Risk Reduction Research Articles

Fostering civic participation and collective actions for disaster risk reduction: Insights from Aotearoa New Zealand case studies

Fostering civic participation and collective actions for disaster risk reduction: Insights from Aotearoa New Zealand case studies

Integration of indigenous knowledge systems (IKS) into climate change mitigation and adaptation endeavours: milestones and gaps in South Africa and Zimbabwe’s climate policy frameworks

AbstractThis article was poised to unravel the merits of integrating IKS and the demerits of its exclusion in climate change programmes and policies. The harrowing impacts of climate change in Sub-Saharan Africa make adaptation and mitigation unescapable discourses. As such, climate change policies demonstrate governments’ commitment to fostering adaptation and mitigating climate change impacts evident in every sector of society. The effectiveness of climate policies is measured by their responsiveness to the different needs, aspirations and circumstances of populations plagued by climate change. In the absence of technoscience-based adaptation and mitigation mechanisms, African communities still rely on the repository of indigenous knowledge systems as a source of information, decision-making, and prediction tools for predicting weather changes. For this reason, in formulating climate change mitigation and adaptation endeavours at policy level, it is critical to identify specific strategies where IKS has been used as a warrant towards its usage. This study was qualitative and operated within the traditional descriptive, analytical and interpretive approaches. It relied on a desktop review of journal articles on climate change and IKS, and climate change policies of South Africa and Zimbabwe. These were purposively sampled based on their relevance to the aim of the study. The Discourse Content Analysis was utilised to analyse data from which the findings were derived. The article established that despite the wide recognition of the role played by IKS in climate change adaptation, mitigation and disaster risk reduction, IKS has not featured predominantly South Africa’s climate change policies as compared to Zimbabwe’s climate policies. Notably, disregarding IKS in climate change policies makes them bereft of effectiveness in vulnerability reduction, fostering adaptation and resilience building for African communities that rely on IKS, among other capitals essential in fostering mitigation and adaptation in the face of climate change.

Effects of Extracted Pulse Proteins on Lipid Targets for Cardiovascular Risk Reduction: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Effects of Extracted Pulse Proteins on Lipid Targets for Cardiovascular Risk Reduction: Systematic Review and Meta-Analysis of Randomized Controlled Trials

A novel clinical prediction model for hip fractures: a development and validation study in the total population of Sweden

Low bone density and osteoporosis are indications for bone-specific treatment. However, given the limited availability of bone density data in clinical practice and the fact that most patients with hip fracture do not have osteoporosis, accurate prediction of hip fracture risk in the absence of bone density data would be crucial. This development and validation study included the entire Swedish population aged 50 years or older in 2005 (N=3,340,977) and was conducted by cross-linking data from nationwide registers. Potential predictive variables included diagnoses, prescription medications, familial factors, frailty-related factors, and socioeconomic factors. The primary endpoint was the 5-year risk of hip fracture. Fracture prediction algorithms were developed and validated using multivariable models. Model performance and validation was also examined in a sub cohort restricted to 504,431 individuals with non-Swedish background. During a total follow-up of 15.2 million person-years, 87,089 individuals suffered a hip fracture within 5 years. In the final prediction model, 19 variables were associated with a population attributable fraction of 93.9% (95% CI, 93.7-94.1) in women and 92.7% (95% CI, 92.2-93.0) in men. The strongest predictor, besides old age, was the use of homemaker service, with a 5-year risk of hip fracture of 7.8% in women and 4.7% in men. The diagnoses most strongly predicting the 5-year risk of hip fracture was Parkinson's disease (6.8% in women, 4.6% in men) and dementia (6.1% in women, 3.6% in men). Validation of the prediction model suggested that the optimal threshold for treatment with bone-specific agents was an estimated 5-year hip fracture risk of 3%. Assuming a threshold of 3% and a 30% relative risk reduction from bone-specific treatment, the number needed to treat to prevent one hip fracture was estimated to 36 in women and 52 in men. Similar results were obtained in the sub cohort with non-Swedish background. A clinical prediction model developed and validated in the total Swedish population could predict the risk of hip fractures with high precision even in absence of data on bone density. The model was associated with a population attributable fraction for hip fracture of more than 90%, and the strongest predictor besides old age was the use of homemaker service, which likely reflect frailty. Based on the model, individuals with an estimated 5-year risk of hip fracture of at least 3% could be considered for bone-specific treatment. None.

Effect of increased systemic oxygen delivery on postoperative outcomes and quality of life in elderly undergoing major abdominal surgery: A randomised controlled trial.

Studies comparing the intentional increase in oxygen delivery and normal oxygen delivery during general anaesthesia in elderly patients undergoing major abdominal surgery are limited and have reported contradictory findings. Therefore, the study aimed to evaluate the effect of intraoperative increase in systemic oxygen delivery on postoperative outcomes and quality of life in elderly patients undergoing major abdominal surgery. This randomised, blinded, parallel-arm, pragmatic clinical trial included elderly patients of >60 years of age undergoing major abdominal surgery. The patients in the intervention arm received noradrenaline or increased fractional inspiration of oxygen to augment central venous oxygen saturation ⩾75%. The primary outcome measure was composite of in-hospital mortality and major organ complications. The secondary outcome measure included comparison of quality of life. A total of 160 patients were assessed for eligibility, and 146 were randomised in the study groups. The mean arterial and central venous oxygen saturation increased and were significantly higher in the intervention arm. The composite primary outcome occurred in 49.31% in the intervention arm and 57.53% in the usual care arm (relative risk; 95% confidence interval: 0.85; 0.63-1.16; absolute risk reduction; 8.22%; p = 0.32). Furthermore, quality of life at the end of three months was similar (0.658 ± 0.19 versus 0.647 ± 0.19; p = 0.771). In conclusion, central venous oxygen saturation-guided increase in systemic oxygen delivery during the intraoperative period of major abdominal surgery in elderly patients did not reduce predefined composite outcome of in-hospital mortality or organ-specific complications.

Implants versus autologous tissue flaps for breast reconstruction following mastectomy.

Women who have a mastectomy for breast cancer treatment or risk reduction may be offered different options for breast reconstruction, including use of implants or the woman's own tissue (autologous tissue flaps). The choice of technique depends on factors such as the woman's preferences, breast characteristics, preoperative imaging, comorbidities, smoking habits, prior chest or breast irradiation, and planned adjuvant therapies. To assess the effects of implants versus autologous tissue flaps for postmastectomy breast reconstruction on women's quality of life, satisfaction, and short- and long-term surgical complications. We searched the Cochrane Breast Cancer Group's Specialised Register, CENTRAL, MEDLINE, Embase, and two trials registries in July 2022. We included studies that compared implant-based reconstruction with autologous tissue-based reconstruction following mastectomy for breast cancer treatment or risk reduction. The minimum eligible sample size was 100 participants. Two review authors independently assessed risk of bias and extracted data using standard Cochrane procedures. We used GRADE to assess the certainty of the evidence. Thirty-five non-randomised studies with 57,555 participants met our inclusion criteria. There were nine prospective cohort studies and 26 retrospective cohort studies. We judged 26 studies at serious overall risk of bias and the remaining studies at moderate overall risk of bias. Some studies measured quality of life and satisfaction using the BREAST-Q (scale of 0 to 100, higher is better). Implants may reduce postoperative psychosocial well-being compared with autologous tissue flaps (mean difference (MD) -4.26 points, 95% confidence interval (CI) -4.91 to -3.61; I² = 0%; 6 studies, 3335 participants; low-certainty evidence). Implants may reduce or have little to no effect on postoperative physical well-being compared with autologous tissue flaps, but the evidence is very uncertain (MD -1.92 points, 95% CI -4.44 to 0.60; I² = 87%; 6 studies, 3335 participants; very low-certainty evidence). Implants may reduce postoperative sexual well-being compared with autologous reconstruction (MD -6.63 points, 95% CI -7.55 to -5.72; I² = 0; 6 studies, 3335 participants; low-certainty evidence). Women who undergo breast reconstruction with implants versus autologous tissue flaps may be less satisfied with the breast, but the evidence is very uncertain (MD -8.17 points, 95% CI -11.41 to -4.92; I² = 90%; 6 studies, 3335 participants; very low-certainty evidence). This outcome refers to a woman's satisfaction with breast size, bra fit, appearance in the mirror (clothed or unclothed), and how the breast feels to touch. Women who undergo breast reconstruction with implants versus autologous tissue flaps may be less satisfied with the reconstruction (MD -5.96 points, 95% CI -10.24 to -1.68; I² = 62%; 4 studies, 1196 participants; low-certainty evidence). This outcome refers to whether the aesthetic outcome has met the woman's expectations, the impact surgery has had on her life, and whether she thinks she made the right decision to have the reconstruction. Implants may reduce or have little to no effect on the risk of short-term complications compared with autologous tissue flaps, but the evidence is very uncertain (risk ratio (RR) 0.80, 95% CI 0.63 to 1.03; I² = 91%; 22 studies, 34,244 participants; very low-certainty evidence). Implants may increase long-term complications compared with autologous tissue flaps, but the evidence is very uncertain (RR 1.56, 95% CI 1.09 to 2.22; I² = 94%; 17 studies, 26,930 participants; very low-certainty evidence). Implants may have little to no effect on the need for reintervention compared with autologous tissue flaps, but the evidence is very uncertain (RR 1.23, 95% CI 0.91 to 1.68; I² = 93%; 15 studies, 14,171 participants; very low-certainty evidence). Implants may reduce the duration of surgery compared with autologous tissue flaps, but the evidence is very uncertain (MD -125.04 minutes, 95% CI -131.41 to -118.67; I² = 0; 2 studies, 836 participants; very low-certainty evidence). The findings of this review show that autologous tissue-based reconstruction compared with implant-based reconstruction may improve participant-reported outcomes such as psychosocial well-being, sexual well-being, and satisfaction with the reconstruction. There is also very uncertain evidence to suggest that autologous tissue-based reconstruction increases satisfaction with the breast and reduces the risk of long-term complications compared with implants. Implant-based reconstruction may be a shorter procedure, but the evidence is very uncertain. Despite the growing demand for breast reconstruction, the best technique has not been adequately studied in randomised controlled trials (RCTs), and the evidence provided by non-randomised studies is often unsatisfactory. There is no superior breast reconstruction technique for all women. Future research should focus on the definition of decisional drivers to guide an evidence-based shared decision-making process in reconstructive breast surgery.

Long-Term Benefits and Safety of Statins in Patients with Kidney Failure: A Target Trial Emulation Study.

Patients with kidney failure are at elevated risk of cardiovascular diseases. Although statins were commonly used to mitigate cardiovascular disease risk among the population with high risk, the evidence for initiating statin therapy among patients with kidney failure remains inconclusive. This study aimed to investigate the long-term benefits and risks associated with statin therapy in patients with kidney failure. Using territory-wide public electronic health records in Hong Kong, 3,019 statin-eligible individuals with kidney failure and elevated LDL cholesterol ≥ 100 mg/dL from Jan 2008 to Dec 2015 were included for analysis. The framework of target trial emulation was adopted to investigate the risk of the major cardiovascular diseases (i.e., a composite of myocardial infarction, heart failure and stroke), all-cause mortality, as well as the major adverse events (i.e., myopathies and liver dysfunction) between statin initiators and statin non-initiators. The pooled logistic model was used to obtain the hazard ratio (HRs) for the outcomes of interest in both intention-to-treat (ITT) analysis and per-protocol (PP) analysis. Significant risk reduction associated with statin therapy (HR [95%CI]) was observed for major cardiovascular diseases (ITT: 0.78 [0.62, 0.98]; PP: 0.66 [0.50, 0.87]) and all-cause mortality (ITT: 0.80 [0.68, 0.95]; PP: 0.60 [0.48, 0.76]). The standardised 5-year and 10-year absolute risk reduction in per-protocol analysis was 7% (3%, 11%) and 11% (4%, 18%), respectively. No significant risks for the major adverse events were observed. Statin therapy was associated with lower risks of cardiovascular diseases and all-cause mortality in patients with kidney failure without a higher risk of major adverse events.

Adopting Government Cyber Security Initiatives - A study of SMEs in Saudi Arabia

The study, which targeted SMEs, aims to determine the risks to cybersecurity in these institutions and implement countermeasures to reduce these risks, such as regulatory, material and technical measures. The study relied on the method of applied research, through a comprehensive questionnaire consisting of several departments targeting more than 60 institutions. For the purpose of data analysis, we used the Information Security Governance (ISG) assessment tool to measure the extent of conformity of implementation and actual documentation the requirements of the standard specification for SMEs in Saudi Arabia. The study reached several results, the most important of which is that cybersecurity in SMEs is exposed to many risks and threats, and that there is a weakness in legislation and laws that protect cybersecurity and the lack of written policies of most institutions participating in the questionnaire confirms the extent of this weakness. We have seen that the role of the national cybersecurity authority in the Kingdom of Saudi Arabia is good but needs to make more practical efforts to enhance cybersecurity inside and outside institutions. At the end of the study, we presented a framework that contains the most prominent international standards for building safe cyber institutions, which include standards for risk management, risk reduction and response, work environment security, access control, communication security, physical security, external relations, and employee awareness training.

Cardiovascular effects of obstructive sleep apnoea and effects of continuous positive airway pressure therapy: evidence from different study models

INTRODUCTIONCardiovascular consequences of obstructive sleep apnoea (OSA) and the effects of continuous positive airway pressure (CPAP) therapy on blood pressure, endothelial dysfunction, and MACE (major adverse cardiovascular events) have been studied over decades using different study designs. However, clinical findings from different study models on cardiovascular outcomes are sometimes contradictory.METHODSA literature search was conducted in PubMed for randomised controlled trials, meta-analyses, population-based epidemiological studies and OSA cohort studies up to September 2023 investigating the cardiovascular effect of OSA and CPAP in adults with OSA on the following cardiovascular endpoints: blood pressure, arterial hypertension, endothelial function, and MACE (myocardial infarction, stroke, transient ischemic attack, cardiovascular death). The level of evidence for these outcomes was discussed on the basis of different study models.RESULTS AND CONCLUSIONSThere is high-level evidence of a causal relationship between OSA and arterial hypertension and endothelial dysfunction, as well as on higher MACE incidence among subgroups of patients with untreated OSA. The cardiovascular effects of OSA depend on the severity of OSA, symptoms, phenotype, and comorbidities. The blood pressure-lowering effect of CPAP is mainly observed in uncontrolled and treatment-resistant hypertension. The MACE risk reduction in OSA depends on good long-term CPAP adherence. Younger, sleepy patients with more severe OSA, higher hypoxaemic burden and without overt cardiovascular end-organ disease may particularly benefit from CPAP treatment in terms of cardiovascular risk reduction. Randomised controlled trials of CPAP or other effective OSA treatments in primary cardiovascular prevention and in patients at highest risk are lacking.

The influence of daily imaging and target margin reduction on secondary cancer risk in image-guided and adaptive proton therapy.

Image-guided and adaptive proton therapy rely on daily CBCT or CT imaging, which increases radiation dose and radiation-induced cancer risk. Online adaptation however also reduces setup uncertainty, and the additional risk might be compensated by reducing the setup robustness margin. 
This work developed a framework to investigate how much this robustness margin should be reduced to offset the secondary cancer risk from additional imaging dose and applied it to proton therapy for head-and-neck cancer. 

Approach:For five patients with head-and-neck cancer, voxel-wise CT and CBCT imaging doses were estimated with Monte Carlo radiation transport simulations, calibrated with air and PMMA phantom measurements. The total dose of several image-guided and adaptive treatments protocols was calculated by summing the planning CT dose, daily and weekly CBCT or CT dose, and therapy dose, robustly optimized with setup margins between 0 and 4 mm. These were compared to a reference protocol with 4 mm setup margin without daily imaging. All plans further used 3% range robustness. Organ-wise excess absolute risk (EAR) of cancer was calculated with three models to determine at which setup margin the total EAR of image-guided and adaptive treatment protocols was equal to the total EAR of the reference.

Results:The difference between the simulated and measured CT and CBCT doses was within 10%. Using the Monte Carlo models, we found that a 1 mm setup margin reduction was sufficient for most patients, treatment protocols, and cancer risk models to compensate the additional risk \imposed by daily and weekly imaging. For some protocols, even a smaller reduction sufficed, depending on the imaging frequency and type. The risk reduction by reducing the margin was mainly due to reducing the risk for carcinomas in the brain and, for some patients, the oral cavity.

Significance: Our framework allows to compare an increased imaging dose with the reduced treatment dose from margin reductions in terms of radiation-induced cancer risk. It is extendable to different treatment sites, modalities, and imaging protocols, in clinic-specific or even patient-specific assessments.

Reduction in 3-Year Risk of Death or Lung Transplantation for Individuals with Advanced CF Lung Disease Treated with Elexacaftor/Tezacaftor/Ivacaftor.

Reduction in 3-Year Risk of Death or Lung Transplantation for Individuals with Advanced CF Lung Disease Treated with Elexacaftor/Tezacaftor/Ivacaftor.

Construction and Validation of a Prognostic Prediction Model for Gastric Mucinous Adenocarcinoma Based on the SEER Database

This study focused on the development and validation of a prognostic model to predict overall survival (OS) in patients with gastric mucinous adenocarcinoma (GMA), utilizing data from the SEER database. A cohort of 537 GMA patients was analyzed to identify factors affecting survival, using both univariate and multivariate Cox regression analyses on demographic and clinicopathological variables. The analysis led to the creation of a nomogram model. Findings revealed that TNM staging and the administration of radiotherapy or chemotherapy were significant factors impacting survival outcomes. Specifically, patients at stages T4, N3, and M1 faced a notably higher mortality risk, while those who received radiotherapy and chemotherapy experienced a significant reduction in mortality risk. The model's performance, as indicated by C-indices of 0.73 in the training set and 0.66 in the validation set, suggests robust predictive capability. The area under the curve (AUC) analysis confirmed high accuracy in predicting 1-year, 3-year, and 5-year survival rates, and calibration curves displayed strong agreement between predicted and actual outcomes. Decision curve analysis (DCA) demonstrated that the model exhibited significant clinical utility across various thresholds. Overall, this study presents a reliable prognostic tool for individualized risk stratification and clinical treatment in GMA patients. Future work should focus on enhancing the model by incorporating molecular biological data to increase its predictive accuracy and applicability.

Cardiovascular disease - risk assessment and reduction: NICE 2023 update for GPs.

Cardiovascular disease - risk assessment and reduction: NICE 2023 update for GPs.

Neuroprotective effects of GLP-1 receptor agonists in neurodegenerative Disorders: A Large-Scale Propensity-Matched cohort study

BackgroundGLP-1 receptor agonists, traditionally used for treating type 2 diabetes mellitus and obesity, have demonstrated anti-inflammatory properties. However, their potential neuroprotective effects in neurodegenerative disorders remain unclear. ObjectiveTo evaluate the impact of GLP-1 receptor agonists on the risk of developing various neurodegenerative conditions in obese patients. MethodsThis comprehensive retrospective cohort study analyzed data from 5,307,845 obese adult patients across 73 healthcare organizations in 17 countries. Propensity score matching was performed, resulting in 102,935 patients in each cohort. We compared the risk of developing neurodegenerative disorders between obese patients receiving GLP-1 receptor agonist therapy and those who were not. ResultsObese patients treated with GLP-1 receptor agonists showed significantly lower risks of developing Alzheimer’s disease (RR = 0.627, 95 %CI = 0.481–0.817), Lewy body dementia (RR = 0.590, 95 %CI = 0.462–0.753), and vascular dementia (RR = 0.438, 95 %CI = 0.327–0.588). The risk reduction for Parkinson’s disease was not statistically significant overall (RR = 0.784, 95 %CI = 0.580–1.058) but was significant for semaglutide users (RR = 0.574, 95 %CI = 0.369–0.893). Semaglutide consistently showed the most pronounced protective effects across all disorders. Additionally, a significant reduction in all-cause mortality was observed (HR = 0.525, 95 %CI = 0.493–0.558). ConclusionThis study provides evidence that the effects of GLP-1 receptor agonists may extend beyond their known metabolic and cardioprotective benefits to include neuroprotection, associated with a decreased risk of developing various neurodegenerative disorders. These findings suggest the potential for expanding the therapeutic applications of GLP-1 receptor agonists to improve neurocognitive outcomes. Further research is warranted to elucidate the mechanisms underlying these neuroprotective effects and to explore their clinical applications in neurodegenerative disease prevention and treatment.

Diet changes and colorectal cancer risk in the UK Biobank.

Modifying dietary behaviors into healthier habits may attenuate the risk of colorectal cancer (CRC) risk. This study aimed to investigate the association between dietary changes and the risk of CRC. Following dietary recommendations for red and processed meat, fruit and vegetables, and alcohol consumption, we classified 50,640 participants into poor and good adherence groups in the UK Biobank. Changes in dietary habits were defined as stable poor, poor to good, good to poor, and stable to good adherence. A Cox proportional hazard model was used to examine the association between dietary changes and CRC risk. Women were more likely to follow dietary recommendations than men. After a median of 3.3 years from the latest follow-up, 8,328 (16.4%) participants followed an improved dietary habit and 5,808 (11.5%) participants had a worsened diet. Compared to men who stably consumed fruit and vegetables <5 servings/day, those who increased their consumption to ≥5 servings/day were related to CRC risk reduction (hazard ratio: 0.24, [0.09-0.63]). However, the beneficial associations of increased fruit and vegetable consumption were not statistically significant in women (hazard ratio: 0.41, [0.11-1.56]). Our findings support the evidence that increasing fruit and vegetable intake could serve as a beneficial strategy to mitigate CRC risk in men. Participants from the UK Biobank significantly changes their adherence to dietary recommendations during the follow-up. Increasing fruit and vegetable consumption was inversely associated with CRC risk among men.

Exposure to sugar rationing in the first 1000 days of life protected against chronic disease.

We examined the impact of sugar exposure within 1000 days since conception on diabetes and hypertension, leveraging quasi-experimental variation from the end of the United Kingdom's sugar rationing in September 1953. Rationing restricted sugar intake to levels within current dietary guidelines, yet consumption nearly doubled immediately post-rationing. Using an event study design with UK Biobank data comparing adults conceived just before or after rationing ended, we found that early-life rationing reduced diabetes and hypertension risk by about 35% and 20%, respectively, and delayed disease onset by 4 and 2 years. Protection was evident with in-utero exposure and increased with postnatal sugar restriction, especially after six months when solid foods likely began. In-utero sugar rationing alone accounted for about one third of the risk reduction.

Time in target range for systolic blood pressure and glucose with cardiovascular disease and all-cause mortality risks.

Evidence on the combined effect of time in the target range (TTR) for systolic blood pressure (SBP) and fasting blood glucose (FBG) in real-world settings was scarce. We aimed to evaluate the separate and combined effects of SBP TTR and FBG TTR on cardiovascular disease (CVD) and all-cause mortality risks among participants with comorbidity of hypertension and diabetes. The data was derived from the Kailuan study. The target ranges for SBP and FBG were set as 110-140 mmHg and 3.9-7.0 mmol/L, and linear interpolation to calculate TTR. Cox proportional hazard regression models were used to estimate the separate and combined effects of SBP TTR and FBG TTR on CVD and all-cause mortality risks. We included 11,899 participants with hypertension and diabetes comorbidity whose mean age was 54.52 ± 10.36 years, and 9,873 (83.00%) were male. After a follow-up of 6.67 years, 1,381 cases of CVD and 2,148 cases of all-cause mortality were documented. In the fully adjusted model, compared with the participants with both SBP TTR and FBG TTR lower than 25%, participants with both greater SBP TTR and FBG TTR had the lowest risks of CVD (HR: 0.53; 95%CI: 0.57-0.78) and mortality (HR: 0.59; 95%CI: 0.47-0.74). Per 1 SD increase in SBP TTR was associated with a 14% reduction in CVD risk (HR, 0.86; 95% CI, 0.80-0.92) and a 10% reduction in mortality risk (HR, 0.90; 95% CI, 0.85-0.95), all significant results were maintained in the FBG TTR analyses. Both higher SBP TTR and FBG TTR were associated with lower risks of CVD and all-cause mortality in participants with comorbidity of hypertension and diabetes. Simultaneous control of SBP and FBG within the target ranges is a beneficial strategy for CVD prevention.

PCSK9 Inhibitors: The Evolving Future.

PCSK9 inhibitors are a novel class of medications that lower LDL cholesterol (LDL-C) by increasing LDL receptor activity, promoting clearance of LDL-C from the bloodstream. Over the years, PCSK9 inhibitors have been explored as adjunct therapies to statins or as monotherapy in high-risk cardiovascular patients. This review aims to provide an updated perspective on PCSK9 inhibitors, assessing their clinical efficacy, safety, and significance, especially in light of recent clinical trials. The review examines the role of PCSK9 in cholesterol regulation and summarizes the results of major cardiovascular trials, including FOURIER, SPIRE-1, SPIRE-2, and ODYSSEY Outcomes. It also discusses emerging treatments like small interfering RNA (siRNA) therapies and evaluates PCSK9 inhibitor effects on LDL-C and lipoprotein(a) levels. Clinical trials have shown PCSK9 inhibitors reduce LDL-C by up to 60%. In the FOURIER trial, evolocumab reduced LDL-C by 59% and major cardiovascular events by 15%-20%. The SPIRE-2 trial, despite early termination, showed a 21% risk reduction in the primary composite endpoint with bococizumab. The ODYSSEY Outcomes trial reported a 57% LDL-C reduction with alirocumab, alongside a 15% reduction in adverse events. Emerging treatments like Inclisiran offer long-term LDL-C control with fewer doses. PCSK9 inhibitors are generally well-tolerated, with the most common side effect being injection site reactions. PCSK9 inhibitors significantly lower LDL-C and reduce cardiovascular events, offering promising therapies for high-risk patients, including those with familial hypercholesterolemia (FH) and those who cannot tolerate statins. Future research will focus on optimizing these inhibitors, integrating complementary therapies, and exploring gene-editing technologies to improve patient outcomes.

Evaluation of a Question Prompt List About Cardiovascular Disease Risk and Prevention After Hypertensive Pregnancy: A Pilot Study.

The aim of this study was to pilot test a question prompt list (QPL) about cardiovascular disease (CVD) risk reduction after hypertensive pregnancy (HDP). In a prospective cohort study of adult women who had HDP given the QPL before and surveyed after a physician visit, we assessed perceived person-centred care, self-efficacy for self-management, perceived self-management and QPL feasibility. Twenty-three women participated: 57% of diverse ethno-cultural groups, 65% < 40 years of age and 48% immigrants. Most scored high for person-centred care (mean 4.1 ± 0.2/5); and moderately for self-efficacy (mean 7.4 ± 0.6/10) and self-management (mean 3.1 ± 0.3/5). Most appreciated QPL design and reported QPL benefits: helped them to prepare for the visit and know what to ask; increased confidence to ask questions, knowledge of the link between HDP and CVD and lifestyle behaviours to reduce CVD risk. Most reported that physicians were receptive to discussing QPL questions. Women appreciated the QPL and knowledge about self-management was high but self-efficacy for or perceived self-management was moderate. It appears feasible to share a QPL with ethno-culturally diverse women who can share it with physicians to facilitate discussions about post-pregnancy HDP-related CVD risk. This study involved women who experienced HDP and engaged ethno-culturally diverse women with lived experience of HDP as study advisors in all stages of the research.

Physical climate change risk and ESG green premium

ABSTRACT We build an asset pricing model that incorporates climate change risk and firms’ ESG engagement to analyse their interactive effects on equity returns. Our model shows that a firm’s ESG engagement has three channels for influencing stock returns: its direct impact on resisting climate change risk, indirect reduction in systematic risk and attraction of green preference, and the empirical evidence shows that both risk–return relation and ESG engagement are priced. We also point out an inevitably negative and convex relation between the market Sharp Ratio and stocks market beta in an economy with climate change risk.