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Unmanaged Hypertension: The Classic ‘Silent Killer’ Continues to Threaten

In both the United States and across the globe, cardiovascular disease stands as the primary preventable cause of premature mortality and disability. Notably, heart attacks and strokes are significant contributors to the more than 900,000 deaths each year in the US and roughly 10 million worldwide.

A significant contributing factor to these conditions is uncontrolled hypertension or high blood pressure. Healthcare strategies often involve lifestyle intervention, exercise, and complementary pharmacological treatments to prevent and manage cardiovascular disease effectively.

A recently published commentary in The American Journal of Medicine highlights the urgency of this issue. Authored by experts from Florida Atlantic University’s Schmidt College of Medicine and their colleagues, the paper serves as a wake-up call to healthcare providers about the persistent threat of the so-called “silent killer.”

According to Stacy Rubin, M.D., senior author and assistant professor of medicine at FAU Schmidt College of Medicine, healthcare providers must recognize the prevalence and severity of uncontrolled hypertension in their patients. Dr. Rubin emphasizes the critical need for effective blood pressure management, noting the alarming statistic that sudden cardiac death accounts for 50% of all cardiovascular disease deaths and often represents the first noticeable symptom in approximately 25% of cases. She further points out that for 76% of those who suffer a stroke, the event itself is the first indication of any problem.

The importance of controlling blood pressure is well-documented and conceptually straightforward, although achieving this has historically been challenging. Before significant studies like the Hypertension Detection and Follow-Up Program in the 1970s in the U.S., awareness and effective management of high blood pressure could have been much higher. Recent data suggests slight improvements, with better understanding and management rates, yet these figures still point to a substantial portion of the population with uncontrolled hypertension.

Current guidelines from authoritative bodies like the American Heart Association and the American College of Cardiology recommend that a healthy individual should maintain a systolic blood pressure below 130 millimetres of mercury (mmHg) and a diastolic pressure under 80 mmHg. With these criteria, around 45% of U.S. adults are affected by hypertension, indicating a widespread public health challenge.

Another significant concern is the prevalence of metabolic syndrome, characterized by factors such as central obesity, elevated triglycerides, low HDL cholesterol, high fasting blood glucose, and hypertension. This syndrome is a significant risk factor for cardiovascular events in the U.S., which has one of the highest obesity rates globally.

Experts like Charles H. Hennekens, M.D., Dr.PH. Advocate for the use of ACE inhibitors or their advanced counterparts, receptor blockers, to manage patients with metabolic syndrome. These medications not only help control blood pressure but also provide protective benefits against heart attacks, strokes, and kidney disease.

Adopting healthier lifestyle choices, such as reducing weight, increasing physical activity, and decreasing salt intake, has been proven beneficial in managing hypertension. Combining these lifestyle modifications with medication can effectively lower blood pressure for individuals with blood pressure readings above 130/80 mmHg. Typically, medications are introduced when lifestyle changes do not reduce the pressure to below 140/90 mmHg.

Both health providers and patients must be aware of the daily and diurnal variations in blood pressure, which complicate the management of hypertension. Effective treatment often requires health providers to tailor treatment algorithms specifically for each patient, who must actively participate by regularly monitoring their blood pressure. The American Heart Association and the American College of Cardiology endorse using devices like the Omron blood monitor for home measurements.

Dr. Hennekens stresses the importance of patients checking their blood pressure both morning and evening and adjusting medication doses based on an average of three readings taken five minutes apart. Through diligent monitoring and management, health providers can play a crucial role in addressing the persistent issue of uncontrolled hypertension, potentially neutralizing the long-standing threat of the “silent killer.”

More information: Barry R. Davis et al, New Clinical Challenges In Hypertension Management, The American Journal of Medicine. DOI: 10.1016/j.amjmed.2024.07.005

Journal information: The American Journal of Medicine Provided by Florida Atlantic University

Differences Observed in Survival Advantages for Individuals Receiving Bystander CPR During Cardiac Arrest

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A study supported by the National Institutes of Health (NIH) has revealed significant race- and gender-based disparities in survival rates from out-of-hospital cardiac arrests among individuals who received bystander cardiopulmonary resuscitation (CPR). The research, published in Circulation, indicates that white adults are three times more likely to benefit from such interventions compared to Black adults, and men are twice as likely compared to women. These findings highlight substantial inequalities in survival outcomes, necessitating targeted efforts to ensure equitable CPR delivery across demographic groups. Paula Einhorn, M.D., a program officer at NIH’s National Heart, Lung, and Blood Institute (NHLBI), emphasized that CPR saves lives. Still, the disparities uncovered require a more profound understanding to achieve uniform survival chances for all CPR-needed patients.

The analysis covered 623,342 cardiac arrest cases in the United States from 2013 to 2022, revealing that nearly one in ten victims survived. About 40% of these patients received CPR from a bystander, which could include a family member, friend, or passerby. Those who received bystander CPR had, on average, a 28% greater chance of surviving compared to those who did not, with fewer instances of severe brain injuries among survivors. Yet, the benefits varied significantly when data were dissected by race, ethnicity, and biological sex. Native American and white adults experienced the highest increases in survival odds, while Black adults and women, especially Black women, consistently showed the most minor benefit.

Researchers conducted subgroup analyses based on neighbourhood diversity and average income to understand potential factors influencing the quality of administered CPR. The results consistently showed that Black adults and women were less likely to benefit from bystander CPR compared to white adults and men, regardless of the cardiac arrest victim’s income levels or residential areas. This prompts a concern about the equality of CPR applications across different communities.

Paul Chan, M.D., the study’s lead author and a cardiologist at Saint Luke’s Mid America Heart Institute, highlighted the need for a nuanced approach to improving survival rates. He pointed out the importance of examining whether CPR delivered by bystanders provides similar survival benefits to all patients, regardless of their demographic background. This includes questioning whether bystander CPR was performed well and equally for everyone so that irrespective of race, ethnicity, or sex, all patients can derive the same level of benefit from CPR.

Previously, studies had indicated that bystander CPR was less frequently performed on Black and Hispanic individuals and women in public spaces. CPR training and awareness programs have expanded nationally, including online courses and developing mannequins designed to resemble women’s bodies. Researchers suggest evaluating the accessibility and effectiveness of various CPR training methods could identify differences in survival outcomes and inform solutions to address these disparities.

Future investigations might focus on the type of training bystanders receive, the presence of multiple bystanders, which could indicate additional support, and the role of underlying health conditions in survival outcomes, considering similar emergency response times across groups. These findings challenge the healthcare community to consider not only the presence of bystander CPR but also its quality and inclusivity, ensuring that every individual, irrespective of race, ethnicity, or gender, has an equal chance of surviving a cardiac arrest.

More information: Paul S. Chan et al, Race and Sex Differences in the Association of Bystander CPR for Cardiac Arrest, Circulation. DOI: 10.1161/CIRCULATIONAHA.124.068732

Journal information: Circulation Provided by NIH / National Heart, Lung, and Blood Institute

Engaging in Dungeons and Dragons Enhances Mental Well-being

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Researchers at University College Cork (UCC) have recently conducted a study highlighting the mental health benefits of playing Dungeons and Dragons, suggesting the role-playing game could be a valuable therapeutic tool. Known for its rich fantasy setting and complex character development, Dungeons and Dragons (D&D) has become a global phenomenon, particularly noted for its collaborative and creative nature. This game demands long-term commitment and frequent interactions, fostering a supportive social environment among players.

The interest in the game surged notably during the COVID-19 pandemic, prompting this research to evaluate its effects on regular players’ mental health. The study identified numerous benefits associated with the game, such as escapism, self-exploration, creative expression, social support, and routine establishment—all contributing to improved mental well-being. These findings were published in the International Journal of Role-Playing, marking a significant advancement in understanding how recreational activities can influence psychological health.

Orla Walsh, the lead researcher and a PhD candidate at the UCC School of Applied Psychology, emphasized the unique aspects of D&D that support mental health. Players reported a profound sense of control and escapism within the game, which was particularly valuable during times of uncertainty in their external lives. Unlike other hobbies, D&D allows players to create and live within the worlds they build, offering a distinctive form of creative expression and escapism.

The study also underscored the game’s capacity to foster strong social connections and provide emotional support. The shared narrative and collaborative storytelling inherent in D&D gameplay create a deep sense of camaraderie and understanding among players, making it more than just a game but a potent social tool. This environment allows players to express themselves freely and explore personal and collective challenges in a supportive setting, fostering a sense of connection and understanding.

Dr. Conor Linehan, another researcher from the UCC School of Applied Psychology, pointed out that while some clinicians and community groups in the United States have already been using role-playing games like D&D therapeutically, the study advocates for a broader application. Such therapeutic use could promote skill development, emotional exploration, and problem-solving, enhancing personal growth and social connections. The findings suggest that incorporating D&D could significantly benefit therapeutic settings, providing a structured yet flexible emotional and psychological development framework.

This research paves the way for future studies and clinical applications, potentially transforming the use of role-playing games in therapy. By demonstrating the multiple benefits of D&D, from enhancing mental health to fostering community and creativity, the study provides a foundation for expanding the use of such games in psychological interventions globally. This could lead to a broader recognition of the therapeutic potential of role-playing games, making them a valuable tool in mental health strategies and offering hope for the future of mental health interventions.

More information: Orla Walsh et al, Roll for Insight: Understanding How the Experience of Playing Dungeons & Dragons Impacts the Mental Health of an Average Player, International Journal of Role-Playing. DOI: 10.33063/ijrp.vi15.321

Journal information: International Journal of Role-Playing Provided by University College Cork

Successful Hepatitis C Treatment Leaves Lasting Marks on Immune Cells

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Led by Director SHIN Eui-Cheol, the team at the Institute for Basic Science (IBS) Korea Virus Research Institute’s (KVRI) Center for Viral Immunology has brought to light significant insights regarding the persistent effects of chronic Hepatitis C virus (HCV) infection on the immune system, which endure even after successful treatment. The research revealed that “epigenetic scars” linger in the regulatory T cells, which show inflammatory traits long after the virus is eliminated. This occurs despite the use of highly effective direct-acting antivirals (DAAs), which have markedly increased cure rates for this disease.

The focus of the study was on patients who achieved a sustained virologic response (SVR) from DAA treatment. SVR, determined when no HCV is detectable in the blood 12 weeks post-treatment, strongly indicates the virus’s eradication. However, the study observed that the frequency of activated regulatory T cells (TREG) remained elevated during and after treatment, suggesting that the immune system does not fully recover even without the virus.

In-depth analyses, including RNA sequencing and ATAC-seq, showed that the transcriptomic and epigenetic landscapes of TREG cells from HCV patients remained altered long after the virus was eradicated. These cells exhibited prolonged inflammatory responses, such as increased TNF signalling, indicating long-term changes induced by the chronic infection. These activated TREG cells from HCV patients continued to produce inflammatory cytokines like TNF, IFN-γ, and IL-17A even after the virus was cleared.

The persistence of these inflammatory features in TREG cells has significant implications for the long-term management of patients treated for chronic HCV infection. Despite successful viral clearance, the continued immune system dysregulation suggests a potential for ongoing chronic inflammation and related health issues. Director SHIN Eui Cheol emphasized the importance of monitoring even after eradicating the virus to understand and fully manage these persistent immune changes.

The research team is now focusing on further investigating the mechanisms behind the sustained inflammatory state of TREG cells. By exploring potential therapeutic interventions that could reverse these epigenetic and transcriptomic changes, they aim to develop more effective strategies to ensure complete recovery and improve the quality of life for HCV patients.

Additionally, Director Shin highlighted an interest in whether other chronic viral infections might cause long-lasting epigenetic changes in the immune system. Identifying the clinical implications of these persistent immune alterations remains one of the team’s primary goals, potentially leading to broader applications in managing chronic viral infections beyond HCV.

More information: So-Young Kim et al, Epigenetic scars in regulatory T cells are retained after successful treatment of chronic hepatitis C with direct-acting antivirals, Journal of Hepatology. DOI: 10.1016/j.jhep.2024.06.011

Journal information: Journal of Hepatology Provided by Institute for Basic Science

Compulsive Eating Disorder More Persistent Than Once Believed

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Binge-eating disorder is estimated to affect between 1 per cent and 3 per cent of adults in the U.S. and is marked by periods when individuals experience uncontrollable eating. The disorder typically begins at around 25 years of age.

Historically, retrospective studies relying on potentially unreliable memories have suggested that the duration of binge-eating disorder spans seven to sixteen years. However, more recent prospective studies that follow individuals over time indicate that many may enter remission within a significantly shorter period, ranging from one to two years.

Researchers have observed that most prior prospective studies have notable limitations, such as small participant groups (fewer than 50 people) and a lack of representativeness, focusing predominantly on adolescent or young adult females with Body Mass Indexes (BMIs) under 30. This is particularly restrictive as approximately two-thirds of individuals with binge-eating disorder have BMIs exceeding 30.

To gain a deeper understanding of the progression of binge-eating disorder, a team of researchers conducted a five-year study with 137 adults from the community diagnosed with the disorder. These participants, aged 19 to 74 with an average BMI of 36, were evaluated at the outset and reassessed after 2.5 and 5 years.

Results after five years indicated that while many participants showed signs of improvement, a significant number continued to experience binge-eating episodes. Specifically, at the 2.5-year checkpoint, 61 per cent still met the full criteria for binge-eating disorder, with an additional 23 per cent displaying significant symptoms. Still, more was needed to meet the full diagnostic criteria. By the end of the study, these figures changed to 46 per cent meeting the full criteria and 33 per cent showing significant but sub-threshold symptoms. Notably, 35 per cent of those who were in remission at the 2.5-year mark had relapsed by the five-year follow-up. With changes in the diagnostic criteria for binge-eating disorder since the study’s inception, even more participants would likely meet the updated criteria at each follow-up.

Javaras pointed out that the sample consisted of community members who might not be undergoing treatment, making the study findings more reflective of the natural progression of binge-eating disorder. Comparisons with treatment-based studies suggest that intervention could expedite remission, highlighting the benefits of treatment for those with the disorder. Despite this, Javaras noted significant disparities in access to treatment for eating disorders.

The researchers found no clinical solid or demographic indicators that could predict the duration or likelihood of remission, suggesting that recovery chances are broadly similar across different groups.

Since completing the study, the research team has continued to explore and develop treatment options for binge-eating disorder. They are investigating the disorder’s neurobiological underpinnings using neuroimaging techniques, which could lead to improved or new treatments. Additionally, efforts are being made to enhance early detection of the disorder, as many affected individuals remain unaware of their condition, underscoring the urgent need for increased awareness and early screening to facilitate timely interventions.

More information: Kristin N. Javaras et al, The natural course of binge-eating disorder: findings from a prospective, community-based study of adults, Psychological Medicine. DOI: 10.1017/S0033291724000977

Journal information: Psychological Medicine Provided by McLean Hospital

Occupational Downgrading as a Factor in Mental Health Issues Among Undocumented Migrants

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A recent research paper titled “Downgraded Dreams: Labor Market Outcomes and Mental Health in Undocumented Migration,” conducted by Carlo Devillanova from Bocconi University’s Department of Social and Political Sciences, alongside Cristina Franco of the European Commission and Anna Spada from the charity Naga, offers a thorough examination of the interplay between occupational downgrading and mental health issues among undocumented migrants in Italy. This study, published in the journal SSM – Population Health, marks a significant advance in exploring how diminished job roles impact the mental health of this particularly vulnerable group.

The core findings of the research come from a distinctive dataset gathered at an outpatient clinic in Milan, focusing on the health conditions and job histories of 1738 undocumented migrants who underwent their initial medical consultations between 2017 and 2018. The data revealed that a significant 66.63% of these migrants experienced occupational downgrading, and 5.58% were diagnosed with mental health disorders. A critical insight from the study is that undocumented migrants facing occupational downgrading are at a notably higher risk of developing mental health issues. Devillanova points out that the detrimental effects of occupational downgrading on mental health are compounded by the myriad other risks these individuals face, underscoring the urgency for policies that support their integration into both the workforce and healthcare systems.

The backdrop of this study is the broader issue of irregular migration, which remains a pressing global challenge. There are about 281 million international migrants, with an estimated 15-20% lacking official documentation. These undocumented migrants often endure unstable living and working conditions, heightening their susceptibility to mental health problems. The research stresses the critical need to rethink migration policies, particularly those concerning entry restrictions and labour market integration, to mitigate their adverse effects on migrants’ health. Devillanova emphasizes the pivotal role of primary healthcare access in breaking the cyclic relationship between labour market exclusion and poor mental health among undocumented migrants.

Reflecting on the current geopolitical climate, the persistent focus on irregular migration in political and media discourse is evident. Recent escalations at European borders and the tightening of migration policies underscore the necessity for strategies that periodically address migrants’ mental health. In this context, the findings from Devillanova and his team are invaluable, providing crucial data that could influence policy-making and foster more compassionate and inclusive approaches.

This groundbreaking study draws attention to the intricate challenges undocumented migrants face and advocates for comprehensive policies that address both employment and health dimensions. The presented evidence prompts a deep reflection and calls for a concerted effort to enhance these vulnerable individuals’ living and working conditions, highlighting an essential area for policy development and humanitarian intervention.

More information: Carlo Devillanova et al, Downgraded dreams: Labor market outcomes and mental health in undocumented migration, SSM – Population Health. DOI: 10.1016/j.ssmph.2024.101652

Journal information: SSM – Population Health Provided by Bocconi University

Rising Use of Ozempic and Wegovy Among Privately Insured Patients Could Exacerbate Health Disparities

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A recent study from the University of Southern California reveals that publicly insured individuals who are most likely to benefit from new medications for diabetes and obesity have less access to them compared to those with private insurance. The research, published today in JAMA Health Forum, shows a surge in prescriptions for semaglutide—known commercially as Ozempic or Wegovy—by over 400% from January 2021 to December 2023. Initially approved for type 2 diabetes and later for weight loss, semaglutide also improves blood pressure and reduces cardiovascular disease risks, which are prevalent among millions of Americans. Despite these benefits, most of the prescriptions are distributed to those with private insurance.

Dima Qato, the study’s senior author and associate professor at the USC Mann School of Pharmacy & Pharmaceutical Sciences, pointed out the significant cardiovascular benefits of Ozempic and Wegovy in treating diabetes and obesity. He emphasized that the lower usage of these drugs in Medicaid and Part D populations, which have a higher incidence of these conditions among Black/Latinx communities, could worsen health disparities. Christopher Scannell, a physician and postdoctoral researcher at the Schaeffer Center and the study’s first author, expressed concerns over the equity of drug access. He highlighted that the media’s focus on semaglutide’s anti-obesity effects might obscure its crucial role in diabetes management, which is essential for some patients to discontinue insulin use.

Ozempic and Wegovy are administered weekly injections, whereas Rybelsus, another semaglutide formulation, takes them daily. Ozempic was first approved in 2017, followed by Rybelsus in 2019 to treat type 2 diabetes, with Wegovy coming in 2021 specifically for weight loss at a higher dosage. These medications are priced steeply, with Ozempic at around $1,000 monthly and Wegovy at approximately $1,350.

The data for this study was sourced from IQVIA’s National Prescription Audit PayerTrak, which records 92% of all prescriptions filled at retail pharmacies in the U.S. The researchers examined the monthly prescription data by brand and payment method—covering commercial insurance, Medicaid, Medicare Part D, and cash payments—from January 2021 through December 2023. By the end of 2023, prescription totals reached 2.6 million, with a remarkable increase in Wegovy prescriptions due to heightened awareness of its weight-loss benefits.

In 2023, less than 10% of semaglutide prescriptions were filled through Medicaid for all three brands, with access varying significantly by state, depending on budgetary and political factors. Medicare Part D covered 28.5% and 32.9% of Ozempic and Rybelsus prescriptions, respectively, but only 1.2% for Wegovy, as it generally does not cover obesity medications unless the patient also has a related condition like cardiovascular disease.

The researchers advocate for further studies to investigate how changes in Medicare Part D and Medicaid coverage affect disparities in access to these essential medications. They also suggest that future research should examine individual-level variables such as age, race, ethnicity, and the specific medical conditions—obesity or diabetes—for which the drugs are prescribed.

More information: Christopher Scannell et al, Prescription Fills for Semaglutide Products by Payment Method, JAMA Health Forum. DOI: 10.1001/jamahealthforum.2024.2026

Journal information: JAMA Health Forum Provided by University of Southern California

Scientists Develop AI System to Create Novel Antibiotics for Superbug Combat

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McMaster University and Stanford University researchers have successfully developed a cutting-edge generative artificial intelligence model, SyntheMol, capable of designing billions of new, affordable antibiotic molecules that are straightforward to synthesise in the laboratory. This innovation is critical as the global spread of drug-resistant bacteria necessitates the rapid development of novel antibiotics. Despite advancements in AI technologies that aid in identifying promising chemical compounds, challenges remain in synthesising and testing these potential drugs in laboratory conditions.

The significance of SyntheMol is highlighted in a study published today in the journal Nature Machine Intelligence. The model is precisely engineered to tackle the spread of Acinetobacter baumannii, a pathogen the World Health Organization identified as one of the most threatening antibiotic-resistant bacteria worldwide. Acinetobacter baumannii is infamously difficult to combat and is associated with severe infections such as pneumonia, meningitis, and wound infections, which can be fatal. With limited treatment options available, the development of effective antibiotics is crucial. However, with the potential of SyntheMol, there is hope for a brighter future in the fight against antibiotic-resistant bacteria.

Jonathan Stokes, the study’s lead author and an assistant professor in McMaster’s Department of Biomedicine & Biochemistry, collaborated with James Zou, a biomedical data science associate professor at Stanford University. Their joint effort underscores the unique challenge with antibiotics: “As soon as we begin to employ them in the clinic, we’re starting a timer before the drugs become ineffective, because bacteria evolve quickly to resist them.” The necessity for a robust, rapid, and cost-effective pipeline of new antibiotics is evident, and AI plays a pivotal role in this process.

The researchers’ generative model is based on a library of 132,000 molecular fragments, which resemble interlocking Lego pieces but vary significantly in their properties. Combining these fragments with 13 chemical reactions, the model can generate up to 30 billion two-component combinations, creating molecules with promising antibacterial properties. These molecules were further evaluated by another AI model trained to predict toxicity, yielding six potent and non-toxic molecules against Acinetobacter baumannii.

“SyntheMol not only designs novel molecules that are promising drug candidates but also generates the recipe for how to make each new molecule. Generating such recipes is a new approach and a game-changer because chemists do not know how to make AI-designed molecules,” says Zou, who co-authored the paper. This breakthrough accelerates the discovery of new antibiotics and transforms the traditional approach to drug development, promising a new era in the fight against antibiotic-resistant bacteria.

More information: Kyle Swanson et al, Generative AI for designing and validating easily synthesizable and structurally novel antibiotics, Nature Machine Intelligence. DOI: 10.1038/s42256-024-00809-7

Journal information: Nature Machine Intelligence Provided by McMaster University

Common weight loss medications associated with rare vision impairment condition

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A recent study spearheaded by researchers from Mass Eye and Ear indicates a higher incidence of a potentially blinding eye condition called NAION among patients prescribed semaglutide, marketed as Ozempic or Wegovy, for diabetes or weight loss. Notably, diabetic patients who were prescribed and filled their semaglutide prescriptions had a more than fourfold increased likelihood of being diagnosed with NAION. Additionally, patients who were overweight or obese faced a more than sevenfold increase in risk when prescribed this medication.

The study was conducted under the leadership of Joseph Rizzo, MD, director of the Neuro-Ophthalmology Service at Mass Eye and Ear and the Simmons Lessell Professor of Ophthalmology at Harvard Medical School. It was published on July 3rd in JAMA Ophthalmology.

Rizzo highlighted that while semaglutide has dramatically benefited many, future discussions between patients and their physicians must consider NAION as a potential risk. He stressed the importance of recognising that, despite the increased risk, NAION remains a relatively uncommon disorder. Occurring in up to 10 out of 100,000 people, NAION is the second leading cause of optic nerve-related blindness—just behind glaucoma—and the most common cause of sudden optic nerve blindness. The condition is believed to stem from reduced blood flow to the optic nerve head, leading to permanent visual loss in one eye. The loss of vision associated with NAION is painless and typically progresses over several days before stabilising, with limited prospects for improvement. Currently, there are no effective treatments for NAION.

The study was initiated following an alarming observation by Rizzo and his team in late summer of 2023, where three patients in a single week were diagnosed with this rare optic nerve disease; all were taking semaglutide. This prompted a retrospective analysis of patient records at Mass Eye and Ear to determine if there was a correlation between the drug, which has become increasingly popular, and the disease. Semaglutide was initially introduced as a treatment for type 2 diabetes under the brand name Ozempic in 2017 and was later approved for weight management as Wegovy in 2021.

Researchers reviewed over 17,000 patient records from the six years following the launch of Ozempic, categorising the patients by those diagnosed with diabetes or those who were overweight/obese. They compared the rate of NAION diagnoses between patients prescribed semaglutide and those using other diabetes or weight loss medications, uncovering significant increases in risk.

The study has limitations: most of the population is white, and Mass Eye and Ear typically see more rare eye disease cases. Additionally, the small number of NAION cases over the six years means that statistical results could vary significantly. Another limitation noted by the researchers is the lack of data on whether patients consistently took their medication or stopped at any point, which could influence the risk assessment.

While the study does not establish causality, and the researchers remain uncertain about the mechanisms underlying the association or the discrepancy in risk between diabetic and overweight patients, Rizzo emphasised the importance of the findings. He suggests these results should be considered significant but preliminary, underscoring the need for further research in a more extensive and diverse population to explore these findings comprehensively. This new information should be integrated into patient-physician discussions, especially for patients with preexisting optic nerve issues like glaucoma or significant visual loss from other causes.

More information: Jimena Tatiana Hathaway et al, Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide, JAMA Ophthalmology. DOI: 10.1001/jamaophthalmol.2024.2296

Journal information: JAMA Ophthalmology Provided by Mass Eye and Ear

Global Neglect and Under-Treatment of Hepatitis B, Particularly Among Women and Asian Minorities in Western Countries

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Recent studies have disclosed a critical gap in the global management of chronic hepatitis B (HBV), with significant underassessment and undertreatment, especially notable among women and Asian minorities in Western countries. This issue is highlighted in a comprehensive study by Elsevier, which was published in the Journal of Hepatology. Medical practitioners continue to encounter patients presenting with advanced liver disease caused by HBV despite the availability of effective vaccines and oral therapies for those eligible for treatment. This underscores the urgent need for simplified and expanded HBV management protocols to address these shortcomings effectively.

The World Health Organization aims to eliminate viral hepatitis by 2030, a goal that demands immediate action to reduce new infections and fatalities associated with the disease. The findings from this recent study provide crucial data that can help healthcare professionals and policymakers refine strategies to meet this objective, enhancing patient care and health outcomes. Dr. Mindie H. Nguyen, leading the research from Stanford University’s Division of Gastroenterology and Hepatology and Department of Epidemiology and Population Health, conducted an extensive international study. This research examined treatment patterns across a global cohort of HBV patients sourced from academic and specialized referral centres, aiming to improve case-finding guidelines, particularly for primary care providers in resource-limited settings.

The research was conducted as part of the REAL-B consortium, a global collaboration involving 25 study centres across nine countries focused on HBV treatment. It revealed that, among 12,566 patients with chronic HBV, about a quarter needed to be more adequately evaluated for treatment. Only about a third of those who were adequately assessed met the international guidelines for treatment eligibility. Surprisingly, 80-85% of those eligible for treatment received it, highlighting significant gaps in the initial assessment phases.

The study also uncovered significant disparities in the evaluation and treatment processes. Women, though more likely to be adequately evaluated for HBV, were 50% less likely to initiate treatment. In contrast, Asian minorities in Western countries were 40-50% less likely to receive adequate evaluations or start treatments when compared to their counterparts in Eastern regions, suggesting cultural and linguistic barriers as potential underlying causes. This disparity underscores the necessity for tailored approaches in medical practice to address these specific community needs effectively.

Oral antiviral therapy, which includes nucleos(t)ide analogs, has proven to be well-tolerated and lifesaving for chronic HBV patients. However, the real-world data on the utilization of these therapies are scarce, pointing to a need for broader documentation and analysis to understand and address the gaps in treatment application. Dr. Nguyen highlights the critical need to explore ongoing barriers to HBV treatment access, particularly for Asian patients in Western contexts, who face additional challenges, such as language and cultural differences, alongside other socioeconomic factors.

The global burden of HBV remains substantial, affecting an estimated 275 to 316 million people worldwide and contributing to 555,000 deaths in 2019. The disease progression risks are high, with up to one-fifth of affected individuals advancing to cirrhosis and a significant fraction of these developing further complications like hepatic decompensation and hepatocellular carcinoma. This research not only sheds light on the current state of HBV management but also calls for a concerted effort to better understand and mitigate the impact of HBV globally, particularly among high-risk groups. Further studies are essential to evaluate the effect of HBV in other disproportionately affected populations and to enhance treatment protocols universally.

More information: Sahith Kudaravalli et al, Sex and ethnic disparities in hepatitis B evaluation and treatment across the world, Journal of Hepatology. DOI: 10.1016/j.jhep.2024.02.033

Journal information: Journal of Hepatology Provided by Elsevier

More young individuals are turning to Wegovy and Ozempic

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Public interest in weight management medications such as Wegovy and Ozempic is experiencing a remarkable surge. Yet, comprehensive national data on their distribution across the United States must be collected. A recent study conducted by Michigan Medicine has revealed a significant escalation in the usage of these weight loss medications among young individuals aged 12 to 25 years, particularly among females.

The study utilised data from 2020 to 2023, sourced from a national database encompassing 92% of pharmacies. This analysis indicated a staggering 594% rise in the monthly usage figures for adolescents and young adults taking Wegovy, Ozempic, and other glucagon-like peptide-1 receptor agonists (GLP-1RAs). The increase in usage among females was particularly pronounced; adolescent girls between 12 and 17 years old saw a rise of 588%, compared to a 504% increase among their male counterparts. Similarly, the number of female young adults aged 18 to 25 using GLP-1RAs jumped by 659%, in contrast to a 481% increase observed in male young adults.

Joyce Lee, MD, MPH, the study’s principal author and a pediatric endocrinologist at the University of Michigan Medical School, highlighted that this study is the first of its kind to document national dispensing trends for GLP-1RAs among the youth. These medications were initially approved for managing type 2 diabetes in 2005 and later for weight control in 2014. Interest in GLP-1RAs soared further following the approval of semaglutide under the brand name Wegovy for adult weight management in 2021, and even more so when its use was approved for adolescents towards the end of 2022.

The findings indicated that endocrinologists, family medicine physicians, and nurse practitioners are the leading prescribers of these medications to the youth, pointing to the need for targeted educational efforts to ensure safe and appropriate use. The study suggests a particular focus on female patients due to the marked increase in their usage rates, educating them about the potential safety concerns of GLP-1RAs during pregnancy.

Additionally, the report noted a rise in the dispensing of Ozempic among the youth despite its lack of approval for use in children for either type 2 diabetes or weight management. This trend indicates a growing prevalence of off-label use in weight management among adolescents and young adults, as stated by Kao-Ping Chua, MD, the study’s senior author and a CHEAR Centre member.

Joyce Lee also raised concerns regarding the long-term implications of using GLP-1RAs, given their high cost and the ongoing uncertainty about their effects on growth and development in younger populations. The increasing reliance on these medications underscores the crucial need to thoroughly understand their long-term safety, efficacy, and cost-effectiveness in treating adolescents and young adults.

More information: Joyce M. Lee et al, Dispensing of Glucagon-Like Peptide-1 Receptor Agonists to Adolescents and Young Adults, 2020-2023, JAMA. DOI: 10.1001/jama.2024.7112

Journal information: JAMA Provided by Michigan Medicine- University of Michigan

Prolonged loneliness could heighten the risk of stroke in elderly individuals

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A recent study led by Harvard T.H. Chan School of Public Health indicates that persistent loneliness may significantly increase the risk of stroke among older adults. Yenee Soh, the lead author and a research associate in the Department of Social and Behavioral Sciences, emphasised the importance of loneliness as a public health issue, noting its potential role in contributing to stroke incidence—a leading cause of severe long-term disability and death globally. The research, slated for publication in eClinicalMedicine on June 24, delves into the correlation between loneliness and stroke risk, expanding on previous studies that linked loneliness with cardiovascular diseases but seldom addressed stroke specifically.

Utilising data from the Health and Retirement Study (HRS) spanning from 2006 to 2018, the research team assessed how changes in loneliness affected stroke incidence over time. Initially, 12,161 participants aged 50 and above who had never had a stroke responded to the Revised UCLA Loneliness Scale in 2006-2008. A follow-up survey in 2010-2012 saw responses from 8,936 of those participants, allowing researchers to categorise them based on their loneliness scores at the two-time points into four groups: “consistently low,” “remitting,” “recent onset,” and “consistently high.” Analysis of stroke occurrence during the follow-up periods showed that 1,237 strokes happened among those assessed only at baseline and 601 strokes among those assessed twice.

The findings revealed a significant link between loneliness and an elevated risk of stroke, with the most substantial risk increase found in those chronically lonely. Participants considered lonely at the initial assessment had a 25% higher stroke risk compared to those not regarded as lonely. Moreover, those who reported persistent high levels of loneliness across both assessments faced a 56% higher risk of stroke than those with consistently low loneliness scores, even after adjusting for other risk factors such as social isolation and depressive symptoms. Interestingly, the data suggested that loneliness impacts stroke risk over a longer term, as those with remitting or newly onset loneliness did not show a consistent pattern of increased risk.

Yenee Soh highlighted the importance of repeated assessments of loneliness to identify individuals at higher risk of stroke and stressed the need for targeted interventions specifically addressing loneliness, distinguishing it from social isolation. The study underscores the necessity for further research into the nuanced changes in loneliness and its long-term patterns to understand its impact on stroke risk better. The findings, while significant, pertain primarily to middle-aged and older adults and may need to be more generalisable to younger populations, signalling a gap that future studies could address.

More information: Yenee Soh et al, Chronic loneliness and the risk of incident stroke in middle and late adulthood: a longitudinal cohort study of U.S. older adults, EClinicalMedicine. DOI: 10.1016/j.eclinm.2024.102639

Journal information: EClinicalMedicine Provided by Harvard T.H. Chan School of Public Health