American journal of medicine open最新文献

{"title":"Risk of Heart Failure-related Events in Patients Exposed to Medical Cannabis: A Longitudinal Cohort Study","authors":"Cerina Dubois PhD ,&nbsp;Dean T. Eurich PhD ,&nbsp;Jason R.B. Dyck PhD ,&nbsp;Elaine Hyshka PhD ,&nbsp;John G. Hanlon MD ,&nbsp;Arsene Zongo PhD","doi":"10.1016/j.ajmo.2025.100120","DOIUrl":"10.1016/j.ajmo.2025.100120","url":null,"abstract":"<div><h3>Objective</h3><div>This study examined the association between the authorized prescription of cannabis and heart failure (HF) events.</div></div><div><h3>Study design</h3><div>We conducted a retrospective cohort study of patients who received an authorized prescription of cannabis in Ontario cannabis clinics between 2014-2019 and controls selected from the general population of Ontario.</div></div><div><h3>Methods</h3><div>Ontario’s health administrative data and clinical data from the cannabis clinics were used. Inverse probability of treatment weights based on propensity scores were used to minimize confounding between cannabis exposure and the study outcomes. Weighted Cox proportional hazards regressions measured the association between exposure to cannabis and ED/hospitalization for HF (primary outcome), and a secondary outcome that extended the primary outcome by including physician claims for HF.</div></div><div><h3>Results</h3><div>Among 54,006 patients exposed to cannabis and 161,265 controls, 39% were aged ≤ 50 years, and 55% were female. For the primary outcome, incidence rates for ED visits/hospitalization due to HF were 5.87/1000 person-years (95%CI: 5.72-6.03) in the cannabis group and 5.14/1000 person-years (5.05-5.22) in the control group.</div><div>Patients exposed to cannabis had a higher risk for the primary outcome with a hazard ratio of 1.15 (95%CI: 1.06-1.25). For the secondary outcome, incidence rates were 18.99 (95% CI: 18.55-19.44) in the cannabis group and 16.69 (95% CI: 16.46-16.93) for controls; with a hazard ratio of 1.13 (95% CI: 1.08-1.19).</div></div><div><h3>Conclusions</h3><div>The results suggest a higher risk of heart failure-related events, including emergency department visits, hospitalizations, and outpatient consultations, among patients who were authorized cannabis for medical purposes.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"15 ","pages":"Article 100120"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Comorbidities on Colorectal Cancer Screening Participation and Mortality","authors":"Rachel Corren ,&nbsp;Sylvia La ,&nbsp;Edgar Corona ,&nbsp;Dalia Martinez ,&nbsp;Urmimala Sarkar ,&nbsp;Blake Gregory ,&nbsp;Uri Ladabaum ,&nbsp;Ma Somsouk","doi":"10.1016/j.ajmo.2025.100123","DOIUrl":"10.1016/j.ajmo.2025.100123","url":null,"abstract":"<div><h3>Aims</h3><div>Organized screening programs improve colorectal cancer (CRC) screening participation, but outreach services can be improved. We sought to understand screening deferral by examining patient-level factors and how they relate to fecal immunochemical test (FIT) orders, completion rates, and long-term mortality.</div></div><div><h3>Methods</h3><div>Patients aged 50-75 years who were not up to date with CRC screening receiving usual care were followed over time (NCT02613260). Patient-level laboratory and cancer registry data were used to identify patients who met a specified laboratory threshold: albumin &lt; 3 g/dL, HIV viral load &gt; 10,000 copies or CD4 &lt; 200 cells/µL, creatinine &gt; 4 mg/dL, platelets &lt; 100,000/µL, total bilirubin &gt; 4 µmol/L, NH3 &gt; 20, positive urine amphetamine or cocaine, serum ethanol &gt; 80, hemoglobin A1C &gt; 10%, and stage 3 or 4 cancer. The proportion of patients with a FIT order, FIT completion in 1-year, and mortality at 8-years were compared in patents with and without the lab abnormality.</div></div><div><h3>Results</h3><div>Nine thousand six hundred seventy-six patients were eligible for screening, of which 1053 met the criteria for laboratory abnormalities. Patients with laboratory abnormalities were less likely to have a FIT order placed (39.5% vs 66.8%, <em>P</em> &lt; .001) and were less likely to complete FIT screening (21.5% vs 51.6%, <em>P</em> &lt; .001). Moreover, patients with laboratory abnormalities experienced higher mortality at 8-year follow-up (32.6% vs 6.7%, <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Patients with laboratory abnormalities were less likely to have a FIT order placed and completed, and experienced higher mortality, suggesting that screening was deferred by providers. Future studies should gather provider input to understand how patient-level electronic data could be considered in the implementation of screening services.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"15 ","pages":"Article 100123"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appropriateness, feasibility, and adoption of a nurse-driven CIWA-Ar symptom-triggered protocol for alcohol withdrawal syndrome in New York City public hospitals","authors":"Carla King MPH ,&nbsp;Michael S. Shen MD ,&nbsp;Jaycee Bayani RN ,&nbsp;Daniel Schatz MD","doi":"10.1016/j.ajmo.2025.100122","DOIUrl":"10.1016/j.ajmo.2025.100122","url":null,"abstract":"<div><h3>Background</h3><div>Effective management of alcohol withdrawal syndrome during hospitalization is paramount to patient safety and quality care. NYC Health + Hospitals initiated a quality improvement project to pilot an electronic health record (EHR) integrated, nurse-driven CIWA-Ar symptom-triggered protocol, including recommendations for medications for alcohol use disorder (MAUD), in medical and surgical units at 3 public hospitals.</div></div><div><h3>Objective</h3><div>To describe implementation processes and to report related implementation outcomes (appropriateness, feasibility, and adoption) of the updated CIWA-Ar protocol in a safety net hospital setting.</div></div><div><h3>Methods</h3><div>NYC Health + Hospitals implemented a standardized CIWA-Ar symptom-triggered, nurse-driven EHR protocol on March 15, 2022. The protocol included order sets, practice advisories, task lists, and reminders for assessments and orders. We measured nursing perspectives on feasibility and appropriateness at 6 months via a survey. We measured provider adoption as the proportion of admissions with a CIWA-Ar protocol ordered among admissions that triggered a recommendation, and MAUD use as the proportion of admissions with a MAUD order during hospitalization among all patients with a protocol ordered.</div></div><div><h3>Results</h3><div>During 13 months of implementation, providers ordered a CIWA-Ar protocol for 59.1% (n = 887/1500) of recommended admissions. Adoption increased over time from 46.0% in month 1 to 63.2%-78.9% in months 11 to 13 (<em>P</em> = .0004). Most nurses agreed that the protocol was suitable, fitting for medicine, easy to use, and improved clinical care for patients experiencing alcohol withdrawal syndrome. MAUD was ordered in 19.2% of admissions, however, did not change over the course of implementation (<em>P</em> = .249).</div></div><div><h3>Conclusions</h3><div>The CIWA-Ar protocol was appropriate, feasible, and adopted at NYC public hospitals. Quality improvements to ensure protocol fidelity with benzodiazepine dosing and MAUD prescribing are needed.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"15 ","pages":"Article 100122"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inpatient NSAID Exposure and Development of Acute Kidney Injury in Medical Inpatients: A Retrospective Cohort Study","authors":"Katie M. Rieck ,&nbsp;Darrell R. Schroeder ,&nbsp;Michael A. Mao","doi":"10.1016/j.ajmo.2025.100119","DOIUrl":"10.1016/j.ajmo.2025.100119","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the risk of hospital-acquired acute kidney injury after nonsteroidal anti-inflammatory drug (NSAID) administration in the general medical population.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study conducted at an academic medical center (Mayo Clinic, Rochester, MN) that included all general care medical patients for 2 years. Patients were analyzed in a propensity-adjusted approach using inverse probability of treatment weighting (IPTW) according to NSAID exposure on hospital day 0 or 1 categorized as follows: (1) no NSAID exposure; (2) only low-dose aspirin; (3) topical exposures, or (4) systemic NSAIDs.</div></div><div><h3>Results</h3><div>A total of 17,885 patients met the initial inclusion criteria, and 11,840 were included in the study. The systemic NSAID cohort were the healthiest and youngest patients at baseline with fewer comorbidities. After adjustment, there was no significant difference seen in the rate of AKI (using the inverse probability of treatment weighting) between cohorts. The odds ratio of hospital-acquired AKI was 1.16 (0.80-1.70) in the Low-dose Aspirin group, 0.65 (0.21-2.03) in the Topical group, and 0.82 (0.27-1.85) in the Systemic NSAID group, with the No NSAID serving as the reference. Adjusted AKI incidence was 3.4% with No NSAIDs, 3.9% with Low-dose Aspirin, 2.2% with Topicals, and 2.8% with Systemic NSAIDs. These differences were not statistically significant.</div></div><div><h3>Conclusion</h3><div>This study provides evidence that carefully selected hospitalized patients may be able to receive NSAIDs without increasing their AKI risk. This increases options for the treatment of pain, which may improve patient satisfaction and decrease opioid-related complications. Further prospective research is required to verify the findings of our study.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"15 ","pages":"Article 100119"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145718976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Resident Note Documentation: A Quality Improvement Initiative to Accurately Capture Patient Complexity","authors":"De-Vaughn Williams MD,&nbsp;Scott Keller MHA,&nbsp;Jennifer Mcentee MD, MPH, MAEd,&nbsp;Escher Howard-Williams MD,&nbsp;Cristin M. Colford MD","doi":"10.1016/j.ajmo.2025.100104","DOIUrl":"10.1016/j.ajmo.2025.100104","url":null,"abstract":"<div><div>Provider notes serve as a critical component of physician workflow, documenting essential aspects of patient care while also fulfilling regulatory and billing requirements. With increasing documentation complexity introduced by the Centers for Medicare and Medicaid Services and the 2021 mandate for open access to clinical notes, physicians in training must develop skills to accurately document patient complexity. This quality improvement initiative aimed to enhance inpatient note documentation by internal medicine residents, focusing on improving the capture of medical complexity in coding and billing standards.</div><div>Our intervention included the development and implementation of a standardized progress note template, a structured scoring rubric, multidisciplinary rounds and curriculum integrating faculty and peer-led feedback. The study measured documentation improvements through rubric scores, Length of Stay Index (LOSi), and complications or comorbidities (CC) and major complications or comorbidities (MCC) capture rates.</div><div>Results demonstrated improvements in LOSi and enhanced CC/MCC capture, leading to improved institutional performance metrics. This initiative highlights the necessity of integrating formal note-writing training within residency curricula to meet evolving documentation demands.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100104"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144262157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring Patient-Reported Outcomes in Ischemic Heart Disease: Validation of the Greek HeartQoL Questionnaire","authors":"Ioanna Dimitriadou ,&nbsp;Christi Deaton ,&nbsp;Evangelos C. Fradelos ,&nbsp;John Skoularigis ,&nbsp;Ioannis Vogiatzis ,&nbsp;Evangelos Sdogkos ,&nbsp;Aikaterini Toska ,&nbsp;Eleni Tsiara ,&nbsp;Anastasios Christakis ,&nbsp;Dimitra Anagnostopoulou ,&nbsp;Maria Saridi","doi":"10.1016/j.ajmo.2025.100098","DOIUrl":"10.1016/j.ajmo.2025.100098","url":null,"abstract":"<div><h3>Background</h3><div>The Greek HeartQoL questionnaire is designed to assess health-related quality of life (HRQoL) in patients with ischemic heart disease.</div></div><div><h3>Objectives</h3><div>This study aims to validate its psychometric properties in Greek patients diagnosed with angina pectoris, myocardial infarction, and ischemic heart failure.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted with 158 patients from five clinical sites in Greece. Participants completed the Greek HeartQoL, the Short Form-36 Health Survey, and the Hospital Anxiety and Depression Scale. Psychometric evaluations included Mokken scale analysis, reliability testing with Cronbach's alpha, and validity assessments through Spearman correlation coefficients, and analysis of covariance.</div></div><div><h3>Results</h3><div>The Greek HeartQoL exhibited excellent internal consistency, with Cronbach's alpha values exceeding 0.90. Factor analysis confirmed the questionnaire's two-factor structure, effectively capturing physical and emotional dimensions of HRQoL. Convergent validity was demonstrated by strong correlations with Short Form-36 Health Survey (<em>r</em> &gt; 0.70), and discriminative validity was confirmed by significant differences in HRQoL scores between patients with angina pectoris, myocardial infarction, and ischemic heart failure (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>The findings suggest that the Greek HeartQoL demonstrates strong reliability and validity in assessing HRQoL in Greek ischemic heart disease patients. However, further studies with larger and more diverse samples are needed to confirm its psychometric properties across different clinical populations.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100098"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association of SGLT2i vs DPP4i on Fracture: A Cohort Study in Veterans with Diabetes","authors":"Kathryn Snyder MD, MPH ,&nbsp;Katherine Griffin MPH ,&nbsp;Amber Hackstadt PhD ,&nbsp;Amir Javid PhD ,&nbsp;Adriana Hung MD, MPH ,&nbsp;Robert Greevy PhD ,&nbsp;Christianne L. Roumie MD, MPH","doi":"10.1016/j.ajmo.2025.100105","DOIUrl":"10.1016/j.ajmo.2025.100105","url":null,"abstract":"<div><h3>Background</h3><div>Increased bone turnover is associated with use of SGLT2i. Patients with diabetes experience adverse effects on bone metabolism. Our aim was to evaluate if SGLT2i was associated with fractures vs DPP4i as add-on therapy to diabetes regimens.</div></div><div><h3>Methods</h3><div>We assembled a retrospective cohort of Veterans with diabetes combining Veterans Administration, Medicare, and National Death Index databases. Using an active comparator new user design, patients starting on SGLT2i or DPP4i were followed from prescription fill until a fracture event, death, stopping medication, loss of follow-up, or study end. Fractures included: face/skull, spine, ribs, long bones, hand/feet/digits, or hip. Fractures were identified based on a validated algorithm with positive predictive value 91.3% (86.8, 94.4). Cox models compared the association of fractures between SGLT2i and DPP4i in a propensity score-weighted cohort that balanced 70+ covariates including comorbidities, vital signs, labs, vitamin D levels, smoking, and medications.</div></div><div><h3>Results</h3><div>The unweighted sample included 115,124 SGLT2i episodes (104,086 Veterans; 94% empagliflozin; 4% canagliflozin; 2% dapagliflozin) and 213,095 DPP4i episodes (173,724 Veterans; 45% saxagliptin; 15% sitagliptin; 34% alogliptin; 6% Linagliptin). After propensity score calculation and matched weighting, the cohort included 76,072 SGLT2i and 75,833 DPP4i episodes. Median age was 69.3 years and diabetes duration 9.7 (6.1, 14.0) years. In the matched weighted analyses, there were 1431 and 1564 fractures among SGLT2i and DPP4i users, respectively. There were no clinical differences in fractures per 1000 person-years: 18.2 (17.4, 19.1) vs 19.8 (19.0, 20.6). The adjusted hazard ratio (adjusted hazard ratio 0.93 [0.87, 0.99]) excluded increased risk of fractures (adjusted hazard ratio &gt; 1) in SGLT2i users.</div></div><div><h3>Conclusions</h3><div>SGLT2i use as add-on treatment for diabetes was not associated with increased fracture outcomes compared to DPP4i.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100105"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Statistical Data Replace Pathophysiologic Rationale?: A Belated Question for the Second Quarter of the 21st Century","authors":"Masis Perk","doi":"10.1016/j.ajmo.2025.100110","DOIUrl":"10.1016/j.ajmo.2025.100110","url":null,"abstract":"","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100110"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144634096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypermobile Ehlers-Danlos Syndrome: Cerebrovascular, Autonomic and Neuropathic Features","authors":"Peter Novak MD, PhD ,&nbsp;David M. Systrom MD ,&nbsp;Sadie P. Marciano PA-C ,&nbsp;Alexandra Witte PA-C ,&nbsp;Arabella Warren MD, PhD ,&nbsp;Donna Felsenstein MD ,&nbsp;Matthew P. Giannetti MD ,&nbsp;Matthew J. Hamilton MD ,&nbsp;Jennifer Nicoloro-SantaBarbara PhD ,&nbsp;Mariana Castells MD ,&nbsp;Khosro Farhad MD ,&nbsp;David M. Pilgrim MD ,&nbsp;William J. Mullally MD ,&nbsp;Mark C. Fishman MD ,&nbsp;Jeff M. Milunsky MD ,&nbsp;Aubrey Milunsky MD ,&nbsp;Joel Krier MD","doi":"10.1016/j.ajmo.2025.100111","DOIUrl":"10.1016/j.ajmo.2025.100111","url":null,"abstract":"<div><h3>Background</h3><div>Hypermobile Ehlers-Danlos syndrome (hEDS) affects multiple systems, but comprehensive evaluations of a larger sample of hEDS patients are lacking. The objective of this study was to describe cerebrovascular, autonomic, and neuropathic features of hEDS.</div></div><div><h3>Methods</h3><div>This retrospective case-control study was conducted at Brigham and Women’s Faulkner Hospital between 2016-2023. Data from hEDS patients who completed autonomic testing and skin biopsies were analyzed. Outcome measures include validated surveys (Survey of Autonomic Functions, Neuropathy Total Symptom Score-6 (SAS)) and autonomic function testing (Valsalva maneuver, deep breathing, head-up tilt and sudomotor), cerebrovascular (cerebral blood flow velocity (CBFv) in the middle cerebral artery), respiratory (capnography), and neuropathic (skin biopsies for assessment of small fiber neuropathy) testing and inflammatory/ autoimmune markers.</div></div><div><h3>Results</h3><div>Total 270 hEDS patients were analyzed and compared to 29 healthy controls. Common hEDS complaints (prevalence &gt; 90% ) were orthostatic sudomotor, vasomotor, gastrointestinal, and pain. Orthostatic cerebral blood flow velocity was reduced in 79% of hEDS and correlated with orthostatic dizziness. The head-up tilt test revealed postural tachycardia syndrome (prevalence 33%), hypocapnic cerebral hypoperfusion (22%), orthostatic cerebral hypoperfusion syndrome (18%), and neurogenic orthostatic hypotension (9%). Widespread but mild autonomic failure was present in 90% of hEDS patients on autonomic testing. Small fiber neuropathy using structural criteria was detected in 64%, and using combined structural and functional criteria in 82%.</div></div><div><h3>Conclusions</h3><div>This study provided evidence of cerebrovascular dysregulation with reduced orthostatic cerebral blood flow velocity associated with symptoms of cerebral hypoperfusion, frequent small fiber neuropathy, and widespread but mild autonomic failure in hEDS.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100111"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144827126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GLP-1 Receptor Agonists Initiation and Risk of Acute Pancreatitis and Pancreatic Cancer: A Real-World Comparative Study","authors":"Omar Faour MD ,&nbsp;Moheb Boktor MD ,&nbsp;Hanford Yau MD ,&nbsp;Mustafa Kinaan MD ,&nbsp;Ishak A Mansi MD","doi":"10.1016/j.ajmo.2025.100114","DOIUrl":"10.1016/j.ajmo.2025.100114","url":null,"abstract":"<div><h3>Background</h3><div>Glucagon-like peptide 1 receptor agonist (GLP-1RA) medications are widely used in managing type 2 diabetes because of their cardio-renal-metabolic benefits. However, concerns persist regarding their potential association with acute pancreatitis (AP) and pancreatic cancer. This study’s objective was to examine the association of GLP-1RAs with the risk of AP and pancreatic cancer.</div></div><div><h3>Methods</h3><div>This retrospective propensity score-matched cohort study used Veterans Health Administration national data during fiscal years 2006 to 2021. Using a new-user active comparator design, we included veterans who initiated either GLP-1RA or dipeptidyl peptidase-4 inhibitor (DPP-4i) medication, the latter as an active comparator. The primary outcomes were incident AP and pancreatic cancer. We excluded patients with a history of pancreatitis, pancreatic tumors, pancreatic congenital anomalies, and alcohol use. Secondary analysis included adjusting for confounders that may have been introduced during the follow-up period, such as gallbladder diseases, and <em>post hoc</em> analysis restricted analysis to people who had normal serum lipase during follow-up.</div></div><div><h3>Results</h3><div>We matched 88,972 pairs of GLP-1RA and DPP-4i users on all characteristics. AP was diagnosed in 214 (0.24%) DPP-4i users versus 273 (0.31%) GLP-1RA users (OR 1.28; 95% CI, 1.07-1.53), and pancreatic cancer was diagnosed in 154 (0.17%) DPP-4i users versus 211 (0.24%) GLP-1RA users (OR 1.37; 95% CI, 1.11-1.69). Secondary and <em>post hoc</em> analyses showed results consistent with the primary analysis.</div></div><div><h3>Conclusions</h3><div>GLP-1RAs are associated with a modest but statistically significant increase in the risk of AP and pancreatic cancer compared to DPP-4i.</div></div><div><h3>Clinical significance</h3><div>GLP-1RA use is associated with modestly increased odds ratio of acute pancreatitis and pancreatic cancer. Whereas the increased risk seems modest compared to their benefits as shown in the literature, vigilance is recommended, specifically, when GLP-1RAs are used for off label indications.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100114"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145046095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}