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Metabolic profiles were better in patients taking the antimalarial drug hydroxychloroquine for rheumatoid arthritis, a systematic review and meta-analysis found.
In seven studies that compared lipid profiles between patients who did or did not use hydroxychloroquine, total cholesterol was 9.8 mg/dL lower and LDL cholesterol 10.6 mg/dL lower with the antimalarial drug in mean pooled findings. HDL was 4.1 mg/dL higher and triglycerides 19.1 mg/dL lower with the drug too, researchers reported online in the.
Antimalarial agents have been used in inflammatory diseases for decades; its effects are thought to stem from interference with toll-like receptor signaling and antigen presentation, along with inhibition of lysosomal activity, which may decrease insulin degradation and interfere with cholesterol formation.
"However, it is not clear whether this translates into reduced cardiovascular risk," Daniel Solomon, MD, a rheumatologist at Brigham and Women's Hospital and Harvard in Boston, told MedPage Today. "These potential benefits need to be weighed against the real risk of macular toxicity among patients using hydroxychloroquine for extended periods."
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The Ross Lasts
A study with 100% follow-up of 310 adults who got the Ross procedure at a single institution showed ", regardless of the need for reintervention," researchers reported in the Journal of the American College of Cardiology.
During a median 15 years and up to 25 years of follow-up, survival wasn't worse for patients who required Ross-related reintervention. But Ross patients overall didn't live as long as an age- and sex-matched general population.
Overall survival at 10 and 20 years was 94% and 84%, respectively. Freedom from any Ross-related reintervention was 93% and 70% at those points, respectively.
Pointing to data from other studies suggesting only 80% 15-year survival with tissue valves, 52% with mechanical valves, and 65% with bovine pericardial valves, : "One may still argue that the Ross procedure does not put them back on the normal life expectancy curve, but nothing else comes nearly as close."
The editorialists argued that with a goal of the longest life with the best quality possible, "This study, along with numerous preceding studies, provides robust support that the Ross procedure should be the operation of choice for patients <50 years of age, with unrepairable aortic valve disease."
Endovascular Stroke Care Rising
The series of positive mechanical thrombectomy stroke treatment trials -- including MR CLEAN, SWIFT-PRIME, ESCAPE, and EXTEND-IA -- that emerged in late 2014 and early 2015 had a rapid effect on care, an analysis of the Get With The Guidelines-Stroke database reported in Circulation.
While endovascular thrombectomy use slowly increased from the beginning of the study period in April 2003, it . As of fall 2016, this approach reached 3.3% of all ischemic stroke patients at all participating hospitals, "representing 15.1% of all patients who were potentially eligible for [endovascular thrombectomy] based on stroke duration and severity." Those numbers were, not surprisingly, higher at endovascular thrombectomy-capable hospitals, (7.5% and 27.3%, respectively).
"Reorganizing stroke systems to route patients to adequately resourced [endovascular thrombectomy] capable hospitals might increase treatment of eligible patients, improve outcomes and reduce disparities," the researchers concluded.