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Tag: The Lancet

  • E-Cigarettes 95% Safer? Not So Fast, Says Top Medical Journal

    E-Cigarettes 95% Safer? Not So Fast, Says Top Medical Journal

    The Lancet, one of the world’s oldest and best-known medical journals, has blasted a widely-publicized report that said e-cigarettes are 95% safer than regular, combustible tobacco.

    “Tobacco is the largest single cause of preventable deaths in England—e-cigarettes may have a part to play to curb tobacco use. But the reliance by PHE on work that the authors themselves accept is methodologically weak, and which is made all the more perilous by the declared conflicts of interest surrounding its funding, raises serious questions not only about the conclusions of the PHE report,” writes the Lancet editorial team.

    The report, from Public Health England, said that e-cigarettes can help smokers quit and are 95% less harmful than regular cigarettes.

    “Many people think the risks of e-cigarettes are the same as smoking tobacco and this report clarifies the truth of this. In a nutshell, best estimates show e-cigarettes are 95% less harmful to your health than normal cigarettes, and when supported by a smoking cessation service, help most smokers to quit tobacco altogether,” said the report.

    “Smokers who have tried other methods of quitting without success could be encouraged to try e-cigarettes (EC) to stop smoking and stop smoking services should support smokers using EC to quit by offering them behavioral support. Encouraging smokers who cannot or do not want to stop smoking to switch to EC could help reduce smoking related disease, death and health inequalities. There is no evidence that EC are undermining the long-term decline in cigarette smoking among adults and youth, and may in fact be contributing to it. Despite some experimentation with EC among never smokers, EC are attracting very few people who have never smoked into regular EC use,” it says.

    But The Lancet calls into question the report, saying the papers it is based upon are faulty at their core.

    “[N]either PHE nor McNeill and Hajek report the caveats that Nutt and colleagues themselves emphasised in their paper. First, there was a “lack of hard evidence for the harms of most products on most of the criteria”. Second, “there was no formal criterion for the recruitment of the experts”. In other words, the opinions of a small group of individuals with no prespecified expertise in tobacco control were based on an almost total absence of evidence of harm. It is on this extraordinarily flimsy foundation that PHE based the major conclusion and message of its report.”

    “The study led by Nutt was funded by Euroswiss Health and Lega Italiana Anti Fumo (LIAF). Riccardo Polosa, one of the authors of the Nutt paper, is the Chief Scientific Advisor to LIAF. In the paper, he reports serving as a consultant to Arbi Group Srl, an e-cigarette distributor. His research on e-cigarettes is currently supported by LIAF. Another author reports serving as a consultant to manufacturers of smoking cessation products. The editors of the journal added a note at the end of the paper warning readers about the “potential conflict of interest” associated with this work.”

    PHE has responded, standing by its findings.

    “We concluded that these new studies do not in fact demonstrate substantial new
    risks and that the previous estimate by an international expert panel (Nutt et al,
    2014) endorsed in an expert review (West et al, 2014) that e-cigarette use is
    around 95% safer than smoking, remains valid as the current best estimate based
    on the peer-reviewed literature,” says PHE.

    Image via Vaping360, Flickr Creative Commons

  • Cholesterol Disorder Medication “Shows Promise” in Study

    A new study by researchers at the University of Pennsylvania has shown that lomitapide “substantially and stably” reduced levels of LDL cholesterol in patients with homozygous familial hypercholesterolemia (HoFH). Lomitapide is a microsomal triglyceride transfer protein (MTP) inhibitor that works by inhibiting MTP, which is necessary in the production of precursors to LDL cholesterol.

    Patients with HoFH, which is a rare condition, have elevated blood levels of cholesterol. Their genetic mutations in the LCL receptor gene impair the liver’s ability to remove LDL from blood. According to researchers, those with HoFH often develop heart and vascular disease during childhood, and their average age at death is 30 years old. Current treatments for high cholesterol have not proven effective for HoFH patients, and the only currently effective therapy is apheresis, which involves removing LDL cholesterol from the blood every one to two weeks by running it through machines.

    The study looked at 29 adult HoFH patients, 23 of whom completed all phases of the trial. The patients received lomitapide during the six-month trial, as well as conventional lipid-lowering therapies. Results show that LDL-C levels in the patients were reduced by an average of 50% at the end of the efficacy phase of the trial, and around one third of the patients saw LDL-C levels that were “close to recommended therapeutic goals.” Overall, the patients average LDL-C levels were down 38% at the end of the study.

    “The magnitude of this reduction in LDL-C and the fact that some patients reached or approached the LDL-C therapeutic goals is truly remarkable for this high risk population that historically doesn’t respond to lipid-lowering drugs,” said Dr. Marina Cuchel, lead author of the study and research assistant professor of Medicine at the University of Pennsylvania School of Medicine. “A reduction in LDL-C of this magnitude is certainly expected to favorably alter the clinical course of this devastating disease.”

  • Alzheimer’s Signs Found in People as Young as 18, Says Study

    Researchers this week announced that the earliest signs of Alzheimer’s disease yet detected have been found in a group of people with a rare inherited form of the disease. Two new studies on the subject were published in the journal Lancet Neurology. The studies were led by doctors from the Banner Alzheimer’s Institute in Arizona, Boston University, and the University of Antioquia in Colombia.

    The studies looked at a group of around 5,000 related people in Colombia who could carry a rare mutation of a gene called presenilin 1 (PSEN1). Around 30% of the group had the mutation, which indicates certain early-onset of Alzheimer’s disease.

    In one study, researchers performed brain imaging, blood tests, and some cerebrospinal fluid analysis on 44 adults age 18 – 26, 20 of whom had the PSEN1 mutation. Though none of the patients had evidence of cognitive impairment at the time of the study, researchers found differences in the “brain structure and function” between those with the mutation and those without. PSEN1 carriers were found to have more brain activity in the hippocampus and parahippocampus regions of the brain, as well as having higher levels of a protein called amyloid beta in their cerebrospinal fluid.

    “These findings suggest that brain changes begin many years before the clinical onset of Alzheimer’s disease, and even before the onset of amyloid plaque deposition,” said Dr. Eric Reiman of the Banner Alzheimer’s Institute. “They raise new questions about the earliest brain changes involved in the predisposition to Alzheimer’s and the extent to which they could be targeted by future prevention therapies.”

    The other study tracked amyloid plaque deposits in the brains of 50 people aged 20 – 56. Those patients with the PSEN1 mutation were discovered to have amyloid plaques begin to accumulate as early as their late 20s. According to the study’s authors, the findings will “help set the stage for the evaluation of treatments to prevent familial Alzheimer’s disease, and hopefully aid our understanding of the early stages of late-onset Alzheimer’s disease, which is more widespread.”

  • Prostate Cancer Blood Test Developed by Scientists

    This week, scientists announced a study that demonstrates a blood test that can detect advanced-stage prostate cancer. The study, from researchers at the Spanish National Cancer research Centre (CNIO), Institute for Cancer Research, and the Royal marsden NHS Foundation Trust, was published this week in the journal Lancet Oncology.

    The new test studies genetic patterns in blood cells, which can then be used with current prostate-specific antigen (PSA) tests to classify patients most in need of treatment. Often, patients may live with prostate cancer for years without showing any symptoms, but other tumors, according to the researchers, can be “very aggressive and deadly.” Their new test can help identify these different types of patients.

    The study scanned the genes in the blood samples of 100 prostate cancer patients. 69 of the patients had advanced stage prostate cancer, while 31 of them had a low-risk tumor. The researchers split the patients into four groups based on their different genetic activity patterns, which they describe as a sort of “barcode.” The researchers then followed the patients for around two and a half years, and found that a group with one specific 9-gene “barcode” had a much lower survival rate.

    Those results were also compared to 70 more patients from the Memorial Sloan kettering Cancer Centre, which confirmed the results. The research suggests, said the study’s authors, that cancer tumors release an “anomalous immune response” as they grow.

    “The test we have developed is simpler and potentially more precise than many other tests we currently have available or than carrying out another biopsy”, said the study’s authors.

    This study comes just days after a different study, published in the Journal of Urology, demonstrated a test that more effectively uses biopsies. That test looks for genetic markers as well, and could help prevent the number of follow-up biopsies doctors require from patients.

  • Heart Attack Risk Linked to Work Stress

    A new study published today in The Lancet shows that people with “highly demanding” job or those with “little freedom” are more likely to have a heart attack. Specifically, they are 23% more likely to have a heart attack than those with less stressful jobs.

    The study, led by Professor Mika Kivimäki from the University College London department of epidemiology and public health, looked at 13 European national cohort studies from Belgium, Denmark, Finland, France Netherlands, Sweden, and the U.K. since 1985. The nearly 200,000 people who participated in the studies were given questionnaires that assessed their job demands, workload, time-pressure demands, and freedom to make decisions at work.

    “The overall population attributable risk (PAR) for CHD events was around 3.4 per cent, suggesting that if the association were causal, then job strain would account for a notable proportion of coronary heart disease (CHD) events in working populations,” said Kivimäki. “As such, reducing workplace stress might decrease disease incidence. However, this strategy would have a much smaller effect than tackling standard risk factors such as smoking (PAR 36%) and physical inactivity (PAR 12%).”

    The 23% higher risk of heart attack the new study finds stays consistent regardless of gender, age, or socioeconomic status. According to the University College London, previous studies linking work stress and heart disease have been limited, inconsistent, and put into question by shortcomings such as publication bias and reverse causation bias.

    “The pooling of published and unpublished studies allowed us to investigate the association between CHD and exposure to job strain – defined by high work demands and low decision control – with greater precision than has been previously possible,” said Kivimäki. “Our findings indicate that job strain is associated with a small, but consistent, increased risk of experiencing a first CHD event such as a heart attack.”