Prevalence Of Modifiable Risk Factors Research Articles

Primary prevention of cardiovascular diseases among women in a South Asian population: a descriptive study of modifiable risk factors

ObjectiveThe aim of this study was the assessment of modifiable risk factors of cardiovascular diseases (CVD) among women versus men at a newly developed preventive cardiology clinic of a large...

Dementia risk reduction in the African context: Multi-national implementation of multimodal strategies to promote healthy brain aging in Africa (the Africa-FINGERS project).

Dementia prevention in Africa is critically underexplored, despite the continent's high prevalence of modifiable risk factors. With a predominantly young and middle-aged population, Africa presents a prime opportunity to implement evidence-based strategies that could significantly reduce future dementia cases and mitigate its economic impact. The multinational Africa-FINGERS program offers an innovative solution, pioneering culturally sensitive, multidomain interventions tailored to the unique challenges of the region. Leveraging insights from landmark global studies such as Worldwide-FINGERS and Alzheimer's Disease Neuroimaging Initiative, the program employs a multideterminant precision prevention framework, grounded in community based systems dynamics. Africa-FINGERS further integrates cutting-edge state-of-the-art multimodal biomarker evaluations tailored to regional contexts, with the goal of advancing brain health and establishing a global standard for dementia prevention. This groundbreaking initiative highlights the potential for scalableand sustainable interventions, thus is poised to transform dementia risk reduction efforts across the continent. HIGHLIGHTS: Dementia rates are escalating in Africa, largely due to longer life spans and increased prevalence of modifiable risk factors. Yet, few regional interventions have directly targeted lifestyle factors to reduce dementia risk. The multinational Africa-FINGERS study will address this gap by adapting the successful FINGERS lifestyle intervention to African populations. Africa-FINGERS will pioneer a culturally informed, multidomain dementia risk reduction intervention in the African region through feasibility dementia prevention trials in rural and urban sites across Kenya and Nigeria in the first instance, enrolling 600 at-risk adults (≥ 50 years). The program adoptsparticipatory research methods to develop culturally appropriate interventions and build infrastructure to evaluate dementia biomarkers from ante and post mortem samples. A cost-effectiveness analysis will be conducted to guide the strategic implementation of Africa-FINGERS into regional health systems. The Africa-FINGERS strategy aligns with the Worldwide-FINGERS framework and integrates the global Alzheimer's Disease Neuroimaging Initiative approach, emphasizing multimodal analysis.

The MARVIN Hypothesis: Linking Unhealthy Lifestyles to Intracranial Aneurysm Rupture Risk and Clinical Prognosis

Background and Objectives: The rising incidence of modifiable lifestyle risk factors and cardiovascular diseases, driven by poor diet, inactivity, excessive alcohol use, and smoking, may influence the development and rupture of intracranial aneurysms (IA). This study aimed to examine the impact of lifestyle-related and cardiovascular risk factors on IA rupture and patient outcomes. Materials and Methods: We developed the “MARVIN” (Metabolic and Adverse Risk Factors and Vices Influencing Intracranial Aneurysms) model and conducted a retrospective analysis of 303 patients with 517 IAs, treated between 2007 and 2020. Of these, 225 patients were analyzed for rupture status and 221 for clinical outcomes. The analysis focused on hypertension, diabetes, hypercholesterolemia, vascular diseases, nicotine and alcohol abuse, obesity, aneurysm rupture status, and clinical outcomes. Logistic regression was used to evaluate the impact of these risk factors. Results: Among those with risk factors, 24.9% (56/225) and 25.3% (56/221) had one, 32.0% (72/225) and 30.8% (68/221) had two, 20.0% (45/225) and 20.4% (45/221) had three, 12.0% (27/225) and 12.2% (27/221) had four, 4.0% (9/225) and 4.1% (9/221) had five, 0.9% (2/225) had six in both groups, and 0.4% (1/225) and 0.5% (1/221) had seven risk factors, respectively. Strong relationships were found between lifestyle-related vascular risk factors, indicating multiple comorbidities in patients with unhealthy habits. Smokers with ruptured aneurysms had higher WFNS (World Federation of Neurosurgical Societies) scores, but nicotine abuse did not affect long-term outcomes. The most significant predictors for poor outcomes were WFNS score and age, while age and a history of vascular diseases were protective against rupture. Despite the high prevalence of modifiable risk factors, they did not significantly influence rupture risk. Conclusions: The findings suggest a need for multifactorial risk assessment strategies in managing IA patients. Future studies with larger cohorts are required to confirm these results and better understand IA progression.

Prevalence and temporal trends of risk factors among young patients with acute myocardial infarction - a nationwide cohort study

Abstract Background Cardiovascular disease, including acute myocardial infarction (AMI) is the leading cause of death globally.(1) While the risk of AMI is higher with increasing age, the consequences of AMI can be more severe in younger individuals, causing larger loss-of-life-expectancy and imposing burdens for society in terms of healthcare costs and premature retirements. Description of the young AMI cohort is of greatest interest to identify modifiable risk factors and/or other predisposing factors that may be optimized. Aims To describe the prevalence and temporal trend of risk factors among young individuals with AMI. Methods We used data from the SWEDEHEART registry, the National Patient Registry, the Drug Prescription registry and the Swedish Population registry. Adult young patients, defined as 18-59 years, admitted with a first AMI from January 2003 to January 2022 were included. Prevalence of the potentially modifiable risk factors; hypertension, diabetes, hyperlipidemia, smoking and obesity was defined on admission. In the analyses the cohort was further divided into two age groups 18-44 and 45-59 years. Results From January 2003 to January 2022, 249 735 patients were admitted with a first AMI and among these, 50 281 (20.1% of the total AMI cohort) were classified as young and included in the study. 44 243 (88.0%) patients were 45-59 years and 6038 (12%) were 18-44 years. The overall prevalence of risk factors was substantial, with higher rates observed in women compared to men (Table 1a) and in the older age group, except for obesity, which was more common in the younger age group (Table 1b). While the prevalence of diabetes and hyperlipdemia remained unchanged over time, smoking decreased and hypertension slightly increased. Notably, the prevalence of obesity more than doubled (Figure 1). Conclusion Among young AMI patients the prevalence of modifiable risk factors was substantial with an even higher prevalence in women than in men. The increasing prevalence of obesity especially in the younger age group may indicate a potential future rising health care risks.Figure 1

Nationwide trends in major cardiovascular risk factors in England in the last 2 decades: Health Survey of England 2003-2019

Abstract Cardiovascular disease (CVD) accounts for a quarter of deaths annually in the UK, with more than 7.6 million people living with the disease. Hypertension, diabetes, and obesity are among the most prevalent modifiable risk factors for CVD, and the strategies to reduce the incidence and prevalence of these CV risk factors are deemed the most effective to reduce this immense toll. In the UK, over the last few decades, several health policy decisions and pathways have been developed to reduce this toll. We used data from 11 nationally representative, cross-sectional surveys from the Health Survey of England between 2003 and 2019 to evaluate trends in the prevalence of these CV risk factors and whether there has been any population-wide improvement in them. These surveys have cumulative information on 94,100 adults, and we applied sample weights, accounting for oversampling and nonresponse. We used "period definitions and cut-offs" to define those with diabetes. For example, for undiagnosed diabetes, we used glycated haemoglobin cut-off equivalent of 7% or more for years before 2011 and the current diagnostic threshold of > 6.5% thereafter. This was done to facilitate and compare the trends after accounting for changes in medical practice and understanding across this period. Similarly, hypertension was defined as doctor-diagnosed hypertension or in its absence regular use of antihypertensive medications or blood pressure ≥ 140/90mmHg (period diagnostic threshold remains unchanged during). Python and STATA were used to conduct analyses, and Join Point regression software was used to develop and compare trends. In England, from 2003-2019, mean population BMI consistently increased over this period, rising by 0.8kg/m2 from 27.6 to 28.8 kg/m2. Obesity prevalence (BMI ≥30kg/m2) increased by 5.4% from 22.6% to 28.0%. Concurrently, mean glycated haemoglobin increased by 0.36% from 6.18% to 6.54%, surpassing the current diabetes diagnostic threshold. Diabetes period prevalence surged from 4.2% to 11.6%, a trend consistent when the current diagnostic threshold was alternatively applied across all periods. Conversely, doctor-diagnosed and total hypertension (including those who are unaware) prevalence exhibited a slight decrease (1.4% and 3%, respectively), mirrored by reductions in population-wide mean systolic and diastolic blood pressure by 4.6mmHg and 1.9mmHg. These results suggest that, with the total population in England standing at 56.3 million in 2019, an estimated 15.8 million adults were within the obese BMI range, 6.5 million had diabetes and 17.6 million had hypertension. The obesity epidemic is likely fuelling the increase in diabetes prevalence. These findings underscore the importance of prioritising obesity reduction in public health initiatives, aiming to subsequently curb diabetes prevalence. Hypertension still remains a major CV risk factor, affecting almost one third of the adult population.

Non-Pharmacological Exercise Randomized Controlled Trials in Alzheimer's Disease.

This narrative review aimed to summarize evidence on responses to exercise in pre-clinical Alzheimer's disease (AD) and on how long-term exercise programs work to improve neuropsychiatric symptoms and cognitive performance. We conducted a narrative review of the body of research on the benefits of long-term exercise programs in improving cognitive performance and reducing neuropsychiatric scores in patients with AD. Long-term exercise therapy appears to improve blood flow, increase hippocampal volume, and promote neurogenesis in patients with AD. Higher levels of physical activity are associated with a lower chance of developing the disease, and most prospective studies have shown that physical inactivity is one of the most prevalent modifiable risk factors for the development of AD. Exercise appears to be beneficial in improving cognitive function, a neuropsychiatric symptom of AD. Exercise has been shown to have fewer side effects, such as non-pharmacological effects and better adherence than medication. In this review, experts provided a snapshot and authoritative summary of evidence for non-pharmacological exercise in patients with AD based on the best synthesis efforts, identified the main knowledge gaps and relevant barriers, and provided directions for future research. Furthermore, experts in randomized trial designs provided practical details and recommendations for researchers working in this area, underscoring the importance of relevant topics.

Sedentary Lifestyle Is a Modifiable Risk Factor for Cognitive Impairment in Patients on Dialysis and after Kidney Transplantation

Background: Chronic kidney disease (CKD) is a risk factor for cognitive impairment (CI), and this risk is the highest in patients with end-stage kidney disease (ESKD). As a multifactorial disease, CI may be influenced by several potentially modifiable lifestyle and behavioral factors that may reduce or increase the risk of dementia. The aim of this study was to evaluate the associations between the known modifiable risk factors for dementia and the risk of CI in patients with ESKD treated with renal replacement therapy. The Charlson Comorbidity Index and the risk of CI in patients with ESKD were also assessed. Methods: In this cross-sectional study, 225 consecutive patients with ESKD treated with different modalities of renal replacement therapy were assessed for cognitive decline using the Addenbrooke’s Cognitive Examination (ACE III) test. Information was also collected on modifiable risk factors for dementia, medical history and demographics. Results: This study included 117 patients after kidney transplantation (KT) and 108 patients with ESKD undergoing peritoneal dialysis and hemodialysis. The prevalence of modifiable risk factors for dementia differed between the groups; KT patients were more likely to be physically active, residing in cities with populations of less than 500,000 inhabitants, and were less likely to suffer from depression. Furthermore, the KT group had a lower Charlson Comorbidity Index score, indicating less severe comorbidities, and a lower risk of CI (3.6 ± 1.67 vs. 5.43 ± 2.37; p = 0.001). In both the KT and dialysis groups, patients with CI were more likely to have a sedentary lifestyle (45% vs. 9%, p = 0.001 and 88% vs. 48%, p = 0.001, respectively), whereas lower educational attainment and depression had a significant negative impact on ACE III test results, but only in KT patients. Finally, cognitive function in dialysis patients was negatively affected by social isolation and living in urban areas. Conclusions: Modifiable risk factors for dementia, particularly a sedentary lifestyle, are associated with a higher risk of CI in patients treated with different renal replacement therapy modalities. As CI is an irreversible condition, it is important to identify lifestyle-related factors that may lead to dementia in order to improve or maintain cognitive function in patients with ESKD.

The contemporary management and coronary angioplasty outcomes in young patients with ST-Elevation myocardial infarction (STEMI) age < 40 years old: the insight from nationwide Thai PCI registry

BackgroundCardiovascular disease (CVD) remains one of the major causes of death around the world in which ST elevation MI (STEMI) is in the lead. Although the mortality rate from STEMI seems to decline, this result might not be demonstrated in young adults who basically have different baseline characteristics and outcomes compared with older patients.MethodsData of the STEMI patients aged 18 years or older who underwent PCI during May 2018 to August 2019 from Thai PCI Registry, a prospective, multi-center, nationwide study, was included and aimed to investigate the predisposing factors and short-term outcomes of patients aged < 40 years compared with age 41–60, and > 61 years.ResultsData of 5,479 STEMI patients were collected. The patients’ mean age was 62.6 (SD = 12.6) years, and 73.6% were males. There were 204, 2,154, and 3,121 patients in the youngest, middle, and oldest groups. The young patients were mainly male gender (89.2% vs. 82.4% and 66.6%; p < 0.001), were current smokers (70.6%, 57.7%, 34.1%; p < 0.001), had BMI ≥ 25 kg/m2 more frequently (60.8%, 44.1%, 26.1%; p < 0.001), and had greater family history of premature CAD (6.9%, 7.2%, 2.9%; p < 0.001). The diseased vessel in the young STEMI patients was more often single vessel disease with the highest percentage of proximal LAD stenosis involvement. Interestingly, there were trends of higher events of procedural failure (2.9%, 2.1%, 3.3%; p = 0.028) and procedural complications (8.8%, 5.8%, 9.4%; p < 0.001) in both youngest and oldest groups compared to the middle-aged group. In-hospital death was found in 3.4% in the youngest group compared to 3.3% in the middle-aged patients and 9.2% in the older patients (p < 0.001).ConclusionsDespite experiencing higher rates of procedural failure and complications during treatment compared to middle-aged and older patients, young STEMI individuals demonstrate a significantly lower risk of death during hospitalization and within one year of the event. Younger patients might have a more robust physiological reserve or benefit from more aggressive post-procedure management. However, the higher prevalence of modifiable risk factors like smoking and obesity in younger individuals underscores the need for preventative measures. Encouraging smoking cessation and weight control in this demographic is crucial not only to prevent STEMI but also to potentially improve their long-term survival prospects.

Prevalence of Cardiometabolic Risk Factors in Women: Insights From the Houston HeartReach Study.

Cardiovascular disease is the leading cause of death among women in the United States. Past research has highlighted the importance of the relationship between female-specific demographics and traditional risk factors. The present analysis aimed to identify the prevalence of modifiable risk factors in women attending a community cardiovascular health screening. Data collected between 2011 and 2019 were obtained from the Houston HeartReach Registry. Participants were classified as having or not having each of 4 traditional cardiometabolic risk factors: hypertension, diabetes, body mass index indicating overweight or obesity, and dyslipidemia. Differences in prevalence were compared using the Pearson χ2 test. Most participants had hypertension, overweight or obesity, and dyslipidemia. Older women (≥65 years) had the highest prevalence of all cardiometabolic risk factors. Black participants had a higher prevalence of hypertension (P = .006) and a lower prevalence of dyslipidemia (P = .009) than non-Black participants. Hispanic participants had a lower prevalence of hypertension (P < .001) and a higher prevalence of overweight or obesity (P = .03) than non-Hispanic participants. Participants in the lowest household income bracket (<$25,000) were more likely to have diabetes (P = .001) and overweight or obesity (P = .004) than participants in the highest income bracket (≥$50,000). Unemployed participants had a higher prevalence of diabetes (P < .001), overweight or obesity (P = .004), and dyslipidemia (P < .001) than employed participants. Comorbidity analysis revealed clustering of multiple cardiometabolic risk factors. Moreover, risk factor hot spots were identified by zip code, which could help select future sites for targeted screening. The analysis found that cardiometabolic risk factor prevalence varies with demographic and socioeconomic status. Geographic areas where cardiometabolic risk factor prevalence was highest were also identified. Further participant recruitment and analysis are required to create predictive models of cardiovascular disease risk in women.

Modifiable risk factors and excess mortality in depression: Data from the UK Biobank

ObjectiveTo study the role of modifiable risk factors in explaining the excess mortality associated with depression using data from the UK Biobank, a middle-aged and elderly cohort recruited in 2006–2010. MethodsWe estimated the prevalence and relative mortality associated with modifiable risk factors and groups of risk factors (socioeconomic factors, diet and exercise, smoking and substance-related disorders, and cardiometabolic diseases) in a subsample of probable cases of lifetime/current depression (n = 51,302) versus non-cases. We also estimated the relative mortality associated with depression and the percentages of excess mortality associated with depression explained by modifiable risk factors in the total sample (499,762). ResultsIn our depression subsample, all modifiable risk factors were associated with increased prevalence and mortality. In our total sample, depression was associated with an age and sex-adjusted mortality hazard ratio of 1.63 (95% CI = [1.58–1.68]). Modifiable risk factors explained 70.5% [66.9%–75.0%] of the excess mortality associated with depression. ConclusionsIn the UK Biobank cohort, depression was associated with a higher prevalence of modifiable risk factors. These risk factors were associated with increased mortality in the depression subsample and explained most of the excess mortality risk associated with depression in the total sample.

Burden of 30 cancers among men: Global statistics in 2022 and projections for 2050 using population-based estimates.

Men exhibit higher prevalence of modifiable risk factors, such as smoking and alcohol consumption, leading to greater cancer incidence and lower survival rates. Comprehensive evidence on global cancer burden among men, including disparities by age group and country, is sparse. To address this, the authors analyzed 30 cancer types among men in 2022, with projections estimated for 2050. The 2022 GLOBOCAN estimates were used to describe cancer statistics for men in 185 countries/territories worldwide. Mortality-to-incidence ratios (MIRs) were calculated by dividing age-standardized mortality rates by incidence rates. In 2022, a high MIR (indicating poor survival) was observed among older men (aged 65 years and older; 61%) for rare cancer types (pancreatic cancer, 91%) and in countries with low a Human Development Index (HDI; 74%). Between 2022 and 2050, cancer cases are projected to increase from 10.3 million to 19 million (≥84%). Deaths are projected to increase from 5.4 million to 10.5 million (≥93%), with a greater than two-fold increase among men aged 65 years and older (≥117%) and for low-HDI and medium-HDI countries/territories (≥160%). Cancer cases and deaths are projected to increase among working-age groups (≥39%) and very-high-HDI countries/territories (≥50%). Substantial disparities in cancer cases and deaths were observed among men in 2022, and these are projected to widen by 2050. Strengthening health infrastructure, enhancing workforce quality and access, fostering national and international collaborations, and promoting universal health coverage are crucial to reducing cancer disparities and ensuring cancer equity among men globally.

Hypertension and Device-Based Therapies for Resistant Hypertension: An Up-to-Date Review.

Hypertension is the most prevalent modifiable risk factor associated with cardiovascular mortality. The World Health Organization (WHO) estimates that hypertension directly or indirectly causes the death of at least nine million people globally every year. The number of people living with hypertension (blood pressure (BP) of ≥140 mmHg systolic or ≥90 mmHg diastolic or on medication) doubled between 1990 and 2019, from 650 million to 1.3 billion. Despite a plethora of antihypertensivedrugs widely available, a sizable part of the antihypertensive population stays uncontrolled. The unmet need of controlling BP in this population may be addressed, in part, by developing new drugs and devices/procedures to treat hypertension and its comorbidities. Several device-based approaches have been introduced to lower BP, and most of these strategies aim to modulate autonomic nervous system activity. Importantly, when considering a device-based treatment, each patient's underlying pathophysiology is considered, and the procedural risks are weighed against the cardiovascular risk attributed to the elevated BP.In November 2023, the FDA approved two renal denervation (RDN) devices. This manuscript discusses current interventional devices and procedures recently approved (RDN) and others in the clinical testing stage for arterial hypertension intervention or management.As we list below, all others have shown promising results and are being evaluated on a larger clinical trial.The new device-based classes are as follows: catheter-based RDN, baroreflex amplification, arteriovenous (AV) malformation, carotid body (CB) ablation, pacemaker-based cardiac neuromodulation, electro-acupuncture, and deep brain stimulation. Baroreflex amplification uses peripheral neuromodulation, while AV malformation leverages AV anastomosis. CB ablation modulates chemoreceptors, and pacemaker-based neuromodulation adjusts atrioventricular intervals. Electro-acupuncture proves potential, and deep brain stimulation offers central nervous system intervention.

A prospective study of age-related differences in modifiable risk factors, stroke subtype, and functional outcome in young and middle-aged patients with first-ever ischemic stroke

The objective of our study was to compare the age-related differences in the prevalence of modifiable risk factors (RF), stroke subtype and functional outcome at hospital discharge in young and middle-aged patients with first-ever ischemic stroke (IS). The study included 120 patients with acute first-ever IS, aged 18&amp;ndash;59 years, admitted to the Neurology Clinic of Dr. Georgi Stranski University Hospital, Pleven. Of these, 41 (34.2%) were in the young-age group and 79 (65.8%) were middle-aged. The middle-aged patients had higher rates of arterial hypertension (81.0%), diabetes mellitus (45.6%), dyslipidemia (83.5%), low levels of HDL cholesterol (68.4%), high levels of LDL cholesterol (72.2%) and arterial fibrillation (7.6%). The most common subtype of IS in middle-aged patients was large artery atherosclerosis (40.5%), small vessel occlusion (29.1%) and cardioembolism (6.3%). In comparison, we found a higher incidence of IS in the young patients with other determined (34.1%) and undetermined aetiology (34.1%). Our data on functional outcomes at hospital discharge confirm age-related differences in the prevalence of modifiable RFs and stroke subtype in young and middle-aged patients with first-ever IS. These findings highlight the need to develop specific therapeutic approaches for early identification and effective control of health- and lifestyle-related RFs to reduce the incidence of the most common subtypes of IS.

Distinct biological signature and modifiable risk factors underlie the comorbidity between major depressive disorder and cardiovascular disease

Major depressive disorder (MDD) and cardiovascular disease (CVD) are often comorbid, resulting in excess morbidity and mortality. Here we show that CVDs share most of their genetic risk factors with MDD. Multivariate genome-wide association analysis of shared genetic liability between MDD and atherosclerotic CVD revealed seven loci and distinct patterns of tissue and brain cell-type enrichments, suggesting the involvement of the thalamus. Part of the genetic overlap was explained by shared inflammatory, metabolic and psychosocial or lifestyle risk factors. Our data indicated causal effects of genetic liability to MDD on CVD risk, but not from most CVDs to MDD, and showed that the causal effects were partly explained by metabolic and psychosocial or lifestyle factors. The distinct signature of MDD–atherosclerotic CVD comorbidity suggests an immunometabolic subtype of MDD that is more strongly associated with CVD than overall MDD. In summary, we identified biological mechanisms underlying MDD–CVD comorbidity and modifiable risk factors for prevention of CVD in individuals with MDD.

Prevalence of modifiable risk factors among patients hospitalized for acute coronary syndrome in Brazil: a call to action for Brazilian healthcare

Prevalence of modifiable risk factors among patients hospitalized for acute coronary syndrome in Brazil: a call to action for Brazilian healthcare

Prevalence of Cardiovascular and Cancer Risk Factors Among Rheumatoid Arthritis Patients Prescribed JAK Inhibitors and Tumor Necrosis Factor Inhibitors: A Cross-Sectional Study.

The study was to determine the prevalence of baseline risk factors for cardiovascular outcomes and cancer among commercially-insured patients with rheumatoid arthritis (RA) during their first dispensed treatment for either tumor necrosis factor inhibitors (TNFi) or JAK inhibitors (JAKi). Patients with RA from August 16, 2019 to March 31, 2022 were identified in the Merative MarketScan Commercial and Medicare databases. The first date that a TNFi or JAKi was dispensed was the index date, and baseline risk factors were assessed among patients continuously eligible for 12 months before the index date. Patients who had the following were stratified into an elevated risk category: age ≥65 years, smoking, or a history of a major adverse cardiovascular event, venous thromboembolism, or cancer. The prevalence of modifiable risk factors was also reported: hypertension, hyperlipidemia, obesity, and diabetes. The crude prevalence and prevalence difference (PD) were reported. A total of 12,673 patients (TNFi [n = 7,748; 61%] and JAKi [n = 4,925; 39%]) met inclusion criteria. The prevalence of elevated risk was the same for all patients using TNFi (n = 2,051; 26%) and JAKi (n = 1,262; 26%). Compared with patients having low risk, patients with an elevated risk also had a higher prevalence of at least one primary modifiable risk factor for both patients using JAKi (79% vs 58%; PD 21%, 95% confidence interval [CI] 18%-24%) and TNFi (81% vs 60%; PD 21%, 95% CI 19%-23%). In recent years, JAKi and TNFi were used in similar proportions to treat RA among commercially-insured patients at elevated cardiovascular and cancer risk. Because uncontrolled disease, modifiable comorbidities, and treatment with JAKi are associated with these adverse events, future studies evaluating how practice patterns may be affected by the emergence of safety data will be of value.

Knowledge, Skills, and Experience With Technology in Relation to Nutritional Intake and Physical Activity Among Older Adults at Risk of Falls: Semistructured Interview Study.

More than one-third of older adults (aged ≥65 y) experience falls every year. The prevalent modifiable risk factors for falling are malnutrition and physical inactivity, among others. The involvement of older adults in the prevention of falls can decrease injuries, hospitalizations, and dependency on health care professionals. In this regard, eHealth can support older adults' self-management through more physical activity and adequate food intake. eHealth must be tailored to older adults' needs and preferences so that they can reap its full benefits. Therefore, it is necessary to gain insight into the knowledge, skills, and mindset of older adults living at home who are at risk of falls regarding eHealth. This qualitative study aims to explore older adults' use of everyday digital services and technology and how they acquire knowledge about and manage their nutritional intake and physical activity in relation to their health. Semistructured interviews were conducted with 15 older adults (n=9, 60% women; n=6, 40% men; age range 71-87 y) who had all experienced falls or were at risk of falling. These individuals were recruited from a geriatric outpatient clinic. The interviews were analyzed using deductive content analysis based on a modification of the Readiness and Enablement Index for Health Technology framework. The qualitative data showed that the informants' social networks had a positive impact on their self-management, use of technology, and mindset toward nutritional intake and physical activity. Although the informants generally lived active lives, they all lacked knowledge about how their food intake influenced their physical health, including their risk of falling. Another finding was the large diversity in the use of technology among the informants, which was related to their mindset toward technology. Older adults can use technology for everyday purposes, but some need additional introduction and support to be able to use it for managing their health. They also need to learn about the importance of proper nutritional intake and physical activity in preventing falls. Older adults need a more personalized introduction to technology, nutrition, and physical activity in their contact with health professionals.

Extra-Anogenital Giant Cutaneous Squamous Cell Carcinomas.

Extra-anogenital giant cSCCs are rare but have worse outcomes compared to smaller tumors. Prompted by limited data, the authors conducted a retrospective study to gather more information about giant cSCCs to optimize clinical care. We identified seven cases of giant cSCCs from a review of cSCC cases treated in the Unit of Dermatosurgery between 2016 and 2022. Most patients were male (85.71%) with a mean age of 80.29 ± 12.22 years. UV radiation was the most common risk factor (five cases) followed by smoking (three cases) and hidradenitis suppurativa (one case). Most giant cases were located in the head area (71.4%) and the diameter of lesions ranged from 6 to 18 cm. All patients corresponded to tumor stage T3, and 42.86% of patients had lymph node metastases. Surgical excision was the treatment of choice in most cases (85.71%), while a combination of cemiplimab and RP1 was used in some cases due to the ineffectiveness of treatment or contraindications to other therapies. The authors emphasize the importance of early detection and prevention of modifiable risk factors, such as UV radiation, and a multidisciplinary approach to treatment. Other therapies, including immunotherapy, may become increasingly important.

Histone deacetylase inhibition by suberoylanilide hydroxamic acid during reperfusion promotes multifaceted brain and vascular protection in spontaneously hypertensive rats with transient ischaemic stroke

Hypertension is the most prevalent modifiable risk factor for stroke and is associated with worse functional outcomes. Pharmacological inhibition of histone deacetylases by suberoylanilide hydroxamic acid (SAHA) modulates gene expression and has emerged as a promising therapeutic approach to reduce ischaemic brain injury. Here, we have tested the therapeutic potential of SAHA administered during reperfusion in adult male spontaneously hypertensive (SHR) rats subjected to transient middle cerebral artery occlusion (tMCAO; 90 min occlusion/24 h reperfusion). Animals received a single dose of SAHA (50 mg/kg) or vehicle i.p. at 1, 4, or 6 h after reperfusion onset. The time-course of brain histone H3 acetylation was studied. After tMCAO, drug brain penetrance and beneficial effects on behavioural outcomes, infarct volume, oedema, angiogenesis, blood-brain barrier integrity, cerebral artery oxidative stress and remodelling, and brain and vascular inflammation were evaluated. SAHA increased brain histone H3 acetylation from 1 to 6 h after injection, reaching the ischaemic brain administered during reperfusion. Treatment given at 4 h after reperfusion onset improved neurological score, reduced infarct volume and oedema, attenuated microglial activation, prevented exacerbated MCA angiogenic sprouting and blood-brain barrier breakdown, normalised MCA oxidative stress and remodelling, and modulated brain and cerebrovascular cytokine expression. Overall, we demonstrate that SAHA administered during early reperfusion exerts robust brain and vascular protection after tMCAO in hypertensive rats. These findings are aligned with previous research in ischaemic normotensive mice and help pave the way to optimise the design of clinical trials assessing the effectiveness and safety of SAHA in ischaemic stroke.

Clinical Characteristics and Outcomes of ST-Elevation Myocardial Infarction in Young Patients: A Single-Center Experience.

Objective This study aimed to examine the clinical characteristics, risk factors, and outcomes of patients aged ≤45 years with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Methods From January 2018 to March 2020, this retrospective observational study took place at a tertiary cardiac center in Bahrain. We included patients aged ≤45 years who were admitted with STEMIand had primary percutaneous coronary intervention (pPCI). Results In this study, 510 patients with STEMIreceiving pPCIwere included, of whom 95 (18%) were younger than 45 years. The young age group had more smokers (57.9% vs. 40.5%, p = 0.003), newly diagnosed dyslipidemia (41.1% vs. 25.5%, p = 0.004), and a positive family history of early coronary artery disease (CAD) (14.7% vs. 4.3%, p = <0.001). Traditional cardiovascular risk factors, such as diabetes mellitus, systemic hypertension, and dyslipidemia, were significantly less common in young patients. Major adverse cardiovascular and cerebrovascular events(MACCE) were also significantly less common in young patients at the one-year follow-up (2.1 vs. 8.4%, p = 0.05). Conclusion Young patients with STEMIare more often smokers with undiagnosed dyslipidemia and have a family history of CAD. MACCE at one year is significantly lower as compared to older patients, but it is not negligible. Public health efforts are needed to reduce the prevalence of modifiable risk factors among the susceptible population.