Journal of Internal Medicine最新文献

{"title":"Metabolic syndrome is associated with breast cancer mortality: A systematic review and meta-analysis","authors":"Sixten Harborg,&nbsp;Helene Borup Larsen,&nbsp;Stine Elsgaard,&nbsp;Signe Borgquist","doi":"10.1111/joim.20052","DOIUrl":"10.1111/joim.20052","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This systematic review and meta-analysis assesses the association between metabolic syndrome and breast cancer (BC) outcomes in BC survivors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Systematic searches were carried out in PubMed and Embase using variations of the search terms: breast neoplasms (population), metabolic syndrome (exposure), and survival (outcome). Metabolic syndrome was characterized according to the American Heart Association, which includes the presence of three out of five abnormal findings among the risk factors: high blood pressure, high triglycerides, low high-density lipoprotein, high fasting glucose, and central obesity. Data were obtained from observational studies and randomized controlled trials that utilized survival statistics and reported survival ratios to investigate how the presence of metabolic syndrome at the time of BC diagnosis is associated with BC outcomes. Study data were independently extracted by two authors, and effect sizes were pooled using random-effects models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From the 1019 studies identified in the literature search, 17 were deemed eligible. These encompassed 42,135 BC survivors. The pooled estimates revealed that BC survivors who had metabolic syndrome at the time of their BC diagnosis experienced increased risk of recurrence (HR 1.69, 95% CI: 1.39–2.06), BC mortality (HR 1.83, 95% CI: 1.35–2.49), and shorter disease-free survival (HR 1.57, 95% CI: 1.36–1.81) compared to BC survivors without metabolic syndrome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among BC survivors, metabolic syndrome was associated with inferior BC outcomes. This necessitates the creation of clinical guidelines that include metabolic screening for BC survivors. Further research should identify effective interventions to reduce the prevalence of metabolic syndrome among BC survivors to improve metabolic health and BC outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 3","pages":"262-275"},"PeriodicalIF":9.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142941974","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":"Epidemiology and outcomes of alpha-1 antitrypsin deficiency in Sweden 2002–2020: A population-based cohort study of 2286 individuals","authors":"Staffan Wahlin,&nbsp;Linnea Widman,&nbsp;Hannes Hagström","doi":"10.1111/joim.20058","DOIUrl":"10.1111/joim.20058","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To estimate the incidence, prevalence, and outcomes of patients with diagnosed alpha-1-antitrypsin deficiency (AATD) in Sweden, 2002–2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design and setting</h3>\u0000 \u0000 <p>The Swedish National Patient Registry was utilized to identify patients with a first diagnosis of AATD between 2002 and 2020. Each patient was matched with up to 10 comparators from the general population. AATD incidence and prevalence were estimated. Causes of death and rates of mortality, transplantation, lung disease, liver cirrhosis, and previous neonatal cholestasis were estimated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The incidence rate of AATD was 1.83 (95% confidence interval [CI] 1.58–2.11) per 100,000 person-years and the total prevalence was 21.04 (95%CI = 20.17–21.94) per 100,000 persons at the end of 2020. Mortality was 3.55 times higher (95%CI = 3.15–3.99) for patients with AATD. Rates of liver—(hazard ratio [HR] = 22.95, 95%CI = 12.61–41.75), lung—(HR = 12.09, 95%CI = 8.87–16.47), and cardiovascular (HR = 1.90, 95%CI = 1.45–2.90) related death were higher in patients with AATD. The cumulative incidence after 10 years of follow-up was 1.69% (95%CI = 1.15–2.41) for liver transplantation and 4.14% (95%CI = 3.20–5.26) for lung transplantation. About 20% of patients were estimated to be alive without lung disease or liver cirrhosis 20 years after an AATD diagnosis. Neonatal cholestasis codes were found in 3.0% of AATD patients and 0.5% of comparators (odds ratio 6.28, 95%CI = 3.81–10.36).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this population-based cohort study on AATD in Sweden, an increasing incidence was observed, and significantly higher rates of death from liver, lung, and cardiovascular causes compared to the general population were found. Only a minority of diagnosed AATD patients were estimated to be free of liver cirrhosis and lung disease after 20 years.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 3","pages":"300-311"},"PeriodicalIF":9.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142941925","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":"Differential long-term impact of primary glomerular diseases on major outcomes: All are not equal!","authors":"Austin G. Stack","doi":"10.1111/joim.20057","DOIUrl":"10.1111/joim.20057","url":null,"abstract":"&lt;p&gt;The landscape of nephrology, particularly that of glomerular diseases, is an evolving dynamic that has witnessed incredible advancements in diagnostic and therapeutic interventions to improve kidney and patient survival [&lt;span&gt;1-3&lt;/span&gt;]. These achievements have been further bolstered by emerging clinical prediction models to enable better and faster clinical decision-making in order to maximize clinical benefit and minimize harm [&lt;span&gt;4-6&lt;/span&gt;]. The more precise we are at defining the primary cause of disease and its epidemiological profile, including clinical course, trajectory pattern and downstream long-term outcomes, the more likely we will improve universal efforts that target its prevention. Greater precision in the classification of disease, its clinical phenotype, targeted therapeutic interventions and outcome measurement is the hallmark of precision medicine [&lt;span&gt;7&lt;/span&gt;]. Glomerular diseases of the kidney are key exemplars where major advances have occurred in elucidating pathogenesis, molecular signatures, diagnostic techniques and novel treatment strategies, all of which have contributed to greater characterization of unique disease phenotypes and clinical outcomes [&lt;span&gt;1-7&lt;/span&gt;]. However, despite these efforts, the scientific community has fallen short in mapping the long-term outcomes of common primary glomerular diseases [&lt;span&gt;8, 9&lt;/span&gt;]. Published comparisons to date have suffered from relatively small samples and short follow-up periods. Many have considered glomerular diseases at the aggregate level rather than at the individual level [&lt;span&gt;1-10&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In this issue of the &lt;i&gt;Journal of Internal Medicine&lt;/i&gt;, Faucon et al. provide new data describing the long-term outcomes of four common primary glomerular diseases from analysis of the Swedish Renal Registry [&lt;span&gt;10&lt;/span&gt;]. In this nationally representative observational study, they profile the trajectory patterns of IgA nephropathy (IgA), focal segmental glomerulosclerosis (FSGS), minimal change disease (MCD) and membranous nephropathy (MN). They reveal significant variation in major long-term outcomes across disease groups and demonstrate that the risks of hospitalization, death and kidney replacement therapy (KRT) for these primary glomerular diseases differ substantially from those of a control CKD population that included patients with diabetes (23.7%), hypertension (39.5%), tubulointerstitial nephritis (3.4%), medication-induced kidney disease (3.0%) and other/unknown causes (30.5%).&lt;/p&gt;&lt;p&gt;Their observations highlight strikingly different patterns of risk for estimated glomerular filtration rate (eGFR) decline, risk of cardiovascular events and mortality associated with each primary glomerular disease. They reveal that the cumulative mortality was highest for patients diagnosed with FSGS and MN and lowest for those with MCD. Similarly, patients with FSGS had cardiovascular event rates that were similar to patients in the control CKD population","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 4","pages":"352-354"},"PeriodicalIF":9.0,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20057","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913398","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":"Regarding: Alpha-1 antitrypsin deficiency associated with increased risks of skin cancer, leukemia, and hepatic cancer: A nationwide cohort study","authors":"Malin Fromme,&nbsp;Katharina Remih,&nbsp;Carolin Victoria Schneider,&nbsp;Pavel Strnad","doi":"10.1111/joim.20055","DOIUrl":"10.1111/joim.20055","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 2","pages":"234-235"},"PeriodicalIF":9.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142908727","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: Alpha-1 antitrypsin deficiency associated with increased risks of skin cancer, leukemia, and hepatic cancer: A nationwide cohort study","authors":"Eskild M. Landt,&nbsp;Sarah C. W. Marott,&nbsp;Morten Dahl","doi":"10.1111/joim.20056","DOIUrl":"10.1111/joim.20056","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 2","pages":"236-237"},"PeriodicalIF":9.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142908724","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":"Treatment strategies to reduce cardiovascular risk in persons with chronic kidney disease and Type 2 diabetes","authors":"Faiez Zannad,&nbsp;Darren K. McGuire,&nbsp;Alberto Ortiz","doi":"10.1111/joim.20050","DOIUrl":"10.1111/joim.20050","url":null,"abstract":"<p>Chronic kidney disease (CKD) is a prevalent and progressive condition associated with significant mortality and morbidity. Diabetes is a common cause of CKD, and both diabetes and CKD increase the risk of cardiovascular disease (CVD), the leading cause of death in individuals with CKD. This review will discuss the importance of early detection of CKD and prompt pharmacological intervention to slow CKD progression and delay the development of CVD for improving outcomes.</p><p>Early CKD is often asymptomatic, and diagnosis usually requires laboratory testing. The combination of estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) measurements is used to diagnose and determine CKD severity. Guidelines recommend at least annual screening for CKD in at-risk individuals. While eGFR testing rates are consistently high, rates of UACR testing remain low. This results in underdiagnosis and undertreatment of CKD, leaving many individuals at risk of CKD progression and CVD. UACR testing is an actionable component of the CKD definition.</p><p>A four-pillar treatment approach for slowing the progression of diabetic kidney disease is suggested, comprising a renin–angiotensin–system (RAS) inhibitor, a sodium–glucose cotransporter 2 inhibitor, a glucagon-like peptide 1 receptor agonist, and the nonsteroidal mineralocorticoid receptor antagonist finerenone. The combination of these agents provides a greater cardiorenal risk reduction compared with RAS inhibitors alone.</p><p>Early detection of CKD and prompt intervention with guideline-directed medical therapy are crucial for reducing CVD risk in individuals with CKD and diabetes. Evidence from ongoing studies will advance our understanding of optimal therapy in this population.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 5","pages":"460-478"},"PeriodicalIF":9.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142908730","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":"Fluid overload trajectories and mortality in hemodialysis patients","authors":"Carmine Zoccali,&nbsp;Giovanni Tripepi,&nbsp;Paola Carioni,&nbsp;Francesca Mallamaci,&nbsp;Matteo Savoia,&nbsp;Len S Usvyat,&nbsp;Franklin W. Maddux,&nbsp;Stefano Stuard","doi":"10.1111/joim.20049","DOIUrl":"10.1111/joim.20049","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Fluid overload remains critical in managing patients with end-stage kidney disease. However, there is limited empirical understanding of fluid overload's impact on mortality. This study analyzes fluid overload trajectories and their association with mortality in hemodialysis patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and patients</h3>\u0000 \u0000 <p>This longitudinal study included 9332 incident hemodialysis patients from the EuCliD database, treated in Fresenius Medical Care NephroCare dialysis centers across seven countries between January 2016 and December 2019, with follow-up until May 2023. Fluid overload was assessed using bioimpedance spectroscopy, and patients were grouped based on fluid overload trajectories using group-based trajectory modeling. Cox regression models, adjusted for potential confounders, were used to investigate the relationship between trajectory groups and mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four distinct fluid overload trajectories were identified. Patients in the highest trajectory group (8.5% of the cohort) had more frequent background cardiovascular complications, lower BMI and serum albumin, and their adjusted mortality risk was 2.20 times higher than the lowest trajectory. There was a dose–response relationship between trajectories and mortality. The incidence rate of death increased with the degree of fluid overload, from 8.6 deaths per 100 person-years in the lowest trajectory to 18.6 in the highest.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This longitudinal study highlights the significant risk of chronic fluid overload in hemodialysis patients. Latent trajectory analysis provides novel information into the dynamic nature of fluid overload and its impact on mortality in the hemodialysis population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 2","pages":"201-212"},"PeriodicalIF":9.0,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891077","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":"Effect of an intensive lifestyle intervention on cystatin C–based kidney function in adults with overweight and obesity: From the PREDIMED-Plus trial","authors":"José Ignacio Martínez-Montoro,&nbsp;Isabel Cornejo-Pareja,&nbsp;Andrés Díaz-López,&nbsp;Antoni Sureda,&nbsp;Estefania Toledo,&nbsp;Itziar Abete,&nbsp;Nancy Babio,&nbsp;Josep A. Tur,&nbsp;Miguel A. Martinez-Gonzalez,&nbsp;J. Alfredo Martínez,&nbsp;Montse Fitó,&nbsp;Jordi Salas-Salvadó,&nbsp;Francisco J. Tinahones,&nbsp;PREDIMED-Plus Investigators","doi":"10.1111/joim.20038","DOIUrl":"10.1111/joim.20038","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Large-scale trials evaluating a multicomponent lifestyle intervention aimed at weight loss on kidney function are lacking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a post hoc analysis of the “PREvención con DIeta MEDiterránea-Plus” (PREDIMED-Plus) randomized controlled trial, including patients with overweight/obesity and metabolic syndrome, measured cystatin C and creatinine. Participants were randomly assigned (1:1) to an intensive weight loss lifestyle intervention (intervention group [IG]) consisting of an energy-restricted Mediterranean diet (MedDiet), physical activity promotion and behavioral support, or a control group (CG) receiving ad libitum MedDiet recommendations. The primary outcome was between-group differences in cystatin C–based kidney function (cystatin C–based estimated glomerular filtration rate—eGFRcys—and combined cystatin C–creatinine-based eGFR—eGFRcr-cys) change from baseline to 12 and 36 months. Secondary outcomes included between-group differences in creatinine-based eGFR (eGFRcr) and urinary albumin-to-creatinine ratio (UACR) change and the predictive capacity of these formulas at baseline for new-onset chronic kidney disease (CKD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1909 participants (65 ± 5 years, 54% men) were included. Twelve-month decline in eGFRcys, eGFRcr-cys, and eGFRcr was greater in the CG compared to the IG, with between-group differences of −1.77 mL/min/1.73 m² [95% confidence interval −2.92 to −0.63], −1.37 [−2.22 to −0.53], and −0.91 [−1.74 to −0.71], respectively. At 36 months, the decline in eGFRcr-cys and eGFRcr was greater in the CG. No between-group differences in UACR were found. Significant adjusted areas under the curve for baseline eGFRcys and eGFRcr-cys were observed for incident CKD at 36 months, which were similar to those for eGFRcr and UACR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In older adults with overweight/obesity and metabolic syndrome, the PREDIMED-Plus intervention may be an optimal approach to preserve kidney function.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 2","pages":"141-155"},"PeriodicalIF":9.0,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891074","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":"Authors reply: Delirium and frailty in older adults: Clinical overlap and biological underpinnings","authors":"Giuseppe Bellelli,&nbsp;Maria Cristina Ferrara,&nbsp;Federico Triolo,&nbsp;Davide Liborio Vetrano","doi":"10.1111/joim.20047","DOIUrl":"10.1111/joim.20047","url":null,"abstract":"&lt;p&gt;Dear Editor,&lt;/p&gt;&lt;p&gt;We thank Drs. da Silva and Caldas for showing interest in our review paper recently published in the &lt;i&gt;Journal of Internal Medicine&lt;/i&gt; and for their thoughtful contributions, which enrich the discussion on this topic [&lt;span&gt;1, 2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;A highlighted key point pertains to the pathophysiology of frailty and delirium. As acknowledged, the biological mechanisms underlying these two conditions remain largely unknown. This limited understanding explains why current prevention and treatment strategies predominantly focus on minimizing observable clinical manifestations (i.e., secondary rather than primary prevention). From a biological perspective, identifying whether certain individuals have an increased susceptibility to develop frailty and delirium remains a key challenge. This underscores the urgent need for a paradigm shift in our approach to these conditions.&lt;/p&gt;&lt;p&gt;In our review, we proposed a unifying framework aimed at offering a novel reading of the complex pathophysiological mechanisms underlying these conditions and, most importantly, providing research perspectives for future etiological studies. While recognizing frailty and delirium as distinct clinical entities, we postulated that they may reflect different manifestations of accelerated biological aging. This viewpoint opens new avenues from a geroscience perspective, particularly in identifying individuals at higher risk of developing delirium when frail or presenting with worsening frailty status after a delirium episode. Additionally, exploring upstream interventions targeting shared biological mechanisms holds significant promise for mitigating both conditions, as well as other burdensome geriatric syndromes. Advancing this line of research could lead to breakthroughs in risk stratification and the development of early, personalized interventions, ultimately improving care outcomes for older adults.&lt;/p&gt;&lt;p&gt;The letter by da Silva and Caldas also raises the critical issue of cognitive decline underdiagnosis, which we fully acknowledge. Cognitive impairment often goes unnoticed, either because healthcare access is strongly influenced by one's socioeconomic status or because healthcare providers often lack the necessary training to identify it. Expanding awareness among healthcare professionals about the interplay among frailty, delirium, and cognitive decline is essential to enhance prevention efforts and foster a more integrated, multidisciplinary approach to the care of, among others, at-risk hospitalized older adults. Equally important is educating communities to recognize cognitive decline as a serious issue that impacts the quality of care for older individuals.&lt;/p&gt;&lt;p&gt;Although our review is not systematic, we believe that its narrative approach offers valuable insights by synthesizing fragmented evidence and generating hypotheses for future studies. Addressing the identified gaps will enable healthcare systems and caregivers to implement interventions ","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 2","pages":"232-233"},"PeriodicalIF":9.0,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20047","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142870657","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":"Safety and efficacy of moderate-intensity statin with ezetimibe in elderly patients with atherosclerotic cardiovascular disease","authors":"Jung-Joon Cha,&nbsp;Ju Hyeon Kim,&nbsp;Soon Jun Hong,&nbsp;Subin Lim,&nbsp;Hyung Joon Joo,&nbsp;Jae Hyoung Park,&nbsp;Cheol Woong Yu,&nbsp;Pil Hyung Lee,&nbsp;Seung Whan Lee,&nbsp;Cheol Whan Lee,&nbsp;Jae Youn Moon,&nbsp;Jong-Young Lee,&nbsp;Jung-Sun Kim,&nbsp;Jae Suk Park,&nbsp;Do-Sun Lim","doi":"10.1111/joim.20029","DOIUrl":"10.1111/joim.20029","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>High-intensity statin therapy significantly reduces mortality and cardiovascular events in patients with atherosclerotic cardiovascular disease (ASCVD). However, moderate-intensity statins are often preferred for elderly patients due to their higher risk of intolerance to high-intensity statins.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare the incidence of statin-associated muscle symptoms (SAMS) and the effect on low-density lipoprotein cholesterol (LDL-C) levels between elderly ASCVD patients receiving high-intensity statin monotherapy and those receiving moderate-intensity statin with ezetimibe in a combination therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>In a prospective, multicenter, open-label trial conducted in South Korea, 561 patients aged 70 years or above with ASCVD were randomly assigned to receive either moderate-intensity statin with ezetimibe combination therapy (rosuvastatin 5 mg with ezetimibe 10 mg) or high-intensity statin monotherapy (rosuvastatin 20 mg) over 6 months. The primary endpoint was the incidence of SAMS, and the key secondary endpoint was the achievement of target LDL-C levels (&lt;70 mg/dL) within 6 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The primary endpoint showed a lower incidence of SAMS in the combination therapy group (0.7%) compared to the high-intensity statin monotherapy group (5.7%, <i>p</i> = 0.005). Both groups achieved similar LDL-C levels, with 75.4% in the combination therapy group and 68.7% in the monotherapy group reaching target levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Moderate-intensity statin with ezetimibe combination therapy offers a lower risk of SAMS and similar LDL-C reduction in elderly patients with ASCVD, compared to high-intensity statin monotherapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 4","pages":"400-408"},"PeriodicalIF":9.0,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142870658","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}