Seungjae Cho, Jessica Mak, Jacob A Udell, Wayne L Gold, Alanna Weisman
{"title":"Diabetic ketoacidosis induced by a sodium-glucose cotransporter-2 inhibitor in a 28-year-old man without known diabetes.","authors":"Seungjae Cho, Jessica Mak, Jacob A Udell, Wayne L Gold, Alanna Weisman","doi":"10.1503/cmaj.241400","DOIUrl":"https://doi.org/10.1503/cmaj.241400","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 17","pages":"E478-E481"},"PeriodicalIF":9.4,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Avis de décès pour avril 2025.","authors":"","doi":"10.1503/cmaj.250545-f","DOIUrl":"https://doi.org/10.1503/cmaj.250545-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 17","pages":"E493-E496"},"PeriodicalIF":9.4,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Wildfire smoke air pollution: new approaches needed to protect people affected.","authors":"Sarah B Henderson","doi":"10.1503/cmaj.250510","DOIUrl":"10.1503/cmaj.250510","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 17","pages":"E483-E484"},"PeriodicalIF":9.4,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Caring for patients with intrathecal baclofen pumps.","authors":"Katherine Archibold, Alex Whelan","doi":"10.1503/cmaj.241230","DOIUrl":"https://doi.org/10.1503/cmaj.241230","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 17","pages":"E482"},"PeriodicalIF":9.4,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Vitiligo.","authors":"Shahnawaz Towheed, Ajith Cy","doi":"10.1503/cmaj.240778-f","DOIUrl":"https://doi.org/10.1503/cmaj.240778-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 17","pages":"E487-E488"},"PeriodicalIF":9.4,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Deaf, to good advice.","authors":"A Mark Clarfield","doi":"10.1503/cmaj.250189","DOIUrl":"https://doi.org/10.1503/cmaj.250189","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 17","pages":"E485-E486"},"PeriodicalIF":9.4,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Défendre la limite.","authors":"Kirsten Patrick","doi":"10.1503/cmaj.250418-f","DOIUrl":"https://doi.org/10.1503/cmaj.250418-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 17","pages":"E489-E490"},"PeriodicalIF":9.4,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"L’importance de la confiance dans le long parcours d’une patiente atteinte d’une névralgie du trijumeau.","authors":"Isabella Spensieri","doi":"10.1503/cmaj.241308-f","DOIUrl":"https://doi.org/10.1503/cmaj.241308-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 16","pages":"E461-E462"},"PeriodicalIF":9.4,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarah Khan, Jason Brophy, Fatima Kakkar, Nancy Nashid, Laura Sauve, Rupeena Purewal, Ari Bitnun
{"title":"Pediatricians' response to presenting formula and breast- or chestfeeding as equivalent options for parents with virally suppressed HIV.","authors":"Sarah Khan, Jason Brophy, Fatima Kakkar, Nancy Nashid, Laura Sauve, Rupeena Purewal, Ari Bitnun","doi":"10.1503/cmaj.152179-l","DOIUrl":"https://doi.org/10.1503/cmaj.152179-l","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 16","pages":"E457"},"PeriodicalIF":9.4,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Danbee Kang, Ki Hong Choi, Seongwoo Yang, Hyunsoo Kim, Taek Kyu Park, Joo Myung Lee, Juhee Cho, Jeong Hoon Yang, Young Bin Song, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Joo-Yong Hahn
Background: Differences exist between European and American guideline recommendations regarding targets for low-density lipoprotein cholesterol (LDL-C) levels after percutaneous coronary intervention (PCI), with European guidance advocating for more aggressive reduction to less than 1.4 mmol/L compared with the American guideline, which recommends an LDL-C level of 1.8 mmol/L or greater as the threshold for treatment intensification. We aimed to evaluate clinical outcomes according to percentage reduction of LDL-C levels and to compare the outcomes according to the attained LDL-C levels after PCI.
Methods: This nationwide cohort study included adults in South Korea who underwent PCI and health screening within 3 years before and after PCI. Participants were divided into groups with a reduction of LDL-C levels of less than 50% and of 50% or greater. The group with LDL-C reduction of 50% or greater was stratified into categories of LDL-C level after PCI: less than 1.4 mmol/L, 1.4 to less than 1.8 mmol/L, and 1.8 mmol/L or greater. The primary end point was major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of cardiovascular death, spontaneous myocardial infarction (MI), repeat revascularization, and ischemic stroke.
Results: We included 135 877 adult participants. A total of 40.1% achieved a reduction of LDL-C levels of 50% or greater (n = 54 551). During a median follow-up of 7.4 years, the group with a reduction of 50% or greater had a multivariable-adjusted hazard ratio (HR) for MACCE of 0.78 (95% confidence interval [CI] 0.76-0.80). Among patients who achieved a reduction of LDL-C levels of 50% or greater, the multivariable-adjusted HR for MACCE was 1.07 (95% CI 1.02-1.13) for the group with LDL-C levels of 1.4 to less than 1.8 mmol/L after PCI and 1.12 (95% CI 1.04-1.21) for the group with levels of greater than 1.8 mmol/L. The risk of spontaneous MI was also higher in the group with LDL-C levels of 1.8 mmol/L or greater than in the group with levels of less than 1.4 mmol/L (HR 1.36, 95% CI 1.14-1.62).
Interpretation: Among patients who underwent PCI, those who achieved a reduction in LDL-C levels of 50% or greater had a reduced risk of MACCE, regardless of baseline LDL-C levels. Among patients with a reduction in LDL-C levels of 50% or greater, compared with patients with an LDL-C level less than 1.4 mmol/L after PCI, those with an LDL-C level of greater than 1.8 mmol/L and a level of 1.4 to less than 1.8 mmol/L had an increased risk of MACCE. These findings suggest that while achieving an LDL-C reduction of 50% or greater remains a critical therapeutic goal, targeting LDL-C levels of less than 1.4 mmol/L after PCI may provide additional clinical benefit.
背景：欧洲和美国指南对于经皮冠状动脉介入治疗（PCI）后低密度脂蛋白胆固醇（LDL-C）水平目标的建议存在差异，欧洲指南主张更积极地将LDL-C水平降低到1.4 mmol/L以下，而美国指南建议LDL-C水平为1.8 mmol/L或更高作为强化治疗的阈值。我们的目的是根据LDL-C水平降低的百分比来评估临床结果，并根据PCI后达到的LDL-C水平来比较结果。方法：这项全国性队列研究包括韩国接受PCI和PCI前后3年内健康筛查的成年人。参与者被分为LDL-C水平降低低于50%和50%或更高的两组。将PCI术后LDL-C降低50%及以上的组按LDL-C水平分为低于1.4 mmol/L、1.4至小于1.8 mmol/L、1.8 mmol/L及以上三组。主要终点是主要心脑血管不良事件（MACCE），定义为心血管死亡、自发性心肌梗死（MI）、重复血运重建术和缺血性卒中的复合。结果：纳入135877名成人受试者。总共40.1%的患者LDL-C水平降低了50%或更高（n = 54 551）。在中位随访7.4年期间，减少50%或以上的组MACCE的多变量调整风险比（HR）为0.78（95%可信区间[CI] 0.76-0.80）。在LDL-C水平降低50%或以上的患者中，PCI术后LDL-C水平在1.4至1.8 mmol/L以下组的MACCE多变量调整HR为1.07 (95% CI 1.02-1.13)，高于1.8 mmol/L组的MACCE多变量调整HR为1.12 （95% CI 1.04-1.21）。LDL-C水平为1.8 mmol/L或更高的组发生自发性心肌梗死的风险也高于低于1.4 mmol/L的组（HR 1.36, 95% CI 1.14-1.62）。解释：在接受PCI的患者中，无论基线LDL-C水平如何，LDL-C水平降低50%或更高的患者发生MACCE的风险降低。在PCI术后LDL-C水平降低50%以上的患者中，与LDL-C水平低于1.4 mmol/L的患者相比，LDL-C水平大于1.8 mmol/L和1.4至小于1.8 mmol/L的患者MACCE的风险增加。这些发现表明，虽然实现LDL-C降低50%或更高仍然是一个关键的治疗目标，但PCI术后LDL-C水平低于1.4 mmol/L可能会提供额外的临床益处。试验注册：ClinicalTrials.gov, NCT06338956。
{"title":"Clinical significance of low-density lipoprotein cholesterol percentage reduction and attained levels after percutaneous coronary intervention.","authors":"Danbee Kang, Ki Hong Choi, Seongwoo Yang, Hyunsoo Kim, Taek Kyu Park, Joo Myung Lee, Juhee Cho, Jeong Hoon Yang, Young Bin Song, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Joo-Yong Hahn","doi":"10.1503/cmaj.241713","DOIUrl":"10.1503/cmaj.241713","url":null,"abstract":"<p><strong>Background: </strong>Differences exist between European and American guideline recommendations regarding targets for low-density lipoprotein cholesterol (LDL-C) levels after percutaneous coronary intervention (PCI), with European guidance advocating for more aggressive reduction to less than 1.4 mmol/L compared with the American guideline, which recommends an LDL-C level of 1.8 mmol/L or greater as the threshold for treatment intensification. We aimed to evaluate clinical outcomes according to percentage reduction of LDL-C levels and to compare the outcomes according to the attained LDL-C levels after PCI.</p><p><strong>Methods: </strong>This nationwide cohort study included adults in South Korea who underwent PCI and health screening within 3 years before and after PCI. Participants were divided into groups with a reduction of LDL-C levels of less than 50% and of 50% or greater. The group with LDL-C reduction of 50% or greater was stratified into categories of LDL-C level after PCI: less than 1.4 mmol/L, 1.4 to less than 1.8 mmol/L, and 1.8 mmol/L or greater. The primary end point was major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of cardiovascular death, spontaneous myocardial infarction (MI), repeat revascularization, and ischemic stroke.</p><p><strong>Results: </strong>We included 135 877 adult participants. A total of 40.1% achieved a reduction of LDL-C levels of 50% or greater (<i>n</i> = 54 551). During a median follow-up of 7.4 years, the group with a reduction of 50% or greater had a multivariable-adjusted hazard ratio (HR) for MACCE of 0.78 (95% confidence interval [CI] 0.76-0.80). Among patients who achieved a reduction of LDL-C levels of 50% or greater, the multivariable-adjusted HR for MACCE was 1.07 (95% CI 1.02-1.13) for the group with LDL-C levels of 1.4 to less than 1.8 mmol/L after PCI and 1.12 (95% CI 1.04-1.21) for the group with levels of greater than 1.8 mmol/L. The risk of spontaneous MI was also higher in the group with LDL-C levels of 1.8 mmol/L or greater than in the group with levels of less than 1.4 mmol/L (HR 1.36, 95% CI 1.14-1.62).</p><p><strong>Interpretation: </strong>Among patients who underwent PCI, those who achieved a reduction in LDL-C levels of 50% or greater had a reduced risk of MACCE, regardless of baseline LDL-C levels. Among patients with a reduction in LDL-C levels of 50% or greater, compared with patients with an LDL-C level less than 1.4 mmol/L after PCI, those with an LDL-C level of greater than 1.8 mmol/L and a level of 1.4 to less than 1.8 mmol/L had an increased risk of MACCE. These findings suggest that while achieving an LDL-C reduction of 50% or greater remains a critical therapeutic goal, targeting LDL-C levels of less than 1.4 mmol/L after PCI may provide additional clinical benefit.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, NCT06338956.</p>","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 16","pages":"E442-E452"},"PeriodicalIF":9.4,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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