Journal of Internal Medicine最新文献

{"title":"Simple step counting captures comparable health information to complex accelerometer measurements","authors":"Jonatan Fridolfsson,&nbsp;Anders Raustorp,&nbsp;Mats Börjesson,&nbsp;Elin Ekblom-Bak,&nbsp;Örjan Ekblom,&nbsp;Daniel Arvidsson","doi":"10.1111/joim.20081","DOIUrl":"10.1111/joim.20081","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Physical activity guidelines recommend accumulating moderate-to-vigorous physical activity but interpreting and monitoring these recommendations remains challenging. Although step-based metrics from wearable devices offer a simpler approach, their relationship with health outcomes requires validation against established accelerometer measurements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate how effectively step-based metrics capture health-related information from accelerometer data and determine optimal step cadence and intensity thresholds associated with cardiometabolic health in middle-aged adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Cross-sectional data from 4172 participants (aged 50–64 years) in the Swedish CArdioPulmonary bioImage Study (SCAPIS) were analyzed. Physical activity was measured using ActiGraph accelerometers, collecting both step metrics (daily steps and cadence) and full accelerometer data. Both cardiorespiratory fitness, estimated using a submaximal cycle ergometer test, and cardiometabolic health, assessed using a composite score of waist circumference, blood pressure, lipids, and glycated hemoglobin (HbA1c), were considered outcomes. Associations between physical activity and outcomes were examined using linear regression and partial least squares analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Step counting metrics retained 88% of the health-related information from full accelerometer data. The optimal accelerometer intensity associated with cardiometabolic health was around four metabolic equivalents of tasks (METs). A step cadence of 80 steps/min, rather than the commonly used 100 steps/min, appeared more relevant for capturing moderate-intensity activity. Combining step and accelerometer data provided additional explanatory power for cardiometabolic health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Step data capture most of the health-related information from accelerometer-measured physical activity in middle-aged adults. These findings support the use of step-based metrics for assessing and promoting physical activity while suggesting a need for recalibration of intensity thresholds in free-living conditions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 5","pages":"492-504"},"PeriodicalIF":9.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20081","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750341","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":"Correction to “Ultradian hydrocortisone replacement alters neuronal processing, emotional ambiguity, affect and fatigue in adrenal insufficiency: The PULSES trial”","authors":"","doi":"10.1111/joim.20076","DOIUrl":"https://doi.org/10.1111/joim.20076","url":null,"abstract":"<p>Russell G, Kalafatakis K, Durant C, Marchant N, Thakrar J, Thirard R, et al. Ultradian hydrocortisone replacement alters neuronal processing, emotional ambiguity, affect and fatigue in adrenal insufficiency: The PULSES trial. <i>J Intern Med</i>. <b>295</b>(1):2024;51–67. https://doi.org/10.1111/joim.13721. Epub 2023 Oct 19.</p><p>Acknowledgements should include Lina Alim and Elizabeth Hudson, two medical students who helped the authors with the processing and analysis of data. These two individuals were inadvertently missed in the original version.</p><p>The online version of the article has been updated.</p><p>We apologize for this error.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 4","pages":"452"},"PeriodicalIF":9.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639019","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":"Non-steroidal anti-inflammatory drugs and risk of kidney cancer: A Swedish nationwide cohort study in the general and high-use populations","authors":"Hjalmar Wadström,&nbsp;Johan Askling,&nbsp;Rolf Gedeborg,&nbsp;Nils Feltelius,&nbsp;Karin Hellgren","doi":"10.1111/joim.20079","DOIUrl":"10.1111/joim.20079","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Data on the association between non-steroidal anti-inflammatory drugs (NSAIDs) and kidney cancer (KC) are conflicting. This study aimed to evaluate this association in the general population and in patients with extensive NSAID use: rheumatoid arthritis (RA) and spondyloarthritis (SpA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a nationwide register-based cohort study of the Swedish general population and among patients with RA or SpA, among whom NSAID use was around five times higher. In each of these cohorts, we assessed the incidence of KC 2010 through 2021 by NSAID exposure as defined by repeated prescriptions. We also evaluated KC mortality in individuals treated (vs. not) with NSAIDs, taking the cancer stage into account. Adjusted hazard ratios (HRs) were calculated through Cox regression, taking age, sex, educational level, comorbidities and family history of KC into account.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Based on 751 incident cases of KC among 393,709 individuals in the general population (33% NSAID-exposed), the HR for NSAID-exposure was 1.32 (95% confidence interval [CI] 1.13–1.54), with the highest HRs during the first year of follow-up (HR thereafter 1.20). The corresponding cancer stage-adjusted HR for mortality from KC with NSAID-exposure was 1.26 (95%CI 0.87–1.82). In RA and SpA, the HRs for KC incidence with NSAID exposure were 0.83 (95%CI 0.58–1.18) and 1.60 (95%CI 0.78–3.29), respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We found up to a 30% increase in the overall incidence and mortality from KC with NSAID in the general population. This association was attenuated beyond the first year of follow-up and inconsistent in populations with much higher NSAID use.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 5","pages":"505-517"},"PeriodicalIF":9.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20079","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584062","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":"Clonal hematopoiesis of indeterminate potential and the risk of autoimmune diseases","authors":"Hanzhang Wu,&nbsp;Jiahe Wei,&nbsp;Yuefeng Yu,&nbsp;Ningjian Wang,&nbsp;Xiao Tan","doi":"10.1111/joim.20080","DOIUrl":"10.1111/joim.20080","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Clonal hematopoiesis of indeterminate potential (CHIP), characterized by the age-related expansion of blood cells carrying preleukemic mutations, is associated with immune aging. This study aimed to investigate the association between CHIP and established autoimmune diseases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed baseline data from 456,692 UK Biobank participants with available whole-exome sequences. The primary outcome was 19 autoimmune disorders. Associations among any CHIP (variant allele fraction ≥2%), large CHIP clones (variant allele fraction ≥10%), and gene-specific CHIP subtypes with the incidence of autoimmune diseases were assessed using Cox regression. Mediation analysis was performed to explore the role of inflammation in the link between CHIP and autoimmune diseases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 17,433 any CHIP and 11,970 large CHIP at baseline. Participants with any and large CHIP were associated with 44% and 43% higher risk for Crohn's disease, 25% and 33% higher risk for psoriasis, 13% and 14% higher risk for rheumatoid arthritis, and 35% and 55% higher risk for vasculitis, respectively. Participants with CHIP status were associated with increased levels of inflammatory markers, including white blood cell, platelets, neutrophils, and neutrophil-to-lymphocyte ratio, with overall mediation ratios of 16.3% for Crohn's disease, 7.1% for psoriasis, 23.2% for rheumatoid arthritis, and 7.2% for vasculitis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CHIP was associated with an increased risk for incident multiple autoimmune diseases, including Crohn's disease, psoriasis, vasculitis, and rheumatoid arthritis, potentially mediated by elevated inflammatory levels. Future research is needed to clarify the mechanisms underlying these associations and to explore potential interventions to reduce the associated risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 6","pages":"642-656"},"PeriodicalIF":9.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20080","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584059","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":"Current challenges in lung transplantation","authors":"Anna Niroomand,&nbsp;Sandra Lindstedt","doi":"10.1111/joim.20072","DOIUrl":"10.1111/joim.20072","url":null,"abstract":"<p>Lung transplantation remains the definitive treatment for end-stage lung disease, but several critical challenges persist. Key issues include the limited availability of donor organs, ongoing debates over optimal preservation methods, and the controversy surrounding the best intraoperative support systems. Additionally, the efficacy of bridging strategies to transplantation continues to be questioned. This review delves into these pressing topics. This includes a focus on donation after cardiac death as a potential solution to expand the donor pool and recent advancements in hypothermic preservation, including innovative portable devices, and the role of bridging strategies. By addressing these multifaceted challenges, this review highlights the importance of continued advancements in donor management, organ preservation, and perioperative care to ultimately improve outcomes for lung transplant recipients.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 4","pages":"355-365"},"PeriodicalIF":9.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555471","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":"Systolic blood pressure targets below 120 mm Hg are associated with reduced mortality: A meta-analysis","authors":"Felix Bergmann,&nbsp;Marlene Prager,&nbsp;Lena Pracher,&nbsp;Rebecca Sawodny,&nbsp;Gloria M. Steiner-Gager,&nbsp;Bernhard Richter,&nbsp;Bernd Jilma,&nbsp;Markus Zeitlinger,&nbsp;Georg Gelbenegger,&nbsp;Anselm Jorda","doi":"10.1111/joim.20078","DOIUrl":"10.1111/joim.20078","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The optimal systolic blood pressure (SBP) target in patients with increased cardiovascular risk remains uncertain. This study evaluated the efficacy and safety of intensive SBP control (&lt;120 mm Hg) compared to standard SBP control (&lt;140 mm Hg) in patients with increased cardiovascular risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a systematic search of PubMed, Embase, Web of Science, and Cochrane Library for RCTs published from database inception through November 2024 that compared intensive SBP control (&lt;120 mm Hg) with standard SBP control (&lt;140 mm Hg) in adults with high cardiovascular risk. Efficacy outcomes included all-cause mortality, major adverse cardiovascular events (MACE), cardiovascular death, stroke, myocardial infarction (MI), and heart failure. Safety outcomes included hypotension, syncope, arrhythmia, acute kidney injury, and electrolyte abnormalities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five RCTs comprising 39,434 patients were included. The all-cause mortality was significantly lower in the intensive SBP control group (672 of 19,712 [3.4%]) compared to the standard SBP control group (778 of 19,722 [3.9%]) (risk ratio 0.87 [95% confidence interval, 0.76–0.99, <i>p</i> = 0.03]). The incidence of MACE, cardiovascular death, MI, stroke, and heart failure was significantly lower in the intensive SBP control group as compared to standard SBP control group. The treatment effect (MACE) was consistent across all subgroups. Conversely, intensive SBP control was associated with an increased risk of hypotension, syncope, arrhythmia, acute kidney injury, and electrolyte abnormalities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Targeting intensive SBP control to less than 120 mm Hg was associated with a lower incidence of all-cause mortality and MACE but a higher incidence of adverse events.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 5","pages":"479-491"},"PeriodicalIF":9.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20078","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555472","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":"Effects of SGLT2 inhibitors on transplant survival and key clinical outcomes in heart transplant recipients with diabetes","authors":"Fu-Shun Yen,&nbsp;Yao-Min Hung,&nbsp;Jing-Yang Huang,&nbsp;Chih-Cheng Hsu,&nbsp;Wan-Yin Cheng,&nbsp;Chii-Min Hwu,&nbsp;James Cheng-Chung Wei","doi":"10.1111/joim.20077","DOIUrl":"10.1111/joim.20077","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chronic kidney disease and heart allograft vasculopathy are the primary causes of morbidity and mortality after cardiac transplant. This study aimed to evaluate the impact of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on transplant survival, cardiovascular events, dialysis, and all-cause mortality in diabetes patients who have undergone heart transplantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this research, we adopted data from the TriNetX collaborative network to observe outcomes in patients who underwent heart transplants between January 01, 2015 and December 31, 2022. A total of 6494 transplant recipients were identified, from which 1063 matched pairs of SGLT2i users and non-users were selected using propensity score matching. The Kaplan–Meier analysis and Cox proportional hazards models were applied to compare the risks of various outcomes between the study and control groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In propensity-matched cohorts, patients using SGLT2i exhibited a lower risk of dialysis [hazard ratio (HR) (95% confidence interval [CI]): 0.566 (0.385–0.833)], graft rejection and failure [0.873 (0.774–0.985)], hospitalizations [0.822 (0.739–0.916)], and all-cause death [0.767 (0.627–0.938)] compared to non-users. Yet, no significant differences were observed between the two groups in the risks of post-transplant infection or sepsis [0.891 (0.739–1.075)], ischemic heart disease (HR: 1.044, 95% CI: 0.939–1.161), and heart failure worsening [0.915 (0.733–1.144)].</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This multicenter cohort study demonstrated that cardiac transplant recipients with diabetes who received SGLT2i had a significantly lower risk of dialysis, graft rejection, hospitalization, and all-cause mortality compared to those who did not receive SGLT2i.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 5","pages":"532-542"},"PeriodicalIF":9.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490311","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":"Regarding: the interplay of delirium and frailty in hospitalized older adults","authors":"Yanling Xu,&nbsp;Mabelline Tan Pei Min,&nbsp;Li Feng Tan","doi":"10.1111/joim.20074","DOIUrl":"10.1111/joim.20074","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 4","pages":"448-449"},"PeriodicalIF":9.0,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143481963","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":"Authors reply: The interplay of delirium and frailty in hospitalized older adults","authors":"Natalie Ling,&nbsp;Reshma Aziz Merchant,&nbsp;Zhiying Lim","doi":"10.1111/joim.20075","DOIUrl":"10.1111/joim.20075","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 4","pages":"450-451"},"PeriodicalIF":9.0,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482013","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":"The combination of statin and ezetimibe is safe, effective, and preferable","authors":"Mats Eriksson","doi":"10.1111/joim.20070","DOIUrl":"10.1111/joim.20070","url":null,"abstract":"&lt;p&gt;In this issue of the Journal of Internal Medicine, Cha et al. from the Republic of Korea reported several important findings in the article entitled “Safety and efficacy of moderate-intensity statin with ezetimibe in elderly patients with atherosclerotic cardiovascular disease” [&lt;span&gt;1&lt;/span&gt;]. The primary endpoint of the study was the incidence of statin-associated muscle symptoms (SAMSs) and the effect on low-density lipoprotein cholesterol (LDL-C) levels in elderly patients treated with high-intensity statin in monotherapy and those treated with moderate-intensity statin in combination with ezetimibe. Despite similar LDL level reductions in the two groups, a significantly lower frequency of SAMS was observed in that treated with the combination. In addition, there was a significant reduction in total cholesterol level, indicating a reduction of non-high-density lipoprotein cholesterol level (non-HDL-C), including “remnants.” Remnants have been shown to be highly atherogenic in patients with prediabetes, diabetes mellitus type 2, and kidney disease.&lt;/p&gt;&lt;p&gt;Muscular side effects of statins are seen in approximately 5% of the patients and are dose-dependent. The most severe side effect, rhabdomyolysis, is very rare (1/100,000) and has been proposed to be related to the development of auto-antibodies against HMG-CoA [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Statins have, in many studies, both in primary and secondary prevention settings, resulted in decreased morbidity and mortality in cardiovascular diseases [&lt;span&gt;3&lt;/span&gt;]. Statins are currently prescribed to more than 10% of the population in many countries.&lt;/p&gt;&lt;p&gt;Statins inhibit the endogenous synthesis of cholesterol via inhibition of 3-hydroxy-3-methylglutaryl coenzyme A reductase. They are most effective in patients with a high synthesis and low cholesterol absorption [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Ezetimibe blocks the uptake of cholesterol in the small intestine. The drug was discovered without a clear understanding of the molecular target of the drug. Later, it was found that the primary target of ezetimibe is the cholesterol transporter Niemann-Pick C1-Like 1 protein, expressed by intestinal enterocytes [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;One of the first studies showing good results of combining statin with ezetimibe was the SHARP study, titled “Study of Heart and Renal Protection” [&lt;span&gt;6&lt;/span&gt;]. The study resulted in a significant 17% reduction in major atherosclerotic events in patients with kidney disease treated with simvastatin plus ezetimibe compared to simvastatin/placebo. The previous study also reported a greater decrease in total cholesterol level compared to LDL-C, indicating a reduction in remnants.&lt;/p&gt;&lt;p&gt;A second study showing the positive effects of the combination of statin and ezetimibe was the IMPROVE-IT trial titled “Improved Reduction of Outcomes: Vytorin Efficacy International trial” [&lt;span&gt;7&lt;/span&gt;]. The study included 18,144 patients with acute coronary syndromes who were randomized to treatmen","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 4","pages":"350-351"},"PeriodicalIF":9.0,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482059","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}