ANEMIA

Monitor older adults given low-dose aspirin

Low-dose aspirin may increase anemia in older adults, according to a study published in Annals of Internal Medicine.

The authors conducted a post hoc analysis of the ASPirin in Reducing Events in the Elderly (ASPREE) randomized controlled trial conducted in Australia and the US in primary and community care settings.

The 19,114 participants were community-dwelling individuals aged 70 years or older (65 years or older for Black and Hispanic individuals). They were randomly assigned to receive either 100 mg of aspirin daily or a placebo.

The study results showed that the incidence of anemia was higher in the aspirin group than in the placebo group. Specifically, the aspirin group had 51.2 anemia events per 1,000 person-years, while the placebo group had 42.9 events per 1,000 person-years.

Furthermore, hemoglobin concentrations declined over time in both groups, but the decline was steeper in the aspirin group. The study also analyzed a subset of participants and found that the aspirin group had a higher prevalence of low ferritin levels and a greater overall decline in ferritin compared with the placebo group.

The findings suggest that low-dose aspirin use in otherwise healthy older adults can increase the risk of developing anemia and lead to a decline in ferritin levels, regardless of major bleeding.

Reference: McQuilten ZK, Thao LT, Pasricha S-R, et al Effect of low-dose aspirin versus placebo on incidence of anemia in the elderly. Ann Intern Med. 2023;176(7):913-921. doi:10.7326/m23-0675.

NEUROREHABILITATION

Normobaric oxygen possible treatment

Brief normobaric 100% oxygen treatment (NbOxTr) is a potential treatment for neurorehabilitation and skill-learning approaches, according to a paper published in Frontiers in Neurscience.

In a study involving 40 healthy young adults, researchers examined the effects of NbOxTr on visuomotor adaptation. The participants were randomly assigned to one of two groups: one receiving 100% oxygen (NbOxTr group) and the other receiving regular air (air group). Gas treatment was only administered during the Adaptation phase of the experiment.

The results showed that the NbOxTr group exhibited significantly faster and improved learning than the air group (approximately 30% improvement, P < .05). Importantly, these learning improvements persisted into subsequent experiment phases, even after stopping the gas treatment (P < .05). The researchers concluded that this brief and simple oxygen treatment significantly impacted fundamental human motor learning processes, suggesting its potential for neurorehabilitation and skill-learning approaches.

Reference: Wang Z, Spielman G, Johannsen N, Greenway F, Irving BA, Dalecki M. Boost your brain: a simple 100% normobaric oxygen treatment improves human motor learning processes. Front Neurosci. 2023;17. doi:10.3389/fnins.2023.1175649.

SUBSTANCE USE DISORDER

Pediatric ADHD treatment not linked to adult substance use

Stimulant treatment in pediatric patients with attention-deficit hyperactivity disorder (ADHD) may not necessarily induce substance use or substance use disorder in adulthood, according to a study published in JAMA Psychiatry.

The Multimodal Treatment Study of ADHD was a multisite study conducted in the US and Canada. Initially a clinical trial, it later became a longitudinal observational study. Participants were children ages 7 to 9 years with ADHD, followed until a mean age of 25 years.

Stimulant treatment for ADHD was measured prospectively over 16 years using parent and self-reports. The study examined the association between stimulant treatment and substance use outcomes such as heavy drinking, marijuana use, and daily cigarette smoking.

The authors analyzed data from 579 participants. They found no evidence of an association between current or prior stimulant treatment and substance use. These results were consistent after adjusting for developmental trends and age. Marginal structural models that accounted for demographic, clinical, and familial factors also showed no association between longer stimulant treatment duration or uninterrupted treatment and substance use or substance use disorder in adulthood.

Reference: Molina BS, Kennedy TM, Howard AL, et al Association between stimulant treatment and substance use through adolescence into early adulthood. JAMA Psychiatry. [e-pub July 5, 2023]

CANNABIS USE DISORDER

Preoperative screening for major elective inpatient surgeries

Preoperative screening for cannabis use disorder should be considered as part of perioperative risk stratification for patients undergoing major elective inpatient surgery, suggest the results of a study published in JAMA Surgery.

This retrospective matched cohort study examined the association between cannabis use disorder and perioperative morbidity and mortality in patients undergoing major elective inpatient surgery. The study used data from the National Inpatient Sample. It included adult patients ages 18 to 65 who underwent cholecystectomy, colectomy, inguinal or femoral hernia repair, mastectomy, lumpectomy, hip or knee arthroplasty, hysterectomy, spinal fusion, and vertebral diskectomy between January 2016 and December 2019. Data were analyzed from February to August 2022.

The exposure of interest was cannabis use disorder, determined by specific diagnostic codes from the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10). The primary outcome was a composite of in-hospital mortality and seven major perioperative complications, including myocardial ischemia, acute kidney injury, stroke, respiratory failure, venous thromboembolism, hospital-acquired infection, and surgical procedure-related complications.

The study included 12,422 hospitalizations, with a cohort of 6,211 patients with cannabis use disorder matched with 6,211 patients without the disorder. The analysis revealed that cannabis use disorder was associated with an increased risk ratio (1.19) of perioperative morbidity and mortality compared with patients without the disorder. The occurrence of the primary outcome was more frequent in the group with cannabis use disorder compared with the group without it.

Reference: Potnuru PP, Jonna S, Williams GW 2nd. Cannabis use disorder and perioperative complications. JAMA Surg. [e-pub July 5, 2023]

TYPE 2 DIABETES

Insulin icodec may be an effective treatment option

Once-weekly insulin icodec demonstrated superior reduction in A1C levels compared with once-daily insulin degludec after 26 weeks of treatment, according to a study published in JAMA.

A randomized, double-masked, noninferiority, treat-to-target, phase 3a trial was conducted from March 2021 to June 2022 at 92 sites in 11 countries, involving adults with type 2 diabetes. The participants had A1C levels ranging from 7% to 11% and were being treated with noninsulin glucose-lowering agents.

The study compared two interventions: once-weekly icodec and once-daily placebo (icodec group) versus once-daily degludec and once-weekly placebo (degludec group). The participants were randomly assigned to these groups in a 1:1 ratio.

The study's primary endpoint was the change in A1C levels from baseline to week 26, with a noninferiority margin of 0.3% percentage points. Secondary endpoints included changes in fasting plasma glucose levels, weekly insulin dose, body weight, and the occurrence of clinically significant hypoglycemic episodes.

Among the 588 participants who were randomized, 96% completed the trial. The study found that the mean A1C levels decreased in both groups, but the reduction was superior in the icodec group compared with the degludec group. The groups had no significant differences regarding fasting plasma glucose levels, weekly insulin dose, and body weight changes.

The occurrence of combined level 2 or 3 hypoglycemic events was higher in the icodec group compared with the degludec group.

Reference: Lingvay I, Asong M, Desouza C, et al Once-weekly insulin Icodec vs once-daily insulin degludec in adults with insulin-naive type 2 diabetes. JAMA. 2023;330(3):228-237. doi:10.1001/jama.2023.11313.