doctor’s meeting

2023-08-31 02:58:38

Studies have shown that statin, a representative treatment for dyslipidemia, reduces the risk of ischemic stroke in patients with cerebral hemorrhage.

Recently, as studies that show that statins reduce the risk of stroke are continuously accumulating, there is a possibility that they will be established as a new treatment option.

The results of a study on the association between statin use and the risk of stroke recurrence following intracerebral hemorrhage conducted by researchers including David Geist of the Department of Neurology at Odense University Hospital in Denmark were published in the international journal Neurology on the 30th (doi.org/10.1212/WNL.0000000000207792).

Studies have shown that statins, a treatment for dyslipidemia, reduce the risk of ischemic stroke recurrence.

Statins, which lower LDL-C and triglycerides, which are referred to as bad cholesterol, are administered to prevent major cardiovascular diseases such as coronary artery disease.

Risk factors for stroke include hypertension, diabetes, heart disease, transient ischemia as well as dyslipidemia.

The researchers entered a cohort analysis to determine whether statin treatment of survivors of cerebral hemorrhage (ICH) had an impact on future hemorrhagic and ischemic stroke (IS).

To determine whether the incidence of stroke, IS, or recurrent ICH differs by statin use or not in 15,151 people who were diagnosed with first ICH between January 2003 and December 2021 and survived 30 days or longer enrolled in the Danish Stroke Registry. The average follow-up was 3.3 years.

Of these, 1959 patients with stroke were matched with 7400 controls, 1073 IS patients were matched with 4035 controls, and 984 patients with recurrent ICH were matched with 3755 controls.

When the incidence of all strokes, IS, and recurrent ICH related to statin exposure was calculated using conditional logistic regression analysis, the incidence of all types of stroke in the statin exposure group was 38.6%, which was lower than that of the control group (41.1%) (aOR 0.88).

Subsequently, a risk reduction of regarding 21% was observed with the incidence of IS at 39.8% and the control group at 41.8%, but no risk reduction was observed for recurrent ICH (39.1% vs. 40.8%).

The research team said, “It was confirmed that administering statins to patients who suffered cerebral hemorrhage mainly lowered the risk of IS. concluded.

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#Effects #statins #patients #cerebral #hemorrhage #Ischemic #stroke #recurrence

2023-08-21 03:19:00

To minimize the fracture side effects of corticosteroids, a study has found that focus should be placed on duration rather than dose.

In the case of short and thick one-time use, the risk of fracture increased and the frequency of taking osteoporosis drugs increased compared to those who were consistently prescribed a similar cumulative dose.

The results of a study on the risk of fracture by corticosteroid use and dose, conducted by researchers including Julian Matthewman of the London School of Hygiene and Tropical Medicine, UK, were published in the international journal JAMA on the 9th (doi:10.1001/jamadermatol.2023.2495). ).

As a result of cohort analysis of the London School of Hygiene and Tropical Medicine in the UK, the duration of steroid administration has an effect on the risk of fracture.

Steroids are widely prescribed as effective anti-inflammatory agents in chronic inflammatory diseases. Steroids begin to lose bone within a few weeks of administration, increasing the risk of fracture, so short-term prescription is recommended for eczema, asthma, and COPD, except for rheumatoid arthritis.

It has been known that the cumulative steroid dose is the largest factor in the decrease in bone density and the risk of fracture, but it has not been confirmed whether the total number of days of administration affects the risk.

Focusing on the fact that the elderly are vulnerable to the risk of steroid-induced fractures, the research team focused on cumulative administration of 450 mg of Prednisolone for a short period of time (high-intensity group), and when 5 mg or more daily was administered over a relatively long time or divided into several times (low-intensity group). We analyzed whether there was a change in fracture risk.

A total of 93,869 patients with eczema, asthma, or COPD (UK cohort 65,195, Canada cohort 28,674) aged 66 years or older who took cumulative oral prednisolone ≥ 450 mg within 6 months for fracture prevention according to increased fracture risk Prescription medications and rates of major osteoporotic fractures were compared.

As a result of risk analysis using a Cox proportional hazards regression model, the risk of receiving fracture prevention treatment was up to twice as high in the high-intensity group who received short-term oral corticosteroids once (UK cohort HR 2.34, Canadian cohort 1.49).

However, the rates of major osteoporotic fractures in both the high- and low-intensity groups were similar (UK HR 1.07, Canada 0.87).

“Previous studies have looked at the association between oral corticosteroid prescribing patterns and fracture risk, but no study has investigated the association with cumulative doses,” the researchers said. Compared to the high-intensity group, the risk of receiving fracture prevention treatment was reduced by half.”

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#Strategies #preventing #steroid #fractures #changed #short #thick #wrong

2023-08-17 03:19:49

A study has found that aspirin, which is administered to prevent blood clots following coronary angioplasty (PCI), can be replaced with the anti-inflammatory drug colchicine.

Aspirin increases the risk of bleeding, but colchicine has a relatively low risk, so colchicine can be a useful option for those at high risk of bleeding.

The results of a study on the effect of a combination therapy of colchicine and a P2Y12 inhibitor to prevent thrombotic events in acute coronary syndrome (ACS) patients conducted by Lee Seung-yul and other researchers at the Cardiovascular Center of Korea University Guro Hospital were published in the Journal of the American College of Cardiology (JACC) on the 16th. doi.org/10.1016/j.jcin.2023.05.035).

A study has found that colchicine can be administered instead of aspirin to patients at high risk of post-PCI bleeding.

Dual antiplatelet therapy (DAPT) consisting of aspirin and a P2Y12 inhibitor has become the standard of care for preventing thrombotic events in patients with ACS undergoing PCI.

The problem is that because the risk of bleeding increases in proportion to the dose and administration time of aspirin, other options were needed for those at high risk of bleeding.

Focusing on the fact that P2Y12 inhibitor monotherapy, excluding aspirin following a short period of DAPT therapy, effectively reduces the risk of bleeding, the research team recently received the first approval from the US FDA as an anti-inflammatory agent that lowers the risk of myocardial infarction, stroke, and coronary artery revascularization. A study was undertaken to confirm the possibility of the received colchicine.

200 patients with non-ST-segment elevation ACS and ST-segment elevation myocardial infarction (STEMI) undergoing PCI were given aspirin in combination with a P2Y12 inhibitor (ticagrel or prasugrel).

The day following PCI, aspirin was discontinued and the P2Y12 inhibitor was changed to low-dose colchicine (0.6 mg once a day), and stent-related thrombosis was determined within 3 months.

Then, a high-sensitivity C-reactive protein (hs-CRP) test, which is used to check platelet reactivity and inflammation levels before discharge, was also performed.

A total of 190 patients completed a 3-month follow-up, and stent-related thrombosis occurred in 2 patients (1.0%), but only one patient reported definitive thrombosis because one did not take antiplatelet drugs.

The overall level of platelet reactivity was 27 ± 42 PRU, and most patients (91%) met the criteria for low platelet reactivity, while only one patient had a high platelet reactivity of 208 or higher.

The hs-CRP level decreased from 6.1 mg/L at 24 hours to 0.6 mg/L at 1 month following PCI, and the prevalence of hyperinflammation greater than 2 mg/L decreased from 81.8% to 11.00%.

“This study confirms that in patients with ACS undergoing PCI, low-dose colchicine administered the day following PCI instead of ticagrel or prasugrel P2Y12 inhibitor combined with aspirin is feasible,” said the researchers. “This approach can improve platelet function and inflammation. It has to do with the profile.”

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#Colchicine #aspirin #postPCI #bleeding #risk #group

2023-08-07 20:30:00

Despite the report that the corona vaccine is relatively safe, it appears that the actual rheumatism patients have a greater adverse effect than the flu vaccine.

This is because the adverse reaction rate and disease activation rate, that is, the risk of rheumatoid disease recurrence, were more than 10 times higher than when receiving influenza vaccine.

A study comparing the adverse reactions between the corona vaccine and the influenza vaccine came out.

On the 14th, the Journal of Korean Medical Science, an international academic journal of the Korean Medical Association, will publish the results of a comparative analysis of the effects of corona vaccine and influenza vaccine on rheumatoid patients.

Despite the current endemic trend, as the number of corona patients continues to increase, the demand for corona vaccines, including diagnostic kits, is gradually increasing.

During the corona pandemic, it was recommended that patients with autoimmune diseases, such as rheumatism patients, benefit from vaccination, but the reality is that there is insufficient evidence on the actual impact on these patients.

In particular, as the corona vaccine is approved and administered at an unprecedentedly fast speed, doubts regarding safety still continue.

This is also the background that the research team led by Professor Kim Hyun-ah of Ajou University Medical School conducted a study on rheumatism patients who actually received the corona vaccine in Korea.

It is to compare the impact of the corona vaccine on patients compared to the influenza vaccine, which many patients are already receiving, to identify the risks.

Accordingly, the research team compared and analyzed the difference in clinical prognosis when vaccinated with the influenza vaccine for 601 rheumatism patients who were vaccinated with the corona vaccine.

Comparative analysis of corona vaccine and influenza vaccine adverse reactions

As a result of the analysis, 42.4% of 601 patients completed the first vaccination and 56.9% received additional vaccination.

The first vaccination was 61.4% with the Pfizer vaccine, and additional vaccinations were also confirmed at 83.3%, Pfizer and Modena at 16.4%.

When comparing the adverse reactions following vaccination, it was found that 52.2% of the rheumatism patients who received the corona vaccine had an adverse reaction. This is quite high compared to only 5.8% following receiving the influenza vaccine.

In terms of adverse reaction rates, muscle pain was the most common at 27.5%, followed by sudden fatigue at 20.8%, headache at 18.1%, and fever at 17.5%. However, there was no significant difference among vaccine manufacturers.

In addition, most of the patients passed without problems regarding adverse reactions following influenza vaccination, but 7.5% of patients visited an outpatient clinic due to adverse reactions to the corona vaccine, and 2.2% were hospitalized in the emergency room.

The rate of disease activation, i.e., the re-activation of well-managed rheumatic diseases, was also much higher with the corona vaccine.

This is because the rate of activation of the disease following receiving the corona vaccine was 16.2%, which was more than 10 times higher than the influenza vaccine (1.4%).

In particular, 80 % of patients were counted as 67.2 % of patients found a medical institution as the disease was activated within 3 days following corona vaccine.

The research team said, “As a result of the study, rheumatism patients who received the corona vaccine had an overwhelmingly higher rate of disease activation, a very important problem, compared to the influenza vaccine.”

“It is meaningful in that it is the first study to compare adverse reactions and disease activation rates between influenza and corona vaccinations,” he said. .

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#Corona #vaccine #dangerous #flu #vaccine #rheumatic #patients