Archive for month: April, 2024

People who use e-cigarettes are significantly more likely to develop heart failure compared with those who have never used them, according to one of the largest prospective studies to date investigating possible links between vaping and heart failure. The findings are being presented at the American College of Cardiology’s Annual Scientific Session.

Heart failure is a condition affecting more than 6 million U.S. adults in which the heart becomes too stiff or too weak to pump blood as effectively as it should. It can often lead to debilitating symptoms and frequent hospitalizations as people age. Electronic nicotine products, which include e-cigarettes, vape pens, hookah pens, personal vaporizers and mods, e-cigars, e-pipes and e-hookahs, deliver nicotine in aerosol form without combustion. Since they were first introduced in the U.S. in the late 2000s, electronic nicotine products have often been portrayed as a safer alternative to smoking, but a growing body of research has led to increased concern about potential negative health effects.

“More and more studies are linking e-cigarettes to harmful effects and finding that it might not be as safe as previously thought,” said Yakubu Bene-Alhasan, MD, a resident physician at MedStar Health in Baltimore and the study’s lead author. “The difference we saw was substantial. It’s worth considering the consequences to your health, especially with regard to heart health.”

For the study, researchers used data from surveys and electronic health records in All of Us, a large national study of U.S. adults run by the National Institutes of Health, to analyze associations between e-cigarette use and new diagnoses of heart failure in 175,667 study participants (an average age of 52 years and 60.5% female). Of this sample, 3,242 participants developed heart failure within a median follow-up time of 45 months.

The results showed that people who used e-cigarettes at any point were 19% more likely to develop heart failure compared with people who had never used e-cigarettes. In calculating this difference, researchers accounted for a variety of demographic and socioeconomic factors, other heart disease risk factors and participants’ past and current use of other substances, including alcohol and tobacco products. The researchers also found no evidence that participants’ age, sex or smoking status modified the relationship between e-cigarettes and heart failure.

Breaking the data down by type of heart failure, the increased risk associated with e-cigarette use was statistically significant for heart failure with preserved ejection fraction (HFpEF)-in which the heart muscle becomes stiff and does not properly fill with blood between contractions. However, this association was not significant for heart failure with reduced ejection fraction (HFrEF)-in which the heart muscle becomes weak and the left ventricle does not squeeze as hard as it should during contractions. Rates of HFpEF have risen in recent decades, which has led to an increased focus on determining risk factors and improving treatment options for this type of heart failure.

The findings align with previous studies conducted in animals, which signaled e-cigarette use can affect the heart in ways that are relevant to the heart changes involved in heart failure. Other studies in humans have also shown links between e-cigarette use and some risk factors associated with developing heart failure. However, previous studies attempting to assess the direct connection between e-cigarette use and heart failure have been inconclusive, which Bene-Alhasan said is due to the inherent limitations of the cross-sectional study designs, smaller sample sizes and the smaller number of heart failure events seen in previous research.

Researchers said the new study findings point to a need for additional investigations of the potential impacts of vaping on heart health, especially considering the prevalence of e-cigarette use among younger people. Surveys indicate that about 5% to 10% of U.S. teens and adults use e-cigarettes. In 2018, the U.S. Surgeon General called youth e-cigarette use an epidemic and warned about the health risks associated with nicotine addiction.

“I think this research is long overdue, especially considering how much e-cigarettes have gained traction,” Bene-Alhasan said. “We don’t want to wait too long to find out eventually that it might be harmful, and by that time a lot of harm might already have been done. With more research, we will get to uncover a lot more about the potential health consequences and improve the information out to the public.”

Bene-Alhasan also said e-cigarettes are not recommended as a tool to quit smoking, since many people may continue vaping long after they quit smoking. The U.S. Centers for Disease Control and Prevention recommends a combination of counseling and medications as the best strategy for quitting smoking.

Researchers said that the study’s prospective observational design allows them to infer, but not conclusively determine, a causal relationship between e-cigarette use and heart failure. However, with its large sample size and detailed data on substance use and health information, Bene-Alhasan said the study is one of the most comprehensive studies to assess this relationship to date.

Reference:

Study links e-cigarette use with higher risk of heart failure, American College of Cardiology, Meeting: American College of Cardiology’s Annual Scientific Session.

A recent study published in the BMC Infectious Diseases discovered that Omadacycline (OMC) which is a newer antibiotic, is just as effective and safe as the more traditionally used Linezolid (LZD) for treating complicated skin and soft tissue infections (cSSTIs) in adults. This findings could significantly impact the approach that healthcare professionals take in managing these challenging infections.

This complicated skin and soft tissue infections represent a substantial burden to the healthcare systems over the world due to their often difficult-to-treat nature. These infections require antibiotics that can treat the infection effectively and minimize the risk of resistance. The search for such antibiotics led Wenxin Liang and team to compare Omadacycline with Linezolid for treating complicated skin and soft tissue infections.

The study synthesizes data from four randomized controlled trials (RCTs) and included a total of 1,757 patients to assess the clinical efficacy, microbiological response and safety profiles of OMC when compared to LZD. The findings indicated that OMC is not inferior to LZD by showing comparable success rates in both the modified intent-to-treat (MITT) and clinically evaluable (CE) populations. Also, the odds ratio (OR) for clinical efficacy in the MITT population was 1.24 (95% CI: [0.93, 1.66], P = 0.15) and in the CE population, it was 1.92 (95% CI: [0.94, 3.92], P = 0.07) that indicated no significant difference between the two drugs.

Also, the study looked into the microbiological response of OMC against LZD and found that OMC had a numerically higher response rate, though not statistically significant. The mortality and adverse event rates were similar for both treatments which suggests a comparable safety profile of OMC to LZD.

These results are significant and this suggest that healthcare providers may have an additional tool to treat cSSTIs that potentially offers a new antibiotic option which is just as effective and safe as the current standard of care. Also, the similarity in efficacy and safety profiles between OMC and LZD brought out that patients who cannot tolerate one medication might have another viable alternative. Th findings of this study could possibly pave the way for Omadacycline to become a more widely used option in treating complicated skin and soft tissue infections.

Reference:

Liang, W., Yin, H., Chen, H., Xu, J., & Cai, Y. (2024). Efficacy and safety of omadacycline for treating complicated skin and soft tissue infections: a meta-analysis of randomized controlled trials. In BMC Infectious Diseases (Vol. 24, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12879-024-09097-3

USA: Perinatal depressive symptoms, ranging from mild to severe, are associated with increased total and nonemergent infant emergency department (ED) use, a recent study published in Health Affairs has revealed. 

The Rutgers Health research contributes to the evidence base linking perinatal depression screening and pediatric use of the emergency department. 

The study examined the association between the severity of perinatal depression and the use of emergency departments in the first year of an infant’s life.

Perinatal mental health conditions affect up to 20 percent of pregnant or postpartum people and are associated with a wide range of adverse outcomes for the child, including increased use of a hospital’s emergency department.

Using the emergency department can be costly, especially for Medicaid, which is billed for disproportionately more pediatric emergency department visits compared with private insurance.

While perinatal people may experience a broad range of depression symptom severity, there is little research examining the relationship between symptom severity and health care use and emergency department use. To address this gap, Slawa Rokicki, an assistant professor at the Rutgers School of Public Health, reviewed data in New Jersey, a state with universal maternal depression screening.

Rokicki, who linked birth record data for the years 2016-2018 to hospital discharge records for infants in their first year of life, found that infants of mothers with moderate to severe depressive symptoms had 21 percent more emergency department visits than those who had no depression, while infants of mothers with mild symptoms had 10 percent more emergency department visits.

According to the study, for infants whose delivery was paid for by Medicaid, the total emergency department charges in the first year were 43 percent higher for infants with mothers with moderate to severe depression and 19 percent higher for mothers with mild symptoms compared to those with no symptoms.

“The large disparities among Medicaid beneficiaries suggests opportunities for that program to optimize screening and referrals for perinatal depression, with potential cost-saving benefits in reducing nonemergency pediatric emergency department visits,” said Rokicki.

The study’s findings suggest that universal screening of perinatal people at delivery may be beneficial in identifying those who may be at risk of postpartum depression before they leave the hospital. “This is critical because postpartum people often face multiple barriers to postpartum care and most people with perinatal mental health conditions are not diagnosed,” said Rokicki.

Additionally, routine screening in emergency departments may also help identify parental mental health conditions and connect individuals to resources.

“We know from prior research that postpartum depression screenings in pediatric emergency departments are feasible,” said Rokicki.

Rokicki said emergency department screens need to follow patient-centered, nonstigmatizing approaches as those in the emergency department who screen positive for depression are likely to be part of a socially vulnerable population.

Reference:

Slawa Rokicki, Perinatal Depression Associated With Increased Pediatric Emergency Department Use And Charges In The First Year Of Life, Health Affairs, https://doi.org/10.1377/hlthaff.2023.01443.

The number of suicides among US college student athletes has doubled over the past 20 years, finds an analysis of data from the National Collegiate Athletic Association (NCAA), published online in the British Journal of Sports Medicine.

Suicide is now the second most common cause of death after accidents in this group of young people, with rates highest among cross-country competitors, the findings show.

US suicide rates rose by around 36% across all age groups between 2001 and 2021, note the researchers. But the evidence around athletes’ vulnerability to suicide, particularly young athletes, is contradictory, they add.

To better inform policy and suicide prevention efforts, they analysed suicide rates from 1 July 2002 to 30 June 2022 among NCAA athletes to see if there were any discernible differences or trends in incidence by age, sex, race, division, sport, time of year and day of the week.

Athletes were defined as those competing in at least one varsity sport at NCAA Division I, II or III institutions.

The cause of each athlete’s death, as well as details of age, race, and sporting discipline, were ascertained through online media reports and obituaries and reviews of post mortem examinations and other official documents.

Deaths were broadly categorised as accident, murder, suicide, unintentional drug/alcohol overdose or medical cause.

During the course of the 20-years,1102 athletes died, 128 (11.5%+) of whom took their own lives: males 98 (77%); females 30. Their average age was 20, but ranged from 17 to 24. Over half (59%; 91) were White.

The yearly incidence rate of suicide for males increased throughout the study period while that for females increased from 2010–11 onwards. This was in sharp contrast to the incidence rate of other deaths, which fell between 2002 and 2022.

Male suicides increased from 31 in the first 10 years to 67 in the second 10 years; similarly, female suicides increased from 9 to 21.

Overall, the proportion of suicide deaths doubled from the first 10 years (just over 7.5%) to the second 10 years (just over 15%), so that by the second decade, suicide became the second most common cause of death after accidents among NCAA athletes.

The highest number of suicides was among male cross-country athletes, and among division I and II athletes compared with division III athletes. But there were no significant differences in rates when analysed by sex, race, or sporting discipline.

Overall, the researchers calculated that there were 9 deaths every 2 years in male athletes; 3 deaths every 2 years in female athletes; and 2 deaths every 5 years in cross-country athletes.

The most suicide deaths occurred at the age of 20 (33; 26%). This is when a college student athlete would be in the middle of their career if they started as a freshman at age 17 or 18, note the researchers.

There also seemed to be temporal and seasonal differences in incidence. Most suicides occurred on Mondays (25; 20%) and Tuesdays (26; 20%).

And while the average number of suicides during the summer months of June–August was 6.7/month, during the rest of the year the average number was 12/month over the entire 20-year period.

The researchers acknowledge various limitations to their findings, including that the study relied on third party reports in the absence of any mandatory reporting system for athlete deaths, so the true incidence may have been underestimated.

Nor was there any information on potentially triggering underlying mental health issues, such as depression and anxiety, among the athletes who died by suicide.

But the researchers point out: “Athletes are generally thought of as one of the healthiest populations in our society, yet the pressures of school, internal and external performance expectations, time demands, injury, athletic identity and physical fatigue can lead to depression, mental health problems and suicide.”

They add: “Athletes may also experience harassment and abuse within their sport, including psychological abuse, physical abuse, sexual abuse, hazing and cyberbullying from the public and members of their team including peer athletes, coaches and members of the entourage.”

The NCAA has renewed efforts to address mental health issues among college student athletes in recent years, point out the researchers. Nevertheless: “Despite recent increased focus on mental health in athletes, death by suicide is increasing,” they highlight.

Additional mental health resources to help raise awareness, screening for early risk identification, training coaches and support staff on how to identify athletes at risk, and providing access to mental health providers trained in sport psychology could all help prevent suicide in this group, they suggest.

Reference:

Whelan BM, Kliethermes SA, Schloredt KA, et alSuicide in National Collegiate Athletic Association athletes: a 20-year analysisBritish Journal of Sports Medicine Published Online First: 04 April 2024. doi: 10.1136/bjsports-2023-107509.