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Cardiovascular Medicine - Coronary Heart Disease, Stable
Increased cardiac events in Black females with ischemia with no obstructive coronary arteries (March 2023)
Black females with ischemia with no obstructive coronary arteries (INOCA) have a higher cardiovascular risk burden, more atypical symptoms, and delayed diagnosis and treatment compared with females of other races and ethnicities. In a study of nearly 600 females with INOCA, of whom 17 percent were Black, Black females had a higher risk of major adverse cardiovascular events and cardiovascular mortality compared with females of other races and ethnicities.2 Patient and provider education about INOCA symptoms, diagnosis, and treatment may be needed to prevent these disparities.
Family Medicine - Adult General Internal Medicine
Non-nutritive sweetener associated with adverse cardiovascular outcomes (March 2023)
Consumption of non-nutritive sweeteners may increase the risk of adverse cardiovascular outcomes through diverse mechanisms. Erythritol is a naturally derived sugar alcohol commonly used in processed foods, the consumption of which may increase platelet reactivity and thrombosis formation. In a discovery cohort of over 1000 patients, greater blood levels of erythritol were associated with increased three-year risk of major cardiovascular outcomes.3 While further studies are needed to establish risks, patients should be aware of consumption of this additive in commonly consumed foods.
Dermatology - Adult Endocrinology and Diabetes
Trial of lebrikizumab for atopic dermatitis (March 2023)
Lebrikizumab is a monoclonal antibody that selectively binds to soluble IL-13. In a phase 3 randomized trial that included 211 adults and adolescents with moderate to severe atopic dermatitis (AD), more patients receiving subcutaneous lebrikizumab plus topical corticosteroids achieved an Investigator's Global Assessment (IGA) score of clear/almost clear at 16 weeks, compared with those receiving placebo plus topical corticosteroids (41 versus 22 percent, respectively).4 Lebrikizumab-related adverse events included conjunctivitis and injection site reaction. Larger and longer-term trials are needed to further evaluate the efficacy and safety of lebrikizumab for AD.
Allergy and Immunology - Urticaria and Angioedema
New urticaria in the weeks after COVID-19 vaccination (March 2023)
Urticaria with or without angioedema has been reported in association with coronavirus disease 2019 (COVID-19) as well as messenger ribonucleic acid (mRNA) vaccines and boosters, particularly the Moderna mRNA booster. In a study of over 3.5 million adults from two cohorts who received a first booster dose of COVID-19 vaccine, the crude incidence of chronic spontaneous urticaria was approximately 2 cases per 100,000 persons.1 Of the 800 patients in two cohorts with newly diagnosed urticaria, more than 90 percent of cases were temporally associated with receiving the Moderna vaccine. Urticaria appeared between one and two weeks after vaccination, occurred most days of the week, and, in most patients, resolved in two to six months. This phenomenon is reminiscent of urticaria associated with viral infections, does not constitute an allergy, and is not a reason to avoid future vaccinations or boosters, although affected patients may prefer to choose a different product.
1. Duperrex O, Tommasini F, Muller YD. Incidence of chronic spontaneous urticaria following receipt of the COVID-19 vaccine booster in Switzerland. JAMA Netw Open. 2023;6(2):e2254298. Epub 2023 Feb 1. [Context Link]
2. Luu JM, Malhotra P, Cook-Wiens G, et al Long-term adverse outcomes in Black women with ischemia and no obstructive coronary artery disease: a study of the WISE (Women's Ischemia Syndrome Evaluation) cohort. Circulation. 2023;147(7):617. Epub 2023 Feb 13. [Context Link]
3. Witkowski M, Nemet I, Alamri H, et al The artificial sweetener erythritol and cardiovascular event risk. Nat Med. 2023. [Context Link]
4. Simpson EL, Gooderham M, Wollenberg A, et al Efficacy and safety of lebrikizumab in combination with topical corticosteroids in adolescents and adults with moderate-to-severe atopic dermatitis: a randomized clinical trial (ADhere). JAMA Dermatol. 2023;159(2):182. [Context Link]
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