Connor Iapoce is an assistant editor for 

 and joined the MJH Life Sciences team in April 2021. He graduated from The College of New Jersey with a degree in Journalism and Professional Writing. He enjoys listening to records, going to concerts, and playing with his cat Squish. You can reach him at 

Connor Iapoce

Quality of life outcomes may have better odds of improvement following invasive management in patients with less advanced 

Among the study population with chronic coronary disease (CCD), the event rates were inversely proportional to kidney function.

“Invasive management was associated with an increase in stroke and procedural myocardial infarction and a reduced risk in spontaneous myocardial infarction, and the effect was similar across CKD stages with no difference in other outcomes, including death,” wrote study author Sripal Bangalore, MD, New York University Grossman School of Medicine.

The investigators noted the guideline recommendations on the treatment of patients with CCD are therefore not predicated according to underlying kidney function or CKD stage. Thus, they aimed to evaluate clinical and quality of life outcomes across the spectrum of CKD following conservative and invasive treatment strategies.

Participants with moderate or severe ischemia on stress testing, with and without advanced CKD, were randomized in the ISCHEMIA-CKD and ISCHEMIA trials, respectively. They were categorized based on baseline kidney function into CKD

stage 1 (estimated glomerular filtration rate [eGFR] 90 mL/min/1.73m2 or greater)

stage 5 (eGFR less than 15 mL/min/1.73m2 or receiving dialysis)

The initial invasive management of coronary angiography and revascularization with guideline-directed medical therapy (GDMT) was compared to the initial conservative management of GDMT alone. Enrollment occurred between July 2021 and January 2018.

The primary clinical outcome was considered the composite of death or nonfatal myocardial infarction (MI), while the primary quality of life outcome was the Seattle Angina Questionnaire (SAQ) summary score.

A total of 5956 participants were included in the analysis (mean age, 64 years; 1410 [24%] female and 4546 [76%] male). From the total population, 1889 (32%) were in CKD stage 1, 2551 (43%) in stage 2, 738 (12%) in stage 3, 311 (5%) in stage 4, and 467 (8%) were in stage 5.

The self-report of demographics saw 18 participants (<1%) were American Indian or Alaska Native, 1676 (29%) were Asian, 267 (5%) were Black, 861 (16%) were Hispanic or Latino, 18 (<1%) were Native Hawaiian or other Pacific Islander, and 3884 (66%) were White. A total of 13 participants (<1%) were multiple races or ethnicities.

Investigators observed an increase in the risk of primary endpoint (3-year rates, 9.52%, 10.72%, 18.42%, 34.21%, and 38.01%, respectively), death, cardiovascular death, myocardial infarction, and stroke in individuals with higher CKD stages).

Moreover, they found invasive management was associated with an increase in stroke (3-year event rate difference, 1%; 95% CI, 0.3 to 1.7) and procedural MI (1.6%; 95% CI, 0.9 - 2.3), with a decrease in spontaneous myocardial infarction (-2.5%; 95% CI, -3.9 to -1.1). This was noted to be similar across CKD stages.

Heterogeneity of treatment effect for quality of life outcomes was observed. Invasive management improved angina-related quality of life in patients with CKD stages 1 to 3 and not in those with CKD stages 4 to 5.

Clinical and Quality-of-Life Outcomes Following Invasive vs Conservative Treatment of Patients with Chronic Coronary Disease Across the Spectrum of Kidney Function

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Event rates were inversely proportional to kidney function in patients with chronic coronary disease.

 Invasive Management Shows No QoL Benefit in Patients with Poorer Kidney Function 

Atheroscleortic plaque was highly prevalent in older adults in China, with a substantial proportion of individuals reaching stenosis of 50% or greater, according to new findings published in 

“This study set the basis for the evaluation of atherosclerosis progression and risk stratification for future vascular events with longitudinal follow-up data,” wrote study author Yongjun Wang, MD, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University and and Tiemin Wei, MD, Department of Cardiology, Lishui Hospital, Zhejiang University School of Medicine. 

Investigators noted that previous data show subclinical carotid atherosclerosis and coronary artery calcification increased the risk of vascular events. However, there are limited findings on the prevalence, vascular distribution, and burden of polyvascular atherosclerosis in the arterial system with intracranial, coronary, and peripheral vascular territories.

As a result, the current cross-sectional study evaluated the prevalence, vascular distribution, and burden of polyvascular atherosclerosis in a community population based on a baseline survey of the Polyvascular Evaluation for Cognitive Impairment and Vascular Events (PRECISE) study.

It enrolled community-dwelling adults who were aged 50 - 75 years based on cluster sampling from 6 villages and 4 living communities of Lushui city in southeast China between May 2017 - September 2019.

The investigators assessed atherosclerotic plaque and stenosis at baseline in multiple vascular territories. It included brain vessel wall magnetic resonance imaging (MRI) for intracranial and extracranial arteries and computer tomography angiography (CTA) for coronary, subclavian, aorta, renal, and iliofemoral arteries. At baseline survey, they performed ankle-brachial index.

Then, the extent of atherosclerosis was assessed according to the number of these 8 vascular sites that were affected, while polyvascular arterosclerotic lesions were defined as ≥2 affected sites in these arteries.

There were a total of 3433 of 4202 invited individuals who consented to participate in the study. Following exclusions, including 366 participants with contraindications for MRI or CTA scanning, a total of 3067 community-dwelling adults were enrolled.

Data show the mean age was 61.2 years, including 1640 (53.5%) women and 74 (2.4%) had prevalent atherosclerotic cardiovascular disease (ASCVD). Most participants (n = 2546; 84.0%) had at least 1 traditional risk factor, while 892 (29.1%) had 2 and 654 (21.3%) had 3 or more risk factors.

Most of the participants (n = 2870 [93.6%]) were found to have atherosclerotic plaque in at least 1 vascular territory. Moreover, atherosclerotic plaques were mostly detected in the aorta (n = 2419 [79.6%]) and iliofemoral arteries (n = 2312 [75.8%]).

This was followed by subclavian (n = 1500 [49.8%]), coronary (n = 1366 [44.9%]), extracranial (n = 1110 [36.4%]), renal (n = 873 [28.7%]), and intracranial (n = 542 [17.7%]) arteries.

Additionally, polyvascular atherosclerotic plaque was observed in 2541 participants (82.8%), with 1436 (46.8%) with plaque affecting 4 or more vascular territories. Polyvascular stenosis was observed in 412 patients (13.4%).

The study, “Prevalence and Vascular Distribution of Multi Territorial Atherosclerosis Among Community-Dwelling Adults in Southeast China,” was published in 

A substantial number of individuals (nearly 40%) reached arterial stenosis of at least 50%, according to the findings. 

Atherosclerotic Plaque Found Highly Prevalent in Older Population in China 

New findings suggest maternal deaths in the United States increased substantially at the onset of the 

This figure (33.3%) was higher than a 22% overall excess death estimate associated with the pandemic itself and the increases were highest for Hispanic and non-Hispanic Black women.

“Change in maternal deaths during the pandemic may involve conditions directly related to COVID-19 (respiratory of viral infection) or conditions exacerbated by COVID-19 or other health care disruptions (diabetes or cardiovascular disease), but could not be discerned from the data,” wrote study author Marie E. Thoma, PhD, Department of Family Science, School of Public Health, University of Maryland.

Between 2019 and 2020, data from the National Center for Health Statistics (NCHS) reported an 18.4% increase in US maternal mortality. As such, the relative increase was 44.4% among Hispanic, 25.7% among non-Hispanic Black, and 6.1% among non-Hispanic White women.

To examine the role of the pandemic in maternal death rates, investigators used deidentified NCHS mortality and natality files from 2018 to 2020. Analyses were limited to maternal deaths based on underlying causes of death. They did not exclusively identify COVID-19 as the cause, even when it was a factor in maternal death.

Therefore, investigators noted COVID-19 was ascertained as a secondary cause from the multiple causes of death area, remaining consistent with other reports on excess mortality from COVID-19. The deaths were stratified by month and year of death into before (2018, 2019, and January - March 2020) or during (April - December 2020) the pandemic

Data show a total of 1588 maternal deaths (18.8 per 100,000 live births) occurred before the pandemic vs 684 deaths (25.1 per 100,000 live births) during the pandemic, at a relative increase of 33.3%. The findings additionally show late maternal mortality increased by 41%.

Moreover, the absolute and relative changes were highest for Hispanic (8.9 per 100,000 live births; 40.2%) and non-Hispanic Black (16.8 per 100,000 live births; 40.2%) women, compared to non-Hisapnic White (2.9 per 100,000 live births; 17.2%) women.

Investigators found the secondary code for COVID-19 was listed in 14.9% (102 of 684) of maternal deaths in quarters 2 to 4, with 0% reported in quarter 1 of 2020. The percentage was highest among Hispanic women (32.1%), followed by non-Hispanic Black (12.9%) and non-Hispanic White (7.3%) women.

Regarding underlying cause-of-death codes, data show the largest relative increase was among indirect causes (56.9%). The relative increases in direct causes (27.7%) were mostly associated with diabetes in pregnancy (95.9%), hypertensive disorders (39.0%), and other specified pregnancy-related conditions (48.0%).

Meanwhile, COVID-19 was often listed as a secondary condition with other viral diseases (16 of 16 deaths [100%]) and diseases of the respiratory system (11 of 19 deaths [57.9%]).

“Future studies of maternal death should examine the contribution of the pandemic to racial and ethnic disparities and should identify specific causes of maternal deaths overall and associated with COVID-19,” Thoma concluded.

All-Cause Maternal Mortality in the US Before vs During the COVID-19 Pandemic

The increase was highest for Hispanic and non-Hispanic Black Women. 

Maternal Deaths in US Saw Substantial Increase at Onset of COVID-19 Pandemic

The inclusion of twice-daily 1 mg varenicline in smoking cessation programs for patients with 

 may result in prolonged abstinence without serious adverse events, according to new findings published in 

The findings suggest the agent was efficacious at weeks 12, 24, and 52 of the randomized clinical trial, in comparison to placebo.

“The findings suggest that substantial changes in smoking habits may occur among patients with type 2 diabetes who intend to stop smoking, leading to prolonged abstinence from smoking,” wrote study author Riccardo Polosa, MD, PhD, Centro per la Prevenzione e Cura del Tabagismo, Azienda Ospedaliero Universitaria Policlinico-V. Emanuele dell’Università di Catania.

Prior observations have noted that stopping smoking has been associated with reduced mortality risk in patients with T2D, so providing counseling on quitting smoking should be a component of routine diabetes care. Varenicline has been shown to be efficacious in smokers with cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), or depressive disorders, but it has not been studied in smokers with diabetes.

The multicenter, double-blind, placebo-controlled RCT included patients from 6 outpatient clinics in 5 hospitals in Italy. Investigators screened eligibility of patients with T2D who were receiving treatment in an outpatient diabetic clinic, smoking ≥10 cigarettes a day, and intending to quit smoking.

It consisted of a 12-week treatment phase followed by a 40-week follow-up, non-treatment phase, with intention-to-treat analysis was performed from December 2020 - April 2021. The primary efficacy endpoint was the continuous abstinence rate (CAR) at weeks 9 to 24.

A total of 300 patients were randomized to either varenicline (n = 150) or placebo (n = 150) treatment, with a mean age of 57.4 years. There were 117 men [78.0%] in the varenicline group and 119 men [79.3%] in the placebo group. Investigators noted the baseline characteristics were comparable between groups and treatment discontinuation was frequent (approximately 30%).

Data show the CAR at weeks 9 to 24 were significantly higher for the varenicline group versus the placebo group (24.0% vs 6.0%; odds ratio [OR], 4.95; 95% CI, 2.29 - 10.70; 

Moreover, the CARs at weeks 9 to 12 (31.3% vs 7.3%; OR, 5.77; 95% CI, 2.85 - 11.66; 

 <.001) and weeks 9 to 52 (18.7% vs 5.3%; OR, 4.07; 95% CI, 1.79 - 9.27; 

 <.001) were also significantly higher for varenclinice, as were the 7-day point prevalence of abstinence at weeks 12, 24, and 52.

Few adverse events were reported (n = 380) and only a few withdrawals from the study occurred as a result (n = 11), according to the investigators. The most frequent adverse events occurring in the varenicline group compared with the placebo group were nausea (41 [27.3%] vs 17 [11.4%], insomnia (29 [19.4%] vs 19 [12.7%], abnormal dreams (19 [12.7%] vs 5 [3.4%]), anxiety (17 [11.4%] vs 11 [7.3%]), and irritability (14 [9.4%] vs 8 [5.4%]).

“These findings support the notion that patients with type 2 diabetes who smoke have greater difficulty quitting when provided with only cessation counseling,” Polosa concluded.

Efficacy and Safety for Varenicline for Smoking Cessation in Patients with Type 2 Diabetes: A Randomized Clinical Trials

Varenicline was efficacious at weeks 12, 24, and 52 of the trial compared with placebo in a smoking cessation program. 

Connor Iapoce

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