Pub Date : 2026-01-01DOI: 10.1016/j.mayocp.2025.08.024
Yi-Hsuan Shen MD , Yu-Chen Huang MD
Objectives
To explore the influence of the control of metabolic factors, including low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TGs), hemoglobin A1c (HbA1c), and uric acid (UA), on psoriatic arthritis (PsA) risk in patients with psoriasis (PsO).
Patients and Methods
This retrospective cohort study used data from the TriNetX research network. Data were retrieved from the TriNetX US Collaborative Network in May 2025; the analysis included patient records up to December 31, 2022. Eligible participants were individuals given a diagnosis of PsO. Patients were divided based on the control of metabolic factors. Poor control was defined as having LDL ≥130 mg/dL, HDL ≤40 mg/dL, TG ≥150 mg/dL, HbA1c >7%, or UA >6 mg/dL at least three instances. The HR was used to compare the rate of PsA occurrence between the poorly controlled and adequately controlled groups.
Results
Patients in the HDL ≤40 mg/dL, the TG ≥150 mg/dL, and the HbA1c >7% group were associated with a significantly increased PsA risk, with an HR of 1.339 (95% CI, 1.022 to 1.755), 1.469 (95% CI, 1.119 to 1.928), and 1.144 (95% CI, 1.012 to 1.294), respectively. However, no significant increase was observed in PsA risk in the patients in the LDL ≥130 mg/dL (HR, 0.983; 95% CI, 0.775 to 1.245), or UA >6 mg/dL (HR, 1.168; 95% CI, 0.863 to 1.581) group compared with their respective lower-level counterparts.
Conclusion
Managing metabolic factors including HDL and TG levels may reduce PsA risk in patients with PsO.
{"title":"Influence of Metabolic Factor Control on Psoriatic Arthritis Risk in Psoriasis Patients","authors":"Yi-Hsuan Shen MD , Yu-Chen Huang MD","doi":"10.1016/j.mayocp.2025.08.024","DOIUrl":"10.1016/j.mayocp.2025.08.024","url":null,"abstract":"<div><h3>Objectives</h3><div>To explore the influence of the control of metabolic factors, including low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TGs), hemoglobin A<sub>1c</sub> (HbA<sub>1c</sub>), and uric acid (UA), on psoriatic arthritis (PsA) risk in patients with psoriasis (PsO).</div></div><div><h3>Patients and Methods</h3><div>This retrospective cohort study used data from the TriNetX research network. Data were retrieved from the TriNetX US Collaborative Network in May 2025; the analysis included patient records up to December 31, 2022. Eligible participants were individuals given a diagnosis of PsO. Patients were divided based on the control of metabolic factors. Poor control was defined as having LDL ≥130 mg/dL, HDL ≤40 mg/dL, TG ≥150 mg/dL, HbA<sub>1c</sub> >7%, or UA >6 mg/dL at least three instances. The HR was used to compare the rate of PsA occurrence between the poorly controlled and adequately controlled groups.</div></div><div><h3>Results</h3><div>Patients in the HDL ≤40 mg/dL, the TG ≥150 mg/dL, and the HbA<sub>1c</sub> >7% group were associated with a significantly increased PsA risk, with an HR of 1.339 (95% CI, 1.022 to 1.755), 1.469 (95% CI, 1.119 to 1.928), and 1.144 (95% CI, 1.012 to 1.294), respectively. However, no significant increase was observed in PsA risk in the patients in the LDL ≥130 mg/dL (HR, 0.983; 95% CI, 0.775 to 1.245), or UA >6 mg/dL (HR, 1.168; 95% CI, 0.863 to 1.581) group compared with their respective lower-level counterparts.</div></div><div><h3>Conclusion</h3><div>Managing metabolic factors including HDL and TG levels may reduce PsA risk in patients with PsO.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 1","pages":"Pages 38-48"},"PeriodicalIF":6.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.mayocp.2025.08.002
Mackenzie D. Maberry MD , Caleb J. Smith MD , Ravindra Ganesh MBBS, MD , Ronald S. Go MD
{"title":"Clinical Utility of Monoclonal Gammopathy Testing in the Evaluation of Fibromyalgia","authors":"Mackenzie D. Maberry MD , Caleb J. Smith MD , Ravindra Ganesh MBBS, MD , Ronald S. Go MD","doi":"10.1016/j.mayocp.2025.08.002","DOIUrl":"10.1016/j.mayocp.2025.08.002","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 1","pages":"Pages 189-191"},"PeriodicalIF":6.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145677968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.mayocp.2025.11.011
Karl A. Nath MBChB (Editor-in-Chief)
{"title":"Lifestyle as a Determinant of Health and Disease: Limelight, January 2026","authors":"Karl A. Nath MBChB (Editor-in-Chief)","doi":"10.1016/j.mayocp.2025.11.011","DOIUrl":"10.1016/j.mayocp.2025.11.011","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 1","pages":"Pages 1-3"},"PeriodicalIF":6.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145877058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.mayocp.2025.03.015
Aamir Ali MD , Dominique E. Howard MD , Immanuel Babu Henry Samuel PhD , Rayelynn Murphy MS , Andreas Pittaras MD , Sara Campbell PhD , Olivia M. Becker , Nikola Mrkoci , Jonathan Myers PhD , Carl Lavie MD , Alexandos Ladas MD , Charles Faselis MD , Peter Kokkinos PhD
Objective
To evaluate the association between cardiorespiratory fitness (CRF), objectively measured by standardized exercise treadmill test (ETT), and colorectal cancer incidence.
Methods
The study involved 643,583 US veterans nationwide (41,968 women) from the Exercise Testing and Health Outcomes Study (ETHOS) cohort. None had cancer diagnosis before ETT or had cancer other than colorectal after ETT. Participants completed an ETT (Bruce) with no evidence of ischemia and were stratified into CRF categories (quintiles) based on peak metabolic equivalents (METs) achieved: least fit (n=119,673; METs: 4.8±1.5), low fit (n=157,059; METs: 7.3±1.4), moderate fit (n=122,194; METs: 8.6±1.4), fit (n=170,324; METs: 10.5±1.0), and high fit (n= 74,333; METs: 13.6±1.8).
Results
During a median follow-up period of 10.0 years, totaling 6,632,561 person-years, 8190 participants had colorectal cancer (12.4 events per 10,000 person-years). Cardiorespiratory fitness was inversely associated to colorectal cancer risk, independent of comorbidities, with a 9% risk reduction per 1-MET higher in CRF (hazard ratio [HR], 0.91; 95% CI, 0.90 to 0.92), for men and women and across all races. Compared with least fit, the risk of those in the next CRF category (low fit) was 14% lower (HR, 0.86; 95% CI, 0.81 to 0.91). The risk declined progressively with increased CRF and was 57% lower (HR, 0.43; 95% CI, 0.29 to 0.48) for those in the high-fit group.
Conclusion
We observed an inverse and graded association between CRF and colorectal cancer incidence, across races and sexes, independent of comorbidities. The lower risk was evident in those with a peak CRF of approximately 8.5 to 10.5 METs, a relatively moderate CRF status attainable by most middle-aged and older individuals.
{"title":"Cardiorespiratory Fitness and Colorectal Cancer Incidence in US Veterans: A Cohort Study","authors":"Aamir Ali MD , Dominique E. Howard MD , Immanuel Babu Henry Samuel PhD , Rayelynn Murphy MS , Andreas Pittaras MD , Sara Campbell PhD , Olivia M. Becker , Nikola Mrkoci , Jonathan Myers PhD , Carl Lavie MD , Alexandos Ladas MD , Charles Faselis MD , Peter Kokkinos PhD","doi":"10.1016/j.mayocp.2025.03.015","DOIUrl":"10.1016/j.mayocp.2025.03.015","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the association between cardiorespiratory fitness (CRF), objectively measured by standardized exercise treadmill test (ETT), and colorectal cancer incidence.</div></div><div><h3>Methods</h3><div>The study involved 643,583 US veterans nationwide (41,968 women) from the Exercise Testing and Health Outcomes Study (ETHOS) cohort. None had cancer diagnosis before ETT or had cancer other than colorectal after ETT. Participants completed an ETT (Bruce) with no evidence of ischemia and were stratified into CRF categories (quintiles) based on peak metabolic equivalents (METs) achieved: least fit (n=119,673; METs: 4.8±1.5), low fit (n=157,059; METs: 7.3±1.4), moderate fit (n=122,194; METs: 8.6±1.4), fit (n=170,324; METs: 10.5±1.0), and high fit (n= 74,333; METs: 13.6±1.8).</div></div><div><h3>Results</h3><div>During a median follow-up period of 10.0 years, totaling 6,632,561 person-years, 8190 participants had colorectal cancer (12.4 events per 10,000 person-years). Cardiorespiratory fitness was inversely associated to colorectal cancer risk, independent of comorbidities, with a 9% risk reduction per 1-MET higher in CRF (hazard ratio [HR], 0.91; 95% CI, 0.90 to 0.92), for men and women and across all races. Compared with least fit, the risk of those in the next CRF category (low fit) was 14% lower (HR, 0.86; 95% CI, 0.81 to 0.91). The risk declined progressively with increased CRF and was 57% lower (HR, 0.43; 95% CI, 0.29 to 0.48) for those in the high-fit group.</div></div><div><h3>Conclusion</h3><div>We observed an inverse and graded association between CRF and colorectal cancer incidence, across races and sexes, independent of comorbidities. The lower risk was evident in those with a peak CRF of approximately 8.5 to 10.5 METs, a relatively moderate CRF status attainable by most middle-aged and older individuals.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 1","pages":"Pages 63-72"},"PeriodicalIF":6.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.mayocp.2025.08.021
Clayton T. Cowl MD, MS , Samantha Westphal RN , Tammy Green MBA , Laura E. Breeher MD, MPH
{"title":"How Health Care Providers Are Contributing to the Iatrogenic Disability Crisis in the United States","authors":"Clayton T. Cowl MD, MS , Samantha Westphal RN , Tammy Green MBA , Laura E. Breeher MD, MPH","doi":"10.1016/j.mayocp.2025.08.021","DOIUrl":"10.1016/j.mayocp.2025.08.021","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 1","pages":"Pages 26-32"},"PeriodicalIF":6.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145549952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.mayocp.2025.08.019
Ziad Zalaquett MD, MSc, Neehal Shukla MD, Joseph Hajj MD, Michel Chedid El Helou MD, MSc, Rohit Moudgil MD, PhD, Patrick Collier MD, PhD
Fluoropyrimidines, including 5-fluorouracil and capecitabine, are widely used in the treatment of numerous malignant neoplasms. However, they are a common cause of chemotherapy-induced cardiac toxicity. The cardiovascular adverse events can range from arrhythmias to myocardial infarction and cardiogenic shock, with incidence rates varying between 1.2% and 30%. Despite increasing recognition of risk factors and clinical presentations, the exact mechanisms underlying fluoropyrimidine cardiotoxicity remain unclear. Proposed mechanisms include coronary vasospasm, direct myocardial toxicity due to mitochondrial injury, endothelial dysfunction, and ferroptosis. It is challenging to identify and diagnose the adverse event because of the variability in clinical manifestations and the absence of specific biomarkers. Biomarkers such as troponins or imaging modalities including electrocardiographic changes and echocardiographic assessment may aid in detecting toxicity, but their predictive value remains limited. The primary approach to management involves discontinuation of therapy and symptomatic treatment. Calcium channel blockers and nitrates are commonly used for vasospasm-related events. Rechallenge strategies incorporating dose modifications and cardioprotective medications have been explored but remain controversial owing to high recurrence rates. This review provides an updated overview of fluoropyrimidine-associated cardiotoxicity, emphasizing epidemiology, pathophysiology, diagnostic approaches, and management strategies to enhance patient safety and treatment outcomes.
{"title":"Cardiovascular Toxicity of Fluoropyrimidines: What We Know","authors":"Ziad Zalaquett MD, MSc, Neehal Shukla MD, Joseph Hajj MD, Michel Chedid El Helou MD, MSc, Rohit Moudgil MD, PhD, Patrick Collier MD, PhD","doi":"10.1016/j.mayocp.2025.08.019","DOIUrl":"10.1016/j.mayocp.2025.08.019","url":null,"abstract":"<div><div>Fluoropyrimidines, including 5-fluorouracil and capecitabine, are widely used in the treatment of numerous malignant neoplasms. However, they are a common cause of chemotherapy-induced cardiac toxicity. The cardiovascular adverse events can range from arrhythmias to myocardial infarction and cardiogenic shock, with incidence rates varying between 1.2% and 30%. Despite increasing recognition of risk factors and clinical presentations, the exact mechanisms underlying fluoropyrimidine cardiotoxicity remain unclear. Proposed mechanisms include coronary vasospasm, direct myocardial toxicity due to mitochondrial injury, endothelial dysfunction, and ferroptosis. It is challenging to identify and diagnose the adverse event because of the variability in clinical manifestations and the absence of specific biomarkers. Biomarkers such as troponins or imaging modalities including electrocardiographic changes and echocardiographic assessment may aid in detecting toxicity, but their predictive value remains limited. The primary approach to management involves discontinuation of therapy and symptomatic treatment. Calcium channel blockers and nitrates are commonly used for vasospasm-related events. Rechallenge strategies incorporating dose modifications and cardioprotective medications have been explored but remain controversial owing to high recurrence rates. This review provides an updated overview of fluoropyrimidine-associated cardiotoxicity, emphasizing epidemiology, pathophysiology, diagnostic approaches, and management strategies to enhance patient safety and treatment outcomes.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 1","pages":"Pages 136-155"},"PeriodicalIF":6.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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