Medical Bulletin 12/October/2023

Overview

Here are the top medical news of the day:

Cardiovascular Kidney Metabolic Syndrome: A Presidential Advisory From the American Heart Association

A deeper understanding of how obesity, diabetes, chronic kidney disease, and cardiovascular disease are interconnected has paved the way for a new concept of Cardiovascular-Kidney-Metabolic Syndrome, according to A Presidential Advisory From the American Heart Association. This syndrome, born from the convergence of metabolic risk factors and chronic kidney disease, is closely tied to higher risks of adverse cardiovascular and kidney outcomes.

While considerable progress has been made in comprehending and managing this syndrome, significant knowledge gaps remain. These gaps include the mechanisms behind disease development, the diverse clinical characteristics of affected individuals, the intricate interplay between social factors and biological risks, and accurate assessments of disease occurrence amid various competing risks.

Moreover, clinical care for Cardiovascular-Kidney-Metabolic Syndrome faces limitations, especially in areas like early-life prevention, risk factor screening, interdisciplinary care models, effective lifestyle modification and weight loss strategies, targeting emerging therapies for heart and kidney protection, managing patients with both cardiovascular disease and chronic kidney disease, and the impact of systematically addressing social determinants of health.

This scientific statement, through an analysis of major guidelines and a review of existing literature, offers insights into the existing scientific evidence and crucial gaps concerning the understanding, screening, prevention, and management of Cardiovascular-Kidney-Metabolic Syndrome. It highlights the need for further research and more comprehensive approaches to tackle this complex syndrome.

Glaucoma: Alcohol Consumption and Smoking Increase Risk

A comprehensive retrospective cohort study conducted at three tertiary glaucoma centers in the USA has shown that alcohol consumption, particularly in men and individuals of African descent, is associated with an increased risk of developing glaucoma, while the risk of glaucoma development in smokers is influenced by age, with older individuals having a higher risk. This research, based on data from the Diagnostic Innovations in Glaucoma Study (DIGS) and the African Descent and Glaucoma Evaluation Study (ADAGES), sheds new light on the risk factors associated with this eye disease.

The study tracked 825 eyes belonging to 610 patients, all of whom were glaucoma suspects with normal visual fields (VF) at the outset. Over an average follow-up period of nine years, researchers identified patients who developed glaucoma, defined as having three consecutive abnormal VF tests.

One of the most striking findings was the association between alcohol consumption and the risk of developing glaucoma. Patients who consumed alcohol exhibited a 57% higher risk of developing the condition, a correlation that held even more prominently in men. In fact, the risk was nearly double for male alcohol drinkers. For individuals of African descent, the risk of developing glaucoma in alcohol drinkers was 79% higher compared to non-drinkers.

Age was also revealed as a significant modifier in the relationship between smoking and the development of glaucomatous VF defects. The study showed that older patients (aged over 61 years) who smoked had a 73% higher risk of developing glaucoma compared to those who had never smoked, even after adjusting for confounding factors.

Ref: Mahmoudinezhad G, Nishida T, Weinreb RN, et alAssociations of smoking and alcohol consumption with the development of open angle glaucoma: a retrospective cohort studyBMJ Open 2023;13:e072163. doi: 10.1136/bmjopen-2023-072163

Bladder Cancer: New Treatment Approach May Help Patients Avoid Life-Altering Surgery

A combination treatment approach with gemcitabine, cisplatin, and nivolumab in muscle-invasive bladder cancer (MIBC) patients resulted in a clinical complete response (cCR) rate of 43%, enabling bladder preservation without immediate cystectomy. The study published in Nature Medicine revealed a cCR rate of 43%, with 97% positive predictive value for cCR, signaling a potential paradigm shift in the treatment of MIBC.

While cystectomy is a major surgery, until now it has been the best chance for patients with MIBC to be cured of the cancer. MIBC is often located in a deep part of the bladder. It can be difficult to completely remove the cancer without removing the entire bladder.

In addition to these findings, the study shed light on the safety profile of this approach, with common adverse events primarily consisting of manageable side effects such as fatigue, anemia, neutropenia, and nausea. Importantly, the study also explored the role of specific genes and tumor mutational burden in predicting treatment outcomes.

Further analyses delved into peripheral blood mass cytometry and soluble protein analytes, revealing intriguing associations between the immune contexture and clinical outcomes. These findings emphasize the significance of personalized medicine and the potential to revolutionize MIBC treatment strategies, offering patients the opportunity for bladder preservation instead of radical surgery.

Ref: Galsky, M.D., Daneshmand, S., Izadmehr, S. et al. Gemcitabine and cisplatin plus nivolumab as organ-sparing treatment for muscle-invasive bladder cancer: a phase 2 trial. Nat Med (2023). https://doi.org/10.1038/s41591-023-02568-1

Type 2 Diabetes: Over 60% Patients Have Vitamin D Deficiency

A recent study found that 64.2% of patients with type 2 diabetes mellitus (T2DM) suffer from vitamin D deficiency (VDD). Factors such as poor glycaemic control, obesity, and other complications were identified as predictors of VDD in these patients.

T2DM is a multifactorial disease triggered by the interplay of many malfunctioning mechanisms that occur simultaneously. In addition to genetics which predisposes individuals to develop T2DM, many environmental factors such as physical inactivity, abnormal dietary practices and obesity contribute greatly to its development. Moreover, recent evidence suggests the existence of vitamin D deficiency (VDD) contribution to the pathogenesis of T2DM.

The analysis included 54 studies with 38,016 participants. The study, conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, identified several factors, including poor blood sugar control and obesity, as predictors of VDD in these patients.

The research, which spanned various databases and included participants from around the world, revealed a substantial level of heterogeneity in VDD prevalence among T2DM patients. Notably, the highest rates were found in African nations (70.9%), while the lowest rates were observed in Middle East countries (57.1%).

Furthermore, the study highlighted a gender association, with female T2DM patients at higher risk of VDD. Other predictors of VDD in these individuals included conditions such as hypertension, dyslipidemia, albuminuria, nephropathy, and retinopathy.

Ref: Taderegew MM, Woldeamanuel GG, Wondie A, et alVitamin D deficiency and its associated factors among patients with type 2 diabetes mellitus: a systematic review and meta-analysisBMJ Open 2023;13:e075607. doi: 10.1136/bmjopen-2023-075607