Category: 8. Health

A recently published study of more than 44,000 patients with idiopathic intracranial hypertension (IIH) showed that glucagon-like peptide 1 receptor agonists (GLP-1 RAs) offer therapeutic benefits including lowered medication use, procedures, and improved symptoms. While more prospective studies are needed to confirm these findings, the data support the potential of these medications as a management strategy.

The retrospective study identified 44,373 patients with IIH from the TriNetX US Collaborative Network who started GLP-1 RAs within 6 months of diagnosis (n = 603) and compared them with nonusers (n = 43,770) on various outcomes. After matching, the analysis included 550 patients for each group, with the GLP-1 group using the following medications: lixisenatide, albiglutide, dulaglutide, semaglutide, liraglutide, and exenatide.

Published in JAMA Neurology, results showed that those on GLP-1s were less likely to require any medication compared with the control group (29.7% vs 56.4%; P <.001), and demonstrated significantly lower mortality (≤2.0% vs 5.0%; P = .003). In addition, those on these medications had a lower prevalence of IIH symptoms such as headache (12.3% vs 27.4%; P <.001), visual disturbances/blindness (7.0% vs 11.7%; P = .007), and papilledema (2.2% vs 11.5%; P <.001).

“We know every guideline for IIH emphasizes weight loss, but getting patients to achieve it is incredibly difficult,” senior author Dennis Rivet, MD, told NeurologyLive. “GLP-1 agonists are very effective for weight loss, and there’s already evidence they work on multiple systems, including the brain. Receptors in the choroid plexus, which helps regulate spinal fluid, suggest a possible direct mechanism beyond just weight loss, making them especially interesting for this disease.”

Rivet, the Harold I. Nemuth Chair in Neurological Disorders at Virginia Commonweath University, believes these data hold significant implications for the use of GLP-1 RAs, which have gained attention in other areas of neurodegenerative disorders, sleep disorders, and weight loss.

In the study, those on GLP-1 RAs had fewer procedures overall (6.8% vs 15.7%; P <.001), including bariatric surgery (5.4% vs 10.1%; P = .004) and cerebrospinal fluid shunt procedures (≤1.8% vs 5.2%; P = .002) than nonusers. In terms of specific medications, investigators noticed a significant decline in use of tricyclic antidepressants (6.8% vs 12.3%; P = .002), furosemide (6.8% vs 14.4%; P <.001), and acetazolamide (8.6% vs 24.0%; P <.001). There was no change in the use of valproate (GLP-1: 2.7% vs nonusers: 3.4%; P = .49).

READ MORE: Real-World Data Points to Greater Impact of Semaglutide Over Tirzepatide in Reducing Heart Attack, Stroke Risk

“Bariatric surgery is effective in IIH, but it carries significant morbidity,” Rivet noted. “What surprised us was that while surgery worked, we didn’t see the same mortality benefit. In contrast, patients on GLP-1 agonists had lower all-cause mortality at one year, which is an intriguing and unexpected finding.”

A subgroup analysis stratifying patients based on body mass index (BMI)–using a benchmark of 40–was conducted, with data confirming all significant associations from the primary analysis except for dizziness, which did not differ in GLP-1 RA users and nonusers with a BMI of 40 or greater. When looking at bariatric surgery and conventional management with bariatric surgery, there were some noted differences, with bariatric surgery associated with greater weight loss in both comparisons.

Overall, the subgroup findings revealed that despite lower 1-year BMI in the surgery group, GLP-1 RA users had lower medication use, fewer symptoms/signs, and procedures. Conversely, among GLP-1 RA nonusers, bariatric surgery resulted in lower medication use and fewer symptoms/signs but required more procedures and had higher mortality. Overall, this suggested that while greater weight loss may be achieved through bariatric surgery, GLP-1 RAs may provide better outcomes through other means.

Rivet added, “A retrospective database study is a signal—it’s encouraging, but it’s not definitive. The obvious next step is a placebo-controlled trial, and I think it could be done, even in a rare condition like IIH. But the reality is many of these patients already meet on-label indications for GLP-1 use, so clinical practice may shift before such a trial is ever performed.”

In terms of where else GLP-1 agonists might play a role, Rivet noted that secondary stroke prevention is an area of need that holds promise. In addition, he suggested that beyond stroke, the rapid effect of these medications on inflammatory markers could leave for potential in diseases like psoriatic arthritis and other inflammatory conditions.

REFERENCE
1. Sioutas GS, Mualem W, Reavey-Cantwell J, et al. GLP-1 Receptor Agonists in Idiopathic Intracranial Hypertension. JAMA Neurol. Published July 14, 2025. doi:10.1001/jamaneurol.2025.2020

Coronary artery calcium (CAC) scoring derived from non-gated low-dose computed tomography (LDCT) scans demonstrates significant capability for predicting long-term cardiovascular mortality, according to a new study involving over 8,700 participants.

For the prospective study, recently published in Radiology, researchers reviewed Early Lung and Cardiac Action Program (ELCAP) CAC scoring for 8,782 participants who underwent LDCT screening between 2000 and 2004. The cohort was comprised of current and former smokers between the ages of 40-85, and there was a median follow-up period of 22.6 years, according to the study.

The researchers found that the cumulative incidence of cardiovascular disease (CVD) death for those with high-risk CAC scoring (4-12) was 30.5 percent in comparison to 16.5 percent for participants with intermediate risk CAC scoring (1-3) and 9.4 percent for people with low-risk CAC scoring (0).

Cumulative all-cause mortality incidence was 63.2 percent for those with high-risk CAC scores, 44.5 percent for cohort participants with intermediate-risk CAC scoring and 30.3 percent for people with low-risk CAC scores, according to the study authors.

The study authors pointed out that adjusted multivariable analysis revealed that high ELCAP-CAC scoring was associated with nearly double the risk of CVD mortality and over a 2.8-fold higher risk of all-cause mortality in contrast to low ELCAP-CAC scoring.

“Our findings show that a single ELCAP-CAC score at LDCT is a powerful long-term predictor of CVD death (hazard ratio, 1.98), while also confirming the prognostic value of absent CAC. Our study brings to light the potential for combining early detection of CVD and lung cancer, which are the top causes of death in the United States,” wrote lead study author Joseph Shemesh, M.D., who is affiliated with the Department of Cardiology at Sheba Medical Center in Ramat Gan, Israel, and colleagues.

Emphasizing the additive benefit with chest CT screening for lung cancer in current and past smokers, the researchers posited that CAC scoring can significantly enhance risk stratification beyond traditional laboratory-based methods for evaluating the potential for CVD.

“Given the risk stratification afforded by ELCAP-CAC scoring, it becomes even more urgent that CAC scoring be acted on in the context of a screening program and perhaps even as a public health measure,” implored Shemesh and colleagues.

(Editor’s note: For related content, see “CT-Based Coronary Artery Calcium Score Helps Predict Post-Op Survival Risks in Elderly Lung Cancer Patients,” “Computed Tomography Study Examines Potential of Automated Coronary Artery Calcium Scoring with Deep Learning” and “Study Says CT Scan is More Predictive than Genetic Risk Factors for Coronary Heart Disease Risk.”)

In regard to study limitations, the authors noted that subtle calcifications may have been missed with thicker section thickness thresholds (up to 5 mm) in older image acquisition with LDCT. Not only could this have led to misclassification of participants having an ELCAP-CAC of zero, but the researchers conceded the potential impact in reducing the predictive value associated with higher ELCAP-CAC scores.

In patients with heart failure (HF) caused by Chagas disease, sacubitril/valsartan was superior to enalapril for the composite primary endpoint, predominantly driven by a significant reduction in N-terminal pro-B-type natriuretic peptide (NT-proBNP), according to late-breaking research presented in a Hot Line session today at ESC Congress 2025.

Chagas disease, caused by Trypanosoma cruzi infection, remains a serious health problem affecting more than 7 million people, primarily from Latin America. T. cruzi parasites are mainly transmitted by contact with faeces/urine of infected triatomine bugs. T. cruzi can also be transmitted by consumption of contaminated food/beverages, during pregnancy or birth, through blood/blood products, organ transplantation and laboratory accidents. Chagas disease is spreading around the world, predominantly due to migration of infected patients to other regions, including North America, Europe, Asia and Australia. Chagas cardiomyopathy is considered the most common and serious manifestation of chronic Chagas disease, occurring in 30-40% of infected people during long-term follow-up.

HF caused by Chagas disease has unique clinical features with worse prognosis than other causes of HF despite the fact that patients are often younger and have fewer comorbidities. There have been no prospective randomized trials testing the effects of standard treatments in patients with Chagas disease and HF. In the general HF population, the angiotensin receptor-neprilysin inhibitor, sacubitril/valsartan improved HF outcomes vs. the angiotensin-converting enzyme inhibitor, enalapril, and we compared these two agents in the largest trial in patients with Chagas disease and HF conducted to date.”

Professor Renato Lopes from Duke University Medical Center, Durham, USA, Principal Investigator of the PARACHUTE-HF trial

PARACHUTE-HF was an academic-led, open-label, blinded-endpoint adjudication, randomized trial conducted at more than 80 sites in Brazil, Argentina, Mexico and Colombia. Eligibility criteria included a diagnosis of Chagas disease confirmed by at least two different serological tests positive for Trypanosoma cruzi infection, left ventricular ejection fraction (LVEF) ≤40%, New York Heart Association functional class II to IV symptoms and NT-proBNP ≥600 pg/ml or ≥400 pg/ml and hospitalization for HF within the last 12 months. Participants were randomized 1:1 to either sacubitril/valsartan (50 or 100 mg twice daily titrated to a target of 200 mg twice daily) or enalapril (2.5 or 5 mg twice daily titrated to a target of 10 mg twice daily). The primary endpoint was a hierarchical composite outcome consisting of cardiovascular death, first hospitalization for HF and the relative change from baseline to week 12 in NT-proBNP, analysed using a win ratio approach.

In total, 922 patients were randomized. The mean age was 64 years, 42.0% were women, mean LVEF was 29.8% and 44.4% had had prior hospitalization for HF.

Following pairwise comparisons, sacubitril/valsartan was associated with a 52% higher likelihood of a better primary outcome compared with enalapril (stratified unmatched win ratio 1.52; 95% confidence interval [CI] 1.28 to 1.82; p<0.001). Over a median of 25 months’ follow-up, rates were similar for sacubitril/valsartan vs. enalapril for cardiovascular death (hazard ratio [HR] 0.95; 95% CI 0.73 to 1.23) and first HF hospitalization (HR 0.92; 95% CI 0.70 to 1.20). The significant difference in the primary outcome was predominantly driven by the percent change in NT-proBNP from baseline to 12 weeks: logarithmic median change from baseline was −30.6% in those assigned to sacubitril-valsartan and −5.5% in those assigned to enalapril (ratio of adjusted geometric mean change 0.68; 95% CI 0.62 to 0.75).

The safety profiles of the two agents were similar, with discontinuations due to adverse events occurring in 6.1% of patients with sacubitril/valsartan and 9.8% with enalapril.

Concluding, Professor Lopes said: “In patients with HF caused by Chagas disease, sacubitril/valsartan was superior to enalapril with respect to the primary outcome, predominantly driven by the 32% reduction in NT-proBNP levels at week 12. Our study provides the first randomized trial evidence to support a pharmacological treatment specifically in this high-risk population. PARACHUTE-HF shows that much-needed studies to better characterise chronic Chagas cardiomyopathy and to define the benefit/risk of new therapies in this condition are possible. In line with the global health spotlight of ESC Congress, the PARACHUTE-HF trial provides a successful model for international collaborations – in this field among cardiologists and infectious disease physicians − with the shared goal of evaluating the impact of new therapies on cardiovascular outcomes in patients with neglected diseases.”

A recent systematic review analyzed how the COVID-19 pandemic disrupted melanoma diagnosis and treatment.¹ Researchers found an increase in disease incidence, severity, and diagnostic delays when comparing results pre- and post-pandemic. This is one of the first systematic reviews to explore the impact of COVID-19 on melanoma treatment practices.

Background

During the unprecedented time of the COVID-19 global pandemic, lockdowns and curfews were implemented, limiting the scheduling of routine appointments like cancer screenings, skin checks, and follow-ups. Melanoma diagnoses dropped by up to 67% in April 2020.² Other cancers, such as breast and colorectal, saw up to a 90% decline in screenings.³ Although cancer and melanoma rates appeared to decrease during this time, it’s likely due to the delayed diagnosis rather than an actual reduction in cases.

Methods & Materials

A literature search of the PubMed, Scopus, Web of Science, and Cochrane Library databases was conducted in September 2024. Investigators compared study findings from pre-pandemic and pandemic periods. Pre-COVID-19 was considered to be between the years 2015 and 2019 while COVID-19/post-COVID-19 included years between 2019 and 2024.

The analysis included clinical trials, observational studies, reviews, and case studies. Of the 503 studies initially screened, 55 were eligible and included in the final review. One was a modeling study while the rest were observational studies. These were conducted in Europe (particularly the United Kingdom), Canada, the United States, Australia, Israel, and South America (particularly in Brazil). In both pre- and post-pandemic periods, the majority of patients were between the ages of 58 and 69, with a slight male predominance.

Authors extracted patient population characteristics along with incidence rates, Breslow thickness, ulceration, stage at diagnosis, mortality, treatment changes, and adaptations. The Newcastle–Ottawa Scale and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist were used to assess the risk of bias.

Results & Critical Findings

Diagnosed melanoma cases decreased during the pandemic, with referrals and biopsies falling dramatically in 53 of the studies. Monthly referrals in Australia declined by 48% with Canada saw a 27% drop in biopsy rates. Initial visits to a dermatologist decreased by up to 37% in Italy. Italy also observed a 29% decrease in sentinel lymph node biopsies.

With this, Breslow thickness and ulceration rates increased, indicating delayed presentations and more advanced, aggressive disease. In some cases, mean Breslow thickness increased from 1.1 mm in the pre-COVID-19 era to 1.8 mm during the pandemic. Ulceration rates nearly doubled in some findings as well (~ 11.7% to 22.6%).

Additionally, less surgical excisions were performed, with a decrease of up to 20%. This could be due to limited surgical resources, reduced hospital capacities, and hesitancy among patients. Many countries saw an increase in presentations with inoperable tumors. These findings are consistent with what was researched in other cancer types, specifically breast, colorectal, prostate, and cervical cancers.

Future Planning for Global Emergencies

With this proven increase in severe melanoma during the pandemic period, it is imperative for health providers to be more prepared and strengthen future pandemic responses. The study authors outlined several methods to help mitigate diagnosis delays and prevent stage migration in melanoma and other cancers.

Clinics should create clear policies and frameworks for cancer care, especially for high-risk patients. This could include clear communication and follow-up methods with patients as well as ensuring there is an adequate number of staff members for procedures, if needed.

The authors also introduced the early implementation of innovative diagnostic methods like teledermatology and artificial intelligence. Although telemedicine is not a substitute, it can be beneficial during public emergencies as an initial check. Additionally, more public education on self-conducted skin checks or other prevention practices can promote earlier intervention in case another global emergency like the COVID-19 pandemic occurs.

References

1.Soni, A., Purcell, E., Lim, B., Marcaccini, G., Seth, I. and Rozen, W.M. (2025), The Silent Spread: A Systematic Review of Delayed Melanoma Diagnosis and Disease Progression During the COVID-19 Pandemic. JEADV Clinical Practice. https://doi.org/10.1002/jvc2.70154

2. McBain RK, Cantor JH, Jena AB, Pera MF, Bravata DM, Whaley CM. Decline and Rebound in Routine Cancer Screening Rates During the COVID-19 Pandemic. J Gen Intern Med. 2021;36(6):1829-1831. doi:10.1007/s11606-021-06660-5

3. Schadendorf D, van Akkooi ACJ, Berking C, et al. Melanoma. Lancet. 2018;392(10151):971-984. doi:10.1016/S0140-6736(18)31559-9

No benefit in terms of prevention of ischemic stroke, transient ischemic attack and cardiovascular mortality after 1 year was observed when surgical left atrial appendage occlusion was performed in high-risk non-atrial fibrillation patients after valvular surgery, according to late-breaking research presented in a Hot Line session today at ESC Congress 2025.

Surgical left atrial appendage occlusion (SLAAO) is a procedure designed to block the left atrial appendage, which is a common site for clot formation.

While SLAAO reduces stroke in atrial fibrillation (AF) patients, its efficacy in high-risk non-AF patients remains uncertain. We conducted the OPINION trial to address this important clinical question – does SLAAO reduce thromboembolic events in non-AF patients at high risk of stroke after valvular surgery?”

Professor Yang Wang, trial presenter, from the State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China

OPINION was an open-label, randomised, superiority trial conducted at three cardiac surgery centres in China. Eligibility criteria included age >18 years, no AF diagnosis, CHA₂DS₂VASc ≥2 and an indication for valvuloplasty or replacement due to mitral or aortic valve lesions. Participants were randomised 1:1 to standard surgical care with concomitant SLAAO or without SLAAO. Intraoperative transoesophageal echocardiography was mandatory to assess the SLAAO, with immediate surgical revision required if the residual appendage stump exceeded 1 cm after the initial closure attempt. The primary endpoint was a composite of ischaemic stroke, transient ischaemic attack (TIA) or cardiovascular mortality assessed at 1 year using the intention-to-treat (ITT) principle.

The ITT population included 2,118 patients who had a mean age of 56 years and 33% were female. The mean CHA₂DS₂VASc score was 2.9.

The primary endpoint of ischaemic stroke, TIA or cardiovascular mortality was not significantly different between the groups, occurring in 6.9% of patients in the SLAAO group and 8.2% of patients in the control group (hazard ratio [HR] 0.83; 95% confidence interval [CI] 0.61 to 1.14; p=0.25).

There was no significant difference in secondary endpoints, including components of the primary endpoint and bleeding events. Prespecified subgroup analyses were generally consistent, although there was a suggestion of benefit with SLAAO in high-risk patients with CHA₂DS₂VASc ≥3 (HR 0.81; 95% CI 0.56 to 1.17).

Summarizing the results, first author, Doctor Xin Yuan, also from the State Key Laboratory of Cardiovascular Disease, said: “The trial found no significant benefit of routine SLAAO in the overall study population. Our results may help avoid unnecessary procedures and guide future research. We have planned further analyses of SLAAO in high-risk subgroups and, given the divergence in primary endpoint event curves observed after 6 months, we are extending follow-up to 3 years. Beyond SLAAO, optimisation of stroke prevention in high-risk patients after valvular surgery may lie in other strategies, including anticoagulation.”

Editors’ Highlights are summaries of recent papers by AGU’s journal editors.

Source: AGU Advances

Auroral Kilometric Radiation (AKR) is a type of radio wave emitted from Earth’s auroral regions. It is the dominant radio emission from Earth and has been extensively studied, though previous analyses were constrained by limited spacecraft coverage.

Today, with the availability of more spacecraft observations, it is possible to improve our understanding of the Earth’s most intense natural radio emission. Thanks to these data, Wu et al. [2025]  find that Auroral Kilometric Radiation preferentially occurs at high-latitudes and on the Earth’s night-side. They also found that the dense plasmasphere, which is a region of high-density plasma around Earth, blocks AKR from traveling, thus forming an equatorial shadow zone around the plasmasphere. Furthermore, the authors discover that the low-density ducts within the plasmasphere act as waveguides, enabling AKR to penetrate the dense plasmasphere and propagate along these channels.

The findings provide valuable insights into Earth’s electromagnetic environments, space weather events and geomagnetic storms that may adversely affect satellites, communication systems, GPS, and power grids on Earth.  

Citation: Wu, S., Whiter, D. K., Zhang, S., Taubenschuss, U., Zarka, P., Fischer, G., et al. (2025). Spatial distribution and plasmaspheric ducting of auroral kilometric radiation revealed by Wind, Polar, and Arase. AGU Advances, 6, e2025AV001743. https://doi.org/10.1029/2025AV001743

—Alberto Montanari, Editor-in-Chief, AGU Advances