Study Reveals Association Between Cardiac Arrhythmias and Macular Degeneration Risk

USA: A recent study presented at the annual meeting of the American Academy of Ophthalmology, which took place from October 18 to 21 in Chicago, found that cardiac arrhythmias, including myocardial infarction and atrial fibrillation, are linked to age-related macular degeneration (AMD). 

Significant cardiovascular conditions, such as myocardial infarction, cardiac valve disease, and ischemic stroke, have been linked to age-related macular degeneration and subretinal drusenoid deposits (SDDs). In light of this, R. Theodore Smith, M.D., Ph.D., of the Icahn School of Medicine at Mount Sinai, and colleagues examined the relationship between cardiac arrhythmias and SDDs and the impact of heart failure on cardiac index (CI). 

For this purpose, the researchers conducted a study involving 55 cardiac patients aged 49 to 91 at Mount Sinai Hospital. The patients underwent spectral domain optical coherence tomography scans to assess the presence of subretinal drusenoid deposits. Patient charts were then reviewed for cardiac index and arrhythmias.

The following were the key findings of the study:

  • Cardiac arrhythmias may contribute to developing subretinal drusenoid deposits through ocular hypoperfusion. Among the 30 patients with arrhythmias, 15 were found to have SDDs, compared to only five out of 25 patients without arrhythmias.
  • The mean cardiac index was significantly lower in patients with SDDs (1.95 ± 0.60 L/min/m²) than those without (2.71 ± 0.73 L/min/m²).

“Patients with common arrhythmias, such as atrial fibrillation, or those with serious cardiovascular conditions like myocardial infarction and stroke should undergo immediate optical coherence tomography of the macula to check for subretinal drusenoid deposits. If SDDs are detected, a retinal referral is warranted,” Smith stated to Elsevier’s PracticeUpdate.

He continued, “A large cohort of age-related macular degeneration patients with SDDs and/or typical drusen should be evaluated for cardiovascular disease through electrocardiograms to check for arrhythmias, as well as cardiac and carotid ultrasound tests for other serious vascular issues. This approach will clarify the true risk associated with SDDs compared to drusen regarding CVD and help identify previously undetected cardiovascular problems, particularly among Black, Hispanic, and female populations, where underdiagnosed CVD is a significant public health concern.”

“Cardiac arrhythmias, such as atrial fibrillation, are linked to subretinal drusenoid deposits in age-related macular degeneration. These arrhythmias can lead to heart failure by disrupting the relationship between ventricular output and filling, potentially contributing to SDDs through ocular hypoperfusion. The observed decrease in cardiac index in patients with SDDs supports this mechanism. Furthermore, SDDs may serve as a biomarker for serious heart disease, highlighting a critical concern for underserved populations and women,” the researchers concluded.

Reference: https://aao.apprisor.org/apsSession.cfm

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Hybrid closed-loop insulin therapy prevents low night-time blood glucose levels among breastfeeding mothers with type 1 diabetes: Study

Hybrid closed-loop insulin therapy prevents low night-time blood glucose levels among breastfeeding mothers with type 1 diabetes suggests a study published in the Diabetologia.

This study aimed to describe the relationship between breastfeeding episodes and maternal glucose levels, and to assess whether this differs with closed-loop vs open-loop (sensor-augmented pump) insulin therapy. Infant-feeding diaries were collected at 6 weeks, 12 weeks and 24 weeks postpartum in the trial of postpartum closed-loop use in 18 women with type 1 diabetes.

Continuous glucose monitoring (CGM) data were used to identify maternal glucose patterns within the 3 h of breastfeeding episodes. Generalised mixed models adjusted for breastfeeding episodes in the same woman, repeat breastfeeding episodes, carbohydrate intake, infant age at time of feeding and early pregnancy HbA1c. Results: CGM glucose remained above 3.9 mmol/l in the 3 h post-breastfeeding for 93% (397/427) of breastfeeding episodes.

There was an overall decrease in glucose at nighttime within 3 h of breastfeeding (1.1 mmol l−1 h−1 decrease on average; p=0.009). A decrease in nighttime glucose was observed with open-loop therapy (1.2 ± 0.5 mmol/l) but was blunted with closed-loop therapy (0.4 ± 0.3 mmol/l; p<0.01, open-loop vs closed-loop). There is a small decrease in glucose after nighttime breastfeeding that usually does not result in maternal hypoglycaemia; this appears to be blunted with the use of closed-loop therapy.

Reference:

Donovan, L.E., Bell, R.C., Feig, D.S. et al. Glycaemic patterns during breastfeeding with postpartum use of closed-loop insulin delivery in women with type 1 diabetes. Diabetologia 67, 2154–2159 (2024). https://doi.org/10.1007/s00125-024-06227-z

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Periodontal Disease Linked to ASCVD due to shared pathways: Study

A trailblazing review proposed
that poor oral health particularly periodontal disease can cause atherosclerotic
cardiovascular disease (ASCVD) due to shared biological pathways like inflammation,
immune response, and bacterial translocation. The study titled ‘Oral Health and
Atherosclerotic Cardiovascular Disease: A Review’ was published in the American
Journal of Preventive Cardiology.

Periodontal disease (PD) is a
prevalent chronic infection of the gums and the surrounding bone seen in older
adults that begins with the accumulation of dental plaque leading to gingivitis.
Gingivitis, an inflammatory response can progress to PD potentially causing
bone loss and tooth damage due to deeper penetration of the bacteria. Risk factors
like smoking, diabetes, and poor oral hygiene many of which are also atherosclerotic
cardiovascular risk factors may worsen the progression of PD. Additionally, an
imbalance in oral flora (dysbiosis) can lead to bacteremia, the spread of
bacteria in the bloodstream, prompting systemic inflammation that might link PD
to ASCVD.

Also Read: Seizures among children swallowing medications or illegal substances doubled over 15-year period: Study

Mechanisms by which PD can lead
to ASCVD:

  • Direct translocation of bacteria like
    porphyromonas gingivalis into the bloodstream or through inflammatory or immune
    responses can affect cardiovascular health as periodontal bacteria have also
    been detected in the atheromatous plaques.
  • Triggering of immune responses or inflammatory
    diseases by bacteria causing PD like the P.gingivals can activate immune cells
    like macrophages, T-cells, and B-cells which are in turn linked to
    atherosclerosis progression.
  • PD can lead to increased platelet activity which
    can in turn cause thrombus formation and transient ischemic attacks increasing
    the risk of atherosclerotic cardiovascular disease.
  • Impaired endothelial function leading to reduced
    vascular flexibility and increased oxidative stress can be caused by
    periodontal disease. Improved endothelial health was seen due to improved periodontal
    condition.
  • Diabetes, smoking, dyslipidemia, hypertension,
    obesity, and poor diet are some of the common and shared risk factors that can
    increase the risk of ASCVD in poor periodontal health.
  • Shared inflammatory pathways and biomarkers suggest
    a strong biological link between PD and ASCVD.
Also Read: Nonsurgical root canal treatment or retreatment of teeth with large apical periodontitis lesions tied to favourable outcomes: Study

Supporting Data:

Literature in the past has also
observed a positive association between PD and ASCVD with PD doubling the risk
of myocardial infarction, peripheral arterial disease, and ischemic stroke. Oral
health can have a long-term impact on vascular health as pediatric Oral
infections are linked to increased carotid artery thickness in adulthood.

Thus, the researchers highlight that
poor periodontal health can increase the risk of cardiovascular diseases. The
authors call for increased awareness and preventive measures, especially in
lower socio-economic areas where the risk of PD causing ASCVD is higher. Further
research is needed to justify the etiology and the potential benefits of
periodontal treatment in reducing cardiovascular diseases.

Further reading: Gianos E, Jackson EA, Tejpal A, et al. Oral health and atherosclerotic cardiovascular disease: A review. Am J Prev Cardiol. 2021;7:100179. Published 2021 Apr 5. doi:10.1016/j.ajpc.2021.100179

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MRI can save rectal cancer patients from surgery, study suggests

Magnetic resonance imaging (MRI) can spare many patients with rectal cancer from invasive surgery that can carry lifelong side effects, new research indicates.

The findings, from UVA Cancer Center’s Arun Krishnaraj, MD, MPH, and collaborators, indicate that MRI can predict patient outcomes and the risk of the tumor reccurring or spreading for patients who have undergone chemotherapy and radiation.

That information could be extremely useful in determining the best course of treatment and deciding whether a patient can avoid surgery in favor of a “watch and wait” approach, the researchers say. In watch-and-wait, doctors continue to monitor patients for cancer reccurrence or spread, holding off on surgery but potentially leaving them uncertain and anxious about the future.

The information MRI can provide would be both useful for doctors and comforting for patients, the new findings suggest.

“After undergoing chemotherapy and radiation for rectal cancer, patients are understandably concerned whether their cancer is gone or whether there may be some leftover disease. Using newer MRI techniques, we are now able to predict much better than in the past whether any cancer remains and, if so, whether it will come back and spread,” said Krishnaraj, a radiologist and imaging expert who is director of UVA Health’s Division of Body Imaging, among other leadership positions. “No one wants to get surgery if they can avoid it. Now we have a powerful tool to help patients and their doctors predict who would benefit from surgery after initial chemotherapy and radiation and who can likely avoid surgery.”

Better Care for Rectal Cancer

Colorectal cancer is increasing among younger adults-those under 50-even as it has been decreasing among older people. It’s estimated that the disease will strike approximately 1 in 23 men and 1 in 25 women, according to the American Cancer Society.

Rectal cancer is typically treated at first with radiation and chemotherapy, but some patients require what is known as “total mesorectal excision” – the removal of a substantial portion of their bowel. This can be lifesaving but it can also be life-changing: Side effects can include the need for a permanent colostomy bag and sexual dysfunction.

To help patients make the best choices and get the best outcomes, Krishnaraj and his collaborators wanted to see if MRI could serve as a crystal ball for the effects of watch-and-wait. To do this, they analyzed the results of the Organ Preservation in Rectal Adenocarcinoma (OPRA) trial to see how MRI results aligned with patient outcomes. In total, they reviewed outcomes from 277 patients, with an average age of 58, who had the stage of their rectal cancer determined by MRI. The average length of the follow-up period was slightly more than 4 years.

After crunching the numbers, the researchers determined MRI was an effective tool for predicting the patients’ overall survival, the risk of their cancer returning and their chances for keeping their bowel intact.

The promising MRI crystal ball can likely be made even more effective by combining it with data from endoscopies (visual inspections) after treatment, the OPRA Consortium researchers say. They are urging additional research on the potential of the combination, which they believe could offer doctors and patients a powerful new tool.

“I am optimistic that continued advancement in MRI and other tools like endoscopy will provide better information about future outcomes,” Krishnaraj said. “Ultimately, I would love to get close to 99% predictive probability in better informing our patients about their potential risk for recurrence or spread of their cancers following treatment. We may not be there quite yet, but that is our goal.”

Developing new ways to improve patient care is an essential mission for UVA Cancer Center, one of only 57 cancer centers designated as “comprehensive” by the National Cancer Institute. The designation honors elite cancer centers with the finest cancer care and research programs in the nation.

Reference:

Hannah Williams, Dana M. Omer, Hannah M. Thompson, Sabrina T. Lin, Floris S. Verheij, Joao Miranda, MRI Predicts Residual Disease and Outcomes in Watch-and-Wait Patients with Rectal Cancer, Radiology,https://doi.org/10.1148/radiol.232748.

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New AHA Guidelines Highlight Strategies to Prevent First Strokes: Emphasis on Lifestyle Changes, Screening

USA: In a significant update, the American Heart Association (AHA) and American Stroke Association (ASA) have released the 2024 Guideline for the Primary Prevention of Stroke, the first major revision in a decade. The new guideline replaces the 2014 version and aims to provide healthcare professionals with the latest strategies for preventing strokes in individuals with no prior history of the condition. The guideline emphasizes the importance of lifestyle management, risk factor control, and primary care screening.

According to the guidelines, adopting healthy lifestyle behaviors—such as maintaining good nutrition, quitting smoking, and staying physically active—can significantly reduce the risk of having a first stroke. Alongside these lifestyle changes, regular health screenings and effective management of cardiovascular disease and stroke risk factors through medication are crucial. Ideally, screening for stroke risk and educating individuals on how to lower their chances of experiencing a stroke should start with their primary care provider and incorporate evidence-based recommendations.

The guidelines, published in the journal Stroke, highlight that over 500,000 Americans experience their first stroke each year, with up to 80% of strokes being preventable. “This guideline is crucial because new evidence has emerged since the last update, allowing us to better identify individuals at risk for their first stroke,” said Dr. Cheryl D. Bushnell, chair of the writing group and a professor at Wake Forest University School of Medicine, said in a press release. The guideline aligns with the AHA’s “Life’s Essential 8,” a framework for promoting cardiovascular health.

One of the notable additions is the recommendation for glucagon-like peptide 1 receptor agonists (GLP-1s), which have shown strong evidence for reducing stroke risk in patients with diabetes and high cardiovascular risk. These medications, which include semaglutide (Ozempic or Wegovy), are recognized for their dual benefits in managing diabetes and promoting weight loss. However, the guideline stresses the need for further studies to confirm their efficacy in stroke prevention when used solely for weight management.

The updated guidelines also underscore the significance of addressing social determinants of health—factors such as education, economic stability, and access to care—that can influence stroke risk. The authors advocate for screening these determinants in clinical settings, recommending evidence-based interventions to tackle their adverse effects. Such measures include ensuring patient education is accessible and relevant, advocating for effective medications, and connecting patients to community resources to address health-related needs like food and housing insecurity.

In addition, the guideline introduces specific recommendations for women’s health. It highlights the need for screening for stroke risks associated with oral contraceptives, endometriosis, and early-onset menopause. The authors emphasize the importance of managing hypertensive disorders during pregnancy to prevent maternal intracerebral hemorrhage.

Blood pressure management is another critical focus. The guidelines recommend that most patients requiring antihypertensive medications for stroke prevention should be prescribed at least two medications, as studies have shown that a single medication is often insufficient.

The guidelines also recognize the increased stroke risk among transgender individuals undergoing estrogen therapy and call for careful evaluation and modification of their risk factors.

Dr. Bushnell noted that implementing these recommendations could substantially reduce the incidence of first strokes and even lower the risk of dementia, another serious condition associated with vascular health. As clinicians adopt these guidelines, the hope is to see a marked decline in stroke incidence, paving the way for healthier communities.

Reference:

Bushnell C, et al “2024 guideline for the primary prevention of stroke: a guideline from the American Heart Association/American Stroke Association” Stroke 2024; DOI: 10.1161/STR.0000000000000475.

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Model predicts number of MII oocytes needed to obtain at least one euploid blastocyst: Study

Female age is significantly and directly related to embryo
aneuploidy rates. The current delay in motherhood has led to a large proportion
of women of advanced maternal age seeking infertility treatment, thus
presenting significantly higher embryo aneuploidy rates. Consequently, these
patients are characterized by lower chances of success in in vitro
fertilization (IVF) treatments with their own oocytes and many of them are
finally encouraged to enter the oocyte donation program.

In the assumption of the statement ‘‘the older the patient,
the lower the number of euploid blastocysts,’’ there is a frequently asked
question in the day-to-day operations of an infertility clinic: how many
oocytes each of our patients’ needs, according to female age, to have the
highest chances of obtaining at least one euploid blastocyst in their IVF
treatment cycles? The answer to this question would constitute useful
information for both the clinician and the patient. On the one hand, the
clinician may be able to better assess each patient’s possibilities and the
feasibility of their treatment cycle because it will be easier to explain the
patient’s options. On the other hand, the patient will understand this
information more easily, helping her to cope emotionally with treatment. This
is nowadays feasible because predicting ovarian response with high precision
before starting treatment has become possible with the use of novel biomarkers,
such as antimullerian hormone levels and/or antral follicle count.

The aim of the present study by Cristina Rodríguez-Varela et
al was to design a similar tool to determine the number of metaphase II (MII)
oocytes needed to obtain at least one euploid blastocyst regarding female age
in IVF treatment cycles, considering our own data from the last 5 years using
next-generation sequencing (NGS) on TE biopsies. This information will help to decide
the best strategy for each patient and her individual situation.

Eligible patients were undergoing their first IVF-PGT-A
treatment cycle, in which at least one MII oocyte was obtained, regardless of
oocyte and semen origin. Oocyte donation cycles were included in the donor
group (≤34
years old). Treatment cycles from women with their own oocytes were selected only
when the oocytes were aged ≥35 years (patient group). Only
trophoectoderm biopsies performed on days 5 or 6 of development and analyzed using
next-generation sequencing were included. Preimplantational genetic testing for
aneuploidy cycles because of a known abnormal karyotype were excluded.

A total of 2,660 IVF-PGT-A treatment cycles were performed
in the study period in the eligible population (patients group = 2,462; donors
group =198). The mean number of MII oocytes needed to obtain one euploid
blastocyst increased with age, as did the number of treatment cycles that did
not get at least one euploid blastocyst. An adjusted multivariate binary
regression model was designed using 80% of the patient group sample (n = 2,462;
training set). A calculator for the probability of obtaining at least one
euploid blastocyst was created using this model. The validation of this model
in the remaining 20% of the patient group sample (n = 493; validation set)
showed that it could estimate the event of having at least one euploid
blastocyst with an accuracy of 72.0%

The minimum number of MII oocytes needed to have high
chances of obtaining at least one euploid blastocyst increases with increasing
maternal age. Study model estimates with an accuracy of 74% the probability of
having at least one euploid blastocyst, considering oocyte age and the number
of MII oocytes. This model has been created with the largest database of
IVF-PGT-A treatment cycles ever used for this purpose, including only PGT-A
treatment cycles using NGS on TE biopsies. Once this model has been validated
prospectively and in multicenter studies, it may be useful for both the
clinician and the patient coming to an infertility clinic, whether or not a
PGT-A analysis is performed. The clinician may use this data to propose the
best strategy for each patient, whereas the patient may use this information to
better understand the likelihood of obtaining an euploid blastocyst, helping
her to cope emotionally with IVF treatment. Nevertheless, to this day, this
model has limited clinical value. It should be further validated and optimized
to use it as a clinical support tool, in our own clinic and in many others.

Source: Cristina Rodríguez-Varela, M.Sc.,a Juan Manuel
Mascaros, M.Sc., a Elena Labarta; Fertil
Steril® Vol. 122, No. 4, October 2024

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Air pollution linked to peanut allergy during childhood, unravels study

Exposure to higher levels of air pollution as a baby is linked to having a peanut allergy throughout childhood, according to a new study. And policies aimed at tackling poor air quality could potentially reduce the prevalence and persistence of peanut allergies, it stated.

The research, led by Murdoch Children’s Research Institute (MCRI) and the University of Melbourne, found being exposed to higher levels of air pollution from infancy was associated with increased odds of developing a peanut allergy and having the allergy persist across the first 10 years of life. However, the same association was not seen for egg allergy or eczema.

Published in the Journal of Allergy and Clinical Immunology, the study is the first to explore the link between air pollution and challenge-proven food allergy over the first decade of life.

The research involved 5,276 children in Melbourne from the HealthNuts study, recruited at age one and followed-up at four, six and 10 years. The research team used estimates of the annual average concentration of fine particulate matter (PM2.5) and nitrogen dioxide (NO2) at each participant’s residential address at the time of each follow up.

MCRI Associate Professor Rachel Peters said the study found that higher levels of air pollution was a risk factor for the development and persistence of peanut allergies. And this was despite Melbourne having generally good air quality compared to our international counterparts, she said.

“The rise in allergy prevalence has occurred at a similar time to increased urbanisation, leading to the belief that environmental factors may be contributing to high allergy rates,” Associate Professor Peters said.

“Eczema and food allergy most often develop in infancy. Both immune conditions can naturally resolve over time, but for some they can persist throughout adolescence and into adulthood.”

“This is the first study to use an oral food challenge, the gold-standard of food allergy diagnosis, to investigate the relationship between food allergy and air pollution.”

University of Melbourne’s Dr Diego Lopez said the co-exposure of peanut allergens in the environment and air pollutants could be increasing the allergy risk.

“Air pollutants have an irritant and inflammatory effect that may boost the immune systems pro-allergic response, potentially triggering the development of food allergies,” he said.

“However, the underlying mechanisms of how air pollution increases the risk of a peanut allergy, and why eczema and egg allergy aren’t impacted in the same way, need to be explored further.”

Allergic disease is one of Australia’s greatest public health challenges, with one in 10 developing a food allergy in their first year of life.

Associate Professor Peters said policies aimed at tackling air pollution could potentially reduce the development and persistence of peanut allergy.

“The research highlights the importance of early-life interventions aimed at reducing exposure to air pollution, which could potentially prevent peanut allergies and other poor child health outcomes,” she said.

“Improving city design to support greater air quality regulation, better promoting public transport and switching to non-combustion fuels may help turn the tide on peanut allergy.”

Mae, 8, was diagnosed with peanut, diary and egg allergies at 8 months old after an allergic reaction saw her breakout in hives across her entire body. She has since gone onto have several anaphylaxis reactions.

Her mum, Eleanor Jenkin, said the most severe episode occurred five years ago during a food challenge at The Royal Children’s Hospital to check Mae’s tolerance for adding egg back into her diet.

“She was eating cupcakes as part of the challenge until she started to refuse to eat anymore,” she said. We thought she was just being fussy, but she began vomiting and lost consciousness. It was her first anaphylaxis and while it was scary, she returned to her normal self a few minutes after being given an adrenaline shot.”

Since then, Mae has carried an EpiPen with her at all times.

“We were hopeful she would grow out of the food allergies but now we have come to accept that Mae will be living with serious and ongoing allergies,” Eleanor said.

“Her allergies are always going to be in the back of her mind, influencing the decisions that she makes every time she eats at a restaurant, orders takeaway or goes to a birthday party. As a family we are learning to manage this new normal as best we can.”

Living in Melbourne’s west, Eleanor said the new MCRI research showed why it was important to tackle air pollution.

“There is a whole suite of reasons why we should be addressing air pollution and its link with peanut allergy just adds to that,” she said.

“Multiple factors are behind the allergy epidemic and if higher levels of air pollution are impacting the prevalence and persistence then that’s an important discovery for families.

“We want to see the quality of life improve for children living with allergies as well as fewer children having to go through what Mae has experienced. The more we know about how to prevent allergies the better.”

The GenV study, tracking the health and wellbeing of Victorians from birth to old age, is also starting to look at the impact of air pollution and climate change on children’s health. GenV has gathered data from more than 120,000 participants, including 48,000 babies.

MCRI researchers are linking information on heat vulnerability with perinatal and child health data from the GenV cohort and are seeking to include temperature extremes and climate related disaster evidence in the future.

Associate Professor Suzanne Mavoa said this would improve our understanding of how climate change impacts the health of children and families, identify those most at risk and test policies and interventions to better protect against severe weather events.

Reference:

Diego J. Lopez, Caroline J. Lodge, Dinh S. Bui, Nilakshi T.Waidyatillake, John C.Su, Luke D. Knibbs, Rushani Wijesuriya, Kirsten P Perrett, Jennifer J Koplin, Victoria X Soriano, Kate Lycett, Yichao Wang, Suzanne Mavoa, Shyamali C. Dharmage, Adrian J. Lowe and Rachel L. Peters. ‘Early life air pollution is associated with persistent peanut, but not egg allergy, across the first ten years,’ Journal of Allergy and Clinical Immunology: In Practice. DOI: 10.1016/j.jaci.2024.08.018,

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Hemodiafiltration may reduce mortality in maintenance hemodialysis patients compared to conventional hemodialysis: Study

Researchers have discovered that a significant reduction in mortality occurs in patients with end-stage renal disease (ESRD) when hemodiafiltration (HDF), is used instead of conventional hemodialysis. A recent study was conducted by Yifan and colleagues published in BMC Nephrology.

In ESRD, a patient always requires dialysis for the removal of the waste products and excess fluids from the blood. Standard treatment is conventional hemodialysis, but in the last few years, HDF has been investigated concerning its apparent advantages regarding mortality as it is a modified form of dialysis that increases toxin removal by combining diffusion and convection.

The researchers systematically searched PubMed, Embase, and the Cochrane Library for RCTs comparing HDF with conventional HD up until January 14, 2024, to collect credible evidence. A total of 10 randomized controlled trials involving 4654 patients were included. The analysis was performed using Review Manager 5.3 software, enabling the assessment of relevant data and the quality of the evidence. The study results focused on four main outcomes: all-cause mortality, cardiovascular mortality, sudden death, and infection-related mortality.

Key Findings

The meta-analysis led to several key findings regarding the impact of HDF compared to conventional HD

  • All-cause mortality: The all-cause mortality was lower with HDF than with HD by 16%, (RR 0.84, 95% CI 0.72–0.99, P = 0.04).

  • Cardiovascular mortality: HDF decreased cardiovascular mortality by 26%, (RR 0.74, 95% CI 0.61–0.90, P = 0.002).

  • Sudden death: The risk of sudden death was not significantly different between the groups (RR 0.92, 95% CI 0.64–1.34, P = 0.68).

  • Death from infection: While the point estimate indicated a reduction in infection-related mortality with HDF, the change was not significant (RR 0.70, 95% CI 0.47–1.03, P = 0.07).

  • HDF had significant superiority to high-flux HD for all-cause mortality (RR 0.81, 95% CI 0.69–0.96, P = 0.01), but not over low-flux HD (RR 0.93, 95% CI 0.77–1.12, P = 0.44).

  • Convective volume: HDF with a convective volume of 22 L or more was superior to the control in lowering both all-cause mortality (RR 0.76, 95% CI 0.65–0.88, P = 0.0002) and cardiovascular mortality (RR 0.73, 95% CI 0.54–0.94, P = 0.01).

The meta-analysis supports the fact that HDF significantly decreases mortality in ESRD patients compared to the conventional method of hemodialysis, with higher volumes of convection. Such preliminary evidence may eventually lead to increased adoption of HDF as a more regular procedure in the treatment of ESRD patients.

Reference:

Zhu, Y., Li, J., Lu, H., Shi, Z., & Wang, X. (2024). Effect of hemodiafiltration and hemodialysis on mortality of patients with end-stage kidney disease: a meta-analysis. BMC Nephrology, 25(1). https://doi.org/10.1186/s12882-024-03810-9

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23-Fold Increase in Heart Attack Risk among Women with Gestational Diabetes and Hypertension, reveals research

France: A recent nationwide cross-sectional cohort study has highlighted alarming insights into the long-term cardiovascular risks faced by women who experience gestational diabetes mellitus (GDM) and gestational hypertension (GH) during pregnancy. The findings were published online in the European Journal of Obstetrics & Gynecology and Reproductive Biology. 

The findings were striking: women with a history of both GDM and GH were found to have a staggering 23-fold increased risk of experiencing a myocardial infarction within the first 5 years of their postnatal lives.

Cardiovascular disease ranks as the leading cause of death among women globally. While the connection between a history of hypertensive disorders during pregnancy or gestational diabetes (GDM) and subsequent cardiovascular events is well documented, the implications of experiencing both gestational hypertension (GH) and GDM together are less clearly understood. To address this gap, Laurent Fauchier, Service de Cardiologie, Centre Hospitalier Universitaire et Faculté de Médecine, Université de Tours, France, and colleagues examined the relationship between GDM and GH, evaluating their individual and combined effects on future cardiovascular risks. 

For this purpose, the researchers identified all female patients discharged from French hospitals in 2013 who had complete follow-ups for five years. These patients were categorized based on their history of gestational diabetes, gestational hypertension, both conditions, or neither. After applying propensity score matching, those with GDM and/or GH were matched 1:1 with patients who had no history of these conditions. The analysis adjusted hazard ratios (HR) for cardiovascular events during the follow-up period, accounting for the patient’s age at baseline.

The study led to the following findings:

  • Women with a history of gestational hypertension exhibited a significantly increased risk of cardiovascular death, with a hazard ratio (HR) of 5.46.
  • Women with a history of gestational diabetes mellitus did not show a significant difference in the risk of cardiovascular events:
    • Myocardial infarction risk (HR 0.88) was not significantly elevated.
    • Cardiovascular death risk (HR 1.25) was also not significantly different.
  • Women with a history of both GDM and GH faced a markedly higher risk of myocardial infarction, with a hazard ratio of 23.33.

In the largest contemporary analysis of hospitalized female patients to date, we present the first findings on the combined cardiovascular risk associated with gestational diabetes mellitus and gestational hypertension within five years postpartum.

“Our results indicate that women with a history of both conditions face a staggering 23-fold increased risk of myocardial infarction. Therefore, those who experience both GDM and GH during pregnancy should be referred for specialized ongoing cardiology care and classified as high risk when presenting with acute symptoms indicative of potential cardiac ischemia,” the researchers concluded. 

Reference:

Bullough, S., Lip, G. Y., Fauchier, G., Herbert, J., Sharp, A., Bisson, A., Ducluzeau, P. H., & Fauchier, L. (2024). The impact of gestational diabetes and gestational hypertension on future cardiovascular events: A nationwide cross-sectional cohort study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 301, 216-221. https://doi.org/10.1016/j.ejogrb.2024.08.021

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Prophylactic infusion of norepinephrine may prevent hypotension during vertebroplasty, reports research

Prophylactic infusion of norepinephrine may prevent hypotension during vertebroplasty, reports research published in the BMC Surgery.

Transient hypotension is a common occurrence during the implantation of bone cement. This placebo-controlled randomized clinical trial study investigated the effect of prophylactic infusion of norepinephrine on the incidence of hypotension in senior patients who underwent vertebroplasty. The trial recruited patients who were greater than or equal to 65 years of age, had an American Society of Anesthesiologist physical status classification of I to III, and underwent vertebroplasty from August 2020 to August 2021 at the Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine in China. The patients were randomly grouped according to whether they received either a norepinephrine infusion of 0.05 µg/kg/min or an equivalent volume of saline 10 min before implantation of bone cement. Intraoperative hemodynamics were monitored continuously by the MostCare system at the following 7 time points: 10 min before implantation of bone cement and immediately, 30 s, 1, 3, 5, and 10 min after implantation of bone cement. We also recorded the number of hypotensive episodes and the total number of vasopressors after implantation of bone cement. Multivariable logistic regression was used to assess the risk factors associated with hypotension after implantation of bone cement. Results: A total of 63 patients were randomized to the control group (n = 31; median [IQR] age, 74 [69–79] years) and the norepinephrine group (n = 32; median [IQR] age, 75 [71–79] years). The incidence of hypotension in the norepinephrine group was significantly lower than that in the control group after implantation of bone cement (12.5% vs. 45.2%; relative risk [RR], 3.61 [95% CI, 1.13–15.07]; P = 0.005). Moreover, the median (IQR) number of hypotensive episodes (0 [0–0] vs. 0 [0–2]; P = 0.005) and the total number of vasopressors (0 [0–0] vs. 0 [0–1]; P = 0.004) in the norepinephrine group were significantly lower than those in the control group. Furthermore, compared with the baseline, the MAP significantly decreased at 1 min (P = 0.007) and 3 min (P < 0.001) after bone cement implantation in the control group. However, the MAP at 3 min in the norepinephrine group was significantly higher than that in the control group (P < 0.001). The incidence of complications was not different between the groups. In multivariable logistic regression, the FRAIL score (OR, 2.29; 95% CI, 1.21–4.31) was identified as a risk factor associated with hypotension. Prophylactic infusion of norepinephrine before bone cement implantation can stabilize hemodynamics and reduce the incidence of hypotension after implantation of bone cement.

Reference:

Fu, Q., Liu, S., Sun, Y. et al. Effect of prophylactic infusion of norepinephrine on the prevention of hypotension during vertebroplasty: a randomized clinical trial. BMC Surg 24, 333 (2024). https://doi.org/10.1186/s12893-024-02640-8

Keywords:

Prophylactic, infusion, norepinephrine, may, prevent, hypotension, during, vertebroplasty, reports, research, Fu, Q., Liu, S., Sun, Y, Hypotension, Norepinephrine, Vertebroplasty, Hemodynamics, Bone cement implantation

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