Journal of Internal Medicine最新文献

{"title":"Elevated lipoprotein(a) and progression of aortic stenosis measured by Doppler echocardiography: A population-based cohort study.","authors":"Jonas Brinck, Karin Littmann, Daniel Eriksson Hogling, Linnea Widman, Kenneth Caidahl, Maria Eriksson, Jonas Johnson, Karolina Szummer, Magnus Bäck","doi":"10.1111/joim.20095","DOIUrl":"https://doi.org/10.1111/joim.20095","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clonal hematopoiesis of indeterminate potential and risk of immune thrombocytopenia","authors":"Qianwei Liu,&nbsp;Tove Wästerlid,&nbsp;Karin E. Smedby,&nbsp;Huiwen Xue,&nbsp;Erik Boberg,&nbsp;Fang Fang,&nbsp;Xinyuan Liu","doi":"10.1111/joim.20092","DOIUrl":"10.1111/joim.20092","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Clonal hematopoiesis of indeterminate potential (CHIP) might contribute to the pathogenesis of immune thrombocytopenia (ITP) through immune dysfunction or impairment of megakaryopoiesis and platelet formation. However, little is known about subsequent risk of ITP among individuals with CHIP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the risk of ITP among individuals with CHIP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We investigated the association of CHIP with risk of ITP by a prospective cohort study, including 466,064 participants in the UK Biobank, during 2006 to 2022. CHIP was ascertained based on data of whole exome sequencing. Incident ITP was identified in inpatient hospital records and death register. Cox regression models were utilized to estimate risk of ITP associated with CHIP. We also performed subgroup analyses by CHIP mutations (<i>DNMT3A</i>, <i>TET2</i>, <i>ASXL1</i>, <i>SRSF2</i>, and <i>JAK2</i>).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 14,466 and 451,598 individuals with and without CHIP, respectively. We identified 34 and 390 cases of ITP among the CHIP group and the reference group, respectively. CHIP was associated with an increased risk of ITP (hazard ratio [HR] 2.33, 95% confidence interval [CI]: 1.64–3.32). Subgroup analysis revealed that the heightened risk of ITP was greatest in CHIP with <i>JAK2</i> mutation (HR 54.31, 95% CI: 17.39–169.59), followed by CHIP with <i>SRSF2</i> (HR 20.11, 95% CI: 8.27–48.87), <i>TET2</i> (HR 4.00, 95% CI: 2.34–6.83), or <i>DNMT3A</i> (HR 1.95, 95% CI: 1.16–3.27) mutation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CHIP was associated with an increased risk of being diagnosed with ITP, particularly for CHIP with <i>JAK2</i> or <i>SRSF2</i> mutation. These findings call for clinical awareness of the risk of ITP among individuals with CHIP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 6","pages":"672-682"},"PeriodicalIF":9.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolomics in cardiometabolic diseases: Key biomarkers and therapeutic implications for insulin resistance and diabetes","authors":"David Rizo-Roca,&nbsp;John D. Henderson,&nbsp;Juleen R. Zierath","doi":"10.1111/joim.20090","DOIUrl":"10.1111/joim.20090","url":null,"abstract":"<p>Cardiometabolic diseases—including Type 2 diabetes and obesity—remain leading causes of global mortality. Recent advancements in metabolomics have facilitated the identification of metabolites that are integral to the development of insulin resistance, a characteristic feature of cardiometabolic disease. Key metabolites, such as branched-chain amino acids (BCAAs), ceramides, glycine, and glutamine, have emerged as valuable biomarkers for early diagnosis, risk stratification, and potential therapeutic targets. Elevated BCAAs and ceramides are strongly associated with insulin resistance and Type 2 diabetes, whereas glycine exhibits an inverse relationship with insulin resistance, making it a promising therapeutic target. Metabolites involved in energy stress, including ketone bodies, lactate, and nicotinamide adenine dinucleotide (NAD⁺), regulate insulin sensitivity and metabolic health, with ketogenic diets and NAD⁺ precursor supplementation showing potential benefits. Additionally, the novel biomarker <i>N</i>-lactoyl-phenylalanine further underscores the complexity of metabolic regulation and its therapeutic potential. This review underscores the potential of metabolite-based diagnostics and precision medicine, which could enhance efforts in the prevention, diagnosis, and treatment of cardiometabolic diseases, ultimately improving patient outcomes and quality of life.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 6","pages":"584-607"},"PeriodicalIF":9.0,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20090","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gut microbiota development across the lifespan: Disease links and health-promoting interventions","authors":"Ida Schoultz,&nbsp;Marcus J. Claesson,&nbsp;Maria Gloria Dominguez-Bello,&nbsp;Frida Fåk Hållenius,&nbsp;Peter Konturek,&nbsp;Katri Korpela,&nbsp;Martin Frederik Laursen,&nbsp;John Penders,&nbsp;H. Roager,&nbsp;Tommi Vatanen,&nbsp;Lena Öhman,&nbsp;Maria C. Jenmalm","doi":"10.1111/joim.20089","DOIUrl":"10.1111/joim.20089","url":null,"abstract":"<p>The gut microbiota plays a pivotal role in human life and undergoes dynamic changes throughout the human lifespan, from infancy to old age. During our life, the gut microbiota influences health and disease across life stages. This review summarizes the discussions and presentations from the symposium “Gut microbiota development from infancy to old age” held in collaboration with the Journal of Internal Medicine. In early infancy, microbial colonization is shaped by factors such as mode of delivery, antibiotic exposure, and milk-feeding practices, laying the foundation for subsequent increased microbial diversity and maturation. Throughout childhood and adolescence, microbial maturation continues, influencing immune development and metabolic health. In adulthood, the gut microbiota reaches a relatively stable state, influenced by genetics, diet, and lifestyle. Notably, disruptions in gut microbiota composition have been implicated in various inflammatory diseases—including inflammatory bowel disease, Type 1 diabetes, and allergies. Furthermore, emerging evidence suggests a connection between gut dysbiosis and neurodegenerative disorders such as Alzheimer's disease. Understanding the role of the gut microbiota in disease pathogenesis across life stages provides insights into potential therapeutic interventions. Probiotics, prebiotics, and dietary modifications, as well as fecal microbiota transplantation, are being explored as promising strategies to promote a healthy gut microbiota and mitigate disease risks. This review focuses on the gut microbiota's role in infancy, adulthood, and aging, addressing its development, stability, and alterations linked to health and disease across these critical life stages. It outlines future research directions aimed at optimizing the gut microbiota composition to improve health.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 6","pages":"560-583"},"PeriodicalIF":9.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20089","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is the lower the better in finding the best practical blood pressure goal under antihypertensive treatment?","authors":"Peter M. Nilsson","doi":"10.1111/joim.20084","DOIUrl":"https://doi.org/10.1111/joim.20084","url":null,"abstract":"&lt;p&gt;Hypertension is a common and treatable cardiovascular risk factor of global importance, even if unmet needs still exist [&lt;span&gt;1&lt;/span&gt;]. Over time, better antihypertensive drugs and treatment algorithms have been developed, as reflected in recent international guidelines [&lt;span&gt;2, 3&lt;/span&gt;]. The combination of effective antihypertensive drugs, often in fixed drug combinations, has made it possible to achieve more intensive blood pressure (BP) goals in many patients, even if still a large proportion of patients on treatment for hypertension do not reach BP goals set in guidelines [&lt;span&gt;4&lt;/span&gt;]. A need, therefore, exists to find more solid evidence to motivate even further search for and definition of BP goals, as has been a continuous development over the last few decades based on numerous clinical trials. It is also challenging that the number of patients with elevated BP in need of treatment and follow-up is ever increasing, in developed countries mostly due to ageing populations and in the global south due to societal transformation affecting how people live, eat, work and travel [&lt;span&gt;1&lt;/span&gt;]. Thus, there is a need to develop &lt;i&gt;sustainable hypertension care&lt;/i&gt; [&lt;span&gt;5, 6&lt;/span&gt;] when integrating scientific evidence with practical and cost-effective methods to guide patients and support the responsible staff, mostly in primary care, where most hypertensive patients are diagnosed, treated and followed.&lt;/p&gt;&lt;p&gt;In the most recent European Guidelines from the European Society of Cardiology 2024 [&lt;span&gt;3&lt;/span&gt;], the systolic BP (SBP) goal for most hypertensive patients was set to a target range of 120–129 mmHg, and the diastolic BP should be lower than 80 mmHg but not less than 70 mmHg, provided that the treatment was well tolerated. In fact, this treatment recommendation was also stated for elderly patients up to an age range of 80–85 years if tolerated. During the review process, however, even tighter SBP control targets were proposed [&lt;span&gt;3&lt;/span&gt;], but this did not end up in the official guidelines, mostly due to lack of evidence.&lt;/p&gt;&lt;p&gt;In this issue of the &lt;i&gt;Journal of Internal Medicine&lt;/i&gt;, a group of authors from Austria has published a well-conducted systematic review and meta-analysis of all available evidence derived from the outcome of randomized clinical trials through November 2024 to search for an updated evidence-based SBP goal in hypertension, comparing a goal of &lt;120 mmHg with a goal of &lt;140 mmHg [&lt;span&gt;7&lt;/span&gt;]. Five randomized controlled trials comprising 39,434 hypertensive patients were included. Of particular interest is that this systematic review includes two new studies from China that were not included in the ESC Guidelines 2024 [&lt;span&gt;3&lt;/span&gt;] because they were published very late in the process or even after the launch of the ESC Guidelines. The two studies [&lt;span&gt;8, 9&lt;/span&gt;] were designed to compare composite MACE outcomes and mortality of a treatment strategy for lowering SBP &lt;120 versus &lt;","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 5","pages":"457-459"},"PeriodicalIF":9.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143877758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic options for human papillomavirus-positive tonsil and base of tongue cancer","authors":"Mark Zupancic,&nbsp;Ourania N. Kostopoulou,&nbsp;Linda Marklund,&nbsp;Tina Dalianis","doi":"10.1111/joim.20088","DOIUrl":"10.1111/joim.20088","url":null,"abstract":"<p>The incidences of human papillomavirus-positive (HPV⁺) tonsillar and base tongue squamous cell carcinomas (TSCC and BOTSCC) have increased in recent decades. Notably, HPV⁺ TSCC and BOTSCC have a significantly better prognosis than their HPV-negative counterparts when treated with current surgical options, radiotherapy, or intensified chemoradiotherapy. However, a cure is not achieved in 20% of patients with HPV⁺ TSCC/BOTSCC. Meanwhile, cured patients often present with severe chronic side effects. This necessitates novel tailored alternatives, such as targeted therapy, immune checkpoint inhibitors (ICIs), and treatment de-escalation, together with better follow-up. Current precision medicine therefore focuses on detecting predictive and driver cancer genes to better stratify patient treatment, provide those with poor prognostic markers targeted therapy, and select those with favorable markers for de-escalated therapy. Moreover, detecting cell-free HPV DNA (cfHPV DNA) in plasma before and after treatment has been attempted to improve follow-up. In this context, this perspective discusses the significance of optimally defining HPV⁺ status, which requires HPV DNA and p16^INKa overexpression, using prognostic markers, such as high CD8⁺ T-cell counts and HPV E2 mRNA expression, tumor size, and following cfHPV DNA for patient selection for specific therapies. Clinical trials with ICI with/without chemotherapy, targeted therapy with specific inhibitors—such as phosphoinositide 3-kinase and fibroblast growth factor receptor inhibitors—or immune therapy with various HPV-based vaccines for treating recurrences have yielded promising results.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 6","pages":"608-629"},"PeriodicalIF":9.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20088","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breaking with the status quo in end-of-life care through de-implementation.","authors":"Chetna Malhotra, Ellie Bostwick Andres","doi":"10.1111/joim.20086","DOIUrl":"https://doi.org/10.1111/joim.20086","url":null,"abstract":"<p><p>This paper addresses the challenge of de-implementing low-value care practices in the end-of-life (EOL) context, where burdensome interventions often offer marginal life-extending benefits, incur substantial costs and diminish quality of life. We examine the complexities involved in discontinuing such practices, including clinician biases, institutional cultures favouring aggressive interventions and communication barriers among healthcare providers, patients and families. We discuss how de-implementation at the EOL is unique from other contexts, prioritizing patient-centred care rather than cost reduction. Effective communication and support for patients, families and clinicians is essential, as de-implementation often represents a shift towards what patients and families value. Our review of existing evidence underscores the need for the development and evaluation of de-implementation strategies tailored to EOL care, as described. De-implementation at the EOL requires sensitivity to the complex, emotional nature of EOL care and provides a unique opportunity to integrate palliative care approaches and improve overall EOL care quality.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Common genetic variants do not impact clinical prediction of methotrexate treatment outcomes in early rheumatoid arthritis","authors":"Anton Öberg Sysojev,&nbsp;Bénédicte Delcoigne,&nbsp;Thomas Frisell,&nbsp;Lars Alfredsson,&nbsp;Lars Klareskog,&nbsp;The SRQ biobank group,&nbsp;Saedis Saevarsdottir,&nbsp;Magnus Boman,&nbsp;Leonid Padyukov,&nbsp;Johan Askling,&nbsp;Helga Westerlind","doi":"10.1111/joim.20087","DOIUrl":"10.1111/joim.20087","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Methotrexate (MTX) is the mainstay initial treatment of rheumatoid arthritis (RA), but individual response varies and remains difficult to predict. The role of genetics remains unclear, but studies suggest its importance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Incident RA patients starting MTX-monotherapy were identified through a large-scale Swedish register linkage. Demographic, clinical, medical, and drug history features were combined with fully imputed genotype data and used to train and evaluate multiple learning models to predict key MTX treatment outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 2432 patients, we consistently observed an estimated area under the curve (AUC) of ∼0.62, outperforming models trained on sex and age. The best performance was observed for EULAR primary response (AUC = 0.67), whereas models struggled the most with predicting discontinuation. Genetics provided negligible improvements to prediction quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite an extensive study population with broad multi-modal data, predicting MTX treatment outcomes remains a challenge. Common genetic variants added minimal predictive power over clinical features.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 6","pages":"693-701"},"PeriodicalIF":9.0,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20087","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased risk of osteoporotic fractures and osteoporosis in patients with Addison's disease in Sweden: A nationwide population-based cohort study","authors":"Stavros Stergianos,&nbsp;Tim Spelman,&nbsp;Daniel Eriksson,&nbsp;Sara Öster,&nbsp;Sigridur Björnsdottir,&nbsp;Olle Kämpe,&nbsp;Jakob Skov,&nbsp;Sophie Bensing","doi":"10.1111/joim.20085","DOIUrl":"10.1111/joim.20085","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The risk of major osteoporotic fractures (MOFs) and osteoporosis in patients with autoimmune Addison's disease (AAD) is unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the risk of MOF in patients with AAD and the possible correlation with adrenal hormone replacement doses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Swedish national health registers were used to identify 1869 subjects with AAD and 16,844 matched controls. The primary outcome was MOF, and the secondary outcome was treatment with osteoporosis medications. Marginal Cox models were used to compare time-to-event outcomes. The study period spanned from 1 July 2005 until 31 December 2020. Individuals at risk were followed from inclusion until censored or the end of the study period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 77 patients with AAD (7.1/1000 person-years [PY]), and 387 matched controls (3.9/1000 PY) were diagnosed with MOF. The risk of MOF was higher in patients with AAD compared to matched controls, with an adjusted hazard ratio (aHR) of 1.82 (95% confidence interval [CI], 1.41–2.35) and increased in both male and female patients, with aHR of 2.51 (95% CI, 1.56–4.02) and 1.65 (95% CI, 1.22–2.24), respectively. Patients with AAD had an increased risk of treatment with osteoporosis medications: aHR 3.25 (95% CI, 2.71–3.99), compared to controls. No significant differences in MOF rates were observed between patients treated with intermediate or high doses of glucocorticoids compared to low doses (<i>p</i> = 0.967 and <i>p</i> = 0.580, respectively). Similarly, stratification by mineralocorticoid dose (&lt;0.10 vs. ≥0.10 mg/day) showed no significant association regarding MOF (<i>p</i> = 0.915).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The risk of MOF is increased in patients with AAD without any apparent correlation to adrenal hormone replacement doses.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 5","pages":"518-531"},"PeriodicalIF":9.0,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chest x-ray aortic size and risk of death and cardiovascular disease in older Chinese: Guangzhou biobank cohort study","authors":"Linye Sun,&nbsp;Wenbo Tian,&nbsp;Jiao Wang,&nbsp;Tianqiong Wu,&nbsp;Xiangyi Liu,&nbsp;Yali Jin,&nbsp;Taihing Lam,&nbsp;Karkeung Cheng,&nbsp;Weisen Zhang,&nbsp;Lin Xu","doi":"10.1111/joim.20082","DOIUrl":"10.1111/joim.20082","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chest radiograph can independently predict adverse outcomes in outpatients. We examined the associations of aortic knob width (AKW), ascending aortic length (AAL), and ascending aortic width (AAW) from chest x-ray with death and cardiovascular events in adults aged 50 and above.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants without cardiovascular disease were included from the Guangzhou Biobank Cohort Study (2003–2008). AKW, AAL, and AAW were indexed by body surface area. Aortic enlargement was defined using sex- and age-specific thresholds, calculated as the average value plus 1.96 multiplied by the standard deviation (SD). The associations of AKW, AAL, and AAW indices with all-cause and cause-specific mortality (cardiovascular and cancer), and incident nonfatal and fatal cardiovascular events, were examined through multivariate Cox regressions. Logistic regressions were performed to determine risk factors for aortic enlargement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 27,047 participants (mean age 62 years ± 7 years SD), there were 6977 deaths and 6478 cardiovascular events over an average follow-up period of 16.3 years. Each SD increase in AKW index was associated with a higher risk of all-cause mortality, cardiovascular mortality, and cardiovascular events, with hazard ratios (95% confidence interval [CI]) of 1.13 (1.11–1.16), 1.20 (1.15–1.25), and 1.11 (1.08–1.14), respectively. Similar findings were observed regarding the AAL and AAW indices. Hypertension was a strong risk factor for enlarged AKW (odds ratio 2.52, 95% CI 2.17–2.93), AAL (1.95, 1.63–2.32), and AAW (1.80, 1.56–2.09), respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Thoracic aortic parameters measured through an accessible, cheap, and safe chest radiograph were associated with higher risks of death and cardiovascular events. Hypertension should be managed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 5","pages":"543-555"},"PeriodicalIF":9.0,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}