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Heart-kidney-metabolism-related diseases get new name
A synopsis of the evidence for the science and clinical management of cardiovascular-kidney-metabolic (CKM) syndrome: a scientific statement from the American Heart Association; Circulation, Oct. 9, 2023.
Touting it as a novel approach for preventing and diagnosing heart disease, the American Heart Association (AHA) announced a new term — cardiovascular-kidney-metabolic syndrome, or CKMS — to describe the connection between heart and kidney diseases, Type 2 diabetes and obesity.
CKMS’s “discoverers” believe this information will allow them to predict the 10- and 30-year risk of heart disease for young people with CKMS, and point to ways to treat the “syndrome.”
The AHA advisory statement did not mention specific therapies.
CKMS categorizes cases according to whether patients have kidney disease, or a metabolic issue like obesity or diabetes, in addition to heart problems.
The CKMS rating scale begins at 0, where prevention has the greatest benefit, to stage 4, the highest-risk cases with established, advanced heart and kidney diseases.
People with stage 1 CKMS have no symptoms other than being overweight with impaired blood sugar processing or pre-diabetes. Lifestyle changes and screening for high blood pressure, cholesterol and blood sugar are the most appropriate interventions during state 1.
Individuals at stage 2 already have Type 2 diabetes, high blood pressure, high triglycerides (blood fats) or kidney disease and are therefore at higher risk. Stage 2 goals involve lowering those risk factors to prevent full-blown heart and kidney disease.
By stage 3, patients have symptomless heart disease with kidney disease but not kidney failure. People with stage 4 CKMS have symptomatic heart disease with or without kidney failure.
In an interview with AHA’s media office, Dr. Chiadi Ndumele, a cardiologist at Johns Hopkins Medicine and study author said:
“The advisory addresses the connections among these conditions with a particular focus on identifying people at early stages of CKM syndrome. Screening for kidney and metabolic disease will help us start protective therapies earlier to most effectively prevent heart disease and best manage existing heart disease.”
Superbug ‘vaccine’ shows promise in mice
A protein-free vaccine stimulates innate immunity and protects against nosocomial pathogens; Science Translational Medicine, Oct. 4, 2023.
A paper in Science Translational Medicine described a vaccine that can prevent hospital-based infections that sicken 2 million U.S. patients annually, kill about 100,000, and cost the U.S. economy more than $40 billion.
Researchers at the University of Southern California Keck School of Medicine tested their vaccine in mice and showed it was effective against six antibiotic-resistant bacteria that commonly cause infections in hospital patients. It also worked against two common hospital-acquired fungal infections.
The novel immune stimulant used in the study contained just three ingredients: aluminum hydroxide, an inedible salt used as an immune stimulant in vaccines for more than 70 years; monophosphoryl lipid A, a fat-like substance from bacteria used to strengthen the immune response to cancer vaccines; and fungal mannan, a starch-like material that stimulates immune cells.
The USC discovery contains no proteins, peptides, genes, living or dead organisms or substances such as antibodies that recognize disease-causing bacteria. And since it contains adjuvants with no antigen, it is not properly a vaccine but rather an adjuvant cocktail.
Adjuvants are irritants vaccine-makers add to their products to prime the immune system to create defenses against microbial invaders.
The preparation was effective 24 hours after the shot and protected for 28 days. A second dose — a booster — provided additional immunity.
If the vaccine is approved, the developers believe hospital patients might take one shot for several-week-long immunity, and a booster if needed when the initial shot’s protection wears off.
Adults can develop Type 1 ‘juvenile’ diabetes, too
Age at diagnosis in U.S. adults with type 1 diabetes; Annals of Internal Medicine, Sept. 26, 2023.
A new study reveals that Type 1 “juvenile” diabetes (Type 1), long considered a childhood disease, often goes undiagnosed or is misdiagnosed as Type 2 “adult onset” diabetes (tTpe 2) in adults.
Published in in Annals of Internal Medicine, the reseach found over a third of surveyed Type 1 patients were not diagnosed until age 30 or later. Since Type 1 and Type 2 diabetes require different treatment strategies, many patients may receive inappropriate or delayed care.
Led by Dr. Elizabeth Selvin, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, the study analyzed data from the National Health Interview Survey (NHIS) over six years, covering 1.3 million U.S. adults.
Of the 947 individuals with Type 1, 37% reported being diagnosed after age 30. This aligns with an earlier study showing a five-fold increase in Type 1 diabetes from ages 20 to 59, with most being adult-onset.
While Type 1 is associated with lower life expectancy, the impact of this diagnosis may diminish over time. A paper in The Lancet this month revealed that the risk of death from all causes for Type 2, relative to non-diabetics, falls sharply by increasing age at diagnosis. For example the added risk of 169% for an age 30-39 diagnosis falls to 84% for ages 50-59 and 39% for those diagnosed after age 70.
The same may hold true for Type 1.
In an interview with the American Journal of Managed Care, Selvin said that distinguishing Type 1 from Type 2 was the key issue:
“Our findings are consistent with American Diabetes Association guidelines that recommend following up with autoantibody testing when there is clinical suspicion of type 1 diabetes. Our results also suggest that more autoantibody testing may be needed in general practice in adults to help distinguish type 1 and type 2 diabetes.”
High blood pressure in youth predicts heart problems later
Blood pressure level in late adolescence and risk for cardiovascular events; Annals of Internal Medicine, Sept. 26, 2023.
High blood pressure (BP) in youth may signal serious health consequences later in life, according to a study in JAMA Opthalmology.
While high BP is a risk factor for heart attack and stroke in older adults, the long-term effects of slightly elevated BP in childhood and adolescence have been unclear.
A long-term Swedish study led by Dr. Helene Rietz of Umeå University examined data on men entering the military between 1969 and 1997. Researchers compared blood pressure values at conscription to hospitalizations and deaths from heart conditions and strokes later in life.
The findings suggest blood pressure issues that begin at a young age can result in serious health issues decades later.
Of the 1,366,519 subjects, average age 18.3, 28.8% had mildly elevated BP readings (120 to 129 diastolic and less than 80 mm Hg), and 53.7% had diastolic pressure above 130, which is clinical hypertension.
BP is reported as two numbers: the larger (first) “diastolic” number measures BP when your heart is pumping; the smaller (second) “systolic” reading is BP between beats when the heart is at rest.
Over an average 35.9-year follow-up period 79,644 subjects (5.8%) experienced a significant heart-health event. Both the frequency and severity of events depended on initial BP readings.
Adenovirus vaccines cause blood disorders, too
Fibrinogenolysis and fibrinolysis in vaccine-induced immune thrombocytopenia and thrombosis; Journal of Thrombosis and Haemostasis, Sept. 19, 2023.
A study in the Journal of Thrombosis and Haemostasis linked vaccine-induced immune thrombocytopenia and thrombosis (VITT) — blood clots and bleeding disorders — to AstraZeneca’s adenovirus-based COVID-19 vaccine.
Researchers led by Dr. Nicola Mutch at the University of Aberdeen, U.K. were looking for ways to identify VITT patients rapidly, as the condition arises unexpectedly and accurate diagnosis through blood and imaging tests is essential for successful treatment with anti-clotting medicines.
The study analyzed blood from 18 suspected VITT cases, finding that 11 of 18 met VITT diagnostic criteria, while 7 were ruled negative. They based their diagnosis on signs of blood clots forming in various tissues, higher inflammation levels, and lower levels of fibrinogen and factor XIII — two proteins that help the blood manage blood clots.
Nine of 11 VITT patients experienced excess bleeding.
Patients with VITT had low platelet counts, meaning their blood did not clot properly, while levels among patients without VITT were normal. D-dimer levels were higher than normal, indicating an ongoing process of clot formation and dissolution. VITT-affected subjects had multiple clots, while very few non-VITT patients had them.
Results confirmed the investigators’ assumption that VITT was an inflammatory condition, with blood levels of several inflammation signals significantly elevated in patients with VITT compared with healthy subjects.
