Tag: pubmed

J Agromedicine. 2026 Aug 30:1-11. doi: 10.1080/1059924X.2026.2725616. Online ahead of print.

ABSTRACT

BACKGROUND: This study analyzed the incidence of skin cancer among rural workers in Brazil, considering the influence of ultraviolet (UV) radiation, skin color, and regional factors.

METHODS: Data from the National Cancer Institute (2008-2022) on skin cancer were used, using historical series of the Ultraviolet Index (UVI) obtained via satellite and cross-referenced with population information obtained from the Brazilian Institute of Geography and Statistics.

RESULTS: Between 2008 and 2022, Brazil recorded 81,378 cases of skin cancer related to rural workers, with an average incidence rate of 318.23 cases per 100,000. The UVI is high in the North and North-East regions of the country, but the highest rate of skin cancer occurs in the South, where 73% of the population is white and the UVI is lower. Correlation and regression analyses revealed that the UVI, the proportion of white people, and the percentage of rural workers significantly influence the skin cancer rate.

CONCLUSIONS: These results show that approximately 28% of a rural worker’s risk of developing skin cancer may be related to the interaction between biological and environmental factors and that prevention and sun protection strategies should take into account demographic and regional variability.

PMID:42669081 | DOI:10.1080/1059924X.2026.2725616

JACC CardioOncol. 2026 Aug 30:S2666-0873(26)00290-5. doi: 10.1016/j.jaccao.2026.08.001. Online ahead of print.

ABSTRACT

BACKGROUND: RADICAL PC-2 (RAndomizeD Intervention for CArdiovascular and Lifestyle Risk Factors in Prostate Cancer Patients) was a pragmatic randomized controlled trial that tested whether routine referral to a cardiologist or an internist for cardiovascular (CV) risk-factor and lifestyle modification improves outcomes in patients with prostate cancer or receiving androgen-deprivation therapy. The intervention group had more favorable outcomes overall, driven by improved cholesterol control, with no differences in rates of CV death, myocardial infarction (MI), stroke, or heart failure (HF).

OBJECTIVES: The authors aim to identify patient subgroups more likely to benefit from routine CV care referral.

METHODS: Prespecified subgroup analyses were used to assess whether patients at higher CV risk derived greater benefit from specialist referral, with treatment-effect heterogeneity assessed using interaction tests. The first primary outcome was a hierarchical composite of CV death, MI, stroke, HF, suboptimal cholesterol, and systolic blood pressure (SBP) control, evaluated using the win ratio. The second primary outcome was time to CV death, MI, stroke, or HF.

RESULTS: Among 2487 participants, treatment effect differed by baseline total cholesterol ≤4 mmol/L vs >4 mmol/L (interaction P = 0.016), with respective win ratios of 1.21 (95% CI: 0.89-1.64) and 1.75 (95% CI: 1.51-2.03), and by baseline BP status (SBP ≥130 mm Hg or diastolic BP ≥80 mm Hg vs BP <130/80 mm Hg; interaction P = 0.003), with respective subdistribution HRs (sHRs) for CV death, MI, stroke, or HF of 0.86 (95% CI: 0.61-1.21) and 4.85 (95% CI: 1.65-14.26). The interaction for diabetes did not reach statistical significance (interaction P = 0.054) although the intervention effect estimates suggested a potential difference by diabetes status, with sHRs of 0.53 (95% CI: 0.24-1.15) among participants with diabetes and 1.25 (95% CI: 0.88-1.78) among participants without diabetes. The win ratio was higher among participants with total cholesterol >4 mmol/L, and sHRs were numerically lower among those with SBP ≥130 mm Hg or diastolic BP ≥80 mm Hg and diabetes.

CONCLUSIONS: Uncontrolled modifiable CV risk factors may identify patients with prostate cancer who are more likely to benefit from routine CV care referral.

PMID:42669076 | DOI:10.1016/j.jaccao.2026.08.001

J Am Coll Cardiol. 2026 Aug 30:S0735-1097(26)07208-6. doi: 10.1016/j.jacc.2026.07.022. Online ahead of print.

ABSTRACT

BACKGROUND: Vutrisiran, an RNA interference therapeutic that suppresses hepatic transthyretin production, improved survival and cardiovascular outcomes in transthyretin amyloidosis with cardiomyopathy (ATTR-CM) in HELIOS-B (A Study to Evaluate Vutrisiran in Patients With Transthyretin Amyloidosis With Cardiomyopathy). Tafamidis, a transthyretin stabilizer, also improves clinical outcomes. Although combining these therapies is mechanistically appealing, clinical evidence supporting this approach is limited.

OBJECTIVES: We sought to evaluate whether the treatment effects of vutrisiran differed according to baseline tafamidis use in HELIOS-B.

METHODS: In HELIOS-B, patients with ATTR-CM were randomized to vutrisiran 25 mg or placebo every 3 months for up to 36 months, with tafamidis use permitted and stratified. We assessed treatment effects according to baseline tafamidis use for the primary outcome of all-cause mortality and recurrent cardiovascular events and secondary endpoints, including individual components of the primary outcome, composite of all-cause mortality, cardiovascular events and outpatient worsening heart failure events, functional capacity (6-minute walk distance), and health status (Kansas City Cardiomyopathy Questionnaire-overall summary score [KCCQ-OSS]).

RESULTS: Among 654 participants, 259 (40%) were receiving tafamidis at baseline. Patients on tafamidis were slightly younger and had higher baseline 6-minute walk distance and higher KCCQ-OSS, while baseline characteristics were generally balanced between randomized groups. The treatment effect estimates of vutrisiran compared with placebo for the primary outcome were directionally consistent across baseline tafamidis strata (rate ratio: 0.79 [95% CI: 0.51-1.21] with tafamidis vs 0.67 [95% CI: 0.49-0.93] without), with no statistically significant interaction (P_interaction = 0.55). Similar patterns were observed for all-cause mortality, cardiovascular events, and outpatient worsening heart failure (all P_interaction > 0.20), although the magnitudes of the estimated effects were numerically smaller among patients receiving tafamidis at baseline. Vutrisiran preserved 6-minute walk distance in both baseline tafamidis strata (P_interaction = 0.24), whereas improvement in KCCQ-OSS appeared attenuated among patients receiving tafamidis at baseline.

CONCLUSIONS: Treatment effect estimates for vutrisiran on clinical outcomes were consistent across baseline tafamidis strata, with no statistically significant interaction according to baseline tafamidis use, with reduced effect size noted in those receiving baseline stabilizers in comparison to monotherapy. These data underscore the need for future prospective studies examining combination therapy in this population. (HELIOS-B: A Study to Evaluate Vutrisiran in Patients With Transthyretin Amyloidosis With Cardiomyopathy; NCT04153149).

PMID:42669070 | DOI:10.1016/j.jacc.2026.07.022

J Am Coll Cardiol. 2026 Aug 5:S0735-1097(26)07209-8. doi: 10.1016/j.jacc.2026.07.023. Online ahead of print.

ABSTRACT

BACKGROUND: Vutrisiran, an RNA interference therapeutic, reduced all-cause mortality and recurrent cardiovascular events in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) in the HELIOS-B trial. Whether concomitant disease-modifying or heart failure therapy modifies the efficacy of vutrisiran has not been described.

OBJECTIVES: We aimed to characterize patterns of concomitant therapy use in HELIOS-B, describe medication initiation rates by treatment arm, and evaluate whether concomitant therapy modified vutrisiran’s treatment effect.

METHODS: In HELIOS-B, 654 randomized patients with ATTR-CM received vutrisiran or placebo. We assessed baseline use and postrandomization initiation of tafamidis, sodium-glucose cotransporter-2 (SGLT2) inhibitors, mineralocorticoid receptor antagonists (MRA), beta-blockers, and renin-angiotensin system inhibitors (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors), and used time-updated Lin-Wei-Yang-Ying models to evaluate treatment effect modification on the primary composite endpoint of all-cause mortality and recurrent cardiovascular events.

RESULTS: At baseline, 40% of participants were receiving tafamidis and 77% at least 1 heart failure medication. MRAs and SGLT2 inhibitors were the most frequently initiated therapies during follow-up, with initiation rates numerically higher across all heart failure medication classes in the placebo group. There was no statistically significant evidence that the treatment effect of vutrisiran was modified by baseline or time-updated use of any medication class (P-interaction: tafamidis 0.95, SGLT2 inhibitors 0.59, MRA 0.92, beta-blockers 0.75, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors 0.82).

CONCLUSIONS: In HELIOS-B, there was no statistically significant evidence that the treatment benefit of vutrisiran on all-cause mortality and recurrent cardiovascular events was modified by concomitant use of tafamidis or heart failure therapies. These findings support the consistency of vutrisiran’s efficacy across the spectrum of contemporary ATTR-CM pharmacotherapy. (HELIOS-B: A Study to Evaluate Vutrisiran in Patients With Transthyretin Amyloidosis With Cardiomyopathy; NCT04153149).

PMID:42669069 | DOI:10.1016/j.jacc.2026.07.023

Biomarkers. 2026 Aug 30:1-13. doi: 10.1080/1354750X.2026.2726961. Online ahead of print.

ABSTRACT

BACKGROUND: C-reactive protein (CRP) is a biomarker of vascular inflammation with prognostic value for future cardiovascular events. This meta-analysis investigates the effect of colchicine, a cheap and widely available anti-inflammatory medication, on CRP levels in the months following myocardial infarction (MI).

METHODS: PubMed, EMBASE, and Cochrane were queried from inception to April 2026 to identify randomized controlled trials comparing colchicine to placebo for at least 1 month following MI. The primary outcome was mean CRP level at follow-up. Effect estimates were pooled with random-effects models and reported as mean differences for continuous variables using 95% confidence intervals.

RESULTS: Four studies met inclusion criteria comprising 3384 patients (mean age 60.7 years; 78.3% male), including 1669 patients randomized to the colchicine arm, and 1715 to placebo. Median follow-up period was 3 months (range: 1-6 months). Colchicine following MI resulted in a statistically significant decrease in mean CRP level (mg/L) at follow-up versus placebo (MD: -0.69; [-1.21, -0.17], p = 0.009). Heterogeneity of effect size estimates was high (I² = 97%).

CONCLUSION: Daily colchicine following MI decreases CRP at a median follow-up period of 3 months compared to placebo. The correlation between CRP reduction with colchicine and adverse cardiovascular event reduction warrants additional study.

PMID:42669068 | DOI:10.1080/1354750X.2026.2726961

Eur Heart J. 2026 Aug 30:ehag740. doi: 10.1093/eurheartj/ehag740. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Randomized trials demonstrated that in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) direct oral anticoagulants (DOAC) and a P2Y12 inhibitor reduce bleeding compared with vitamin K antagonist (VKA) plus dual antiplatelet therapy (DAPT) with no increase in ischemic risk; however, important gaps in knowledge remain, limiting certainty and generalizability of these findings.

METHODS: In this patient-level meta-analysis of randomized trials evaluating antithrombotic strategies in patients with AF undergoing PCI, Cox proportional hazard models, stratified by trial, were used to estimate hazard ratios and 95% confidence intervals (HR, 95%CI). The primary efficacy and safety outcomes were the composite of cardiovascular death, myocardial infarction, or stroke, and TIMI major bleeding, respectively. The study was registered in PROSPERO (CRD420251130025).

RESULTS: Six trials (10,634 patients) comparing DOAC plus P2Y12 inhibitor (4,083), VKA plus single antiplatelet therapy (SAPT, 1,247), VKA plus DAPT (3,715), and DOAC plus DAPT (1,589) were included. The transition from DAPT to SAPT was recommended at 1 (1-3) and 3 (1-7) days in the DOAC plus P2Y12 inhibitor and VKA plus SAPT groups, respectively. At 1 year, the risk of the primary efficacy outcome did not differ across the antithrombotic strategies (reference group: VKA plus DAPT; DOAC plus P2Y12 inhibitor: HR 1.16, 95%CI 0.97-1.41; VKA plus SAPT: 1.14, 0.85-1.54, DOAC plus DAPT: 0.99, 0.75-1.30), without any statistically significant interaction between treatment effects and all prespecified subgroups, including age, sex, bleeding risk, and thrombotic risk. However, 14-day landmark analysis showed an increased risk of myocardial infarction and definite/probable stent thrombosis in patients receiving DOAC plus P2Y12 inhibitor or VKA plus SAPT in the early phase after PCI. DOAC plus P2Y12 inhibitor reduced the risk of the primary safety outcome compared with VKA plus DAPT (0.48, 0.38- 0.65) and VKA plus SAPT (0.62, 0.40-0.97); only a borderline reduction was observed compared to DOAC plus DAPT (0.66, 0.44-1.01). DOAC plus P2Y12 inhibitor reduced intracranial hemorrhage compared with VKA plus DAPT (0.21, 0.07-0.64).

CONCLUSIONS: In patients with AF undergoing PCI, the risk of cardiovascular death, myocardial infarction, or stroke did not significantly differ according to whether patients received a DOAC or VKA, whereas a modest increase in risk with single compared with dual antiplatelet therapy cannot be excluded, given the higher risk of early coronary events. DOACs compared with VKAs reduced the risk of bleeding across all severity grades, including intracranial hemorrhage, whereas omission of a second antiplatelet agent reduced the risk of TIMI major or minor bleeding.

PMID:42669062 | DOI:10.1093/eurheartj/ehag740

Ann Med. 2026 Dec;58(1):2722412. doi: 10.1080/07853890.2026.2722412. Epub 2026 Aug 30.

ABSTRACT

BACKGROUND: Whether a laryngeal mask airway (LMA) can be safely used during liver transplantation remains unclear. However, in clinical practice, the choice of an airway device may also reflect a broader recovery-oriented perioperative strategy rather than an isolated technical substitution.

METHODS: We retrospectively reviewed adult patients who underwent primary elective liver transplantation at our center between January 2024 and November 2025. The patients were grouped according to their primary intraoperative airway device (LMA or endotracheal tube [ETT]). Propensity score matching was used to reduce baseline imbalance. Intraoperative variables, postoperative airway-related events, postoperative pulmonary complications (PPCs), intensive care unit (ICU) stays, and postoperative hospital stays were compared.

RESULTS: After matching, 25 and 44 patients in the LMA and ETT groups, respectively, were analyzed. The LMA group showed a higher rate of immediate airway device removal, lower rocuronium use during anesthetic maintenance, less postoperative noninvasive ventilation, less postoperative sore throat, and a shorter postoperative hospital stay. PPCs were numerically less frequent in the LMA group, but the between-group difference was not statistically significant after matching. No increase in major airway-related adverse events was observed in the LMA group.

CONCLUSIONS: In carefully selected liver transplant recipients, use of LMA within a recovery-oriented perioperative context appeared feasible and was associated with several favorable early postoperative outcomes.

PMID:42669055 | DOI:10.1080/07853890.2026.2722412

Eur Heart J. 2026 Aug 30:ehag729. doi: 10.1093/eurheartj/ehag729. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Hypertension is a common attributable cause of chronic kidney disease (CKD). Mineralocorticoid receptor overactivation can lead to hypertension and contributes to CKD progression. In FIND-CKD, finerenone reduced kidney function decline in participants with CKD without diabetes. This prespecified FIND-CKD analysis assessed finerenone efficacy and safety in participants with hypertensive nephropathy.

METHODS: Adults with estimated glomerular filtration rate (eGFR) 25-&lt;90 mL/min/1.73 m2 and urinary albumin-to-creatinine ratio (UACR) 200-3500 mg/g were randomized 1:1 to once-daily finerenone or placebo. Hypertensive nephropathy was investigator-reported. Total eGFR slope from baseline to Month 32 was assessed, along with a kidney-cardiovascular composite of sustained ≥57% eGFR decline, kidney failure, hospitalization for heart failure, or cardiovascular death.

RESULTS: Of 1584 randomized participants, 459 (29.0%) had hypertensive nephropathy. Mean blood pressure (± SD) was 134/80 ± 14/10 mmHg, mean eGFR was 44 ± 15 mL/min/1.73 m2, median UACR was 797 mg/g (Q1, Q3: 566, 1247). In participants with hypertensive nephropathy, finerenone slowed total eGFR decline versus placebo by 0.65 mL/min/1.73 m2/year (95% CI: 0.02, 1.29; P = .044) and was associated with a reduction in composite kidney-cardiovascular outcome events (HR: 0.61; 95% CI: 0.38, 0.99; P = .045). These effects were consistent irrespective of baseline systolic blood pressure (SBP) (P-interaction: eGFR slope, 0.96; composite outcome, 0.91). Finerenone reduced SBP by -3.5 mmHg and UACR by 33% at Month 6 vs placebo. Hyperkalaemia occurred more frequently with finerenone (17.1%) than placebo (9.8%); related discontinuation was uncommon (1.3% vs 0.0%, respectively).

CONCLUSIONS: Finerenone slowed eGFR decline and reduced kidney-cardiovascular outcome risk in participants with hypertensive nephropathy, supporting its use in this population. ClinicalTrials.gov registration: NCT05047263.

PMID:42669052 | DOI:10.1093/eurheartj/ehag729

Europace. 2026 Aug 4;28(8):euag214. doi: 10.1093/europace/euag214.

ABSTRACT

AIMS: Population-based screening for atrial fibrillation (AF) should be considered in elderly individuals to enable AF detection. However, participation in systematic screening programmes is often suboptimal. STROKESTOP III evaluated whether opportunistic screening could improve participation compared with systematic screening.

METHODS AND RESULTS: STROKESTOP III is a cluster-randomized trial including individuals aged 75-76 years from 16 primary care centres in Region Värmland, Sweden. Centres were randomized to systematic screening, using mailed invitations, or opportunistic screening, using invitations during visits.In the systematic arm, 1312 individuals were eligible and invited, of whom 607 participated (46.3%). In the opportunistic arm, 1390 individuals attended participating primary care centres and were potentially eligible for invitation. However, 641 individuals (46.1%) were not assessed for eligibility. Among the 749 assessed individuals, 609 were eligible and 374 participated.Participation among invited eligible individuals was significantly higher with opportunistic than systematic screening (374/609, 61.4% vs. 607/1,312, 46.3%; P < 0.005). However, overall reach was lower in the opportunistic arm because of incomplete assessment for invitation (374/1,479, 25.3% vs. 607/1,437, 42.2%; P < 0.005). Participants in the opportunistic arm had a higher cardiovascular risk burden, including more hypertension, diabetes, and a higher CHA2DS2-VASc-score (3.99 vs. 3.60; P < 0.005). Exclusion rates were higher (18.7% vs. 8.7%; P < 0.005), mainly due to previously diagnosed AF and cognitive impairment.

CONCLUSION: Opportunistic screening increased participation among invited individuals and identified a higher-risk population, but its overall population reach was limited by incomplete eligibility assessment. Combining opportunistic and systematic strategies may optimize reach and participation in AF screening programmes.

PMID:42669050 | DOI:10.1093/europace/euag214

Pediatr Pulmonol. 2026 Sep;61(9):e71817. doi: 10.1002/ppul.71817.

ABSTRACT

BACKGROUND: Parapneumonic pleural effusion (PPE) is a frequent complication of pediatric pneumonia. Some cases progress to complicated PPE (cPPE), which is associated with greater morbidity, longer treatment, and a higher likelihood of need for pleural drainage. Early identification of children at risk of progression remains difficult at presentation, and pediatric evidence on early predictors is scarce and inconsistent.

METHODS: We conducted a retrospective observational study including children aged <18 years admitted with PPE between 2015 and 2025. cPPE was defined through standard laboratory and/or imaging criteria. Twenty clinical, laboratory, and radiological candidate predictors available at initial evaluation were assessed. After univariate screening, variables with statistical association and clinical relevance were entered into a multivariate logistic regression model. After model assessment, a simplified score was derived from the original model for bedside use.

RESULTS: A total of 122 children were included, 77 (63%) with cPPE and 45 (37%) with uncomplicated PPE. In univariate analyses, younger age, dyspnea, chest wall retractions, reduced lung sounds, C-reactive protein, lower hemoglobin, pleural effusion thickness, and mediastinal shift were associated with cPPE. In the final multivariate model, five variables remained independently associated: age (OR 0.73, 95% CI 0.63-0.84), retractions (OR 3.23, 95% CI 1.16-8.95), C-reactive protein ≥176.5 mg/L (OR 2.83, 95% CI 1.02-7.82), pleural effusion thickness (OR 2.16, 95% CI 1.27-3.70), and mediastinal shift (OR 10.75, 95% CI 2.24-51.64). The model showed good discriminatory performance, with an AUC of 0.883 (95% CI 0.817-0.948). The optimal probability threshold was 0.49, yielding a sensitivity of 92.2% and a specificity of 71.1%. A simplified additive clinical score derived from the model demonstrated similar performance, allowing stratification into four risk groups with progressively increasing observed rates of cPPE.

CONCLUSIONS: Early risk stratification of pediatric PPE is feasible using a small set of readily available clinical, laboratory, and radiological variables. The proposed model and the adapted clinical score showed good discriminatory ability and may help identify children at increased risk of progression to cPPE who could benefit from closer monitoring and early optimized management. External validation is needed before routine clinical implementation.

PMID:42669040 | DOI:10.1002/ppul.71817