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Coronary Sinus Reducer Efficacy: Meta-Analysis Reveals Smaller Benefits

by Dr. Michael Lee โ€“ Health Editor
written by Dr. Michael Lee โ€“ Health Editor

Coronary Sinus Reduction: New Analysis Suggests Modest Benefits for Refractory Angina

A novel approach to treating severe chest pain – coronary sinus reduction (CSR) using an hourglass-shaped stent – is facing renewed scrutiny. While initial studies hinted at significant relief for patients with refractory angina (chest pain that doesn’t respond to conventional treatments), a new meta-analysis published in JACC: Cardiovascular Interventions suggests the benefits may be less substantial than previously thought.

The analysis, led by Dr. rasha Al-Lamee of Imperial College London,pooled data from three randomized controlled trials encompassing 180 patients,alongside 13 single-arm studies involving 668 individuals. The procedure itself appears safe, boasting a 98.3% success rate. However, a key finding reveals a stark contrast between the results of rigorously controlled trials and earlier, less controlled studies.

Patients did report improvements in angina symptoms in both types of studies. however,the magnitude of improvement was considerably smaller in the randomized controlled trials. Specifically, approximately 26% of patients in the controlled trials experienced at least a one-class improvement in angina severity (according to the Canadian Cardiovascular Society classification), while 17% saw at least a two-class improvement. These figures represent roughly a third of the gains observed in the single-arm studies.

Crucially, the controlled trials failed to demonstrate any objective benefits. Continuous measurements like the Seattle Angina questionnaire showed no significant change, and there was no evidence of improved blood flow to the heart muscle following the procedure.

Dr. Deepak Bhatt, a cardiologist at Mount Sinai in New York City, who penned an accompanying editorial, emphasized the need for more effective treatments for refractory angina patients, who have often fatigued all other options. While CSR holds potential, he cautioned that larger, more definitive trials are essential before widespread adoption. “We need robust,objectively measured evidence to justify the cost of this procedure,” he stated. He pointed to past examples, like percutaneous laser therapy, which initially appeared promising but ultimately proved ineffective in rigorous trials.

Currently approved for use in the UK and Europe, where its adoption is growing, the CSR device is not yet available in the United States. The ongoing COSIRA-II trial, enrolling approximately 380 patients, is expected to provide the conclusive data needed for potential US approval.

Dr. Al-Lamee believes that if COSIRA-II demonstrates clear benefits, the device coudl become a preferred treatment option before more invasive procedures like repeat coronary artery bypass surgery. “Why resort to a high-risk revascularization if a safe and effective option exists?” she proposed.

Dr. Al-Lamee disclosed financial ties to Shockwave Medical, the manufacturer of the CSR device. Dr. Bhatt reported no relevant financial conflicts.

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Health

Preeclampsia: New Biomarkers and Risk Assessment Advancements

by Dr. Michael Lee โ€“ Health Editor
written by Dr. Michael Lee โ€“ Health Editor

Here are a few options for rewriting the provided text, focusing on different aspects and tones:

Option 1 (Concise and Action-Oriented):

Improving Preeclampsia Diagnosis and Management with PlGF Testing

Dr. John Kingdom highlights the significant role of placental growth factor (PlGF) testing in managing preeclampsia and related conditions. In high-risk pregnancies, real-time PlGF testing aids in diagnosing post-viability issues like fetal growth restriction. For those on aspirin prophylaxis from 12 weeks, a 16-week PlGF test combined with placental ultrasound can guide management, offering reassurance with normal results or prompting further intervention when levels are low.

Kingdom also advocates for PlGF testing in low-risk pregnancies, citing a decade-old UK study that demonstrated its ability to improve preterm preeclampsia identification when used with clinical risk assessment. His recent Mount Sinai Hospital study of over 9000 unselected patients found that a low PlGF level (<100 pg/mL) at 24-28 weeks was associated with a nearly 80-fold increased risk of preterm birth. He emphasizes that plgf testing is practical, cost-effective, and easily integrated into existing gestational diabetes screening. Future directions in Preeclampsia Prevention:

Experts anticipate that improved risk assessment will lead to greater adherence to aspirin prophylaxis and a broader adoption of evidence-based nonpharmacologic interventions. Research is also ongoing into other potential prophylactic agents like heparin, metformin, and statins, as aspirin alone only prevents a portion of the disease.

Studies suggest higher aspirin doses may be slightly more effective and equally safe. Metformin has shown promise in prolonging pregnancies in early-onset preeclampsia, while low-molecular-weight heparin may improve vascular health and boost plgf production. Statins,particularly pravastatin,are also being investigated for their potential to prevent preeclampsia in specific patient subgroups.

Option 2 (More Explanatory and Detailed):

PlGF Testing: A Key Tool for Preeclampsia Prediction and Management, Say experts

Dr. John Kingdom, MD, emphasizes the utility of placental growth factor (PlGF) testing in optimizing the care of pregnant individuals. For high-risk patients, real-time PlGF testing is instrumental in diagnosing conditions that arise after fetal viability, such as fetal growth restriction. Moreover, in high-risk individuals who begin aspirin prophylaxis at 12 weeks to prevent preeclampsia, a PlGF test at 16 weeks, coupled with placental ultrasound, can inform management decisions. “A normal result provides reassurance, while a low level prompts consideration of adjunctive therapies,” Dr. Kingdom explained.

He also asserts that PlGF testing can predict preeclampsia in patients without pre-existing high-risk factors.A study conducted over a decade ago in the UK indicated that plasma PlGF levels at 14-16 weeks gestation, when combined with clinical risk assessment, improved the identification of preterm preeclampsia in nulliparous women compared to clinical risk factors alone.

In a recent prospective cohort study led by Dr. Kingdom at Mount Sinai Hospital, Toronto, over 9000 unselected, predominantly low-risk patients were evaluated. The findings revealed that a low PlGF level (<100 pg/mL) detected during routine gestational diabetes screening (24-28 weeks) was associated with a significant 79.4-fold increased risk for preterm birth. Dr. Kingdom stressed the need for high precision,practicality,and widespread implementation in preeclampsia screening,noting that PlGF testing in mid-pregnancy is "cheap,easily interpreted,unimodalโ€ฆand can be tagged onto current diabetes screening." Advancing Preeclampsia Prevention: Future Therapies and Actions

Experts believe that as risk assessment becomes more precise, adherence to aspirin prophylaxis recommendations will rise, alongside a greater appreciation for evidence-based nonpharmacologic interventions.However, there is also hope for more data on the potential prophylactic benefits of other agents, including heparin, metformin, and statins. Dr. Bernstein commented,”Even when used in the right patient,aspirin prevents only a portion of disease.”

Ongoing research is exploring optimal aspirin regimens, with data suggesting that higher doses may offer slightly greater effectiveness with comparable safety. Dr. Kingdom noted that metformin has demonstrated in at least one randomized controlled trial the ability to prolong pregnancy by at least 10 days in patients diagnosed with early-onset preeclampsia.

Low-molecular-weight heparin, which can enhance vascular health through nonanticoagulant mechanisms, “has been shown to boost the production of PlGF by placental tissues and by the endothelial cells,” he added.

Dr. McElrath expressed interest in research investigating the role of statins in preeclampsia prevention, particularly the efficacy of pravastatin. He anticipates that further study may identify “specific subgroups who will benefit [most].”

Option 3 (Focus on the “Why” and Impact):

Unlocking Better Preeclampsia Outcomes: The Power of PlGF Testing and Emerging Therapies

Dr. John Kingdom,

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Health

High Tibial Osteotomy Slows Knee OA in Bowlegged Patients

by Dr. Michael Lee โ€“ Health Editor
written by Dr. Michael Lee โ€“ Health Editor

Here’s a breakdown of the provided text, focusing on the key data about the study:

Study Focus:

Procedure: High tibial osteotomy (HTO) combined with nonsurgical management versus nonsurgical management alone.
 target Condition: Knee osteoarthritis (OA) primarily affecting the medial tibiofemoral compartment in patients with varus alignment.
Goal: To assess the impact of HTO on slowing the progression of knee OA and improving patient outcomes.

Study Design:

Location: Fowler kennedy Sport Medicine Clinic in London, Ontario.
Participants: Patients with varus alignment and radiographic knee OA in the medial tibiofemoral compartment.
 Randomized Arm:
Treatment Group: HTO + nonsurgical management.
 Control Group: Nonsurgical management alone.
Nonsurgical Management: Included a 3-month structured exercise program (in-person and home workouts) and nutrition counseling.
 Parallel Preference Arm: Patients chose their preferred treatment (HTO or nonsurgical management alone).
Outcome Measures:
 Change in articular cartilage thickness in the medial tibiofemoral compartment (baseline to 2-year follow-up).
Change in the total Knee Injury and Osteoarthritis Outcome Score (KOOS).

Key Findings:

Cartilage Preservation: HTO appeared to slow the progression of knee OA.
HTO Group: Mean loss of medial tibiofemoral articular cartilage thickness was -0.07 mm (2% from baseline). Control Group: Mean loss was -0.25 mm (9% from baseline).
Difference: 0.18 mm, which is significant given the minimal clinically vital difference for cartilage loss is 6.3%.
 Improved Outcomes (KOOS):
HTO Group: Mean change in total KOOS was 24.95 points.
 Control Group: Mean change was 9.06 points.
Difference: Nearly 16 points, indicating a substantial improvement in patient-reported outcomes for the HTO group.
 Preference Arm Results: Patients who chose HTO also showed less cartilage deterioration and greater KOOS improvement compared to those who opted for nonsurgical management alone.
Adverse events: 5 participants who received HTO required additional surgery due to an adverse event.Expert Commentary:

S. Robert Rozbruch, MD:
Emphasizes that “realignment will help preserve the joint.”
 Suggests that younger patients with less severe arthritis due to varus alignment would benefit most.
Believes HTO could perhaps alter the disease’s course, possibly preventing the need for total knee replacement in some cases.
 Birmingham (likely a researcher involved in the study):
Highlights that improving unfavorable biomechanics leads to long-term, clinically critically important benefits.
 Expresses hope that these findings will encourage intervention in other treatments.

Publication:

The study was published on July 28 in Annals of Internal Medicine.

Funding:

Canadian Institutes of Health Research, Arthritis society Canada, and Bernard & Norton Wolf Family Foundation.

In essence, the study suggests that high tibial osteotomy, when combined with conservative management, can substantially slow the loss of knee cartilage and improve patient-reported outcomes in individuals with varus alignment and medial knee osteoarthritis. The findings also support the idea that addressing biomechanical issues in joints can lead to long-term benefits.

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Health

Subclinical Aldosteronism Linked to Increased Cardiovascular Risk

by Dr. Michael Lee โ€“ Health Editor
written by Dr. Michael Lee โ€“ Health Editor

Hear’s a rewritten version of the article, aiming for 100% unique phrasing while retaining the core data:

New study Suggests Subclinical Aldosterone Imbalance May Predict cardiovascular Risk

A recent investigation into the “E” cohort has shed light on a potential link between subtle imbalances in the renin-angiotensin-aldosterone system (RAAS) and the likelihood of experiencing critically important cardiovascular events. The research aimed to determine if subclinical primary aldosteronism (PA), a condition where the adrenal glands produce too much aldosterone without obvious symptoms, is associated with major adverse cardiovascular events (MACEs). MACEs in this study were defined as a combination of heart attack, stroke (both ischemic and hemorrhagic), hospital admission for heart failure, and death from cardiovascular causes.

The participants in this study had a median age of 56 years, with the vast majority (92%) identifying as White. Approximately half of the individuals (55%) presented with blood pressure readings exceeding 130/80 mm Hg. Notably, a small proportion of the cohort had diabetes (7%) or a prior history of cardiovascular disease (3%).

Median levels of aldosterone were recorded at 219 pmol/L (with an interquartile range of 163-299 pmol/L), and renin concentrations averaged 7.5 ng/L (IQR, 4.5-11.7 ng/L). The median aldosterone-to-renin ratio (ARR), a key indicator of PA, was 30 pmol/L per ng/L (IQR, 19-50 pmol/L per ng/L).

Over a median follow-up period of 10.8 years (IQR, 10.6-11.0 years), 2.8% of the participants experienced an incident MACE. The most frequent MACE was myocardial infarction, followed by stroke and hospitalization for heart failure. During the study, seven individuals died from cardiovascular causes, contrasting with 47 non-cardiovascular deaths.

The findings revealed that lower renin levels (adjusted hazard ratio [aHR], 2.22; 95% confidence interval [CI],1.02-4.76) and a higher ARR (aHR, 2.43; 95% CI, 1.15-5.12) were both linked to an increased risk of MACE.However,the researchers did not find a significant association between higher aldosterone concentrations alone and MACE.

Further multivariable analysis indicated that a renin concentration of 4 ng/L or less was associated with a 2.1-fold greater risk of MACE (95% CI, 1.21-3.72). Similarly,an ARR of 70 pmol/L per ng/L or higher was linked to a twofold increase in MACE risk (aHR,2.03; 95% CI,1.09-3.80).

Individuals who met both of these criteria – representing about 21% of the study population – faced approximately 2.4 times the likelihood of experiencing a MACE (aHR, 2.42; 95% CI, 1.25-6.48). The researchers also noted that over 80% of participants with an ARR of 70 pmol/L per ng/L or more also had renin levels of 4 ng/L or lower. Importantly, these associations remained consistent nonetheless of blood pressure levels.

Dr. Hundemer, a lead researcher, suggested that individuals with normal blood pressure who later develop hypertension may be more likely to have underlying subclinical PA.He posited that many cases currently categorized as “primary” or “essential” hypertension might actually be driven by aldosterone-mediated mechanisms due to subclinical PA. He emphasized the need to move beyond a generalized approach to early hypertension management and adopt a more individualized strategy that addresses the specific biological drivers of hypertension and cardiovascular disease in each person.

Dr. Wenyu Huang, an associate professor at Northwestern University’s Feinberg School of Medicine, concurred that current practices might be overlooking a considerable number of at-risk individuals. She pointed out that while Endocrine Society guidelines now recommend screening all hypertensive patients for primary aldosteronism, this new study extends the concern to individuals with normal blood pressure. Although the study establishes an association rather than causation, Dr. Huang believes these findings warrant significant attention.

Both Dr. Hundemer and Dr. Huang reported no relevant financial conflicts of interest. Paul Basilio, a freelance writer and editor based in Glenside, Pennsylvania, contributed to this report.

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Health

Loneliness & Aging: Home Care Study Challenges Mortality Link

by Dr. Michael Lee โ€“ Health Editor
written by Dr. Michael Lee โ€“ Health Editor

Loneliness Doesn’t increase Mortality Risk in Older Adults Receiving Home Care,Study Finds

Waterloo,Ontario – Contrary to widely held beliefs and reports suggesting loneliness is as harmful as smoking 15 cigarettes a day,a new international study reveals loneliness is not associated with an increased risk of death among older adults receiving home care. In fact, the research indicates loneliness may even be linked to reduced mortality risk in this population.

The study, led by researchers at the university of Waterloo and published in the journal of the American Medical directors Association, analyzed data from over 300,000 home care recipients across Canada, Finland, and New Zealand [[1]]. Researchers found that loneliness was associated with an 18% reduction in one-year mortality risk in Canada, 15% in Finland, and 23% in New Zealand after adjusting for numerous confounding factors.

“Loneliness doesn’t have to kill you to be a major public health issue,” explained study author Bonaventure A. Egbujie, MD, PhD, adjunct professor of public health sciences at the University of Waterloo. He urges policymakers to address loneliness as a quality-of-life issue rather than framing it as a direct threat to mortality, arguing that the latter approach hinders effective intervention [[1]].

Key Findings:

The study included 178,611 participants from Canada, 35,073 from finland, and 85,065 from New Zealand, all aged 65 or older.
 Loneliness prevalence ranged from 15.9% in Canada to 24.2% in New Zealand, generally increasing with age.
Individuals experiencing loneliness tended to have better baseline physical function but reported worse pain and cognitive performance.
 Cancer and meaningful changes in health status were identified as the strongest predictors of mortality across all three countries.

Why the Discrepancy?

Researchers suggest the findings differ from previous studies linking loneliness to mortality due to the specific population examined – older adults receiving home care. This group hasn’t been extensively studied, and their circumstances may differ from the general population [[2]].

Limitations & Future Research:

The study acknowledges limitations, including a one-year follow-up period and the use of a single-item measure of loneliness. Further long-term research is needed to explore potential causal relationships between loneliness and health outcomes

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Vitamin C & Colds: Does It Really Help?

by Dr. Michael Lee โ€“ Health Editor
written by Dr. Michael Lee โ€“ Health Editor

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