Citations

Abstract Background Socioeconomic position (SEP) is a fundamental social determinant of health (SDoH) contributing to observed disparities in cancer and cardiovascular (CV) care among individuals with prostate cancer (PC). Understanding the influence of SEP on CV health is essential for addressing outcome inequities within this population. Methods We conducted a retrospective study utilizing Surveillance, Epidemiology, and End Results (SEER)-Medicare to evaluate CV outcomes in patients ≥65 years with PC from 2009 to 2017. We studied the impact of SEP on cardiovascular events (CVEs), cardiovascular mortality (CVm), PC-specific mortality (PCsm), and all-cause mortality. CVE, CVm, and PCsm were analyzed using competing risk models and all-cause mortality with Cox proportional hazards models. A subgroup analysis was performed in Non-Hispanic Black and Non-Hispanic White individuals. Results We included 141 242 patients of whom 76 844 were in high SEP areas (45.6%) and 64 398 in low SEP ones (54.4%). Both groups had a mean age of 72 years; patients in low SEP areas were 67.5% Non-Hispanic White, 34.4% having diabetes, 73.3% hypertension, and 67.7% dyslipidemia versus the high SEP group with 85.6% Non-Hispanic White, 30.4% diabetes, 69.9% hypertension, and 70.7% dyslipidemia. Patients in low SEP areas had higher risks of CVm (subdistribution hazard ratio [sHR] = 1.18, 95% CI = 1.12 to 1.25), PCsm (sHR = 1.12, 95% CI = 1.06 to 1.17), CVE (sHR = 1.07, 95% CI = 1.04 to 1.09), and all-cause mortality (HR 1.16, 95% CI = 1.13 to 1.20). Accentuated results were shown in the Non-Hispanic Black subgroup. Conclusion Adverse SEP plays a significant role in shaping outcomes among older patients with PC, contributing to elevated risks of adverse CV and survival outcomes.

Abstract Background Onco-hypertension, the interplay between cancer and hypertension, is an emerging specialty highlighting the bidirectional relationship between carcinogenesis, anticancer therapies, and blood pressure regulation. In Pakistan, data on physicians’ awareness and management of onco-hypertension are limited, yet critical given the rising global burden of cancer (24.5 million new cases; 9.6 million deaths in 2017) and hypertension (7.6 million annual deaths) worldwide. Methods A cross-sectional survey was conducted from May to October 2023 among physicians in oncology, internal medicine, cardiology, and allied specialties across tertiary hospitals, private clinics, and teaching institutions in Pakistan. A self-structured questionnaire, covering sociodemographic, knowledge, attitudes, and clinical practices, was distributed online and in person. Descriptive statistics summarized respondent characteristics, and inferential tests (t-tests, ANOVA) examined associations (p < 0.05). Results Mean respondent age was 37.5 ± 7.8 years; 58% male. Specialty distribution: internal medicine (45%), oncology (16%), cardiology (17%), nephrology (8%), pulmonology (13%), and others (1%). Nearly half (49%) rated their onco-hypertension knowledge as “average,” and 62% reported challenges managing hypertensive cancer patients. Key perceived causes in previously normotensive patients were anxiety (48%) and corticosteroid use (40%). Sixty-three percent sometimes adjusted antihypertensive regimens based on cancer therapies, and 80% endorsed the necessity of interdisciplinary coordination for optimal management. Conclusion Pakistani physicians demonstrate moderate understanding of onco-hypertension with prevalent management challenges. Findings underscore the need for targeted educational initiatives, validated clinical guidelines, and structured interdisciplinary collaboration to improve cardiovascular outcomes in cancer care.

Abstract Background and Aims Upadacitinib (UPA)—an oral, reversible selective Janus kinase inhibitor—has a favorable benefit–risk profile for patients with Crohn’s disease (CD) and ulcerative colitis (UC). We evaluated the benefit–risk of UPA in select subgroups with CD or UC. Methods Patients were randomized to UPA 45 mg (UPA45) once daily (QD) or placebo (PBO) induction for 12 (CD: U-EXCEED, U-EXCEL) or 8 weeks (UC: U-ACHIEVE, U-ACCOMPLISH). Clinical responders were re-randomized to QD UPA 15 mg (UPA15), UPA 30 mg (UPA30), or PBO for 52-week maintenance (CD: U-ENDURE; UC: U-ACHIEVE). This exploratory post hoc analysis assessed efficacy and safety outcomes (adverse events of special interest [AESIs]: serious infections, major adverse cardiovascular [CV] events, malignancies, and venous thromboembolic events) by CV risk, prior treatment failure, and age. Results This analysis included 1021 patients with CD and 1097 with UC during induction, and 673 with CD and 746 with UC during maintenance. Improved efficacy outcomes comparable to the overall study populations were observed with UPA versus PBO across subgroups. Patients receiving UPA30 generally showed numerically higher rates of improvements versus UPA15. AESI rates were generally comparable between UPA and PBO across subgroups except for numerically higher rates of herpes zoster and serious infections in CD with UPA. Conclusions UPA resulted in consistent benefit versus placebo across CV risk, prior treatment failure, and age subgroups. No treatment differences were seen in AESIs across subgroups except herpes zoster and serious infections, reinforcing the favorable benefit–risk profile for UPA in CD and UC seen in the overall study populations. Clinical trial numbers NCT02819635, NCT03653026, NCT03345836, NCT03345849, NCT03345823

Abstract Introduction There are limited data on the impact of glucagon-like peptide-1 receptor agonist (GLP-1RA) on the risk of recurrent pouchitis after ileal pouch–anal anastomosis (IPAA) for ulcerative colitis (UC). Methods A retrospective cohort study was conducted in the TriNetX Research Network in adult patients with obesity and IPAA for UC with a history of pouchitis in whom a GLP-1RA was initiated compared to those patients in whom a GLP-1RA was not initiated. The primary outcome was the risk of recurrent pouchitis within 12 months. The secondary outcomes were mean number of antibiotic prescriptions, anti-diarrheal medication use, Crohns-like disease of pouch (CLDP), and pouch excision. One-to-one propensity score matching was performed. Results We identified 43 UC-IPAA patients with obesity and history of pouchitis (mean age 51.7 ± 14.7 years, mean body mass index [BMI] 34.4 ± 6 kg/m2, 60.4% female). After propensity score matching, the GLP-1RA cohort had a significantly decreased risk of recurrent pouchitis (26.3% vs 52.6%; adjusted odds ratio [aOR], 0.32; 95% CI, 0.12-0.84) compared to the control cohort. Mean antibiotic prescriptions were numerically lower in the GLP-1RA cohort (2 vs 4.4, P = .16). Anti-diarrheal medication use was lower in the GLP-1RA cohort (18.4% vs 47.3%; aOR, 0.23; 95% CI, 0.07-0.67). There was no difference in the risk of CLDP. Zero patients required pouch excision in both cohorts. Conclusion Our study in a small cohort of patients with UC-IPAA and obesity with a history of pouchitis showed that GLP-1RA use was associated with decreased risk of recurrent pouchitis and anti-diarrheal medication use.

ABSTRACT Background Transvenous lead removal (TLR) in patients with a history of mediastinal radiation poses unique challenges due to potential radiation‐induced fibrosis, vascular changes, and anatomical distortion, which may increase procedural complexity and complication risk. However, contemporary data on clinical outcomes in this population remain limited. Methods We analyzed the National Readmissions Database (2016–2021) to identify adults (≥ 18 years) undergoing TLR. Patients were stratified by prior mediastinal radiation. Baseline characteristics were compared using standard statistical tests. Multivariable logistic regression was used to evaluate the association between prior mediastinal radiation and in‐hospital outcomes, 30‐day mortality, and 30‐day readmissions after adjustment for demographics and comorbidities. Results A total of 48,985 patients underwent TLR, of whom 735 (1.5%) had a history of mediastinal radiation. Compared with patients without radiation, those with prior radiation were older (70.1 vs. 66.2 years, p < 0.01), were more frequently females (38.2% vs. 31.6%, p < 0.01), and had higher rates of valvular heart disease, atrial fibrillation, and peripheral vascular disease. Adjusted analyses demonstrated no increased risk of in‐hospital mortality (2.3% vs. 3.4%; adjusted odds ratio [aOR] 0.65, 95% confidence interval [CI] 0.41–1.18, p = 0.29) or major complications, including cardiac arrest, pericardial complications, vascular injury, pulmonary complications, or embolic events. Similarly, (3.6% vs. 5.3%; aOR 0.76, 95% CI 0.48–1.43, p = 0.35) and 30‐day all‐cause readmissions (8.7% vs. 9.1%; aOR 0.81, 95% CI 0.64–1.28, p = 0.70) were not significantly different between groups. Subgroup analyses by indication for TLR (infection vs. mechanical complication) revealed no differences in outcomes. Conclusion Despite theoretical concerns, prior mediastinal radiation was not associated with excess procedural risk or worse short‐term outcomes after TLR. These findings may inform procedural planning and risk counseling in clinical practice.

Viral hepatitis (VH) remains a leading cause of preventable mortality in the United States (US). Despite advancements in antiviral therapies, disparities in VH-related mortality persist across demographic, racial, and geographic groups. This study analyzes trends in VH-related mortality among US adults between 1999 and 2020 to identify high-risk subgroups and inform public health interventions. This retrospective cohort study analyzed VH-related deaths among US adults (≥25 years). Data were obtained from the CDC WONDER database, with cases identified using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes B15–B19. Age-adjusted mortality rates (AAMRs) were calculated per 1,00,000 individuals and stratified by age, gender, race and geographical location. Temporal trends in mortality were analyzed by estimating annual percentage changes (APCs) in the AAMRs using the joinpoint regression model. A total of 3,59,035 VH-related deaths were recorded among US adults during 1999 to 2020 with a cumulative overall AAMR of 7.36 (95% CI: 7.33–7.38). Overall, the AAMRs increased significantly from 1999 to 2013 (APC: +3.21; P < .01), followed by a significant decline until 2020 (APC: −5.61; P < .01). Men exhibited higher AAMRs than women, with middle-aged adults (45–64 years) most affected compared to young (25–44 years) and older adults (65 to 85+ years). Non-Hispanic (NH) American Indians/Alaska experienced the highest AAMRs followed by NH Blacks/African Americans, Hispanics, NH Asians/Pacific Islanders and NH Whites populations. Geographically, mortality rates were higher in urban areas than in rural areas, in the Western region relative to other regions and in the District of Columbia compared to other states. Significant disparities in VH-related mortality persist across demographic and geographic subgroups, with particularly higher rates among men, NH American Indian/Alaska Native population, middle-aged adults, and residents of urban and Western US regions. Targeted public health strategies are essential to address these inequities and improve outcomes.