Latest news with #PREVENT
Medscape
22-05-2025
- Health
- Medscape
Managing Crohn's After Surgery: Expert Insights
This transcript has been edited for clarity. Hello. My name is Robert Battat. I am an associate professor of medicine at the University of Montreal and a gastroenterologist. I'm also the director of the Center for Clinical Excellence and Translational Research in Inflammatory Bowel Diseases at the University of Montreal Hospital Center. Today, we're going to be talking about postoperative care in Crohn's disease. The most common surgery that is performed is an ileocolonic resection or an ileocecal resection with primary ileocolic anastomosis. The first question that we want to ask is, who needs an operation? As effective therapies have entered into the market, there has been less need for surgery overall, but there's a greater need for surgery, particularly, in patients with Crohn's disease who have strictures. The two typical profiles of patients who are going to undergo surgery are patients who have severe stricturing disease at the onset, or selected patients who have nonstricturing Crohn's disease, but either because of patient preference or for other reasons that you may not want to try to treat the condition medically, surgery is attempted as a first option, which is reasonable in selected cases. Once a patient undergoes surgery, this is a critical period because patients have lost bowel, and according to clinical trials where they've tested drugs — particularly in the PREVENT trial, which tested the efficacy of infliximab vs placebo for prevention of recurrence — we saw that 60% of patients who received placebo had recurrence 6 months after the operation, as was indicated on a colonoscopy. We're seeing similar data in the recent REPREVIO trial, which tested the efficacy of vedolizumab vs placebo. If you give nothing overall, in the general postoperative Crohn's population, approximately 60%-65% of patients will have lesions, which can be seen on a colonoscopy. It doesn't mean that you're going to have symptoms. That's an important point — that patients, often, after surgery will not feel the recurrence, but definitely the recurrence will have happened. Being vigilant is very important for that reason. We have data that show that one of the most important things that you can do for a patient after surgery, even before thinking about another treatment, is planning to do a colonoscopy 6 months postoperatively. There was a randomized clinical trial called the POCER trial, which compared two treatment approaches. One treatment arm was based on doing a colonoscopy postoperatively and another treatment arm was based on standard of care. The treatment arm that used colonoscopy postoperatively had lower recurrence rates and better long-term outcomes just by the act of 'looking' early [with colonoscopy] and acting early if there was a recurrence than when a colonoscopy was done further out. We saw that just doing a colonoscopy early on was associated with lower rates of recurrence in the long run. When I have a patient who has a surgery, the first thing I'm thinking is, well, I have to look or [do a colonoscopy] 6-8 months after the surgery is done. That's nonnegotiable for all patients, unless there's some reason that I should not do the procedure for safety reasons. The other question that comes up is, 'Do I give the patient a postoperative prophylactic medication?' In my practice, because I tend to see higher-risk patients, I tend to give most patients prophylaxis against recurrence. However, there are ways that you can manage the use of prophylaxis because there are some patients who may not end up needing a medicine after surgery. The most recent data come from a large, multicenter international Inflammatory Bowel Disease Genetics Consortium cohort based out of Toronto showing that the highest risk factors for recurrence are being male, smoking, and having had previous surgeries. Those are three factors that are highly associated with recurrence. Interestingly, having fistulae in multiple cohorts was not [a risk factor]. For people who have those previously noted risk factors, those are patients for whom you definitely would want to try to give prophylaxis. A protective factor against recurrence is obviously treatment. What are the treatments that we give? There are older data on immunomodulators, such as azathioprine or 5-aminosalicylic acid (5-ASA) molecules, and although there is some mixed evidence for prevention of recurrence with these drugs, the main agents that are used in 2025 are biologic agents. The two biologic agents with the most robust data are infliximab, from the PREVENT trial that we previously described, and vedolizumab. Both agents were effective in preventing postoperative endoscopic recurrence. Both agents work, and I think the proof of concept really is that most biologic agents are likely to work. If you want to rely on only the highest level of evidence, those two agents are the most well studied. In terms of other considerations for postoperative Crohn's disease patients, there are some data for antibiotics. However, particularly for metronidazole, the issue is that giving it long term is not only not associated with long-term prevention with recurrence but also is associated with side effects such as neuropathy. You also want to start to think about non–IBD-related issues, such as vaccinations and absorption. If you have ileal resection, which is the most common site of resection, you do want to be ensuring that B12 levels in the blood are adequate, particularly if you've had more than 20 cm of ileum removed. Often, patients will get diarrhea and knowing that there are other causes of diarrhea is important. It can be the Crohn's disease; however, it could also be bile salt diarrhea or bile acid diarrhea, and so that should be on the differential diagnosis. The last thing I'd like to point out is that a useful tool to differentiate symptoms of Crohn's from other entities is the fecal calprotectin level. Fecal calprotectin indicates whether there is intestinal inflammation. Typically, I use it at 3 months postoperatively to risk-stratify patients. I use a value of 150 µg/g; if it's less than 150 µg/g, I assume it not to be postoperative recurrence causing the symptoms, but more likely bile salt diarrhea. If it is elevated, it may prompt an ileal colonoscopy to try to optimize therapy. Thank you.
Yahoo
21-05-2025
- Health
- Yahoo
PREVENT equation accurately estimated 10-year CVD risk and those with calcium buildup
Research Highlights: The American Heart Association's PREVENTTM risk calculator accurately identified participants who had calcium buildup in their heart arteries and those who had a higher future heart attack risk, in an analysis of about 7,000 adults in New York City referred for heart disease screening. The PREVENT scores also predicted future heart attack risk. Embargoed until 4 a.m. CT/5 a.m. ET Wednesday, May 21, 2025 (NewMediaWire) - May 21, 2025 - DALLAS The PREVENTTM risk calculator helped to identify people with plaque buildup in the arteries of the heart, in addition to predicting their risk of a future heart attack, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association. In addition, when combining PREVENT and a coronary calcium score, risk prediction was further improved, with patients with the highest risk of heart attack matched the group of participants who had a heart attack during the follow-up period. "These findings are important because when we can better predict a patient's risk of heart attack, we can also tailor care and determine who may benefit from treatment to prevent a heart attack, such as cholesterol-lowering medications," said corresponding author Morgan Grams, M.D., Ph.D., the Susan and Morris Mark Professor of Medicine and Population Health at New York University's Grossman School of Medicine in New York City. The PREVENT (Predicting Risk of cardiovascular disease EVENTs) risk calculator, released by the American Heart Association in 2023, can estimate 10-year and 30-year risk for heart attack, stroke, heart failure or all three in adults as young as age 30. PREVENT factors in age, blood pressure, cholesterol, body mass index, Type 2 diabetes status, social determinants of health, smoking and kidney function to estimate future risk of heart attack, stroke or heart failure. One tool for screening heart health is coronary computed tomography angiography (CCTA), a non-invasive imaging test that visualizes plaque buildup in the heart's arteries. From the CCTA, patients are given a coronary artery calcium (CAC) score, which helps to inform decisions about heart disease prevention and treatment, including when it may be appropriate to prescribe cholesterol-lowering medications. In this study, researchers investigated whether the PREVENT score matched the level of calcium buildup according to the CAC score. In addition, they used the PREVENT risk assessment and coronary artery calcium scores, separately and in combination, to predict future heart attack risk and assessed the accuracy of each with the participants who had a heart attack during the follow-up period. They reviewed electronic health records for nearly 7,000 adults who had had CCTA screening at NYU Langone Health in New York City between 2010 and 2024. The analysis found that for all participants: The PREVENT tool-estimated risk of a heart attack was low (less than 5%) for 43.6% of patients; mildly elevated (5%-7.5%) for 15.8% of the participants; moderately increased (7.5%-20%) for 34.4.%; and high (more than 20%) for 6.2% of people in the study. PREVENT scores were directly correlated with CAC scores, meaning those who had high PREVENT scores, indicating a higher risk of heart attack, matched the group who had higher CAC scores. PREVENT risk ranked as low-to-mildly elevated was associated with CAC of less than or equal to 1, which indicates low risk of heart attack. PREVENT risk ranked as moderate-high was associated with participants who had a CAC score higher than 100, which indicates moderate-to-high risk of heart attack. Researchers then added the CAC score to the PREVENT tool to calculate risk of future heart attack, and, together, they more accurately identified the participants who were at higher risk and who had a heart attack during the follow-up period. "The findings illustrate that PREVENT is accurate in identifying people who may have subclinical risk for cardiovascular disease, meaning blocked arteries before symptoms develop," said Grams. "This study used a real-world set of patients, so our findings are important in shaping future guidelines on the use of the PREVENT calculator and coronary computed tomography angiography." Study co-author and American Heart Association volunteer expert Sadiya Khan, M.D., MSc., FAHA, said the CAC score can help classify risk for heart disease by analyzing calcium buildup. "CT scans to evaluate for coronary calcium and extent of coronary artery calcium buildup may be useful when patients are uncertain if they want to start lipid-lowering therapy or if lipid-lowering therapy should be intensified. We have so many tools in our armamentarium for reducing risk of heart attack, we want to be able to optimize treatments for patients, and especially those with higher risk," said Khan, who chaired the writing group for the Association's 2023 Scientific Statement announcing PREVENT, Novel Prediction Equations for Absolute Risk Assessment of Total Cardiovascular Disease Incorporating Cardiovascular-Kidney-Metabolic Health. Study details, background and design: More than 9 million electronic health records at NYU Langone Health in New York City were reviewed and included adults who had coronary computed tomography angiography performed between 2010 and 2024. Participants in this analysis included 6,961 adults between the ages of 30 and 79 years with no history of heart disease. Their average age was 57.5 years; 53% were women, and 77% were noted in the electronic health records as white adults. Participants' CAC scores were compared to the PREVENT scores calculated based on data in the electronic health records including demographics, vital signs, laboratory values and coexisting conditions. Participants who had a heart attack were noted according to the standard ICD-10 diagnosis codes in the electronic health records. Overall, there were 485 heart attacks during the average of 1.2 years of follow-up. Investigators evaluated the accuracy of using PREVENT or CAC score vs. both PREVENT and CAC combined to predict heart attack risk and compared this to data for patients with an ICD-10 code for heart attack. The study had several limitations, including that patients were screened at a single institution and the majority of participants were noted as white, so the findings may not be generalizable to other people. The analysis only included people who had undergone coronary calcium screening, and electronic health records were the sole source of data. In addition, the follow-up time was short at 1.2 years, and the presence of non-calcified plaque in the heart's arteries was not assessed. Finally, the study may overestimate the prevalence of coronary artery calcium in low-risk people since participants in this study were referred for CCTA/CAC score by a health care professional, which means they may have more heart disease risk factors than the general population. Co-authors, disclosures and funding sources are listed in the manuscript. Studies published in the American Heart Association's scientific journals are peer-reviewed. The statements and conclusions in each manuscript are solely those of the study authors and do not necessarily reflect the Association's policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives more than 85% of its revenue from sources other than corporations. These sources include contributions from individuals, foundations and estates, as well as investment earnings and revenue from the sale of our educational materials. Corporations (including pharmaceutical, device manufacturers and other companies) also make donations to the Association. The Association has strict policies to prevent any donations from influencing its science content. Overall financial information is available here. Additional Resources: Multimedia is available on the right column of release link. After May 21, 2025, view the manuscript online. AHA news release: New scientific research will test PREVENT risk calculator among diverse groups (Feb. 2024) AHA news release: Leading cardiologists reveal new heart disease risk calculator (Nov. 2023) Follow AHA/ASA news on X @HeartNews Follow news from the Journal of the American Heart Association @JAHA_AHA ### About the American Heart Association The American Heart Association is a relentless force for a world of longer, healthier lives. Dedicated to ensuring equitable health in all communities, the organization has been a leading source of health information for more than one hundred years. Supported by more than 35 million volunteers globally, we fund groundbreaking research, advocate for the public's health, and provide critical resources to save and improve lives affected by cardiovascular disease and stroke. By driving breakthroughs and implementing proven solutions in science, policy, and care, we work tirelessly to advance health and transform lives every day. Connect with us on Facebook, X or by calling 1-800-AHA-USA1. For Media Inquiries and AHA/ASA Expert Perspective: 214-706-1173 Bridgette McNeill: For Public Inquiries: 1-800-AHA-USA1 (242-8721) and
Associated Press
21-05-2025
- Health
- Associated Press
PREVENT equation accurately estimated 10-year CVD risk and those with calcium buildup
Research Highlights: Embargoed until 4 a.m. CT/5 a.m. ET Wednesday, May 21, 2025 ( NewMediaWire ) - May 21, 2025 - DALLAS — The PREVENTTM risk calculator helped to identify people with plaque buildup in the arteries of the heart, in addition to predicting their risk of a future heart attack, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association. In addition, when combining PREVENT and a coronary calcium score, risk prediction was further improved, with patients with the highest risk of heart attack matched the group of participants who had a heart attack during the follow-up period. 'These findings are important because when we can better predict a patient's risk of heart attack, we can also tailor care and determine who may benefit from treatment to prevent a heart attack, such as cholesterol-lowering medications,' said corresponding author Morgan Grams, M.D., Ph.D., the Susan and Morris Mark Professor of Medicine and Population Health at New York University's Grossman School of Medicine in New York City. The PREVENT (Predicting Risk of cardiovascular disease EVENTs) risk calculator, released by the American Heart Association in 2023, can estimate 10-year and 30-year risk for heart attack, stroke, heart failure or all three in adults as young as age 30. PREVENT factors in age, blood pressure, cholesterol, body mass index, Type 2 diabetes status, social determinants of health, smoking and kidney function to estimate future risk of heart attack, stroke or heart failure. One tool for screening heart health is coronary computed tomography angiography (CCTA), a non-invasive imaging test that visualizes plaque buildup in the heart's arteries. From the CCTA, patients are given a coronary artery calcium (CAC) score, which helps to inform decisions about heart disease prevention and treatment, including when it may be appropriate to prescribe cholesterol-lowering medications. In this study, researchers investigated whether the PREVENT score matched the level of calcium buildup according to the CAC score. In addition, they used the PREVENT risk assessment and coronary artery calcium scores, separately and in combination, to predict future heart attack risk and assessed the accuracy of each with the participants who had a heart attack during the follow-up period. They reviewed electronic health records for nearly 7,000 adults who had had CCTA screening at NYU Langone Health in New York City between 2010 and 2024. The analysis found that for all participants: 'The findings illustrate that PREVENT is accurate in identifying people who may have subclinical risk for cardiovascular disease, meaning blocked arteries before symptoms develop,' said Grams. 'This study used a real-world set of patients, so our findings are important in shaping future guidelines on the use of the PREVENT calculator and coronary computed tomography angiography.' Study co-author and American Heart Association volunteer expert Sadiya Khan, M.D., MSc., FAHA, said the CAC score can help classify risk for heart disease by analyzing calcium buildup. 'CT scans to evaluate for coronary calcium and extent of coronary artery calcium buildup may be useful when patients are uncertain if they want to start lipid-lowering therapy or if lipid-lowering therapy should be intensified. We have so many tools in our armamentarium for reducing risk of heart attack, we want to be able to optimize treatments for patients, and especially those with higher risk,' said Khan, who chaired the writing group for the Association's 2023 Scientific Statement announcing PREVENT, Novel Prediction Equations for Absolute Risk Assessment of Total Cardiovascular Disease Incorporating Cardiovascular-Kidney-Metabolic Health. Study details, background and design: The study had several limitations, including that patients were screened at a single institution and the majority of participants were noted as white, so the findings may not be generalizable to other people. The analysis only included people who had undergone coronary calcium screening, and electronic health records were the sole source of data. In addition, the follow-up time was short at 1.2 years, and the presence of non-calcified plaque in the heart's arteries was not assessed. Finally, the study may overestimate the prevalence of coronary artery calcium in low-risk people since participants in this study were referred for CCTA/CAC score by a health care professional, which means they may have more heart disease risk factors than the general population. Co-authors, disclosures and funding sources are listed in the manuscript. Studies published in the American Heart Association's scientific journals are peer-reviewed. The statements and conclusions in each manuscript are solely those of the study authors and do not necessarily reflect the Association's policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives more than 85% of its revenue from sources other than corporations. These sources include contributions from individuals, foundations and estates, as well as investment earnings and revenue from the sale of our educational materials. Corporations (including pharmaceutical, device manufacturers and other companies) also make donations to the Association. The Association has strict policies to prevent any donations from influencing its science content. Overall financial information is available here. Additional Resources: ### About the American Heart Association The American Heart Association is a relentless force for a world of longer, healthier lives. Dedicated to ensuring equitable health in all communities, the organization has been a leading source of health information for more than one hundred years. Supported by more than 35 million volunteers globally, we fund groundbreaking research, advocate for the public's health, and provide critical resources to save and improve lives affected by cardiovascular disease and stroke. By driving breakthroughs and implementing proven solutions in science, policy, and care, we work tirelessly to advance health and transform lives every day. Connect with us on Facebook, X or by calling 1-800-AHA-USA1. For Media Inquiries and AHA/ASA Expert Perspective: 214-706-1173 Bridgette McNeill: [email protected] For Public Inquiries: 1-800-AHA-USA1 (242-8721) and
Irish Daily Mirror
05-05-2025
- Health
- Irish Daily Mirror
'Positivity' for Alzheimer's treatment as new drug approved that slows it down
There has never been 'such positivity' about treatments for Alzheimer's, and big changes will come in just a few months. This is according to Immunologist Luke O'Neill, as a drug that will slow down the disease was recently approved by the European Medicines Agency (EMA). Recent studies also suggest that the shingles vaccine may be associated with a reduced risk of developing Alzheimer's and other forms of dementia. Some research has indicated a 20% lower risk of developing the disease over a seven-year period. Speaking to the Irish Sunday Mirror, Professor O'Neill said: 'There was a big conference in Vienna two weeks ago, which I wasn't at but I saw the reports and you've never heard such a positivity. 'It's extremely encouraging was the phrase they were using and as to what's happening with things like Alzheimer's.' The drug approved by the EMA and earlier by the FDA is called Lecanemab. It works by targeting and removing amyloid-beta proteins from the brain, which are believed to play a key role in the development and progression of Alzheimer's disease. The immunologist said massive work is underway to identify what people this drug is working for. He believes in the 'coming months' this will be made more clear. Professor O'Neill continued: 'It's causing great excitement because it's the first drug ever to slow down the disease, as it gets worse and worse as you get older. 'So here we have the first example of something slowing it down. The main thing is to find out who is going to respond, and that's going to happen in the coming months.' There is currently massive work on this underway, including in Dublin. The PREVENT dementia programme is the world's largest study investigating the origins and early diagnosis of dementia in a mid-life 'at risk' cohort. It has recruited and deeply phenotyped 700 participants aged 40-59 across the UK and Ireland. AI is also expected to vastly speed up drug trials, as Professor Luke says 'there's no doubt' it will positively impact the pharmaceutical industry. There are currently 127 drugs being tested for Alzheimer's, as incidence is increasing. In Ireland, the number of people living with Alzheimer's and other forms of dementia are expected to double by 2045. However, Professor O'Neill stressed that these drugs are looking very positive, and that lifestyle changes also have a massive impact. He continued: 'Good news is amazing studies have come out showing that if you to change your lifestyle, you'll decrease your risk of Alzheimer and dementia in general. And you wouldn't believe the data on this is getting stronger and stronger. 'They reckon that 45% of dementia can be prevented by changing your lifestyle. We're talking about the usual things like good diet, exercise, keeping your brain active.' The immunologist said high cholesterol, loss of hearing and loneliness are also risk factors for the disease. He added: 'These are things we can all do to decrease our risk of getting it, and they are very optimistic.'
