Post-Sepsis Inflammation Biomarkers Flag Mortality Risk Cardiovascular
Total Page：16
File Type：pdf, Size：1020Kb
PULMONOLOGY CARDIOLOGY LUNG CANCER SLEEP MEDICINE Transient opioid use is associated Sudden cardiac death may be COPD complicates shared decision Suicide attempts may be reduced with COPD exacerbation // 8 preceded by silent MI // 12 making in lung cancer screening // 20 with sleep disorder treatment // 25 VOL. 14 • NO. 9 • SEPTEMBER 2019 Post-sepsis inflammation biomarkers flag mortality risk BY JEFF CRAVEN MDedge News nflammation and immunosuppression can persist for some patients up to a year after a Ihospitalization for sepsis, and these patients are more likely to experience worsened long- term outcomes, readmission after discharge, and mortality, according to a study published in JAMA Network Open. “Individuals with persistent biomarkers of inflammation and immunosuppression had a Doucefleur/Getty Images higher risk of readmission and death due to car- diovascular disease and cancer compared with those with normal circulating biomarkers,” Sachin Cardiovascular impact of smoking Yende, MD, of the VA Pittsburgh Healthcare System and the University of Pittsburgh and col- leagues wrote. “Our findings suggest that long- may last up to 25 years term immunomodulation strategies should be explored in patients hospitalized with sepsis.” BY BIANCA NOGRADY line, 38.6% quit during the course of the study Dr. Yende and colleagues performed a multi- MDedge News and did not relapse but 51.4% continued to center, prospective cohort study of 483 patients smoke until they developed cardiovascular dis- who were hospitalized for sepsis at 12 different uitting smoking significantly reduces the ease or dropped out of the study. sites between January 2012 and May 2017. They risk of cardiovascular disease, but past Current smokers had a significant 4.68-fold measured inflammation using interleukin-6, Qsmokers are still at elevated cardiovascular higher incidence of cardiovascular disease, SEPSIS // continued on page 7 risk, compared with nonsmokers, for up to 25 compared with those who had never smoked, years after smoking cessation, research in JAMA but those who stopped smoking showed a 39% INSIDE HIGHLIGHT suggests. decline in their risk of cardiovascular disease NEWS FROM CHEST A retrospective analysis of data from 8,770 in- within 5 years of cessation. dividuals in the Framingham Heart Study com- However, individuals who were formerly heavy SLEEP STRATEGIES pared the incidence of myocardial infarction, smokers – defined as at least 20 pack-years of Noninvasive ventilation: stroke, heart failure, or cardiovascular death in smoking – retained a risk of cardiovascular ever-smokers with that of never-smokers. disease 25% higher than that of never-smokers Redefining insurance guidelines Only 40% of the total cohort had never until 10-15 years after quitting smoking. At 16 Page 34 smoked. Of the 4,115 current smokers at base- SMOKING // continued on page 6 Register Today chestmeeting.chestnet.org Rosemont, IL 60018 IL Rosemont, Lebanon Jct. KY Jct. Lebanon Suite 280 Suite Permit No. 384 No. Permit PAID 10255 W Higgins Road, Higgins W 10255 U.S. Postage U.S. CHANGE SERVICE REQUESTED SERVICE CHANGE Presorted Standard Presorted CHEST Physician CHEST NEWS FDA takes another swing at cigarette pack warnings BY M. ALEXANDER OTTO and advertisements on Aug. 15, nies filed a law suit, which ultimate- and obstructive pulmonary disease MDedge News 2019, that feature graphic, colored ly shut down a similar proposal. – and would take up the top half images illustrating the harms of The warnings focus on lesser- of the front and back of cigarette he U.S. Food and Drug Ad- smoking, but this could be subjected known complications – including packs, and at least the top 20% of ministration has proposed to legal challenge. diabetes, cataracts, gangrene, stroke, print advertisements. Each pack and Twarnings for cigarette packs Several years ago, tobacco compa- bladder cancer, erectile dysfunction, ad would be required to carry 1 of 4 • SEPTEMBER 2019 • CHEST PHYSICIAN the 13 proposed warnings, accord- (for example, Am J Prev Med. 2007 groups, but challenged in the courts federal judge then ordered the agen- ing to the announcement. Mar;32[3]:202-9). by R.J. Reynolds and other tobacco cy to publish a new rule by August The approach would be similar The new proposal is the FDA’s companies, and blocked on appeal in 2019, and issue a final rule in March to, but not as aggressive as Canada’s. second attempt to enact something 2012 as an abridgment of commer- 2020. For years, cigarettes packs sold in comparable in the United States, cial free speech. The federal govern- This time around, the FDA “took Canada have included disturbing after being directed to do so by the ment dropped the case in 2013. the necessary time to get these new photographs of diseased lungs, rot- Tobacco Control Act of 2009. The American Lung Association proposed warnings right ... based on ted teeth, and dying patients. The The first effort to add strong, and other public health groups sub- – and within the limits of – both sci- lasting impact of such imagery has illustrated warnings to cigarette sequently sued the FDA in 2016 to ence and the law,” the agency said. been demonstrated in the literature packs was widely backed by medical enact the Tobacco Act mandate. A The new images, though graphic, are less disturbing than those used in Canada and the agency’s previous proposals, which included an appar- ent corpse with a sternotomy. The 1-800-Quit-Now cessation hotline number, which was a sticking point U.S. U.S. Food and Drug Administration The proposed warnings would cover half the pack. in the 2012 ruling, has also been dropped. When asked about the new ef- forts, R.J. Reynolds spokesperson Kaelan Hollon said, “We are care- fully reviewing FDA’s latest proposal for graphic warnings on cigarettes. We firmly support public aware- ness of the harms of smoking cig- arettes, but the manner in which those messages are delivered to the public cannot run afoul of the First Amendment protections that apply to all speakers, including cigarette manufacturers.” Warnings on U.S. cigarettes hav- en’t changed since 1984, when the risks of lung cancer, heart disease, emphysema, and pregnancy com- plications were added to the side of cigarette packs. With time, the FDA said the surgeon general’s warnings have become “virtually invisible” to consumers. The American Lung Association, American Academy of Pediatrics, and other plaintiffs in the 2016 suit called the new proposal a “dramatic improvement” over the current sit- uation and “long overdue” in a joint statement on Aug. 15. Although rates have declined sub- stantially in recent decades, about 34.3 million U.S. adults and almost 1.4 million teenagers still smoke. Comments on the proposed rule are being accepted through Oct. 15. The agency is open to suggestions for alternative text and images. [email protected] MDEDGE.COM/CHESTPHYSICIAN • SEPTEMBER 2019 • 5 NEWS NEWS FROM CHEST // 26 Smoking cessation had effect on risk // continued from page 1 SLEEP STRATEGIES // 34 years, the 95% confidence inter- from the division of cardiovascular val for cardiovascular disease risk medicine at the Vanderbilt Uni- among former smokers versus that versity Medical Center, Nashville, CHEST PHYSICIAN of never- smokers finally and consis- Tenn., and coauthors. “Although the IS ONLINE tently included the null value of 1. exact amount of time after quitting CHEST Physician is available at David A. Schulman, MD, The study pooled two cohorts; at which former smokers’ CVD risk chestphysician.org. FCCP, is Medical Editor in the original cohort, who attended ceases to differ significantly from Chief of CHEST Physician. their fourth examination during that of never-smokers is unknown 1954-1958 and an offspring cohort (and may further depend on cu- who attended their first examina- mulative exposure), these findings tion during 1971-1975. The authors support a longer time course of saw a difference between the two risk reduction than was previously cohorts in the time course of car- thought, yielding implications for American College of Chest CHEST Physician, the newspaper of the American diovascular disease risk in heavy CVD risk stratification of former Physicians (CHEST) College of Chest Physicians, provides cutting-edge reports from clinical meetings, FDA coverage, clinical smokers. smokers.” EDITOR IN CHIEF David A. Schulman, MD, FCCP trial results, expert commentary, and reporting on the In the original cohort, former However, they did note that the business and politics of chest medicine. Each issue also heavy smoking ceased to be sig- study could not account for environ- PRESIDENT provides material exclusive to CHEST members. Content Clayton T. Cowl, MD, MS, FCCP for CHEST Physician is provided by Frontline Medical nificantly associated with increased mental tobacco smoke exposure and EXECUTIVE VICE PRESIDENT & CEO Communications Inc. Content for News From Chest is cardiovascular disease risk within that the participants were mostly Robert Musacchio provided by the American College of Chest Physicians. PUBLISHER, CHEST® JOURNAL The statements and opinions expressed in CHEST 5-10 years of cessation, but in the of white European ancestry, which Physician Nicki Augustyn do not necessarily reflect those of the offspring cohort, it took 25 years limited the generalizability of the American College of Chest Physicians, or of its officers, after cessation for the incidence to findings to other populations. MANAGER, EDITORIAL RESOURCES regents, members, and employees, or those