Journal of Internal Medicine最新文献

{"title":"Acute clinical events and trajectories of frailty after age 60: A population-based cohort study","authors":"Clare Tazzeo,&nbsp;Caterina Gregorio,&nbsp;Debora Rizzuto,&nbsp;Laura Fratiglioni,&nbsp;Francesco Innocenti,&nbsp;Jonas Bjurgert,&nbsp;Stefania Maggi,&nbsp;Anna-Karin Welmer,&nbsp;Alberto Zucchelli,&nbsp;Amaia Calderón-Larrañaga,&nbsp;Davide L. Vetrano","doi":"10.1111/joim.70102","DOIUrl":"10.1111/joim.70102","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We aimed to examine the relationship between acute events and frailty trajectories of community-dwelling adults aged 60 and older.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included 3146 participants, aged 60+, from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). We considered all myocardial infarctions (MIs), lower respiratory tract infections (LRTIs) and falls that resulted in a hospitalization 5 years before to 12 years after SNAC-K baseline (2001–2004). Frailty was operationalized using a data-driven frailty index (FI), scored from 0 to 1. Linear quantile mixed models were used to examine the relationship between number and type of acute events and FI trajectories over a median follow-up of 11 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Falls (<i>n</i> = 690) were most common, followed by LRTIs (<i>n</i> = 353) and MIs (<i>n</i> = 205). Those with more acute events showed significantly higher frailty levels over time from age 75 to 95. The greatest differences in frailty trajectories by event count were observed at age 80, with increases between zero to one, one to two and two to three or more events of 0.04 (95% confidence interval [CI] = 0.03–0.05), 0.08 (95% CI = 0.05–0.11) and 0.09 (95% CI = 0.05–0.13) FI units, respectively. Falls emerged as most deleterious, but there were also clear differences by MI and LRTI count after imputing frailty at death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Older adults who experience falls, LRTIs and MIs are more likely to sustain unfavourable frailty trajectories, with increasingly higher frailty levels with each additional acute event. Prevention, before age 75, should be optimized to avoid a vicious cycle of acute events and frailty progression as well as reduced lifespan.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"300 1","pages":"39-50"},"PeriodicalIF":9.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.70102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147758361","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: Poor long-term cardiovascular risk factor management after acute coronary syndrome: An observational cohort study","authors":"Jessica Schubert,&nbsp;Maria Svensson K,&nbsp;Margret Leosdottir,&nbsp;Bertil Lindahl,&nbsp;Håkan Melhus,&nbsp;Elin Täufer,&nbsp;Nina Johnston,&nbsp;Thomas Cars,&nbsp;Emil Hagström","doi":"10.1111/joim.70106","DOIUrl":"10.1111/joim.70106","url":null,"abstract":"&lt;p&gt;Dear Editor,&lt;/p&gt;&lt;p&gt;We thank Fauchier et al. for their interest in our study and their thoughtful methodological considerations regarding the interpretation of sex differences in post-acute coronary syndrome (ACS) management [&lt;span&gt;1&lt;/span&gt;]. The authors raise two main concerns: potential confounding by myocardial infarction (MI) subtype (STEMI vs. NSTEMI) and an insufficient consideration of age as an effect modifier. Both aspects were considered in our analytical framework.&lt;/p&gt;&lt;p&gt;Age was incorporated as a covariate in all regression models, guided by directed acyclic graphs (DAGs). In addition, the observed (sex) differences in statin prescription rates were consistent across all examined age strata (Supporting Information), arguing against residual confounding by age as a likely explanation for our findings.&lt;/p&gt;&lt;p&gt;Regarding MI subtype, current ESC guidelines recommend uniform secondary prevention targets and follow-up for all ACS patients, irrespective of the index event [&lt;span&gt;2&lt;/span&gt;]. Our objective was to evaluate whether these targets are achieved in routine care; accordingly, the ACS population as a whole constituted the relevant unit of analysis. Sex was modeled as the exposure in fully adjusted models, and differences in case-mix by MI subtype are therefore unlikely to explain the observed associations.&lt;/p&gt;&lt;p&gt;As discussed by Hernán et al., Simpson's paradox reflects a mismatch between statistical conditioning and underlying causal structure [&lt;span&gt;3&lt;/span&gt;]. In our DAG framework, MI subtype lies on the causal pathway between sex and subsequent management as it is partly determined by sex and influences care. Treating MI subtype as confounder would therefore be inappropriate. Conditioning on MI subtype would block part of the causal effect of interest that we aimed to estimate, potentially introducing bias. We therefore estimated marginal associations, adjusted for confounders as identified through our DAGs, which provide an appropriate measure of the overall sex disparity.&lt;/p&gt;&lt;p&gt;This approach aligns with our study aim which was to quantify overall differences in post-ACS care between women and men, while preserving the total effect of sex on outcomes. It also reflects clinical practice, where secondary prevention targets are not stratified by MI subtype [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;We agree that sex differences in post-ACS care are multifactorial. Nevertheless, the consistent findings observed in our study, including lower LDL-C measurement rates, lower target achievement, and lower statin use in women across age groups and follow-up, support the presence of a clinically relevant disparity in secondary prevention.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Jessica Schubert&lt;/b&gt;: Writing – orginal draft, writing – review and editing, conceptualization. &lt;b&gt;Margret Leosdottir&lt;/b&gt;: Writing – review and editing. &lt;b&gt;Maria Svensson K&lt;/b&gt;.: Writing – review and editing. &lt;b&gt;Elin Täufer&lt;/b&gt;: Writing – review and editing. &lt;b&gt;Bertil Lindahl&lt;/b&gt;: Writing – review and editing. &lt;b&gt;Håkan ","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"300 1","pages":"99-100"},"PeriodicalIF":9.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.70106","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147808993","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":"Blood biomarkers of Alzheimer's disease and 15-year decline in cognitive and motor functions in older adults","authors":"Elena Pinardi,&nbsp;Giulia Grande,&nbsp;Alice Margherita Ornago,&nbsp;Martina Valletta,&nbsp;Debora Rizzuto,&nbsp;Claudia Fredolini,&nbsp;Matilda Dale,&nbsp;Erika J. Laukka,&nbsp;Patrizia Mecocci,&nbsp;Bengt Winblad,&nbsp;Laura Fratiglioni,&nbsp;Giuseppe Bellelli,&nbsp;Davide Liborio Vetrano","doi":"10.1111/joim.70110","DOIUrl":"10.1111/joim.70110","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Individuals showing concurrent and rapid declines in cognitive and motor performance (i.e., dual decliners) are at increased risk of faster progression to dementia. Still, the role of Alzheimer's disease (AD) pathology in motor/cognitive joint trajectories remains poorly understood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To test the association between blood AD biomarkers and different patterns of decline of cognitive and motor functions in an aging, community-dwelling population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included 1660 dementia-free participants from the Swedish National Study on Aging and Care in Kungsholmen. Cognitive and motor functions were assessed over 15 years using the Mini-Mental State Examination and gait speed. Based on individual decline rates derived from linear mixed models, participants were classified as slow/non-decliners, fast motor decliners, fast cognitive decliners, or dual decliners. Baseline plasma concentrations of AD biomarkers (amyloid-β [Aβ] 42/40 ratio, phosphorylated tau 217 [p-tau217], phosphorylated tau 181 [p-tau181], total tau, neurofilament light chain [NfL], and glial fibrillary acidic protein [GFAP]) were quantified using single-molecule array assays. Associations between standardized biomarker levels and decline patterns were tested using multinomial logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Higher plasma levels of p-tau217 (odds ratio [OR] 2.69, 95% confidence interval [CI] 2.34–3.09), p-tau181 (OR 1.78, 95% CI 1.60–1.98), and NfL (OR 1.47, 95% CI 1.34–1.61) were most strongly associated with dual decline, compared with slow/no decline. Although a lower Aβ42/40 ratio and higher GFAP levels were mainly linked to isolated cognitive, p-tau217 alone was associated with future isolated motor decline.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this population-based study, distinct AD blood biomarkers were associated with different patterns of cognitive and motor decline. Whether these represent separate pathways or a clinical continuum, further research is needed to clarify underlying mechanisms and inform clinical applications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"300 1","pages":"64-77"},"PeriodicalIF":9.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.70110","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147925149","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 “Non-steroidal anti-inflammatory drugs versus acetaminophen and risk of venous thromboembolism: An active comparator new user cohort study”","authors":"","doi":"10.1111/joim.70109","DOIUrl":"10.1111/joim.70109","url":null,"abstract":"&lt;p&gt;Matsuo Y, Okada A, Yasunaga H. Non-steroidal anti-inflammatory drugs versus acetaminophen and risk of venous thromboembolism: an active comparator new user cohort study. &lt;i&gt;J Intern Med&lt;/i&gt;. 2026;299:381–397. https://doi.org/10.1111/joim.70063&lt;/p&gt;&lt;p&gt;In this article, there were errors in the text of the Methods and Results sections, Tables 2 and 5, Figs. 4 and 5, the References section, and Supporting Information.&lt;/p&gt;&lt;p&gt;In Paragraph 1 of the “Adjustment variables” subsection in the “Methods” section, the text “year of the index date (categorized into 2013–2016, 2017–2019, and 2022–2022)” was incorrect. This should have read: “year of the index date (categorized into 2013–2016, 2017–2019, and 2020–2022).”&lt;/p&gt;&lt;p&gt;In Paragraph 1 of the “Adjustment variables” subsection in the “Methods” section, the text “the number of hospitalizations during the 12 months preceding the index date (categorized as 0, 1, 2, and &gt;3)” was incorrect. This should have read: “the number of hospitalizations during the 12 months preceding the index date (categorized as 0, 1, 2, and ≥3).”&lt;/p&gt;&lt;p&gt;In Paragraph 1 of the “Incidence of VTE among new users of NSAIDs and acetaminophen” subsection in the “Results” section, the text “1504 patients (0.022%)” was incorrect. This should have read: “1504 patients (0.021%).”&lt;/p&gt;&lt;p&gt;In the second row and fourth column of “Table 2,” the text “0.015% (0.0014%–0.0017%)” was incorrect. This should have read: “0.015% (0.014%–0.017%).”&lt;/p&gt;&lt;p&gt;In the second row and fifth column of “Table 2,” the text “0.022% (0.0019%–0.0025%)” was incorrect. This should have read: “0.022% (0.019%–0.025%).”&lt;/p&gt;&lt;p&gt;The corrected Table 2 is below:&lt;/p&gt;&lt;p&gt;In the fourth row and first column of “Table 5,” the text “COX-selective NSAID vs. nonselective NSAID users” was incorrect. This should have read: “COX-2 inhibitor vs. nonselective NSAID/COX-1 inhibitor users.”&lt;/p&gt;&lt;p&gt;In the second row and second column of “Table 5,” the text “181/642,326 (0.028%) vs. 652/2,728,202 (0.024%)” was incorrect. This should have read: “181/642,507 (0.028%) vs. 652/2,728,202 (0.024%).”&lt;/p&gt;&lt;p&gt;In the fourth row and second column of “Table 5,” the text “181/642,326 (0.028%) vs. 616/3,278,096 (0.019%)” was incorrect. This should have read: “181/642,507 (0.028%) vs. 616/3,278,096 (0.019%).”&lt;/p&gt;&lt;p&gt;The corrected Table 5 is below:&lt;/p&gt;&lt;p&gt;In the number indicating the number at risk for the non-user group at Day 45 of “Fig. 4,” the text “31,295,311” was incorrect. This should have read: “31,295,313.”&lt;/p&gt;&lt;p&gt;The corrected Fig. 4 is below:&lt;/p&gt;&lt;p&gt;In the numbers indicating the number at risk for the acetaminophen group in the upper right panel of “Fig. 5,” the text “3,003,149 3,992,656 2,981,159 3,967,930 2,953,709” was incorrect. This should have read: “3,003,149 2,992,656 2,981,159 2,967,930 2,953,709.”&lt;/p&gt;&lt;p&gt;In the title of the lower left panel of “Fig. 5,” the text “COX-2 inhibitors vs. nonselective NSAIDs/COX-2 inhibitors” was incorrect. This should have read: “COX-2 inhibitors vs. nonselective NSAIDs/CO","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"300 1","pages":"101-104"},"PeriodicalIF":9.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.70109","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147925169","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":"Immune endotypes in tuberculosis: Keys to decoding disease complexity.","authors":"Shamila D Alipoor, Julia Guthrie, Lina Davies Forsman, Andrew R Di Nardo, Susanna Brighenti","doi":"10.1111/joim.70092","DOIUrl":"10.1111/joim.70092","url":null,"abstract":"<p><p>Tuberculosis (TB) remains a major global health challenge, with multi-drug antibiotic regimens as the current standard of care. While effective at killing Mycobacterium tuberculosis, these treatments do not resolve persistent inflammation, prevent lung damage, or reverse immune dysregulation that contribute to poor outcomes and disease recurrence. Precision medicine offers a promising alternative but requires deeper insight into disease mechanisms to enable tailored interventions. This comprehensive review introduces the concept of immune endotyping to define the underlying disease mechanisms as tools to decode clinical and immunological heterogeneity in TB. TB displays a wide spectrum of clinical phenotypes, from latent or asymptomatic infection to mild or severe disease with characteristic non-cavitary or cavitary lung pathology. Instead, distinct immune endotypes capture the diverse biological pathways that shape disease progression and treatment response. Similar clinical presentations may arise from different immune dysfunctions, underscoring the need to move beyond broad phenotypic classifications. Advances in multi-omics and computational analyses uncover immune signatures that enable stratification for host-directed therapies (HDTs) targeting hyperinflammation, immunosuppression, coagulopathy or metabolic exhaustion. Integrating clinical, radiological, and immunological data through multimodal profiling is essential for developing personalized interventions. We also explore how endotyping has transformed treatment in other diseases, offering valuable insights for TB. Additionally, we present examples of how putative immune endotypes may be targeted with appropriate HDTs. In summary, this review underscores the potential of immune endotypes to advance precision medicine in TB, moving beyond one-size-fits-all treatment to improve outcomes, especially in severe and drug-resistant cases.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":"670-693"},"PeriodicalIF":7.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147607713","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":"High cholesterol absorption efficiency enhances proatherogenic properties of low-density lipoprotein particles.","authors":"Katariina Öörni, Lauri Äikäs, Maija Ruuth, Feven Tigistu-Sahle, Reijo Käkelä, Ingmar Wester, Helena Gylling, Piia Simonen","doi":"10.1111/joim.70085","DOIUrl":"10.1111/joim.70085","url":null,"abstract":"<p><strong>Background and aims: </strong>High cholesterol absorption efficiency is determined by genetic variation in small intestinal sterol transporters and affects one-third of individuals. Their risk for atherosclerotic cardiovascular disease (ASCVD) is increased compared with low cholesterol absorbers, despite similar serum lipid concentrations. We investigated the association of cholesterol absorption efficiency with proatherogenic properties of low-density lipoproteins (LDLs).</p><p><strong>Methods: </strong>The study cohort consisted of 90 middle-aged participants, 56 females and 34 males, without lipid-lowering therapy or ASCVD. They were divided into low (n = 45) and high (n = 45) cholesterol absorbers by the median value of serum cholestanol to cholesterol ratio. LDL aggregation susceptibility and binding of lipoproteins to proteoglycans were determined as biomarkers of lipoprotein atherogenicity. Nuclear magnetic resonance spectroscopy, mass spectrometry, and gas-liquid chromatography were used to determine lipoprotein subclass profile, LDL lipidome, and serum concentrations of cholesterol and noncholesterol sterols, respectively.</p><p><strong>Results: </strong>Age, dietary cholesterol, and serum total cholesterol or lipoprotein cholesterol levels did not differ between the groups. In the high absorbers, LDL particles were larger, and LDL aggregation susceptibility and the binding of lipoproteins to proteoglycans were increased in the low absorbers. Of LDL surface lipids, sphingomyelin 42:3;O2, and phosphatidylcholine (PC) 32:0 correlated positively, whereas PC 32:1 correlated negatively with serum cholestanol levels. These LDL surface lipids were also associated with increased LDL aggregation susceptibility and proteoglycan-binding.</p><p><strong>Conclusions: </strong>The present findings suggest that increased proatherogenic properties in high cholesterol absorbers may contribute to increased ASCVD risk.</p><p><strong>Registration: </strong>https://clinicaltrials.gov/study/NCT01315964.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":"711-725"},"PeriodicalIF":7.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147607686","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 \"Identifying subjects at risk of liver cirrhosis via a range of thresholds for common fibrosis markers: A Welsh general population-based cohort study\".","authors":"","doi":"10.1111/joim.70090","DOIUrl":"10.1111/joim.70090","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":"781"},"PeriodicalIF":7.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147571393","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":"Poor long-term cardiovascular risk factor management after acute coronary syndrome: An observational cohort study.","authors":"Jessica Schubert, Maria K Svensson, Margret Leosdottir, Bertil Lindahl, Håkan Melhus, Elin Täufer Cederlöf, Nina Johnston, Thomas Cars, Emil Hagström","doi":"10.1111/joim.70086","DOIUrl":"10.1111/joim.70086","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular risk factor control reduces the risk of recurrent events after acute coronary syndrome (ACS). Long-term post-ACS management is poorly studied.</p><p><strong>Objectives: </strong>To assess frequency of low-density lipoprotein cholesterol (LDL-C) and systolic blood pressure (SBP) monitoring and target achievement during 3 years post-ACS.</p><p><strong>Methods: </strong>Data from all patients hospitalized for ACS in Uppsala between 2012 and 2020 were obtained from electronic health records (EHRs). The probability of measurement and target achievement was estimated with adjusted regression models. Associations were assessed for sex, participation in cardiac rehabilitation (CR), presence of diabetes with nurse-led follow-up and documentation of an ICD-10 code for chronic ischaemic heart disease in the EHR.</p><p><strong>Results: </strong>Among 6083 patients (median age 73 years, 34% female), follow-up data were available for 72% in year 1, 56% in year 2 and 44% in year 3. Year 3 LDL-C was not measured in 48% of patients, and 19% were at target (<1.8 mmol/L). For SBP, 16% lacked a measurement, and 50% were at target (<140 mmHg). Female sex was associated with lower probability of having LDL-C measured or having LDL-C or SBP at target. CR participation, structured diabetes follow-up or having a chronic ischaemic heart disease code in the EHR was associated with a higher probability of LDL-C and SBP measurements at 2 and 3 years.</p><p><strong>Conclusions: </strong>Lack of measurement and low risk factor achievement highlight missed opportunities in secondary prevention. Female sex, lack of structured follow-up and the absence of diagnostic labelling were associated with less frequent monitoring and poorer risk factor control.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":"726-740"},"PeriodicalIF":7.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483957","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":"Depression following the initiation of glucagon-like-peptide-1 receptor agonist therapy: A multinational self-controlled case series study.","authors":"Vincent Ka Chun Yan, Zi-Yang Peng, Vincent Kai Chung Wong, Ian Chi Kei Wong, Esther Wai Yin Chan, Huang-Tz Ou, Eric Yuk Fai Wan","doi":"10.1111/joim.70098","DOIUrl":"10.1111/joim.70098","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":"776-780"},"PeriodicalIF":7.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147687474","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":"Individualized management of primary hyperparathyroidism.","authors":"Jens Bollerslev, Filomena Cetani, Neil Gittoes, Lars Rolighed","doi":"10.1111/joim.70089","DOIUrl":"10.1111/joim.70089","url":null,"abstract":"<p><p>Primary hyperparathyroidism (PHPT) is a common endocrine disease that typically presents in peri- and postmenopausal women. PHPT is due to a single parathyroid adenoma in most cases, which leads to stable hypercalcemia over years. Nowadays, the diagnosis is often coincidental, reached by chance in subjects without specific symptoms-asymptomatic PHPT. However, the patients might have subtle disease-related manifestations. Management standards have been reviewed through international workshops over more than three decades, leading to absolute and relative indications for parathyroidectomy (PTX), the only curative treatment. The alternative to PTX is observation without intervention in asymptomatic patients without organ manifestations and only mildly elevated calcium levels (mild PHPT). On the basis of recent literature, our aim is to challenge current recommendations for managing PHPT with focus on mild asymptomatic disease, integrating informed patient preferences. Considering the changing patient demography with increasing life expectancy, more sensitive visualization procedures, improved surgical techniques, and new data on PHPT-related morbidity, we test some of the established indications for PTX, particularly age as an isolated criterion, and the validity of a circulating calcium \"threshold\" for considering PTX. Additionally, bone mineral density (BMD) decreases for at least a decade with observation in contrast to PTX, where BMD normalizes after surgery and remains stable in the axial compartments for years. Therefore, skeletal-related thresholds for PTX also deserve review. In conclusion, we suggest integrating more clinical outcomes and wider perspectives in decision-making for the management of mild PHPT, taking patient preferences into consideration, and focusing on informed and shared decision-making.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":"650-669"},"PeriodicalIF":7.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621167","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}