like batteries, they can leak toxins as they age. Mitophagy is the process by which cells conduct quality control, throwing away old and defective mitochondria like taking out the trash.

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Mediterranean diet may offset genetic risk of Alzheimer’s, suggests study

A new study led by investigators from Mass General Brigham, Harvard T.H. Chan School of Public Health, and the Broad Institute of MIT and Harvard suggests that a Mediterranean-style diet may help reduce dementia risk. The study, published in Nature Medicine, found that people at the highest genetic risk for Alzheimer’s disease benefited more from following a Mediterranean-style diet, showing a greater reduction in dementia risk compared to those at lower genetic risk.

“One reason we wanted to study the Mediterranean diet is because it is the only dietary pattern that has been causally linked to cognitive benefits in a randomized trial,” said study first author Yuxi Liu, PhD, a research fellow in the Department of Medicine at Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, and a postdoctoral fellow at the Harvard Chan School and Broad. “We wanted to see whether this benefit might be different in people with varying genetic backgrounds, and to examine the role of blood metabolites, the small molecules that reflect how the body processes food and carries out normal functions.”

Over the last few decades, researchers have learned more about the genetic and metabolic basis of Alzheimer’s disease and related dementias. These are among the most common causes of cognitive decline in older adults. Alzheimer’s disease is known to have a strong genetic component, with heritability estimated at up to 80%.

One gene in particular, apolipoprotein E (APOE), has emerged as the strongest genetic risk factor for sporadic Alzheimer’s disease — the more common type develops later in life and is not directly inherited in a predictable pattern. People who carry one copy of the APOE4 variant have a 3-to-4-fold higher risk of developing Alzheimer’s. People with two copies of the APOE4 variant (called APOE4 homozygous) have a 12-fold higher risk of Alzheimer’s than those without.

To explore how the Mediterranean diet may reduce dementia risk and influence blood metabolites linked to cognitive health, the team analyzed data from 4,215 women in the Nurses’ Health Study, following participants from 1989 to 2023 (average age 57 at baseline). To validate their findings, the researchers analyzed similar data from 1,490 men in the Health Professionals Follow-Up Study, followed from 1993 to 2023.

Researchers evaluated long-term dietary patterns using food frequency questionnaires and examined participants’ blood samples for a broad range of metabolites. Genetic data were used to assess each participant’s inherited risk for Alzheimer’s disease. Participants were then followed over time for new cases of dementia. A subset of 1,037 women underwent regular telephone-based cognitive testing.

They found that the people following a more Mediterranean-style diet had a lower risk of developing dementia and showed slower cognitive decline. The protective effect of the diet was strongest in the high-risk group with two copies of the APOE4 gene variant, suggesting that diet may help offset genetic risk.

“These findings suggest that dietary strategies, specifically the Mediterranean diet, could help reduce the risk of cognitive decline and stave off dementia by broadly influencing key metabolic pathways,” Liu said. “This recommendation applies broadly, but it may be even more important for individuals at a higher genetic risk, such as those carrying two copies of the APOE4 genetic variant.”

A study limitation was that the cohort consisted of well-educated individuals of European ancestry. More research is needed in diverse populations.

In addition, although the study reveals important associations, genetics and metabolomics are not yet part of most clinical risk prediction models for Alzheimer’s disease. People often don’t know their APOE genetics. More work is needed to translate these findings into routine medical practice.

“In future research, we hope to explore whether targeting specific metabolites through diet or other interventions could provide a more personalized approach to reducing dementia risk,” Liu said.

Reference:

Liu, Y., Gu, X., Li, Y. et al. Interplay of genetic predisposition, plasma metabolome and Mediterranean diet in dementia risk and cognitive function. Nat Med (2025). https://doi.org/10.1038/s41591-025-03891-5

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Pioneering Pain Control: Which Technique Wins? TAP vs. Intrathecal Hydromorphone in the OR for abdominal surgery, study finds

Recent article compares two different pain management techniques used after upper abdominal surgeries. One is called intrathecal hydromorphone (ITH), where a pain medication is injected directly into the spinal fluid. The other is called a transversus abdominis plane (TAP) block, where numbing medicine is injected into the abdominal wall. The researchers found that patients who received the ITH technique had less severe pain when moving around on the first day after surgery, compared to those who got the TAP block. This suggests the ITH was better at controlling pain during movement. However, the TAP block had some advantages. Patients who got the TAP block had less itching as a side effect, and their bowels started working again sooner after surgery. The amount of pain medication needed was also a bit lower in the TAP block group. Overall, the study suggests that ITH may provide better pain relief, especially when patients are moving around, compared to the TAP block. But the TAP block has some benefits too, like less itching and faster recovery of bowel function. The researchers think the reason for these differences is that the ITH provides longer-lasting pain relief, while the TAP block is more focused on the abdominal area. Since upper abdominal surgeries tend to be very painful, the longer-lasting pain relief from ITH may be more helpful. However, this was a retrospective study, which means the researchers looked back at medical records rather than doing a controlled experiment. So there could be other factors that influenced the results that the researchers didn’t account for. The authors recommend that doctors consider the type of surgery when choosing between ITH and TAP block for pain management. For open abdominal surgeries, ITH may be the better choice. But for less invasive laparoscopic surgeries, the TAP block may be preferable due to its benefits for recovering bowel function. Overall, this study provides helpful information to doctors on the pros and cons of these two pain management techniques for patients undergoing upper abdominal surgery. But more research, especially controlled studies, is still needed to fully understand which approach works best.

Key points –

– Intrathecal hydromorphone and transversus abdominis plane (TAP) block are commonly used analgesic techniques for upper abdominal surgeries, with intrathecal opioid injection providing prolonged analgesia with a lower dose compared to intravenous administration.

– A retrospective study aimed to compare the analgesic efficacy of intrathecal hydromorphone and TAP block in upper abdominal surgeries by assessing the primary outcome of moderate-to-severe pain during movement at 24 hours postoperatively.

– Propensity score-matching (PSM) was used to minimize baseline differences and reduce potential confounding in outcome comparisons, with 91 matched patients in each group showing evenly distributed baseline characteristics.

– The study found that intrathecal hydromorphone was superior to TAP block in reducing moderate-to-severe pain during movement on the first postoperative day after upper abdominal surgery, with a lower incidence of pain and higher comfort levels in the intrathecal group.

– Patients receiving intrathecal hydromorphone required less opioid medication, reported higher satisfaction levels, but had a higher incidence of pruritus and delayed first flatus compared to the TAP block group.

– Future research should focus on integrating the benefits of intrathecal hydromorphone into multimodal analgesia for upper abdominal surgeries and conducting well-designed randomized controlled trials to compare the most effective analgesic technique for this surgical population.

Reference –

Yue-Xin Huang et al. (2025). Intrathecal Hydromorphone Vs. Transversus Abdominis Plane Block For Upper Abdominal Surgery: A Propensity Score-Matching Study. *BMC Anesthesiology*, 25. https://doi.org/10.1186/s12871-025-03107-w.

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Nitazoxanide Reduces Oxidative Stress and Inflammation in Type 2 Diabetes Without Affecting Glycemic Control: Study

A new study published in the Endocrine journal showed that nitazoxanide lowers inflammation and oxidative stress without compromising glucose regulation in type 2 diabetes.

Hyperglycemia and anomalies in the metabolism of proteins, fats, and carbohydrates are hallmarks of diabetes mellitus (DM), a complicated metabolic disease. The majority of patients do not attain ideal glycemic control, even with the advancements in anti-diabetic medication therapy.

Using one-dimensional drug profile matching, nitazoxanide (NTZ), a broad-spectrum anti-infective medication that has efficacy against a variety of bacteria, viruses, helminthes, and protozoa, was determined to be an agonist of the peroxisome proliferative activated receptor gamma (PPARγ).

According to preclinical evidence, nitazoxanide (NTZ) may be a useful PPAR-γ agonist for type 2 diabetes. Therefore, this study was conducted by Eman Ghonaim and team with to investigate the tolerance and initial effects of NTZ as a supplement to the current metformin-vildagliptin combination on inflammatory biomarkers and glycemic control in individuals with type 2 diabetes.

In the control and NTZ groups, 88 patients (44 in each group) were examined. The combination of metformin and vildagliptin was used to treat every patient. Twice a day, 500 mg of nitazoxanide was administered orally to the NTZ group. Glycemic control, as measured by fasting blood glucose and glycated hemoglobin (HbA1c), was the main result. Fasting insulin, serum interleukin-6 (IL-6), asprosin, malondialdehyde (MDA), and high mobility group box 1 (HMGB-1) were examples of secondary outcomes. Every outcome was assessed both at baseline and three months later.

When comparing NTZ to control, a between-groups comparison showed substantially decreased levels of inflammatory markers [HMGB-1: 10.46 ng/mL (6.37–14.61) vs. 22.60 ng/mL (20.18–27.37) and IL-6: 23.64 ng/L (21.00–32.71) vs. 32.52 ng/L (29.63–36.13), P < 0.001 for both].

Insulin, asprosin, MDA, fasting blood glucose, and HbA1c did not significantly differ between the two groups. Following NTZ therapy, there were significantly decreased levels of IL-6 (P = 0.009), HMGB-1 (P < 0.001), asprosin (P = 0.002), and MDA (P < 0.001).

In contrast, the control group had a substantial rise in both HMGB-1 and IL-6 (P < 0.001 for both). There were no notable changes in any biomarkers between the two groups. Overall, despite no improvement in glycemic indices, nitazoxanide may reduce inflammation and oxidative stress in type 2 diabetes.

Source:

Ghonaim, E. M., Ibrahim, O. M., Hegazy, S. K., Farrag, W. F., & Badr, H. R. (2025). Repurposing nitazoxanide in type 2 diabetes mellitus: a randomized controlled trial. Endocrine. https://doi.org/10.1007/s12020-025-04387-5

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