Wall Street increasingly believes U.S. drug regulators will approve Biogen 's (BIIB) latest experimental Alzheimer's treatment following the release of detailed late-stage clinical trial data. It's a development that may carry positive implications for Eli Lilly (LLY) because the Club holding is investigating a similar drug targeting the disease. Lecanemab — jointly developed by Biogen and Japanese pharmaceutical firm Eisai — "moderately" slowed cognitive and functional decline in early Alzheimer's patients who took the drug compared with placebo recipients, according to a New England Journal of Medicine review of the 18-month trial results. The full phase three trial results were published Tuesday, roughly two months after Biogen and Eisai released encouraging topline data from the Clarity AD study. While there are some concerns about lecanemab's safety, analysts at JPMorgan said the adverse events observed during the trial such as brain swelling appear "manageable." "BIIB/Eisai have already filed the drug for accelerated approval and we see results from Clarity AD supporting full approval for the product," the firm wrote in a note to clients Tuesday night. "Today's data also bodes well for LLY's donanemab," the analysts added. Donanemab is the name of Eli Lilly's Alzheimer's drug in its own late-stage trials. JPMorgan has a neutral (hold) rating on Biogen shares and an overweight (buy) rating on Eli Lilly shares. "Some points for debate around the edges, but data should further de-risk approval" for lecanemab, wrote Barclays analysts, who have the equivalent of a hold rating on Biogen shares. The analysts also note there are questions about the magnitude of lecanemab's clinical benefit. Shares of Massachusetts-based Biogen rose more than 5% on Wednesday. Lilly shares were higher in mid-afternoon trading. What it means for Eli Lilly Eli Lilly has a phase three trial underway for its donanemab Alzheimer's drug that is similar to lecanemab, which is why the Biogen-Eisai data has been interpreted as favorable for the Club holding. Eli Lilly's large-scale trial data is expected by the middle of next year. Alzheimer's is a progressive disease, meaning it worsens over time, and there is no available cure. However, both experimental treatments are intended slow the progression of Alzheimer's disease by reducing build up on the brain of amyloid beta protein . This approach has become known as the a-beta hypothesis. Clumps of the protein, known as amyloid plaques, are one of the key markers of Alzheimer's disease. The other primary marker are tangles of the tau protein . The accumulation of amyloid plaques and tau tangles in between neurons disrupts normal brain functioning. This leads to the destruction of brain cells, resulting in the loss of memory and thinking ability. The longstanding question among Alzheimer's researchers has been whether reducing the presence of amyloid plaques would actually slow the rate of cognitive decline. Previous drugs developed around the a-beta hypothesis — including those from Eli Lilly — have failed to meaningfully delay the disease's progression. Biogen and Eisai also jointly developed Aduhelm, the only drug targeting amyloid beta that has been approved by the Food and Drug Administration. However, significant concerns about its efficacy caused the federal government's Centers for Medicare & Medicaid Services (CMS) to sharply limit the drug's insurance coverage, making a commercial failure. Some believe the trial data for lecanemab data is much more convincing than Aduhelm and lend support to the a-beta hypothesis, bolstering hopes that Eli Lilly's latest drug may also slow the disease's progression. The Club take While Eli Lilly's Alzheimer's efforts are not central to our investment case, we do generally think that donanemab is a promising experimental therapy. ( We've written about it in the past — that much of our bullishness around Lilly has to do with its new type-2 diabetes drug Mounjaro getting additional approval as an obesity treatment.) Eli Lilly understandably tries to keep public expectations in line — after all, millions of people with Alzheimer's disease and their caregivers want there to be an effective drug — so we cannot be sure about donanemab's results until we actually see them sometime next year. Given a long history of failed amyloid-targeting drugs, it's important to keep expectations measured. At the same time, that's why we take news around Biogen and Eisai's lecanemab in stride. It's a much-needed incrementally positive development for other drugs predicated on the a-beta hypothesis, after the Aduhelm setback. In fact, Eli Lilly CEO Dave Ricks has said the topline data released by Biogen and Eiasi in September "certainly reinforce our confidence in donanemab." It's not about Lilly being first to market, but rather about whether these type of drugs can actually slow the memory-stealing disease. (Jim Cramer's Charitable Trust is long LLY. See here for a full list of the stocks.) As a subscriber to the CNBC Investing Club with Jim Cramer, you will receive a trade alert before Jim makes a trade. Jim waits 45 minutes after sending a trade alert before buying or selling a stock in his charitable trust's portfolio. If Jim has talked about a stock on CNBC TV, he waits 72 hours after issuing the trade alert before executing the trade. THE ABOVE INVESTING CLUB INFORMATION IS SUBJECT TO OUR TERMS AND CONDITIONS AND PRIVACY POLICY , TOGETHER WITH OUR DISCLAIMER . 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A pedestrian walks past Biogen Inc. headquarters in Cambridge, Massachusetts, on Monday, June 7, 2021.
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Wall Street increasingly believes U.S. drug regulators will approve Biogen's (BIIB) latest experimental Alzheimer's treatment following the release of detailed late-stage clinical trial data. It's a development that may carry positive implications for Eli Lilly (LLY) because the Club holding is investigating a similar drug targeting the disease.
The World Health Organization, or WHO, will officially begin using the term "mpox" instead of "monkeypox" after the Biden Administration pressured the international organization to change the name because of racial connotations associated with it.
On the international organization’s website, it says both names will be used simultaneously for a year until "monkeypox" is phased out.
Test tubes labeled "Monkeypox virus positive and negative" are seen in this illustration taken May 23, 2022. (REUTERS/Dado Ruvic/Illustration)
"When the outbreak of monkeypox expanded earlier this year, racist and stigmatizing language online, in other settings and in some communities was observed and reported to WHO," the organization said in a press release. "In several meetings, public and private, a number of individuals and countries raised concerns and asked WHO to propose a way forward to change the name."
The WHO is tasked with assigning names to diseases, whether new or existing. Through consultations with experts, countries, and the public, the WHO recommended that mpox be adopted as the new term in English for the disease, will become the preferred term after one year, and that "monkeypox" will remain as a searchable term for historical information.
Last week, the WHO announced it was set to change the name of "monkeypox" to "mpox" after senior Biden officials urged the WHO to make the change. The administration even reportedly threatened to adopt new terminology without the WHO’s approval.
According to the report, the Biden administration believed the name "monkeypox" carries an unnecessary stigma for people of color.
TUSTIN, CA - August 16: Families Together of Orange County held a monkeypox vaccine clinic in Tustin, CA on Tuesday, August 16, 2022. The Jynneos vaccine consists of two doses administered 28 days apart. ((Photo by Paul Bersebach/MediaNews Group/Orange County Register via Getty Images))
After the WHO’s announcement of the name change on Monday, the Biden Harris Administration announced its support for the change.
"We welcome the change by the World Health Organization," U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra said in a statement. "We must do all we can to break down barriers to public health, and reducing stigma associated with disease is one critical step in our work to end mpox."
In the same release, the administration said Human monkeypox first got its name in 1970, before the WHO published its best practices when naming diseases in 2015.
The best practices for naming new diseases should "minimize unnecessary negative impact of names on trade, travel, tourism or animal welfare, and avoid causing offense to any cultural, social, national, regional, professional or ethnic groups."
Health experts said the old nomenclature was imprecise, played into racist stereotypes and fueled stigmatization, making it harder to contain the most recent outbreaks.
The World Health Organization, responding to complaints that the word monkeypox conjures up racist tropes and stigmatizes patients, is recommending that the name of the disease be changed to mpox. Both names are to be used for a year until monkeypox is phased out.
The recommendation, issued on Monday, follows outbreaks that began about six months ago in Europe and United States, prompting widespread fears that the pathogen could spread widely across the globe.
The virus had quietly circulated in rural parts of Central Africa and West Africa for decades, but in recent months most of those who contracted the disease were men who had sex with men on other continents, compounding the stigma of a community long burdened by its association with AIDS.
The new name was the result of a monthslong review process that included experts from around the world and input from the general public.
“W.H.O. will adopt the term mpox in its communications, and encourages others to follow these recommendations, to minimize any ongoing negative impact of the current name and from adoption of the new name,” the health organization said in a statement.
Monkeypox was always a bit of a misnomer, because monkeys have almost nothing to do with the disease and its transmission. (Rats are the most likely animal reservoir for the virus.)
The name was inspired by a colony of caged lab monkeys in Denmark, where the virus was first identified by researchers more than a half-century ago. Since 2015, the W.H.O. has promoted new criteria for naming infectious diseases. According to the recommendations, names should aim to reduce unnecessary negative impact on travel, tourism or animal welfare, and “avoid causing offense to any cultural, social, national, regional, professional or ethnic groups.”
Critics said monkeypox reinforced ugly Western stereotypes about Africa as a reservoir of pestilence and sexually transmitted pathogens. Some critics said it also played into racist stereotypes, deeply rooted in American culture, that compare Black people to primates.
“Names matter, and so does scientific accuracy, especially for pathogens and epidemics that we are trying to control,” Tulio de Oliveira, a bioinformatician at Stellenbosch University in South Africa, said last summer as researchers campaigned for the W.H.O. to adopt a new name.
An open letter by Dr. de Oliveira and two dozen other African scientists warned that the failure to find less problematic nomenclature would hamstring efforts to contain the disease.
Critics also took aim at media coverage of the outbreak, noting that some Western outlets had initially selected photos of lesion-pocked Africans to illustrate an outbreak that was almost entirely affecting white men.
Before this year’s outbreak, human-to-human transmission in Africa was relatively uncommon, with most infections occurring in rural areas among people who had direct contact with wild animals. The disease can cause high fevers, painful rashes and lesions, but is seldom fatal.
“In the context of the current global outbreak, continued reference to and nomenclature of this virus being African is not only inaccurate but is also discriminatory and stigmatizing,” the letter said.
The word monkeypox will not disappear entirely. It will remain searchable in the International Classification of Diseases, allowing access to historical information about the disease, the W.H.O. said.
Despite its high-profile debut in the United States and in Europe, mpox has largely faded as a serious public health threat as cases have plummeted.
According to the Centers for Disease Control and Prevention, there have been 28,248 cases and 14 deaths since the outbreak first began last spring. In November, there were a dozen or so reported cases each day across the country, down from more than 400 cases last August.
Ultimately, the pathogen remained within a narrow demographic of gay and bisexual men, especially those with multiple partners.
The drop in new infections has been tied to a shift in sexual behavior, the widespread availability of vaccines, and a lucky break of sorts: The virus requires close contact to spread, making it easier to contain than its more deadly and transmissible viral cousin, SARS-CoV-2.
Summary:Previous TBI increased the risk of frontotemporal dementia in those without a genetic risk factor for FTD. Additionally, researchers found those with FTD tend to be less educated than those with Alzheimer’s disease.
Source:University of Eastern Finland
Two recent studies from the University of Eastern Finland show that educational background and previous traumatic brain injury may potentially affect the risk of frontotemporal dementia.
Frontotemporal dementia (FTD) is one of the most common causes of dementia in working-age people. FTD spectrum disorders have, depending on the subtype, major effects on behavior, linguistic functions and cognitive processing.
Many genetic mutations have been implicated as contributing to these disorders, but their non-genetic and thus potentially preventable risk factors remain unknown and scarcely studied.
According to a recent study conducted at the University of Eastern Finland, patients with frontotemporal dementia were, on average, less educated than patients with Alzheimer’s disease. In addition, FTD patients who did not carry a genetic mutation causing the disease were less educated and had a higher prevalence of cardiac disease compared to FTD patients carrying a mutation.
The researchers utilized extensive data from over 1,000 patients, including patients from Finland and Italy, with all the most common subtypes of FTD represented.
In addition to patients with FTD and patients with Alzheimer’s disease, the study included a control group that did not have a diagnosis of any neurodegenerative disease. The results were reported in Annals of Clinical and Translational Neurology.
Frontotemporal dementia (FTD) is one of the most common causes of dementia in working-age people. Image is in the public domain
Based on the study, it seems that patients with different subtypes of the FTD spectrum, and patients with genetic and non-genetic disease, are different in terms of several risk factors.
A second study shows that previous traumatic brain injury may increase the risk of FTD, especially in patients who did not carry a causal genetic mutation. In addition, patients who had suffered a head injury appeared, on average, to develop FTD earlier than others.
The researchers compared Finnish FTD patients with patients with Alzheimer’s disease, and with healthy controls. The findings were reported in Journal of Alzheimer’s Disease.
“These results offer a better understanding of the disease mechanisms and, possibly in the future, an opportunity to prevent frontotemporal dementia,” says Doctoral Researcher and lead author of both articles Helmi Soppela of the University of Eastern Finland.
Traumatic Brain Injury Associates with an Earlier Onset in Sporadic Frontotemporal Dementia
Background: Currently, there are few studies considering possible modifiable risk factors of frontotemporal dementia (FTD). Objective:In this retrospective case-control study, we evaluated whether a history of traumatic brain injury (TBI) associates with a diagnosis of FTD or modulates the clinical phenotype or onset age in FTD patients.
See also
Methods: We compared the prevalence of prior TBI between individuals with FTD (N = 218) and age and sex-matched AD patients (N = 214) or healthy controls (HC; N = 100). Based on the patient records, an individual was categorized to the TBI+ group if they were reported to have suffered from TBI during lifetime. The possible associations of TBI with age of onset and disease duration were also evaluated in the whole FTD patient group or separately in the sporadic and genetic FTD groups.
Results: The prevalence of previous TBI was the highest in the FTD group (19.3%) when compared to the AD group (13.1%, p = 0.050) or HC group (12%, p = 0.108, not significant). Preceding TBI was more often associated with the sporadic FTD cases than the C9orf72 repeat expansion-carrying FTD cases (p = 0.003). Furthermore, comparison of the TBI+ and TBI- FTD groups indicated that previous TBI was associated with an earlier onset age in the FTD patients (B = 3.066, p = 0.010).
Conclusion: A preceding TBI associates especially with sporadic FTD and with earlier onset of symptoms. The results of this study suggest that TBI may be a triggering factor for the neurodegenerative processes in FTD. However, understanding the precise underlying mechanisms still needs further studies.
Abstract
Modifiable potential risk factors in familial and sporadic frontotemporal dementia
Objective
Only a few studies have evaluated modifiable risk factors for frontotemporal dementia (FTD). Here, we evaluated several modifiable factors and their association with disease phenotype, genotype, and prognosis in a large study population including Finnish and Italian patients with FTD and control groups.
Methods
In this case–control study, we compared the presence of several cardiovascular and other lifestyle-related diseases and education between Finnish and Italian patients with familial (n = 376) and sporadic (n = 654) FTD, between different phenotypes of FTD, and between a subgroup of Finnish FTD patients (n = 221) and matched Finnish patients with Alzheimer’s disease (AD) (n = 214) and cognitively healthy controls (HC) (n = 100).
Results
Patients with sporadic FTD were less educated (p = 0.042, B = -0.560, 95% CI −1.101 to −0.019) and had more heart diseases (p < 0.001, OR = 2.265, 95% CI 1.502–3.417) compared to patients with familial FTD. Finnish FTD patients were less educated (p = 0.032, B = 0.755, 95% CI 0.064–1.466) compared with AD patients. The Finnish FTD group showed lower prevalence of hypertension than the HC group (p = 0.003, OR = 2.162, 95% CI 1.304–3.583) and lower prevalence of hypercholesterolemia than in the HC group (p < 0.001, OR = 2.648, 95%CI 1.548–4.531) or in the AD group (p < 0.001, OR = 1.995, 95% CI 1.333–2.986). Within the FTD group, clinical phenotypes also differed regarding education and lifestyle-related factors.
Interpretation
Our study suggests distinct profiles of several modifiable factors in the FTD group depending on the phenotype and familial inheritance history and that especially sporadic FTD may be associated with modifiable risk factors.
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November 27, 2022 at 06:54AM
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Educational Background and Previous Brain Injury May Be Associated With Higher Risk of Frontotemporal Dementia - Neuroscience News
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SALT LAKE CITY — Utahns are excited to get back to their Thanksgiving traditions after two years of restrictions under the coronavirus pandemic. But, just because COVID-19 is not as prevalent, does not mean that we don't need to take precautions.
"The last couple years, COVID was the main thing we were worried about spreading around the family get-together," said Dr. Per Gesteland, a pediatric hospitalist at Primary Children's Hospital and University of Utah Health.
This year there's less worry about COVID-19, he said, but more concern about RSV and the flu. Right now, those viruses are still sending kids to the hospital.
"We're surviving up here," Gesteland said, referring to Primary Children's Hospital. "We were running 95-100% capacity, and it's definitely busy."
We are facing a viral blizzard, he said.
Gesteland helped create high-risk 20 years ago, which shows us that RSV and the flu are on the rise today across much of the state. RSV can be especially tough on kids, the elderly, and those with high risk health conditions.
"It started in October and then has really taken off," the doctor said. "The slope for our outbreak last year was a little bit gentler. This year it's a very steep incline, which suggests very rapid transmission throughout our communities."
The flu is just starting to rise in Utah, lagging behind the surge in hospitalizations seen in other states.
"We expect things to just get worse from here on for a few more weeks before we start to see a break in our influenza activity," Gesteland said.
Meantime, COVID-19 still has more than 120 people hospitalized statewide.
On average, one person is still dying each day from complications related to COVID-19.
"COVID is still out there, and it's still definitely causing trouble," the doctor said.
Gatherings of healthy people should be fine this holiday, he said. If you or your kids are sick, stay home and avoid contact with vulnerable people. He advises that we wash our hands regularly and avoid close contact with anyone coughing or sneezing.
"We've made a lot of progress with getting people vaccinated against COVID," Gesteland said. "So we're all feeling a little bit better, especially vulnerable populations."
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November 25, 2022 at 02:12AM
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A multivalent nucleoside-modified mRNA vaccine against all known influenza virus subtypes - Science
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Measles is an "imminent threat" around the world, according to a new joint report released Wednesday by the Centers for Disease Control and Prevention and the World Health Organization.
Despite a two-dose vaccine that is more than 97% effective at preventing infection being available for decades, gains made at beating back the potentially dangerous childhood disease have been lost during the COVID-19 pandemic.
The report found that in 2021, nearly 40 million children -- a record-high -- missed a dose of the measles vaccine. Specifically, 25 million missed their first dose and 14.7 million missed their second dose.
"The paradox of the pandemic is that while vaccines against COVID-19 were developed in record time and deployed in the largest vaccination campaign in history, routine immunization programs were badly disrupted, and millions of kids missed out on life-saving vaccinations against deadly diseases like measles," said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, in a statement.
Sick child with red rash spots from measles.
Bilanol/Getty Images/iStockphoto
"Getting immunization programs back on track is absolutely critical. Behind every statistic in this report is a child at risk of a preventable disease," the statement continued.
To prevent the disease from spreading and to achieve herd immunity, the CDC and WHO say at least 95% of children need to receive the vaccine.
However, just 81% of children globally have received the first dose and 71% have received the second dose, the lowest coverage worldwide seen since 2008.
Consequently, there were 9 million cases of measles and 128,000 deaths around the world with at least 22 countries experiencing "large and disruptive outbreaks."
"The record number of children under-immunized and susceptible to measles shows the profound damage immunization systems have sustained during the COVID-19 pandemic," CDC Director Dr. Rochelle Walensky said in a statement.
"Measles outbreaks illustrate weaknesses in immunization programs, but public health officials can use outbreak response to identify communities at risk, understand causes of under- vaccination, and help deliver locally tailored solutions to ensure vaccinations are available to all."
No region of the world has achieved and sustained measles elimination, the report found. Since 2016, at least 10 countries that had previously eliminated measles reported outbreaks – including the U.S.
Measles is an incredibly contagious disease. According to the CDC, one infected patient can infect at least 10 close contacts who are not protected either through masking or vaccination.
Measles complications can range from non-threatening, including rashes, to severe, such as viral sepsis, pneumonia or brain swelling.
Prior to the measles vaccine, an estimated 3 to 4 million Americans were infected annually with measles, 48,000 were hospitalized and 400 to 500 died, the CDC says.
"Plummeting measles vaccination rates should set off every alarm," Elizabeth Cousens, president and CEO of the United Nations Foundation, said in a statement. "Tens of millions of children are at risk of this deadly, yet entirely preventable disease until we get global vaccination efforts back on track. There is no time to waste. We must work urgently to ensure life-saving vaccines reach every last child."
According to a new study, which was supported by the National Institutes of Health (NIH), “good cholesterol” may not be as effective as scientists once believed in uniformly predicting cardiovascular disease risk among adults of different racial and ethnic backgrounds.
Study challenges “good” cholesterol’s role in universally predicting heart disease risk.
Lower levels of HDL cholesterol were associated with increased risks for heart attacks in white but not black adults, and higher levels were not protective for either group.
A study found that high-density lipoprotein (HDL) cholesterol, often called the “good cholesterol,” may not be as effective as scientists once believed in uniformly predicting cardiovascular disease risk among adults of different racial and ethnic backgrounds. The study was supported by the National Institutes of Health (NIH).
The research found that while low levels of HDL cholesterol predicted an increased risk of heart attacks or related deaths for white adults – a long-accepted association – the same was not true for black adults. Additionally, higher HDL cholesterol levels were not associated with reduced cardiovascular disease risk for either group. The study was published on November 21 in the Journal of the American College of Cardiology,
LDL (low-density lipoprotein) cholesterol, sometimes called “bad” cholesterol, makes up most of your body’s cholesterol. High levels of LDL cholesterol raise your risk for heart disease and stroke. HDL (high-density lipoprotein) cholesterol, sometimes called “good” cholesterol, absorbs cholesterol in the blood and carries it back to the liver.
“The goal was to understand this long-established link that labels HDL as the beneficial cholesterol, and if that’s true for all ethnicities,” said Nathalie Pamir, Ph.D., a senior author of the study and an associate professor of medicine within the Knight Cardiovascular Institute at Oregon Health & Science University, Portland. “It’s been well accepted that low HDL cholesterol levels are detrimental, regardless of race. Our research tested those assumptions.”
To do that, Pamir and her colleagues reviewed data from 23,901 United States adults who participated in the Reasons for Geographic and Racial Differences in Stroke Study (REGARDS). Previous studies that shaped perceptions about “good” cholesterol levels and heart health were conducted in the 1970s through research with a majority of white adult study participants. For the current study, researchers were able to look at how cholesterol levels from black and white middle-aged adults without heart disease who lived throughout the country overlapped with future cardiovascular events.
Study participants enrolled in REGARDS between 2003-2007 and researchers analyzed information collected throughout a 10- to 11-year period. Black and white study participants shared similar characteristics, such as age, cholesterol levels, and underlying risk factors for heart disease, including having diabetes, high blood pressure, or smoking. During this time, 664 black adults and 951 white adults experienced a heart attack or heart attack-related death. Adults with increased levels of low-density lipoprotein (LDL) cholesterol and triglycerides had modestly increased risks for cardiovascular disease, which aligned with findings from previous research.
However, the study was the first to find that lower HDL cholesterol levels only predicted increased cardiovascular disease risk for white adults. It also expands on findings from other studies showing that high HDL cholesterol levels are not always associated with reduced cardiovascular events. The REGARDS analysis was the largest U.S. study to show that this was true for both black and white adults, suggesting that higher than optimal amounts of “good” cholesterol may not provide cardiovascular benefits for either group.
“What I hope this type of research establishes is the need to revisit the risk-predicting algorithm for cardiovascular disease,” Pamir said. “It could mean that in the future we don’t get a pat on the back by our doctors for having higher HDL cholesterol levels.”
Pamir explained that as researchers study HDL cholesterol’s role in supporting heart health, they are exploring different theories. One is quality over quantity. That is, instead of having more HDL, the quality of HDL’s function – in picking up and transporting excess cholesterol from the body – may be more important for supporting cardiovascular health.
They are also taking a microscopic look at properties of HDL cholesterol, including analyzing hundreds of proteins associated with transporting cholesterol and how varying associations, based on one protein or groups of proteins, may improve cardiovascular health predictions.
“HDL cholesterol has long been an enigmatic risk factor for cardiovascular disease,” explained Sean Coady, a deputy branch chief of epidemiology within the National Heart, Lung, and Blood Institute (NHLBI)’s Division of Cardiovascular Sciences. “The findings suggest that a deeper dive into the epidemiology of lipid metabolism is warranted, especially in terms of how race may modify or mediate these relationships.”
The authors conclude that in addition to supporting ongoing and future research with diverse populations to explore these connections, the findings suggest that cardiovascular disease risk calculators using HDL cholesterol could lead to inaccurate predictions for black adults.
“When it comes to risk factors for heart disease, they cannot be limited to one race or ethnicity,” said Pamir. “They need to apply to everyone.”
Reference: “Race-Dependent Association of High-Density Lipoprotein Cholesterol Levels With Incident Coronary Artery Disease” by Neil A. Zakai MD, Jessica Minnier PhD, Monika M. Safford MD, Insu Koh PhD, Marguerite R. Irvin PhD, Sergio Fazio MD, PhD, Mary Cushman MD, Virginia J. Howard PhD and Nathalie Pamir PhD, 21 November 2022, Journal of the American College of Cardiology. DOI: 10.1016/j.jacc.2022.09.027
The REGARDS study is co-funded by the National Institute of Neurological Disorders and Stroke and the National Institute of Aging and received additional support from NHLBI.
High-density lipoprotein, or HDL, cholesterol – often referred to as the “good” cholesterol – may not be as useful in predicting the risk of heart disease and protecting against it as previously thought, according to new researched funded by the National Institutes of Health.
A study from the 1970s found that high levels of HDL cholesterol concentration were associated with low coronary heart disease risk, a link that has since been widely accepted and used in heart disease risk assessments. However, only White Americans were included in that study.
Now, research published Monday in the Journal of the American College of Cardiology found that low levels of HDL cholesterol were associated with higher risk of heart attack among White adults, but the same was not true among Black adults. Also, higher levels of HDL cholesterol were not found to reduce the risk of cardiovascular disease for either group.
“It’s been well accepted that low HDL cholesterol levels are detrimental, regardless of race. Our research tested those assumptions,” said Nathalie Pamir, a senior author of the study and an associate professor of medicine at the Knight Cardiovascular Institute at Oregon Health & Science University, Portland, in a news release. “It could mean that in the future, we don’t get a pat on the back by our doctors for having higher HDL cholesterol levels.”
The researchers used data from thousands of people who were enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. Participants were at least 45 years old when they enrolled in the program between 2003 and 2007, and their health was analyzed over an average of 10 years.
The researchers found that high levels of low-density lipoprotein (LDL) cholesterol and triglycerides “modestly” predicted heart disease risk among both Black and White adults.
But they suggest that more work is needed to understand what’s driving the racial differences in the link between HDL and heart disease risk.
And in the meantime, current clinical assessments for heart disease risk “may misclassify risk in Black adults, potentially hindering optimal cardiovascular disease prevention and management programs for this group,” they wrote.
CNN Medical Correspondent Dr. Tara Narula, associate director of the Lenox Hill Women’s Heart Program, said the study “highlights the very important need for more race- and ethnic-specific research and that there is not a one-size-fits-all approach. Additionally, this research emphasizes the continued need to educate that high levels of HDL are not a free pass and focus must be placed on controlling elevated LDL and other known markers of increased cardiovascular risk. “
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Study suggests that HDL or 'good' cholesterol is less beneficial than previously thought, especially for Black adults - CNN
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The fungus histoplasma, which causes lung infections, was concentrated in the Midwest in the 1950s and 60s (top map), but now causes significant disease throughout much of the country (bottom).Graphic: Patrick Mazi and Andrej Spec/Washington University
An illness-causing fungus known as histoplasma is in the soil of nearly all U.S. states, a new study suggests. The researchers behind the work say doctors may be relying on outdated risk maps and therefore missing diagnoses of the infections, which can sometimes be deadly.
The CDC claims that histoplasma, or histo, is found in the soil of central and eastern U.S. states, primarily in Ohio and the Mississippi River valleys. But that assumption is based on research from the 1950s and 1960s, says the team behind a new paper published in Clinical Infectious Diseases. In reality, they say, histo is found all across the country. When a person breathes in spores of the fungus, they can contract an infection called histoplasmosis.
“Every few weeks I get a call from a doctor in the Boston area – a different doctor every time – about a case they can’t solve,” said study author Andrej Spec, an associate professor of medicine at Washington University in St. Louis, in a press release. “They always start by saying, ‘We don’t have histo here, but it really kind of looks like histo.’ I say, ‘You guys call me all the time about this. You do have histo.’”
The research team, led by Patrick B. Mazi, a clinical fellow in infectious diseases at Washington University in St. Louis, analyzed more than 45 million Medicare fee-for-service beneficiaries extending from 2007 through 2016. They looked at diagnoses across the country of three fungal diseases: histoplasmosis, coccidioidomycosis, and blastomycosis. Histo, the most common, was causing clinically relevant rates of illness in at least one county in 48 of 50 states, as well as Washington, D.C. The other two infections were each found in more than half of states.
“Fungal infections are much more common than people realize, and they’re spreading,” Spec said in the release. “The scientific community has underinvested in studying and developing treatments for fungal infections. I think that’s beginning to change, but slowly.” Climate change may be driving this spread as warming temperatures make more habitats suitable for the fungi.
While histo can be easily combatted in healthy adults, and many people who are exposed never develop symptoms, those who are immunocompromised as well as infants and people 55 years and older may develop more serious illness, including a cough, fever, chest, pain, body aches, and fatigue, according to the CDC. Symptoms appear within three to 17 days after exposure; most symptoms will go away within a month, but if it spreads from a person’s lungs to other organs, the illness can become severe and require months of treatment.
People can be exposed to histo and other fungal pathogens through activities that disrupt soil, like farming, landscaping, and construction. They can also be exposed inside caves and while working in basements and attics. Spec noted: “It’s important for the medical community to realize these fungi are essentially everywhere these days and that we need to take them seriously and include them in considering diagnoses.”
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November 18, 2022 at 05:28AM
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A growing measles outbreak in Columbus, Ohio, has sickened dozens of unvaccinated children and hospitalized nine of them, and local public health officials are seeking assistance from the US Centers for Disease Control and Prevention.
“We asked the CDC for assistance and they will be sending two epidemiologists at the end of the month to assist with our local investigation,” Kelli Newman, a spokesperson for Columbus Public Health, told CNN in an email Thursday.
The CDC confirmed Thursday that it is aware of the cases and is “deploying a small team to Ohio to assist on the ground with the investigation.”
“State and local health authorities are in the process of notifying potentially exposed residents, making sure they are vaccinated, and helping any community members who may have been exposed understand the signs and symptoms of measles infection,” CDC spokesperson Kristen Nordlund said in an email to CNN. “Anyone who may have been exposed should follow up with their healthcare provider.”
When the measles outbreak was first reported last week, only four confirmed cases had been identified in one child-care facility, which temporarily closed – but the number of cases and facilities involved has grown.
“As of today, we are investigating 24 cases of measles at nine day cares and two schools,” Newman said. “All cases are in unvaccinated children, and all but one are less than 4 years old. One child is 6 years old.”
Health officials with Columbus Public Health and Franklin County Public Health have been investigating these cases and tracing any contacts who may have been exposed to the measles virus.
Officials at Columbus Public Health are encouraging parents to make sure their children are up to date on their immunizations, including the measles, mumps and rubella vaccine, known as the MMR vaccine.
Experts recommend that children receive the vaccine in two doses: first between 12 months and 15 months of age and a second between 4 and 6 years old. One dose is about 93% effective at preventing measles if you come into contact with the virus. Two doses are about 97% effective.
“We are working diligently with the cases to identify any potential exposures and to notify people who were exposed,” Columbus Public Health Commissioner Dr. Mysheika Roberts said in a news release last week. “The most important thing you can do to protect against measles is to get vaccinated with the measles-mumps-rubella (MMR) vaccine, which is safe and highly effective.”
About 90% of unvaccinated people who are exposed to measles will become infected, according to Columbus Public Health, and about 1 in 5 people in the US who get measles will be hospitalized.
However, the CDC says that more than 90% of children in the US have been vaccinated against measles, mumps and rubella by age 2.
Measles is a highly contagious disease that can spread through the air when an infected person coughs or sneezes or if someone comes into direct contact with or shares germs by touching the same objects or surfaces. Measles symptoms may include fever, cough, runny nose, watery eyes and a rash of red spots. In rare cases, it may lead to pneumonia, encephalitis or death.
The measles outbreak in Columbus is a “fairly typical scenario” of an infectious virus finding its way into one environment and spreading among unvaccinated people, said Dr. David Freedman, professor emeritus of infectious diseases at the University of Alabama at Birmingham and founding director of the Travelers’ Health Clinic.
Freedman said that during the early days of the Covid-19 pandemic, while many people stayed home and some health-care facilities were closed, many children missed their routine immunizations – and they still may not have gotten their MMR shots.
“There are a lot of children nationwide that are behind on their routine vaccinations. So I think the message is still, if your child is 1 year of age or older, they need to be vaccinated,” said Freedman, a spokesperson for the Infectious Diseases Society of America.
“Measles is not particularly a wintertime disease. It is not as likely to be affected by travel because it usually is in young, not immune children. Most adults are vaccinated,” he said. However, he added, “measles is highly contagious. Measles is probably the most contagious disease we know. It’s probably 10 times as contagious as Covid is.”
The history of measles in America
In 1912, measles became a nationally notifiable disease in the United States, meaning health care providers and laboratories were required to report diagnosed cases. In the decade afterward, an average of about 6,000 measles-related deaths were reported annually.
In the 1950s, researchers isolated the measles virus in a patient’s blood, and in the 1960s, they were able to transform that virus into a vaccine. The vaccine was licensed and then used as part of a vaccination program.
Before the measles vaccination program was introduced in the United States in 1963, an estimated 3 million to 4 million people got the disease each year nationwide, according to the CDC. Afterward, cases and deaths from measles in the United States and other developed countries plummeted. There were 963 cases reported in the United States in 1994 and 508 in 1996.
The last major measles outbreak reported in the US was in 2019. It was the largest since the disease was declared eliminated in 2000 and involved more than a thousand confirmed cases in 31 states – the highest number of cases reported in the US since 1992.
Overall, the number of measles infections reported in the United States each year remains low because of the widespread use of vaccines, said Dr. Martin Hirsch, professor of medicine at Harvard University and Massachusetts General Hospital, who also serves as editor of the Journal of Infectious Diseases.
As of October 28, a total of 33 measles cases have been reported this year in five jurisdictions across the United States, according to the CDC.
“Over 90% of people in the United States have been vaccinated against measles, and even though it’s a highly transmissible virus, I wouldn’t expect to see the rates, for example, that we’re seeing with RSV now because we don’t have an RSV vaccine,” Hirsch said, referring to a surge of respiratory syncytial virus infections across the country, mostly among children.
“Most of the cases of measles that we do see in the United States result from people who are coming to this country from other countries where the immunization rates are much less, followed by transmission to US residents who are not vaccinated,” said Hirsch, a spokesperson for the Infectious Diseases Society of America. “So the possibility that someone carrying measles virus coming into the country could spread into an unvaccinated population is always there.”
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November 18, 2022 at 03:39AM
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As measles outbreak sickens dozens of children in Ohio, local health officials seek help from CDC - CNN
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