A new analysis suggests that serial measurements of high-sen | Figure 1

A new analysis of hsCRP in ACS

A new analysis suggests that serial measurements of high-sensitivity C-reactive protein (hsCRP) during follow-up after acute coronary syndrome (ACS) may help identify patients at higher risk for mortality and morbidity.

In a secondary analysis of the Vascular Inflammation Suppression to Treat Acute Coronary Syndrome for 16 Weeks (VISTA-16) trial, researchers assessed whether longitudinal increases in hsCRP measurements during the 16 weeks after ACS were independently associated with a greater risk of major adverse cardiac events (MACE); the composite of cardiovascular death, myocardial infarction, non-fatal stroke or unstable angina with documented ischaemia requiring hospitalisation; all-cause death and cardiovascular death.

They found that among 4,257 trial participants, higher baseline hsCRP level (hazard ratio [HR] 1.36; 95% CI 1.13-1.63; P=.001) and higher longitudinal hsCRP level (HR 1.15; 95% CI 1.09-1.21; P<.001) were independently associated with MACE. There were similar associations between baseline and longitudinal hsCRP levels and cardiovascular death and all-cause death.

The authors said more research is needed to determine whether initial and serial hsCRP measurements can help guide the use of targeted anti-inflammatory therapies after ACS to help further reduce residual cardiovascular risk in this vulnerable population.

Source: JAMA CARDIOL.

Background

Sleep problems (SP) can indicate underlying sleep disorders, such as obstructive sleep apnea, which may adversely impact cancer risk and mortality.

Methods

We assessed the association of baseline and longitudinal sleep apnea and insomnia symptoms with incident cancer (N = 3930) and cancer mortality (N = 4580) in the Cardiovascular Health Study. We used Cox proportional hazards regression to calculate adjusted hazard ratios (HR) and 95% confidence intervals (CI) to evaluate the associations.

Results

Overall, 885 incident cancers and 804 cancer deaths were identified over a median follow-up of 12 and 14 years, respectively. Compared to participants who reported no sleep apnea symptoms, the risk of incident cancer was inversely associated (HR (95%CI) with snoring [0.84 (0.71, 0.99)]. We noted an elevated prostate cancer incidence for apnea [2.34 (1.32, 4.15)] and snoring [1.69 (1.11, 2.57)]. We also noted an elevated HR for lymphatic or hematopoietic cancers [daytime sleepiness: 1.81 (1.06, 3.08)]. We found an inverse relationship for cancer mortality with respect to snoring [0.73 (0.62, 0.8)] and apnea [(0.69 (0.51, 0.94)]. We noted a significant inverse relationship between difficulty falling asleep and colorectal cancer death [0.32 (0.15, 0.69)] and snoring with lung cancer death [0.56 (0.35, 0.89)].

Conclusions

The relationship between SP and cancer risk and mortality was heterogeneous. Larger prospective studies addressing more cancer sites, molecular type-specific associations, and better longitudinal SP assessments are needed for improved delineation of SP-cancer risk dyad.

Source: Arthur Sillah et al. Cancer Epidemiol. 2021.

Coronary Heart Disease Systematic Review

Background

Coronary heart disease, also known as cardiovascular disease, is the leading cause of death worldwide with approximately 7.4 million deaths each year. Coronary heart disease is caused by decreased blood supply to the heart. The severity of the disease ranges from chest pain during exercise to heart attack. Antibiotics might help patients with coronary heart disease and reduce their risk of heart attacks, strokes, chest pain, revascularization procedures, and death. However, a randomised clinical trial and several observational studies suggested that antibiotics increased the risk of cardiovascular events and death.

Review question

The aim of this Cochrane systematic review was to assess the benefits and harms of antibiotics in adult patients with coronary heart disease. We primarily assessed the benefits and harms at maximum follow‐up and secondly at 24±6 months follow‐up.

Study characteristics

We searched various scientific databases from their inception to December 2019 and found 38 trials where people with coronary heart disease were randomly allocated to antibiotics versus placebo or no intervention. The 38 trials included 26,638 adults with a mean age of 61.6 years. 23 out of the 38 trials reported data on 26,078 participants that could be analyzed. The vast majority of the data was contributed by trials assessing the effects of macrolide antibiotics (28 trials; 22,059 participants) and quinolone antibiotics (two trials; 4162 participants), while insufficient data were contributed by trials assessing the effects of tetracycline antibiotics (eight trials; 417 participants). Three trials were at low risk of bias and the remaining trials were at high risk of bias.

Key results and conclusion

Patients receiving antibiotics (macrolide antibiotics or quinolone antibiotics) compared with patients receiving placebo or no intervention seemed at a slightly higher risk of death from all causes, death from a cardiac cause, and having a stroke at maximum follow‐up. Moreover, a slightly higher risk was also observed when assessing death from all causes, death from a cardiac cause, and sudden death from a cardiac cause at 24±6 months follow‐up. None of the trials sufficiently reported the number of participants with serious adverse events. No data were provided on quality of life.

Future trials on the safety of macrolide antibiotics or quinolone antibiotics for the secondary prevention in adult patients with coronary heart disease do not seem ethical.

New Developments in Nephrology

New From Nephrology Times: Hiddo J. L. Heerspink, PhD, and colleagues reported results from a patient-level meta-analysis of 49 cohorts including 148,994 participants evaluating associations of urinary albumin creatinine ratio and urinary protein creatinine ratio with kidney and cardiovascular outcomes. Over a median follow-up of 3.8 years, associations of both measures with cardiovascular outcomes were similar. Urinary albumin creatinine ratio was more strongly associated with kidney failure risk than urinary protein creatinine ratio, particularly in high-risk subgroups, supporting the use of urinary albumin creatinine ratio for risk stratification.

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?