Risultati per: AGA: linee guida sulla de-prescrizione degli inibitori della pompa protonica

‘Fare raffronti con altre regioni è atto di cialtroneria’

Circulation, Ahead of Print. BACKGROUND:It is unknown whether dietary intake of polyunsaturated fatty acids (PUFA) modifies the cardiovascular disease (CVD) risk associated with a family history of CVD. We assessed interactions between biomarkers of low PUFA intake and a family history in relation to long-term CVD risk in a large consortium.METHODS:Blood and tissue PUFA data from 40 885 CVD-free adults were assessed. PUFA levels ≤25th percentile were considered to reflect low intake of linoleic, alpha-linolenic, and eicosapentaenoic/docosahexaenoic acids (EPA/DHA). Family history was defined as having ≥1 first-degree relative who experienced a CVD event. Relative risks with 95% CI of CVD were estimated using Cox regression and meta-analyzed. Interactions were assessed by analyzing product terms and calculating relative excess risk due to interaction.RESULTS:After multivariable adjustments, a significant interaction between low EPA/DHA and family history was observed (product term pooled RR, 1.09 [95% CI, 1.02–1.16];P=0.01). The pooled relative risk of CVD associated with the combined exposure to low EPA/DHA, and family history was 1.41 (95% CI, 1.30–1.54), whereas it was 1.25 (95% CI, 1.16–1.33) for family history alone and 1.06 (95% CI, 0.98–1.14) for EPA/DHA alone, compared with those with neither exposure. The relative excess risk due to interaction results indicated no interactions.CONCLUSIONS:A significant interaction between biomarkers of low EPA/DHA intake, but not the other PUFA, and a family history was observed. This novel finding might suggest a need to emphasize the benefit of consuming oily fish for individuals with a family history of CVD.

Giuliano Amato: “Iper-protezione che rasenta la follia”

Giuliano Amato: “Iper-protezione che rasenta la follia”

Circulation, Volume 148, Issue 21, Page 1733-1734, November 21, 2023.

Andreoni, 2,7 milioni di posti letto l’anno per l’antibioticoresistenza

Biomarkers are used frequently for evaluation and monitoring of patients with Crohn’s disease (CD). This American Gastroenterological Association (AGA) guideline is intended to support practitioners in decisions about the use of biomarkers for the management of CD.

Cirrhosis is a major cause of morbidity and mortality in the United States and worldwide. It consists of compensated, decompensated, and further decompensated stages; median survival is more than 15 years, 2 years, and 9 months for each stage, respectively. With each stage, there is progressive worsening of portal hypertension and the vasodilatory–hyperdynamic circulatory state, resulting in a progressive decrease in effective arterial blood volume and renal perfusion. Vasoconstrictors reduce portal pressure via splanchnic vasoconstriction and are used in the management of variceal hemorrhage.

Circulation, Volume 148, Issue Suppl_1, Page A13948-A13948, November 6, 2023. Background:Tailored P2Y12 inhibitor therapy is gaining popularity and is described as a method to balance safe and effective prescribing of clopidogrel. Based on previous work, 28% of our patients with CYP2C19 genotyping do not metabolize clopidogrel effectively (intermediate or poor metabolizers).Aim:We aim to describe the economic impact of a guided P2Y12 inhibitor strategy and the practice of escalation (clopidogrel to ticagrelor/prasugrel) and de-escalation (ticagrelor/prasugrel to clopidogrel) practices at a single health system. We hypothesize a guided approach is economically feasible vs. a universal ticagrelor or prasugrel approach. We also aim to determine how quickly clinicians escalate or de-escalate in response to CYP2C19 results.Methods:3-year (2020-2022) data was collected from our EMR. Annually an average of 950 patients received CYP2C19 testing to guide P2Y12 inhibitor therapy (n=2799), and an average of 316 patients were either escalated or de-escalated (n=949). Of the 2799 patients, clopidogrel was most often the initial P2Y12 inhibitor (n=2240), followed by ticagrelor (n=525), and prasugrel (n=34). We estimated overall medication and CYP2C19 testing costs over the course of an average year (Figure 1) based on the assumption that over the course of 1-year patients would begin on 30 days of either ticagrelor, prasugrel, or clopidogrel and escalate/de-escalate therapy thereafter as guided by testing.Results:The time to escalation was similar if the CYP2C19 result was ordered before or after the first order for P2Y12 inhibitor therapy, median of 6.2 and 6.5 days respectively (p = .07). There was a difference in time to de-escalation based on time of CYP2C19 testing in comparison to medication ordering with a median time of 32.1 and 8 days when testing was ordered before initiation and after, respectively (p