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Hyperuricemia and cardiovascular risk: Insights and implications
No full textHyperuricemia, characterized by elevated serum uric acid levels, has been linked to cardiovascular diseases such as hypertension, atrial fibrillation, chronic kidney disease, heart failure, metabolic syndrome, and coronary artery disease. This relationship, however, is complex; while some studies indicate a strong association, others suggest it may be influenced by confounding factors. The rising global prevalence of hyperuricemia underscores the necessity for a deeper understanding of its cardiovascular implications. Hyperuricemia results from an imbalance in uric acid production and excretion, driven by dietary factors, obesity, insulin resistance, and other conditions. Elevated uric acid levels contribute to cardiovascular risk through mechanisms such as inflammation, oxidative stress, endothelial dysfunction, and activation of the renin-angiotensin-aldosterone system. This review highlights the importance of ongoing research to clarify hyperuricemia\u27s role in cardiovascular disease and suggests that urate-lowering therapies, such as xanthine oxidase inhibitors, may confer cardiovascular benefits; however, evidence remains conflicting. The CARES trial indicated an increased risk of cardiovascular and all-cause mortality with febuxostat compared to allopurinol, raising safety concerns. In contrast, the FAST trial demonstrated that febuxostat was non-inferior to allopurinol, with even lower all-cause mortality. These opposing findings emphasize the complexity of treatment decisions and the need for individualized management strategies for hyperuricemia. Clinical decisions should consider individual patient risks and characteristics. Ultimately, this comprehensive analysis aims to enhance prevention and management strategies for cardiovascular diseases related to hyperuricemia. The overview includes discussions on major studies such as the Framingham Heart Study, CARES, FAST, PRIZE, and FREED trials, examining their results. It explores whether hyperuricemia is a causal factor versus an associated risk factor and whether it serves as a marker or mediator of disease. Additionally, the review addresses novel biomarkers and predictive models, the management of hyperuricemia in the context of cardiovascular risk, the role of urate-lowering therapies in cardiovascular disease, variability in guidelines and recommendations, and the impact of hyperuricemia in special populations such as those with diabetes and chronic kidney disease. The cardiovascular risk associated with hyperuricemia across various demographics is also discussed. Furthermore, the review suggests that existing risk scores might be modified to include uric acid levels in patients with hyperuricemia. • Hyperuricemia is linked to cardiovascular diseases through inflammation, oxidative stress, and endothelial dysfunction. • Urate-lowering therapies may offer cardiovascular benefits but require individualized risk assessment. • Cardiovascular risks of hyperuricemia vary by demographics and comorbidities, necessitating personalized management. • Its role as a causal factor versus a risk marker remains unclear, warranting further research
A whole-of-society approach to depression prevention during the global pandemic: Preliminary data from three large-scale trials
No full textObjective: Despite the prevalence of depressive disorders among youth, there is no health system model to address the prevention of these disorders.
Method: With the goal of creating effective, tolerable, and scalable interventions for the prevention of adolescent depression, we have fielded three randomized clinical trials, centered in health care delivery organizations that use a whole-of-society approach: (a) Path 2 Purpose ( N = 664), comparing the Competent Adulthood Transition with Cognitive Behavioral, Humanistic, and Interpersonal Training (CATCH-IT; B. W. Van Voorhees et al., 2015), guided digital health intervention to a synchronous mental health specialist-led group cognitive behavioral intervention, Coping with Depression Course-Adolescent; (b) PATHway ( N = 400), examining the efficacy of the CATCH-IT components; and (c) Behavioral Health Stratified Treatment ( N = 780), which examines the feasibility and potential benefit of a coordinated care, risk stratification, and intervention matching approach for adolescents with intellectual and developmental disabilities using both CATCH-IT (lower risk) and the Coping with Depression Course-Adolescent (higher risk).
Results: The study samples for all three trials include youth from traditionally underrepresented groups (71.8%) with some economic distress (47.6%). Intervention utilization was moderate across trials. Feedback from study teams reveals general barriers to implementation and challenges specific to the pandemic.
Conclusions: We review these trials, report preliminary data on demographics and intervention utilization, and provide feedback from study teams on implementation challenges encountered. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
The Effects of a Mindfulness-Based Intervention on Depression and Anxiety in the Long-COVID Population
No full textLong-COVID is a complicated, post-viral syndrome involving multiple body systems and can present with neuropsychiatric symptoms. Little has been reported about the neuropsychiatric symptoms of long-COVID, and validated treatments do not yet exist. There is prior evidence that mindfulnessbased strategies have been helpful for those with chronic illnesses; shown significant decreases in anxiety, stress, and depression; and enhanced quality of life. In this study, we report on the utility of a mindfulness-based intervention on levels of anxiety and depression in a long-COVID population. Our hospital system founded both a “Covid Recovery Clinic” (CRC) and a “Post-COVID Resilience Program” (PCRP). The PCRP consisted of a six-week virtual group therapy protocol that focused on mindfulness-based practices. Before and after the therapy intervention, participants answered questionnaires to capture depressive and anxiety symptoms. Pre- and post-questionnaire scores do not show a significant improvement in depressive or anxiety symptoms, although the study was limited by a small sample size. Further research is needed to investigate whether similar programs with a larger sample size can improve the mental health status of patients suffering from long-COVID
Tolerability and safety of a new oral device for prevention and treatment of oral mucositis in patients with hematologic malignancies undergoing chemotherapy
No full textPurpose: Around 40% of patients undergoing systemic chemotherapy develop oral mucositis (OM), a major cause of morbidity in cancer patients. There are only a few options for preventing and treating OM. This study examines the tolerability of a novel oral device (Bocaliner™), designed to enhance the effects of oral topical therapies, in patients with hematologic malignancies receiving chemotherapy.
Methods: Data from phase 1/phase 2 randomized controlled trial SPOM (Study for the Prevention of Oral Mucositis) was analyzed. Patients from the Yeolyan Hematology and Oncology Center (Yerevan, Armenia) were randomized into two groups: benzydamine or saline mouthwash. Half of the patients in each study group were randomly assigned to Bocaliner™. Tolerability and safety questionnaires on days 1 and 14 of chemotherapy were completed.
Results: Twenty-eight patients (mean age of 49 years; 50% female) received oral devices and completed the study. On the tryout of the device, 22 (78.6%) patients reported tolerating it well, and six (21.4%) reported some discomfort. After 14 days, 15 patients (35.7%) reported benefit from the use, with six (21.4%) of patients stating the device helped to reduce pain, four (14.3%) indicating that it helped them to eat, and five (17.8%) claiming both. Adverse events included discomfort (n = 2, 7.1%), pain around the cheekbone (n = 3, 10.7%), nausea (n = 2, 7.1%), and increased salivation (n = 1, 3.6%); none of these led to discontinuation of the use. Eighteen (64%) participants said they would use the device again. OM developed in five patients (17.8%).
Conclusions: The use of a new medical device designed to enhance oral topical medications in combination with oral topical therapy is well tolerated among patients with hematologic malignancies on chemotherapy
Optimization of renin-angiotensin-aldosterone inhibitor therapies for evidence-based indications: A call to action from the cardio-kidney community
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The Prognostic Significance of Donor-Derived Cell-Free DNA within 30 Days After Heart Transplant
No full textCognitive impairment without dementia: A treatable case of dural arteriovenous fistula
No full textDural arteriovenous fistula (DAVF) can present with a wide range of symptoms depending on its location and the degree of arteriovenous shunting. Rarely, they may manifest as cognitive impairment due to chronic venous dysfunction. This is the case of an elderly man evaluated for subacute onset of memory loss without dementia. Magnetic resonance imaging (MRI) of the brain revealed a subtle subarachnoid vascularity in the right occipital lobe, without cerebral edema or parenchymal abnormality. Digital subtraction angiography (DSA) confirmed a low-flow Borden type III DAVF, draining via an occipital cortical vein into the basal vein of Rosenthal and the vein of Galen. Subjective cognitive symptoms resolved following successful treatment with transarterial Onyx embolization. The role of DAVFs in mild cognitive impairment without dementia is likely underrecognized due to their rarity and inherent difficulties in diagnosis. This suggests a potential role for detailed cognitive evaluation in guiding the management of DAVFs