NEJM evidence最新文献

AbstractRandomized controlled trials have demonstrated a reduction in the composite of heart failure events and death from cardiovascular causes with use of SGLT2 inhibitors, regardless of whether a patient has type 2 diabetes mellitus. This evidence led to a class 1A indication for SGLT2i for adults with heart failure. However, recent data demonstrate that the adoption of SGLT2i into practice has been slow. This article describes benefits, risks, pivotal trials, prescribing pearls, and areas of uncertainty related to the use of SGLT2i for adults with heart failure.

Background: Identification of chronic obstructive pulmonary disease (COPD) diagnosed before 50 years of age ("young COPD") will help enable the study of preventive and therapeutic interventions for classically diagnosed COPD in later life. However, there remains uncertainty about the definition of young COPD and its prognostic significance.

Methods: We assessed the prevalence of young COPD, defined here as spirometric airflow obstruction plus symptoms of cough, phlegm, and dyspnea or 10 or more pack-years of smoking, among 18-to-49-year-old participants from four pooled, prospective U.S. cohorts. We evaluated the association of young COPD with premature mortality and respiratory and cardiovascular events over follow-up, using multivariable-adjusted proportional hazards models.

Results: Among 10,680 participants (median age, 40 years; 56.8% women; 41.7% Black; 51.1% unexposed to smoking), the prevalence of people meeting our case definition of young COPD was 4.5%. Compared with nonobstructed participants, the adjusted hazard ratio (an adjusted hazard ratio greater than unity indicates more incident cases) for participants with young COPD for death before 75 years of age was 1.43 (95% confidence interval [CI], 1.19 to 1.73; P<0.001); for incident hospitalization or death due to chronic lower respiratory disease, the adjusted hazard ratio was 2.56 (95% CI, 2.05 to 3.20); for coronary heart disease, the adjusted hazard ratio was 1.12 (95% CI, 0.85 to 1.47); and for heart failure, the adjusted hazard ratio was 1.72 (95%CI, 1.26 to 2.35). The hazards of the clinical outcomes in participants with simple obstruction (spirometric obstruction without symptoms and <10 pack-years; prevalence, 2.4%) were similar to those of nonobstructed participants.

Conclusions: Young COPD was present in 4.5% of adults under 50 years of age in the cohorts examined. The diagnosis was associated with premature mortality as well as respiratory and heart-failure events. (Funded by the National Heart, Lung, and Blood Institute and others.).

AbstractStatistical testing of more than one hypothesis has the potential to increase the risk of wrongly concluding that the result for a given end point is statistically significant (false discovery). This review is designed to acquaint nonstatisticians with traditional approaches for controlling type I error and with the seemingly complex procedure known as graphical testing.

Background: Lung cancer is the leading cause of cancer-related death worldwide. The aim of the KBP-2020 study was to describe survival among patients diagnosed with lung adenocarcinoma in France in 2000, 2010, and 2020, outside academic medical centers.

Methods: We collected prospective data from all patients diagnosed with lung cancer in nonacademic public hospitals in France in 2020. We compared these data with those from similar studies performed in 2000 and 2010 to map the evolution of survival.

Results: The KBP-2020 cohort comprised 5015 patients with lung adenocarcinoma. The 3-year overall survival (OS) rate was 38.6%, ranging from 21.3% among patients with metastatic disease at diagnosis to 84.0% for those with stage I disease at diagnosis. The median OS in the overall population more than doubled in 20 years, from 8.5 months in 2000 to 20.7 months in 2020. Female sex, higher performance status, and earlier disease stage were associated with an increased 3-year OS. Patients with metastatic lung adenocarcinoma with EGFR, ALK, or ROS1 molecular alterations who were treated with targeted therapy had a higher 3-year OS rate than such patients without these alterations - 36.0% versus 18.5%. Among those patients with metastatic disease without the above-noted molecular alterations, the 3-year OS rate was 36.2% with first-line immunotherapy versus 14.3% without immunotherapy, and median OS was 21.0 months versus 4.2 months.

Conclusions: Improvements in the OS of patients with lung adenocarcinoma were seen over 20 years in this setting of nonacademic public hospitals in France. Targeted therapy and immunotherapy were associated with longer OS among patients with metastatic disease. (Le Nouveau Souffle and others; trial registration number, NCT04402099.).