2025 ESC/EACTS Valvular Heart Disease Guidelines Stress Heart Team, Advanced Imaging

Switzerland: The European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) have released their updated 2025 guidelines for the management of valvular heart disease (VHD), replacing the 2021 guidelines. The new document published in the European Heart Journal aims to provide concise, practical recommendations to assist healthcare providers in their daily clinical decision-making.

A central theme of the updated guidelines is the reinforced importance of a multidisciplinary Heart Team operating within an integrated regional Heart Valve Network. This network approach, which incorporates outpatient clinics and specialist Heart Valve Centres, aims to ensure timely diagnosis and optimal patient care. The guidelines recommend that complex procedures be concentrated in high-volume, experienced centers to ensure high-quality treatment.
The 2025 update also highlights the growing importance of advanced imaging modalities. Techniques such as three-dimensional (3D) echocardiography, cardiac computed tomography (CCT), and cardiac magnetic resonance (CMR) have become crucial for the screening, evaluation, and intervention planning for patients with VHD.
Significant new evidence has reshaped recommendations for specific conditions. For severe aortic stenosis (AS), intervention is now supported irrespective of symptoms, left ventricular ejection fraction, or flow reserve. The criteria for selecting between transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) have been refined, incorporating a combination of age, procedural risk, anatomical suitability, and lifetime management considerations.
In mitral regurgitation (MR), the guidelines stress the importance of correctly assessing the cause and distinguishing between atrial and ventricular secondary mitral regurgitation (SMR), as this has clear implications for prognosis and management. For tricuspid regurgitation (TR), growing evidence supports concomitant TV repair during left-sided valve surgery and highlights the role of transcatheter options in improving quality of life.
The guidelines also feature updated recommendations on the use of direct oral anticoagulants (DOACs) and introduce a new dedicated section on sex-specific considerations in patients with VHD.
Key Takeaways from the 2025 ESC/EACTS VHD Guidelines:
1. Heart Team and Network: An integrated regional Heart Valve Network, with Heart Teams at its core, is essential for optimal patient care. Complex procedures should be performed in the most experienced centers.
2. Advanced Imaging: Multimodality imaging, including 3D echocardiography, CCT, and CMR, is now central to the diagnosis, planning, and guiding of interventions in VHD.
3. Aortic Stenosis (AS) Intervention: Intervention is recommended for symptomatic patients with severe AS. The choice between TAVI and SAVR is based on Heart Team assessment of age, life expectancy, procedural risk, and lifetime management. TAVI is recommended for suitable patients aged ≥70 years.
4. Asymptomatic Severe AS: For asymptomatic patients with severe, high-gradient AS and low procedural risk, early intervention should be considered as an alternative to close active surveillance.
5. Mitral Regurgitation (MR) Classification: Distinguishing between primary, ventricular secondary, and atrial secondary MR is crucial, as the evaluation and management differ for each type.
6. Secondary MR Management: Guideline-directed medical therapy is the essential first step for ventricular SMR. TEER is recommended for specific symptomatic patients to reduce heart failure hospitalizations. For atrial SMR, surgery and AF ablation should be considered.
7. Tricuspid Regurgitation (TR): Concomitant TV repair is preferred for patients with moderate or severe TR undergoing left-sided valve surgery. For high-risk patients with isolated severe TR, transcatheter treatment should be considered to improve quality of life.
8. Mixed Aortic Valve Disease: Intervention is recommended for symptomatic patients with mixed moderate AS and moderate AR if they present with a high gradient (mean gradient ≥40 mmHg or Vmax ≥4.0 m/s).
9. Mechanical Heart Valves (MHV): Lifelong anticoagulation with a Vitamin K antagonist (VKA) is required. Patient education and INR self-monitoring are recommended to improve efficacy.
10. Sex-Specific Considerations: A new dedicated section acknowledges sex-specific differences in VHD prevalence, pathophysiology, and outcomes, which may influence management strategies.
The authors stress that these recommendations support, but do not override, individual clinical judgment. By identifying key gaps in evidence, the guidelines standardize care and direct future research.
Reference:
Praz, F., Borger, M. A., Lanz, J., Abreu, A., Adamo, M., Ajmone Marsan, N., Barili, F., Bonaros, N., Cosyns, B., De Paulis, R., Gamra, H., Jahangiri, M., Jeppsson, A., Klautz, R. J., Mores, B., Pöss, J., Prendergast, B. D., Rocca, B., Rossello, X., . . . Moorjani, N. 2025 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the task force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal. https://doi.org/10.1093/eurheartj/ehaf194

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Court cannot decide what should be taught in medical education-SC rejects change plea

The Supreme Court recently refused to entertain a Public Interest Litigation (PIL) seeking changes in the medical syllabus. While considering the issue, the Apex Court bench led by Chief Justice of India (CJI) BR Gavai clarified that the court cannot take up the responsibility to decide what should be taught in medical education.

“This is not our work. We cannot decide what syllabus should or shouldn’t be. Approach the university or govt,” remarked the top court bench comprising CJI Gavai, while further observing that syllabus-related issues fell within the domain of academic bodies and the government and therefore they must be addressed by expert authorities and not decided through judicial intervention.

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

Court cannot decide what should be taught in medical education- SC junks plea seeking changes in medical syllabus

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Long COVID associated with abnormal uterine bleeding and cycle-phase symptom variation

The Center for Reproductive Health, University of Edinburgh reports that long COVID was associated with abnormal uterine bleeding in a UK population, with increased menstrual volume, longer duration and more intermenstrual bleeding with no impaired ovarian function, alongside differences in peripheral and endometrial inflammation.

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Hemodialysis Patients Face Higher Restenosis Risk After DCB Therapy, But Limb Salvage Remains High: POPCORN Registry

Japan: Data from the real-world POPCORN registry has revealed that peripheral artery disease (PAD) patients on hemodialysis experience worse vessel patency after drug-coated balloon (DCB) interventions compared to non-dialysis patients. However, 3-year limb salvage rates remain high, exceeding 90%.

The findings, published in JACC: Cardiovascular Interventions by Yasutaka Yamauchi of the Cardiovascular Center, Takatsu General Hospital, Kawasaki, and colleagues, suggest important insights into long-term outcomes of DCB therapy in a high-risk population that has traditionally been underrepresented in large-scale vascular studies.

The study analyzed data from a prospective, multicenter registry that included patients treated with DCBs—either Lutonix or IN.PACT Admiral—for femoropopliteal artery disease between March 2018 and December 2019. Of the 3,165 lesions treated, 991 were in patients undergoing hemodialysis. The primary outcome of interest was freedom from restenosis over three years.

The study led to the following findings:

  • After propensity score matching, the 1-year freedom from restenosis rate was 82.2% in the hemodialysis group and 85.8% in the non-dialysis group.
  • At three years, freedom from restenosis declined to 61.9% in hemodialysis patients and 66.3% in those not on dialysis.
  • Restenosis outcomes consistently favored patients not undergoing dialysis.
  • Risk factors linked to poorer vessel patency in the hemodialysis group included the absence of below-the-knee runoff, prior endovascular therapy, popliteal artery lesions, severe vascular calcification, use of the Lutonix balloon, and severe dissection after the procedure.
  • In the hemodialysis group, restenosis was observed in 363 lesions during a median follow-up of 16.2 months.
  • Despite the higher restenosis rates, over 90% of hemodialysis patients achieved limb salvage within three years.
  • The high limb preservation rate supports the role of DCB therapy as an effective option, even in complex hemodialysis patients.
  • Hemodialysis patients were generally younger (average age 72 years) compared to non-dialysis patients (76 years).
  • In the hemodialysis group, there was a higher prevalence of diabetes and chronic limb-threatening ischemia.
  • These underlying conditions may have contributed to the increased complexity and poorer patency outcomes observed in patients on dialysis.

The authors wrote, “DCB endovascular therapy represents a viable and effective treatment option for managing femoropopliteal lesions in patients undergoing hemodialysis. While the durability of vessel patency may be somewhat reduced in this high-risk group, the consistently high rates of limb preservation highlight its clinical value.”

They emphasize the importance of adopting a tailored approach to endovascular care—one that takes into account specific anatomical and procedural factors—to optimize long-term outcomes in patients on dialysis.

Reference:

Yamauchi, Y, Takahara, M, Soga, Y. et al. Vessel Patency After Femoropopliteal Drug-Coated Balloon Therapy in Patients on Hemodialysis. J Am Coll Cardiol Intv. 2025 Jul, 18 (13) 1660–1670.

https://doi.org/10.1016/j.jcin.2025.05.001

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Low-Dose Antithymocyte Globulin Effective in Preserving Beta-Cell Function in Type 1 Diabetes: Study

Belgium: A phase 2 international trial published in The Lancet has found that low-dose antithymocyte globulin (ATG) can slow the loss of insulin-producing beta-cell function in children and young adults recently diagnosed with stage 3 type 1 diabetes. 

“Both 2.5 mg/kg and 0.5 mg/kg intravenous doses preserved C-peptide levels over 12 months compared with placebo, indicating that even a reduced dose of this immunosuppressing drug may help modify the course of the disease,” Prof Chantal Mathieu, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium, and colleagues reported. 
The MELD-ATG study enrolled participants aged 5 to 25 years who had been diagnosed with type 1 diabetes within the previous 3 to 9 weeks. Conducted across 14 centres in eight European countries, the double-blind, randomized, placebo-controlled trial used an adaptive design to identify the smallest effective dose of ATG.
Participants were stratified by age and randomly assigned to receive either a placebo or varying doses of the drug over two consecutive infusion days. All volunteers had at least one diabetes-related autoantibody and a minimum random C-peptide concentration of 0.2 nmol/L at baseline, a marker of residual beta-cell activity.
The study led to the following findings:
  • A total of 117 participants were randomised: 31 received a placebo, 33 received 2.5 mg/kg ATG, and 35 received 0.5 mg/kg, with smaller numbers in the lowest and intermediate dose groups that were later discontinued.
  • After one year, the 2.5 mg/kg ATG group showed a mean stimulated C-peptide AUC of 0.535 nmol/L per minute compared with 0.411 nmol/L per minute in the placebo group, a significant difference of 0.124 nmol/L per minute.
  • The 0.5 mg/kg ATG group achieved a mean AUC of 0.513 nmol/L per minute, with a baseline-adjusted difference from placebo of 0.102 nmol/L per minute.
  • Cytokine release syndrome was reported in about one-third of participants receiving 2.5 mg/kg ATG and about one-quarter of those given 0.5 mg/kg, but none in the placebo group.
  • Serum sickness occurred in 82% of participants on the higher dose and 32% on the lower dose.
  • No deaths or treatment-related life-threatening events were recorded.
The results suggest that antithymocyte globulin—commonly used to prevent organ transplant rejection—may be repurposed at a lower dose to protect remaining pancreatic function soon after type 1 diabetes diagnosis. By preserving the body’s own insulin production for longer, such an approach could reduce dependence on injected insulin and help stabilize blood glucose levels.
Investigators note that the adaptive design allowed efficient dose selection and demonstrated that 0.5 mg/kg provides a balance of efficacy and tolerability.
“Larger and longer-term studies will be needed to confirm whether this lower dose can deliver durable clinical benefits and to refine strategies for integrating ATG into early treatment plans. For now, the findings offer hope for a disease-modifying therapy in a condition where none currently exists,” they concluded.
Reference:
Mathieu, C., et al. (2025). Minimum effective low dose of antithymocyte globulin in people aged 5–25 years with recent-onset stage 3 type 1 diabetes (MELD-ATG): a phase 2, multicentre, double-blind, randomised, placebo-controlled, adaptive dose-ranging trial. The Lancet. doi.org/10.1016/S0140-6736(25)01674-5. 

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Ivabradine did not reduce occurrence of myocardial injury after noncardiac surgery: ESC Study

Ivabradine did not reduce the occurrence of myocardial injury after noncardiac surgery (MINS), according to late-breaking research presented in a Hot Line session today at ESC Congress 2025.

MINS is a common and serious complication, which has been found to account for approximately 13% of all deaths within 30 days of surgery. Explaining the rationale of the PREVENT-MINS trial, Principal Investigator, Professor Wojciech Szczeklik from Jagiellonian University Medical College, Krakow, Poland, said: “It has been proposed that increased heart rate at the time of surgery leads to higher myocardial oxygen consumption, a supply-demand mismatch and myocardial injury. Giving beta-blockers around the time of surgery lowers heart rate and decreases the risk of myocardial infarction, but these benefits may be offset by increased risk of hypotension, death and stroke. Ivabradine is a currently available medicine used in angina and heart failure that more selectively slows heart rate than beta-blockers. The PREVENT-MINS trial assessed whether ivabradine could prevent MINS in patients after noncardiac surgery with, or at risk of, atherosclerotic disease.”

The double-blind, placebo-controlled, randomised PREVENT-MINS trial was conducted at 26 hospitals in Poland. Eligible patients were aged ≥45 years and had either established atherosclerotic disease (i.e. coronary artery disease, peripheral artery disease or prior stroke) or substantial risk factors for atherosclerotic disease (e.g. diabetes, hypertension and age ≥70 years). Patients were randomised 1:1 to receive ivabradine (5 mg orally twice daily for up to 7 days, starting one hour before surgery) or placebo. The primary outcome was MINS within 30 days from randomisation. The trial had intended to enrol around 2,500 patients; however, the independent Data Monitoring Committee recommended early termination in March 2025 for futility, based on the prespecified interim analysis.

All 2,101 participants who underwent randomisation were included in the intention-to-treat population. The median age was 70.0 years and 49.4% were women.

MINS occurred in 17.0% of patients in the ivabradine group and 15.1% in the placebo group (relative risk [RR] 1.12; 95% confidence interval [CI] 0.92 to 1.37; p=0.25). In prespecified subgroup analyses, ivabradine was associated with an increased risk of MINS among patients with a history of coronary artery disease (RR 1.49; 95% CI 1.03 to 2.16) but not among patients without a history of coronary artery disease (RR 0.98; 95% CI 0.78 to 1.24).

The intraoperative mean heart rate was lower in the ivabradine group by 3.2 beats per minute than in the placebo group, with no difference in intraoperative mean arterial pressure. Clinically important bradycardia was more common in the ivabradine group (RR 1.18; 95% CI 1.00 to 1.40).

Professor Szczeklik concluded: “Ivabradine did not reduce the risk of MINS in patients undergoing noncardiac surgery. Heart-rate lowering was modest and the possible higher MINS incidence in patients with known coronary artery disease is contrary to our original hypothesis. Further research is needed to establish a method to safely control the heart’s stress associated with noncardiac surgery.”

Reference:

Wojciech Szczeklik, Jakub Fronczek, Ivabradine in Patients Undergoing Noncardiac Surgery: a Randomized Controlled Trial, Circulation, https://doi.org/10.1161/CIRCULATIONAHA.125.076704

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Mount Sinai study reveals genetic clues explaining why obesity affects people differently

An international team of researchers led by Icahn School of Medicine at Mount Sinai and the University of Copenhagen in Denmark has pinpointed some of the reasons why obesity does not affect everyone in the same way. Their study, published today in Nature Medicine, identifies genetic differences that help explain why some people with obesity remain relatively healthy while others develop serious conditions like diabetes and heart disease.

The team analyzed genetic data from 452,768 people and discovered variants in 205 regions of the genome linked to higher body fat but better metabolic health. Using these discoveries, they developed a genetic risk score that adds up the impact of these variants. Individuals with higher scores were more likely to develop obesity-but were less likely to suffer from complications such as high blood pressure, high cholesterol, diabetes, or heart disease. This is due, in part, to the way fat cells behave in different people.

Importantly, these protective genetic effects were already visible in children. Kids carrying the protective variants were more likely to develop obesity but did not show the expected warning signs of metabolic disease.

“Our study shows that obesity is not a single condition-it is made up of different subtypes, each with its own risks,” said Nathalie Chami, PhD, first author on this paper and Instructor of Environmental Medicine, and Artificial Intelligence and Human Health, at the Icahn School of Medicine. “By uncovering these genetic differences, we can start to understand why obesity leads to different health outcomes in different individuals. This could eventually change how we predict, prevent, and treat obesity and its complications.”

The research also identified eight distinct obesity subtypes, each linked to unique health risks. “These insights could eventually help doctors predict which patients are most vulnerable to complications and inform new treatments that mimic the protective genetic effects found in some people,” said Dr. Chami.

The research team cautions that the findings do not mean obesity is harmless. “Most people with obesity still face health challenges, and lifestyle factors such as diet and exercise remain critical for overall health” said Zhe Wang, PhD, co-first author on this paper, and Adjunct Assistant Professor of Artificial Intelligence and Human Health, at the Icahn School of Medicine; and Assistant Professor at the University of Alabama at Birmingham.

The study was conducted in individuals from the UK Biobank, comprising people of European ancestry, and future work will extend to more diverse populations. It leveraged this data to perform a comprehensive multi-trait genome-wide screen. The team wanted to find new genes that affect body fat without being linked to cardiometabolic comorbidities by analyzing three adiposity and eight cardiometabolic traits, including lipid, glycemic, and blood pressure traits.

“By revealing new biological pathways that separate obesity from related diseases, the findings may pave the way for more personalized care, better-targeted therapies, and earlier prevention strategies-even from childhood,” said Ruth Loos, PhD, corresponding author, and Professor of Environmental Medicine at Icahn School of Medicine, and Professor at the University of Copenhagen in Denmark.

Reference:

Chami, N., Wang, Z., Svenstrup, V. et al. Genetic subtyping of obesity reveals biological insights into the uncoupling of adiposity from its cardiometabolic comorbidities. Nat Med (2025). https://doi.org/10.1038/s41591-025-03931-0

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Aspirin use associated with increased birthweight without increasing the rate of LGA neonate: Study

Pre-eclampsia (PE) is a major cause of maternal and
perinatal morbidity and mortality. In the Combined Multimarker Screening and
Randomised Patient Treatment with Aspirin for Evidence-based Preeclampsia
Prevention (ASPRE) trial, treatment of high-risk women with aspirin 150mg daily
from the first trimester to 36 weeks led to 62% and nearly 90% lower rates of
PE with delivery before 37 and 32weeks of gestation, respectively. The study
was conducted from 2014 to 2016, and the high-risk group was identified using
the first trimester Fetal Medicine Foundation (FMF) competing risks algorithm
that combines maternal characteristics and medical history with mean arterial
pressure, mean uterine artery pulsatility index on Doppler ultrasound, and
serum biomarkers. In a secondary analysis of the ASPRE data, authors
demonstrated that this protective effect may be, at least partly, driven by
improvements in placental perfusion.

Pre-existing diabetes mellitus (DM) is considered a major
risk factor for the development of PE. This has led to recommendations from
prominent institutions such as the National Institute for Health and Care
Excellence (NICE) in the UK and the American College of Obstetricians and
Gynaecologists (ACOG) to treat type 1 and type 2 DM as major risk factors for
PE and to offer aspirin prophylaxis to all women with these conditions.
However, previous studies on PE prediction and prevention in diabetic women are
limited, and the effectiveness of aspirin in this high-risk subgroup has been
debated. Observational studies and randomised trials have questioned the
efficacy of aspirin in the prevention of PE among diabetic women and raised
concerns that it might increase the risk of large-for-gestational-age (LGA)
neonates, as well as complications such as traumatic birth and shoulder
dystocia. It is biologically plausible that, by increasing placental perfusion,
aspirin leads to larger placental mass, higher circulating levels of
hyperglycaemic hormones such as placental lactogen, and further increased
glucose availability to the foetus. On the other hand, previous studies have
suggested that aspirin stimulates insulin and glucagon secretion, increasing
glucose tolerance in non-pregnant individuals.

In this secondary analysis of the ASPRE trial, authors
examined the effects of aspirin on the birthweight distribution and the rates
of LGA neonates among participants at increased risk of preterm PE, stratified
according to the presence of pre-existing DM and the development of PE.

This is a post hoc secondary analysis of the ASPRE trial
data. The ASPRE trial was conducted in 2014–2016 at 13 maternity hospitals in
the United Kingdom, Spain, Italy, Belgium, Greece and Israel. In the
participating hospitals, screening for preterm PE was carried out at 11–13+6
weeks of gestation using the FMF first trimester competing risks algorithm that
combines maternal demographic characteristics and medical and obstetric history
with the measurements of mean arterial pressure, mean uterine artery
pulsatility index on Doppler ultrasound, and serum pregnancy-associated plasma
protein A (PAPP-A) and placental growth factor (PlGF) measured on the day of
the ultrasound examination.

Of 26,941 women with singleton pregnancies screened, 1776
high-risk participants were randomly allocated in a double-blind manner to
receive treatment with aspirin 150mg daily, or placebo, at night from
11–14weeks to 36weeks or delivery, whichever came first. A total of 152 women
(8%) withdrew consent during the study, four (0.2%) were lost to follow-up, and
the remaining 1620 participants were included in the intention-to treat
analysis.

The primary outcome was PE with delivery before 37 weeks of
gestation, which was reduced by 62% in the aspirin group compared to the
placebo group (1.6% vs. 4.3%, odds ratio adjusted for site and estimated risk
0.38, 95% confidence interval (CI) 0.20 to 0.74; p=0.004). The effect of
aspirin was stronger in participants with good adherence to treatment. Only
live births were included in this secondary analysis. Miscarriages, pregnancy
terminations and stillbirths were excluded.

Among 1571 singleton, live neonates (777 from the aspirin
group and 794 from the placebo group), aspirin was associated with a shift in
birthweight from <2500 to 2500–4000 g, and birthweight percentile from <25th
to 25th—75th percentiles, with no significant increase in LGA neonates (5.5%
vs. 6.2%, p=0.667). Logistic regression demonstrated a significant interaction
between treatment and pre-existing diabetes (p-value 0.034), and a positive
association between maternal weight and LGA neonates (adjusted odds ratio
1.040, 95% confidence interval 1.030–1.051, p <0.001).

In this secondary analysis of the ASPRE trial, authors
investigated the effects of aspirin on birthweight and the rates of LGA
neonates among women at high risk of preterm PE. Although in the main trial
there was no significant reduction in SGA neonates, in this secondary analysis
aspirin was associated with a shift in the birthweight distribution by reducing
the rates of neonates born with weights below 2500 g and the 25th percentile.
It increased the rate of birthweight between the 25th and the 75th percentiles,
without increasing the rate of LGA or macrosomic neonates among non-diabetic
women. Our findings suggest, however, a possible shift in the birthweight
distribution and an increase in LGA neonates among women with DM who received
aspirin, and with increasing maternal weight. Although this may be partly
explained by a reduction in preterm births, a shift in gestational age-adjusted
percentiles may also suggest a higher rate of large neonates irrespective of
gestational age.

Aspirin is associated with an increase in birthweight
without increasing the rate of LGA neonates. However, in women with
pre-existing diabetes, aspirin may be associated with a stronger shift in
birthweight and a higher risk of LGA neonates, warranting further
investigation.

Source: Daniel L. Rolnik, Liona C. Poon,
Argyro Syngelaki; BJOG: An International Journal of Obstetrics &
Gynaecology, 2025; 0:1–9 https://doi.org/10.1111/1471-0528.18263

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Potassium and Zinc Linked to Lower Depression Risk in New Study

Around 5% of adults have depression world wide. The study found that higher mineral intake is linked to lower depression risk in Korean and American adults. Further research suggests that minerals like potassium and zinc may help reduce the risk of developing depression alongside healthy lifestyle habits. The study was published in the journal of Nutrients by Jiwoo K. and fellow researchers.

https://doi.org/10.1016/j.xkme.2025.101093•

Depression is among the world’s major health burdens, and whereas psychological and social determinants have been extensively investigated, nutritional determinants are increasingly being recognized. Prior evidence indicates that nutritional deficiencies, particularly involving minerals, may be involved in the risk of depression. Limited studies on the association between certain minerals like sodium and potassium and depression exist.

The research compared cross-sectional information from extensive national health surveys conducted in Korea and the United States. Seven minerals were analyzed: sodium, potassium, phosphorus, magnesium, iron, zinc, and calcium. Depression was operationalized using the Patient Health Questionnaire-9 (PHQ-9), with 10 or more as indicative of depression. Multivariable-adjusted logistic regression was employed to examine mineral intakes and depression relationships, with subgroup analyses adjusted for by sex, obesity status, and age.

Results

•The samples included participants from both nations, and there were significant differences in depression rates.

• Among the Korean dataset (KNHANES), 537 participants (4.1%) were identified as having depression, while among the U.S. dataset (NHANES), 588 participants (6.2%) were rated as having depression.

• In Korean adults, consumption of sodium, potassium, and phosphorus was negatively associated with depression, where higher levels of their consumption were linked with lower risk of depression.

• In American adults, the same preventive associations were found for potassium, iron, and zinc that were negatively correlated with depression risk.

• Subgroup analyses illustrated that these correlations varied among population subgroups.

• Differentials were observed according to sex, age group, and obesity status, suggesting that individual factors are capable of modifying the impact of mineral intake on mental health.

This study demonstrated strong associations between mineral intake and depression among Korean and American adults and identified potassium as having uniform protective effects across both populations.

Reference:

Gómez-Fregoso, J. A., Zaragoza, J. J., González-Duarte, J. A., Nuño-Guzmán, C. M., Hernández-Barajas, E. M., Andrade-Jorge, Z., Leon, J. C., Padilla-Armas, J. L., Ornelas-Ruvalcaba, R. L., Cabrera-Aguilar, J. S., Chávez-Alonso, G., Villalvazo-Maciel, E., Orozco-Chan, C. E., Rodríguez-García, G., Navarro-Blackaller, G., Medina-González, R., Gallardo-González, A. M., Alcantar-Vallin, L., Abundis-Mora, G. J., … Chávez-Iñiguez, J. S. (2025). Severe acute kidney injury associated with intestinal ostomies. Kidney Medicine, 101093, 101093. https://doi.org/10.1016/j.xkme.2025.101093

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Shunting Benefits in Idiopathic Normal-Pressure Hydrocephalus: NEJM

A new clinical trial published in the New England Journal of Medicine found that among patients with idiopathic normal-pressure hydrocephalus who responded to temporary cerebrospinal fluid (CSF) drainage, shunting significantly improved gait velocity and gait/balance measures at 3 months, but showed no benefit for cognition or incontinence.

The study investigated the effects of shunting among patients carefully selected for surgery based on prior improvement in gait after temporary CSF drainage. To assess the effectiveness of the procedure, this trial was set out.

A total of 99 participants were randomly assigned to either an open-shunt group, where the device was set to allow fluid drainage at a low opening pressure (110 mm of water), or a placebo group, where the valve was set at a high pressure (>400 mm of water), essentially preventing drainage. 

The primary measure of success was gait velocity 3-months after surgery. The results found that the patients’ walking speed improved by an average of 0.23 meters per second in the open-shunt group, when compared to virtually no improvement (0.03 meters per second) in the placebo group. This 0.21 m/s difference was statistically significant, illuminating that shunting has a real and measurable benefit for mobility.

On the Tinetti scale, which measures gait and balance, the open-shunt group improved by an average of 2.9 points, compared with only 0.5 points in the placebo group. However, the cognitive measure, the Montreal Cognitive Assessment (MoCA), showed only modest gains (1.3 points vs. 0.3 points), and improvements in urinary incontinence were minimal (a decrease of 3.3 points vs. 1.5 points on the Overactive Bladder Questionnaire).

While fewer falls were reported in the open-shunt group (24% vs. 46%), risks of complications were notable. Subdural bleeding occurred more often in the open-shunt group (12% vs. 2%), and positional headaches were also more frequent (59% vs. 28%). Rates of cerebral bleeding were equal in both groups (2%). Overall, this trial demonstrates that shunting offers meaningful improvements in gait speed and stability for patients with iNPH who first respond to CSF drainage, though benefits for cognition and bladder symptoms remain limited.

Reference:

Luciano, M. G., Williams, M. A., Hamilton, M. G., Katzen, H. L., Dasher, N. A., Moghekar, A., Hua, J., Malm, J., Eklund, A., Alpert Abel, N., Raslan, A. M., Elder, B. D., Savage, J. J., Barrow, D. L., Shahlaie, K., Jensen, H., Zwimpfer, T. J., Wollett, J., Hanley, D. F., & Holubkov, R. (2025). A Randomized Trial of Shunting for Idiopathic Normal-Pressure Hydrocephalus. New England Journal of Medicine. https://doi.org/10.1056/nejmoa2503109

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