Medical Bulletin 10/ August/ 2024

A recent published study journal in the Lancet oncology states that providing radiotherapy after surgery could prevent breast cancer from returning in the same place for up to 10 years. This protective effect is limited after a decade, when the risk of cancer recurrence is similar to that in those who have not received radiotherapy. The findings provide a more complete picture of the long-term benefits of radiotherapy with breast cancer surgery, followed by radiotherapy which remains the standard care for women with early-stage breast cancer. Radiotherapy targets high doses of radiation to the breast to destroy any remaining cancer cells after removal of the tumour.

The Scottish Breast Conservation Trial, led by the University of Edinburgh, looked at 585 women who received treatment for early-stage breast cancer in Scotland – half received radiotherapy and half did not. The average follow-up period for patients was 18 years, with some cases followed for more than three decades.

After 10 years, 16 per cent of those who had radiotherapy had experienced the return of their cancer in the same location, compared with 36 per cent of those who did not have the treatment. Despite a reduction in cancer recurrence, survival rates did not improve with radiotherapy treatment. Average overall survival rates after 30 years were similar for those who received postoperative radiotherapy and those who did not – 19.2 years and 18.7 years, respectively. There were fewer deaths from breast cancer among those who received radiotherapy than those who did not – 37 per cent versus 46 per cent. By contrast, there were more deaths from other cancers in the group who received radiotherapy – 20 per cent versus 11 per cent.

Based on the study findings, it can be concluded that radiotherapy for breast cancer provides substantial and sustained benefits, significantly reducing the risk of recurrence and mortality over a period of at least ten years. These long-term advantages underscore the importance of radiotherapy as a critical component of breast cancer treatment protocols, highlighting its role in improving patient outcomes and survival rates. The study's results support continued use and optimization of radiotherapy techniques to maximise its effectiveness for breast cancer patients.

References: Reanalysis and results after 12 years of follow-up in a randomised clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1995; 333: 1456-1461

A recent published study in the journal BMJ, A new global analysis of the dietary habits of children and adolescents from 185 countries revealed that youth, on average, consumed nearly 23% more sugar-sweetened beverages in 2018 compared to 1990. Overall, intakes were similar in boys and girls, but higher in teens, urban residents, and children of parents with lower levels of education.

The study drew from the Global Dietary Database, a large comprehensive compilation of what people around the world eat or drink, to generate the first global estimates and trends of sugar-sweetened beverage intake in youth. These were defined as soda, juice drinks, energy drinks, sports drinks, and home-sweetened fruit drinks such as aguas frescas with added sugars and containing more than 50 kcal per 1 cup serving.

The research team found that youth were drinking more and had nearly twice the overall intake of adults. Sugar-sweetened beverage intake among young people varied dramatically by region, averaging 3.6 servings per week globally and ranging from 1.3 servings per week in South Asia to 9.1 in Latin America and the Caribbean. The researchers found that children and teens in 56 countries, representing 238 million young people or 10% of the global youth population, averaged 7 or more servings per week.

In recent years, many governments worldwide have been implementing measures such as soda taxes and restrictions on the sale of sugary drinks in schools to promote healthy dietary habits. These efforts are new and also face strong opposing forces such as aggressive industry marketing and the globalisation of the food sector.

It is concluded that the intake of sugar-sweetened beverages (SSBs) is on the rise globally among children and teenagers, posing significant public health concerns. The increasing consumption of SSBs is associated with various adverse health outcomes, including obesity, type 2 diabetes, and dental cavities. The findings emphasise the urgent need for effective public health strategies and policies to reduce SSB consumption in young populations, such as educational campaigns, taxation, and restrictions on marketing targeted at children and adolescents. Addressing this growing trend is crucial for improving the long-term health and well-being of future generations.

References: Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 2006;1:11–25 [PubMed] [Google Scholar]

In a recent study published in the journal JACC Advances, researchers examined the presence of coronary atherosclerosis using coronary computed tomography angiography (CCTA) in asymptomatic adults without traditional risk factors based on their serum levels of low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), and apolipoprotein B (apoB). They found that coronary atherosclerosis is common, and the prevalence increases with increasing levels of atherogenic lipoproteins, even in low-risk adults without traditional risk factors.

Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of mortality worldwide, primarily due to coronary atherosclerosis, which begins early and progresses over time. Elevated LDL-C is a major contributor to ASCVD, and lowering LDL-C levels is essential for prevention. Traditionally, LDL-C levels of ≥160 mg/dL were considered elevated, while levels <100 mg/dL were deemed optimal. However, these thresholds may still be inadequate for preventing atherosclerosis or ASCVD.

Data for the present study included a total of 1,033 participants aged 40–65 years. All participants were free of clinically symptomatic cardiovascular disease and were not undergoing lipid-lowering therapy. A subgroup of 184 participants with optimal risk factors was also identified. Individuals with high-risk conditions such as obesity, high creatinine levels, asthma, cancer, or pregnancy were excluded from the study. The median age of the participants was 51 years. Data on demographics, clinical history, and coronary computed tomography angiography (CCTA) imaging were collected. Coronary atherosclerosis was diagnosed using the Agatson method and classified according to the American Heart Association guidelines.

The study cohort had median serum LDL-C, non-HDL-C, and apoB levels of 125, 144, and 94 mg/dL, respectively. A majority of the participants had a lower predicted 10-year ASCVD risk, with over 86% having <5% risk. Men showed a higher body mass index, atherogenic lipoprotein levels, and ASCVD risk compared to women.

In conclusion, the study suggests that among asymptomatic, apparently healthy, middle-aged adults without traditional ASCVD risk factors, coronary atherosclerosis is common even at serum cholesterol levels considered to be normal. The condition's prevalence increases with higher LDL-C, non-HDL-C, and apoB. Despite this population's relatively infrequent high-risk plaque features, healthcare professionals should consider lowering serum atherogenic lipoproteins through diet, lifestyle changes, or medication to potentially prevent or delay coronary atherosclerosis and improve their health outcomes.

References: Serum Lipoproteins are Associated with Coronary Atherosclerosis in Asymptomatic U.S. Adults Without Traditional Risk Factors. Faridi, K. et al., JACC Advances, 7_Part_1 (2024), DOI:10.1016/j.jacadv.2024.101049,https://www.jacc.org/doi/10.1016/j.jacadv.2024.101049

The study published in the journal Cardiovascular Diabetology States that Having higher than usual blood sugar levels at the time of hospital admission for an ischemic stroke significantly increases the risk of a poor functional prognosis or death within three months of the stroke. This is the main conclusion of a study by the Endocrinology and Nutrition Services and the Neurology Department of Hospital del Mar, with researchers from the hospital's Research Institute, the RICORS-ICTUS network, and the CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM).

Inflammatory states in certain diseases can cause increased blood sugar levels, or hyperglycemia, which can influence prognosis. In ischemic stroke, elevated blood sugar levels are common but have not been thoroughly analysed. The Hospital del Mar study addresses this issue by reviewing data from 2,774 patients with ischemic stroke. The study considers blood sugar levels at the time of admission and compares them with each patient's usual levels. Additionally, variables such as age, diabetes, disability, stroke severity, and treatment received were taken into account.

The study confirmed that elevated blood glucose levels at stroke admission are associated with worse functional outcomes and increased mortality three months post-stroke, independent of other factors. Even a modest 13% increase above usual glucose levels significantly worsens prognosis, regardless of baseline glucose levels. This association was also observed in patients with a history of diabetes, who comprised 35% of the study population.

The study concluded that elevated blood sugar levels at the time of stroke admission are associated with a poorer prognosis. Higher admission glucose levels correlate with increased risk of adverse outcomes, including greater neurological impairment and reduced functional recovery. These findings have highlighted the importance of managing blood sugar levels promptly and effectively in stroke patients to improve overall outcomes and reduce long-term complications. Enhanced glycemic control during the acute phase of stroke may be crucial for optimising patient recovery and minimising disability.

References: Climent, E., et al. (2024). Acute-to-chronic glycemic ratio as an outcome predictor in ischemic stroke in patients with and without diabetes mellitus. Cardiovascular Diabetology. doi.org/10.1186/s12933-024-02260-9.