Medical Bulletin 02/ January/ 2025

Here are the top medical news for the day:

Some Components of HDL May Be Associated with Increased Prevalence of Cardiovascular Disease

A new study has shown that certain components of so-called "good" cholesterol -- high-density lipoproteins (HDL) -- may be associated with an increased prevalence of cardiovascular disease. The findings are published in Journal of Lipid Research.

In pre-clinical studies, the research team discovered that HDL with a high content of free cholesterol is likely dysfunctional. To validate their findings and prove their hypothesis, they are currently at the halfway point of the Houston Heart Study in which they will be studying 400 patients with a range of plasma HDL concentrations.

"The most surprising finding from our study thus far is that there is a strong link between the amount of free cholesterol in HDL and how much of it accumulates in white blood cells called macrophages, which can contribute to heart disease," Henry J. Pownall, Ph.D., professor of biochemistry in medicine at the Houston Methodist Research Institute said.

Pownall said their data shows that in the context of high plasma HDL concentrations, the reverse is true, wherein free cholesterol transfer from HDL to the white blood cells in blood and tissues could actually raise one's risk for cardiovascular disease.

The researchers say once they reach their immediate goal of showing that excess free cholesterol in HDL is associated with excess cardiovascular disease, they plan to develop new diagnostics and treatments for managing heart disease, as well as use HDL-free cholesterol as a biomarker to identify patients requiring HDL-lowering therapies.

Reference: https://www.houstonmethodist.org/newsroom/houston-methodist-scientists-make-surprising-discovery-pinpointing-when-good-cholesterol-becomes/

Study Finds Price of One Cigarette: 20 minutes of Life

A recent study has revealed that smoking a single cigarette can cut an average of 17 minutes off a man's life and 22 minutes off a woman’s. This updated estimate nearly doubles the widely-cited figure of 11 minutes from a 2000 BMJ study. The findings are published in the journal addiction.

Researchers at University College London (UCL) analysed data from the British Doctors Study and the Million Women Study, which tracked smoking habits and health outcomes across decades. They determined that smokers who do not quit lose approximately 10 to 11 years of life expectancy compared to non-smokers.

The study also explored the cumulative impact of quitting. A smoker who consumes 10 cigarettes daily could prevent losing a full day of life by quitting for just one week and gain back a month of life by abstaining for eight months. By the end of the year, such a smoker could have avoided losing 50 days of life.

The harm caused by smoking is not limited to the later years of life.

The researchers said that complete cessation is the only way to maximise health benefits, with partial reductions offering minimal gains.

Reference: Jackson, S.E., Jarvis, M.J. and West, R. (2024), The price of a cigarette: 20 minutes of life?. Addiction. https://doi.org/10.1111/add.16757

Clinical Trial Shows Behavioral Intervention Helps Alleviate Pain’s Impact on Daily Life

Among people with dialysis-dependent kidney failure, a form of psychological therapy called pain coping skills training reduced how much pain got in the way of their daily lives, also known as pain interference. The clinical trial found that training people on how to manage pain reduced the extent to which pain affected their work and social activities, mood, and relationships.

The multi-center trial enrolled 643 adults being treated with maintenance dialysis for end-stage kidney disease and experiencing chronic pain. About half of participants were assigned to the pain coping skills training intervention, while the other half received usual clinical care with no trial-based intervention. The pain coping skills training comprised 12 weeks of virtual, one-on-one, coach-led sessions to teach coping skills for chronic pain, enhance self-efficacy, and reduce pain-related sleep difficulties, anxiety, and stress. The intervention included instruction, modeling of skills, guided practice, and experiential training. The coach-led sessions were followed by 12 weeks of automated interactive voice response sessions to refresh the newly acquired skills.

At 12 weeks, 51% of people in the pain coping skills training group reported a reduction in pain interference vs. 37% in the usual care group, and the benefit continued throughout the 24-week intervention period. The difference between the two groups diminished at week 36, 12 weeks after the intervention ended. Researchers believe people receiving pain coping skills training may need continued reinforcement to see additional or long-term benefit.

The study results indicate that pain coping skills training may be an appealing alternative or complement to pain medications.

Reference: Dember LM, Hsu JY, Mehrotra R, et al. Pain Coping Skills Training for Patients Receiving Hemodialysis: The HOPE Consortium Randomized Clinical Trial. JAMA Intern Med. Published online December 30, 2024. doi:10.1001/jamainternmed.2024.7140