Category: 8. Health

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Patients with atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF) who were prescribed a combination of GLP-1 RAs and SGLT2 inhibitors exhibited an overall reduction in 1-year mortality and hospitalization in a recent trial.¹

Previous randomized controlled trials have supported the benefit of SGLT2 inhibitors in major adverse cardiovascular events in patients with both ASCVD and HF while GLP-1 RAs have also been noted as potentially beneficial to this cohort.^2,3 Despite these results, however, little literature exists examining the effects of combining the 2 therapies in patients with both ASCVD and HF.

“Given the significant overlap between ASCVD and HF in clinical practice, addressing this knowledge gap is essential for optimizing treatment strategies,” wrote Sih-Yao Chen, MD, department of internal medicine, Chi Mei Medical Center, and colleagues.¹ “To address this, our study aims to leverage the TriNetX database to compare the outcomes of patients treated with GLP-1 RA in addition to SGLT2i vs. those treated with SGLT2i alone, with a specific focus on hard endpoints such as mortality and HF hospitalizations.”

Chen and colleagues conducted a retrospective observational study analyzing patients with ASCVD and HF from August 2016 to September 2024. To be included, patients had to be ≥18 years old and have been recently prescribed a GLP-1 RA and SGLT2i, or an SGLT2i alone. Patients were then divided into 2 groups based on the treatment they received. Patients in the SGLT2i group who had received GLP-1 RAs prior to investigation were excluded, along with those who had been hospitalized within 1 week of initiating GLP-1 RAs.¹

Covariates included age, sex, race, ethnicity, respiratory disease, diabetes mellitus, endocrine or metabolic disease, circulatory disease, nutritional disease, and other conditions. Additionally, patients prescribed medications such as angiotensin-converting enzyme inhibitors, beta blockers, spironolactone, and eplerenone, among others, were excluded.¹

A total of 2,797,317 patients were initially selected for review. After screening for exclusion criteria, a remainder of 96,051 were included in the final analysis. Of these, 5548 patients were given both a GLP-1 RA and a SGLT2i, while 90,503 received only the SGLT2i. Propensity score matching resulted in 5272 patients in each group.¹

A baseline for comparison was established by using acute cholecystitis, fracture, and gastric ulcer as negative control outcomes. A prespecified subgroup analysis based on HF type, the presence of diabetes mellitus, obesity, and chronic kidney disease was also conducted, aiming to identify potentially influential subgroups. 3 types of GLP-1 RAs – liraglutide, dulaglutide, and semaglutide – were also utilized in testing to determine whether the benefits were consistent across different varieties.¹

After the first year, 2162 patients in the combination cohort and 2462 in the SGLT2i cohort experienced hospitalization or mortality. This incidence was substantially lower in the combination group (HR .78; 95% CI, .74-.83; P <.0001). The risk of mortality (HR .72; 95% CI, .62-.84; P <.0001), hospitalization (HR .78; 95% CI, .73-.83; P <.0001), and HFE (HR .77; 95% CI, .72-.83, P <.0001) were all significantly lower in the combination cohort as well. Negative control analysis indicated no significant difference between the cohorts, and results were consistent across all subgroups. The outcome benefits persisted at 2- and 3-year follow-ups, and remained consistent regardless of the variables used in the PSM analysis.¹

“In the current era, coronary artery bypass surgery is the only treatment proven to reduce mortality in patients with ischemic cardiomyopathy, while other medical therapies primarily address HF management,” wrote Chen and colleagues. “Our research suggests a potential new therapeutic option to improve prognosis in patients with both ASCVD and HF.”¹

References

1. Chen SY, Wu JY, Liao KM, Lin YM. Prognostic benefit of glucagon-like peptide-1 receptor agonists addition to sodium-glucose cotransporter 2 inhibitors in patients with atherosclerotic cardiovascular disease and heart failure: a cohort study. Eur Heart J Cardiovasc Pharmacother. 2025;11(4):324-333. doi:10.1093/ehjcvp/pvaf014

2. Cannon CP, Pratley R, Dagogo-Jack S, et al. Cardiovascular Outcomes with Ertugliflozin in Type 2 Diabetes. N Engl J Med. 2020;383(15):1425-1435. doi:10.1056/NEJMoa2004967

3. Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. N Engl J Med. 2023;389(24):2221-2232. doi:10.1056/NEJMoa2307563

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“Is it an itch that rashes, meaning you are manipulating the skin by scratching and now create visible change, or is a rash that itches a primary skin disease that is pruritic?” Adam Friedman, MD, FAAD, asked attendees of the DERM 2025 NP PA CME Conference in Las Vegas, Nevada.¹ The answer, he explained, will set the clinician in 2 distinct directions in informing the treatment strategy, he said.

With that in mind, Friedman, who is professor and chair of dermatology, and director of translational research at The George Washington University School of Medicine & Health Sciences, takes an organized approach to determine what is driving the disease. “Think about the big things, the big systems,” he said in an interview with Dermatology Times. He recommends starting with a very focused initial lab workup that includes a CBC and comprehensive metabolic panel.

Friedman also considers issues with the kidneys, the liver, and even the thyroid.

“Do not forget, pruritus can be a presenting sign of many different flavors of malignancy, probably best known would be lymphoma,” Friedman added. Thus, he suggested considering a chest x-ray in the right circumstances.

Then think about other dermatological disorders, like bullous pemphigoid, which can present as pruritus.

“Certainly looking for some pathognomonic features on the patient, which means just because they say, ‘Oh, I itch all over and have no rash,’ it doesn’t mean you’re not going to look that patient head to toe,” he advised.

“When it comes to treatment, be aggressive and layer cake,” Friedman told Dermatology Times. He explained there are both over the counter and prescription options that can be used.

“Probably the hottest thing out there are going to be your topical JAK inhibitors and PD-4 inhibitors, both of which have unique influence on sensory neurons,” he said. “And then systemically, the take home is take a little from aisle A, take a little from aisle B. Meaning: Go after neuropathic or nerve targeting therapies like SSRIs, gabapentinoids, in combination with anti-inflammatories.”

There is a “litany of biologics” that target key cytokines or receptors that drive inflammation and the sensitization of those neurons, Friedman added.

Ultimately, Friedman advocates for using a thoughtful, strategic approach to determining what the itch is will also help marry the itch to the treatment. “Be creative, ask lots of questions, don’t forget to look, and absolutely climb the therapeutic ladders that focus on the nerves and inflammation,” he said.

Reference

1. Friedman A. Itch Break: Wiping Out Chronic Pruritus. Presented at DERM 2025 NP PA CME Conference; July 23-26, 2025; Las Vegas, Nevada.

Almost 40% of women going through perimenopause experience moderate to severe hot flushes and night sweats but have no treatment options, new research has found.

The study, published in the Lancet Diabetes & Endocrinology, explored differences in symptom prevalence by menopausal stage among women aged 40-69 years.

More than 8,000 participants who self-identified as a woman completed the Australian women’s midlife years (AMY) study.

After excluding women on medication or those who had undergone a procedure that would affect their hormones or symptoms, Monash University researchers analysed the remaining 5,509: 1250 were classified as pre-menopausal, 344 early perimenopausal, 271 late perimenopausal, and 3,644 postmenopausal.

Senior author, Prof Susan Davis, said while vasomotor symptoms (VMS) – such as hot flushes and night sweats – were already known to be typical of menopause, the study found moderate to severe VMS symptoms to be the most defining symptom of perimenopause, the time period leading up to the final menstrual period.

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Although other symptoms were commonly reported by perimenopausal women, including poor memory and low mood, analysis showed none differed in prevalence enough from pre-menopause to differentiate between menopausal stages.

The study found 37.3% of women in late perimenopause had moderately-to-severely bothersome hot flushes: meaning they were five times more prevalent among perimenopausal women compared with pre-menopause.

Severe vaginal dryness was 2.5 times more prevalent among perimenopausal women compared with pre-menopause.

Menopausal hormonal therapy (MHT, also known as HRT) is effective for treating VMS due to menopause, but there are no specifically designed or approved interventions for these symptoms for perimenopausal women, the researchers noted.

Treating perimenopause is not the same as treating post-menopause because women are still randomly ovulating, contraception needs to be considered, MHT can make bleeding heavier and progesterone worsens PMS, Davis said.

The study also challenged the assumption that menstrual irregularity is the earliest sign of perimenopause.

Davis said it is common for women to ask their GPs if their heavier periods and hot flushes are a sign of perimenopause, only for the doctor to respond: “If you’re still getting regular cycles, you can’t possibly be perimenopausal.”

But when the study compared pre-menopausal women with VMS whose periods were still regular but had changes – becoming lighter or heavier – they were the same as women who had VMS but who’d started experiencing changes in period cycle frequency.

“So we’re really saying ignoring hot flushes and night sweats is wrong,” she said.

Dr Rakib Islam, also a study author, said defining perimenopause and menopause by menstrual cycle overlooks women with regular cycles and those who no longer menstruate, such as those who have had an endometrial ablation or hysterectomy, and users of hormonal contraception.

“Our findings support a more symptom-based approach, enabling earlier recognition of perimenopause and more timely care,” Islam said.

Davis said it was “critical” that women were recruited to the study with no mention made of menopause, so the sample was not biased.

Prof Martha Hickey, the chair of obstetrics and gynaecology at the University of Melbourne and lead author of last year’s Lancet series on menopause called it an important study.

The study reached quite a large number of women and provided deeper insight into perimenopause, an area traditionally overlooked in menopause research,” she said.

“More than a third of research in medical treatments is done by pharmaceutical companies. They traditionally have excluded perimenopausal women from the research because the perimenopausal women are still producing their own hormones in a sometimes unpredictable way, and it didn’t fit with the study design that they wanted,” Hickey said.

Hickey said the study’s main limitation was that it was a cross-sectional survey. So while it was helpful for knowing what symptoms women categorised to a particular stage might experience, “it doesn’t tell us how these things change as women go through menopause”.

A Salmonella outbreak that sickened over 160 people in California and a handful of individuals in other states was caused by raw milk products from a single dairy farm, a new report explains.

The outbreak — described Thursday (July 24) in the Morbidity and Mortality Weekly Report (MMWR), which is published by the Centers for Disease Control and Prevention — took place between September 2023 and March 2024. The California Department of Public Health was first notified of the outbreak when nine people fell ill after consuming a specific brand of raw milk produced by the same dairy. This prompted an investigation by state and federal officials.

In a significant stride toward combating one of the world’s deadliest diseases, which is spread by mosquitoes, a large-scale, cluster-randomized clinical trial has demonstrated that mass administration of ivermectin, a drug used to treat parasitic infections, can substantially reduce malaria transmission.

Published in the New England Journal of Medicine on July 23, 2025, results from the BOHEMIA trial, the most extensive study of its kind, found that ivermectin led to a 26% decrease in new malaria infections among children when combined with standard bed nets.

Regina Rabinovich, BOHEMIA principal investigator and director of ISGlobal’s Malaria Elimination Initiative, commented in a press release, “This research has the potential to shape the future of malaria prevention, particularly in endemic areas where existing tools are failing.”

This finding, along with a study published in 2019, offers a promising approach against a parasite that continues to evade traditional control measures impacting the health of millions of people, primarily in Africa and South America.

In addition to reducing malaria transmission, the BOHEMIA team observed a significant reduction in the prevalence of skin infestations, such as scabies and head lice, in the ivermectin group in Mozambique. Furthermore, the Kenya community reported a substantial decrease in bed bugs.

According to the press release, the study’s findings have been reviewed by the WHO Vector Control Advisory Group, which concluded that the study had demonstrated impact and recommended further studies.

The U.S. Centers for Disease Control and Prevention Algorithm for the Diagnosis and Management of Malaria guides the recommended steps to treat malaria patients. Recommendations for antimalarial drugs to prevent malaria vary by country of travel and can be found in the CDC’s Yellow Book, specifically in the chapter on Malaria Prevention Information.

As of July 25, 2025, international travelers in the United States, such as those in Florida, have been diagnosed with malaria.

Additionally, malaria vaccines have been approved for use in Africa; however, they are not available in the United States as of 2025.

In the United States, immigration status has long created hierarchies within our society, where some can participate fully in public life, while others are excluded. These divisions have serious consequences for our communities, including when it comes to public health. A research project led by the University of California, Santa Cruz recently uncovered a particularly alarming example of this effect by looking back on excess deaths in California throughout the course of the COVID-19 pandemic.

Alicia Riley , an associate professor of sociology at UC Santa Cruz and core faculty member in the campus’s Global and Community Health Program, led a team of researchers from UCSF Stanford, MIT, and Boston University in modeling pandemic-related excess mortality in California adults across immigration statuses and a wide range of other socioeconomic factors. The study found that pandemic-period relative excess mortality was twice as high among potentially undocumented immigrants as among those who appeared to be documented immigrants.

Between March 2020 and May 2023, there was an estimated 55% increase in the death rate above pre-pandemic levels among potentially undocumented immigrants, who were born outside the U.S. and lacked a valid social security number, compared to a 22% increase among immigrants who appeared to be documented, who were foreign-born with a reported valid social security number, and a 12% increase in mortality among U.S.-born citizens.

“My main takeaway from this study was just how high excess mortality was when we looked specifically at people who were potentially undocumented immigrants, regardless of race or ethnicity,” Riley said. “A 55% increase in deaths above what was normal prior is really shocking, on a community level. Families are still living with the consequences of those deaths today.”

Uncovering an overlooked variable behind pandemic inequities

While racial and ethnic inequalities in COVID-19 deaths have previously been well studied, Riley’s new paper is the first to examine the interplay of immigration status with other sociodemographic factors. In California, people born in Latin America make up the largest share of the immigrant population, yet there had been no prior data indicating how specific immigration statuses might play into the higher rate of COVID-19 deaths among the state’s Latino population.

“In the absence of data and the rush to explain things, I saw some really terrible examples of stereotyping early in the pandemic,” Riley said. “Even some county public health departments were trying to use cultural stereotypes to explain the high death rates among Latinos or pointing to comorbidities. But there was no scientific evidence that these things were driving the trends.”

Riley and her team set out to counteract harmful narratives by examining societal factors that might be behind the disparities, particularly immigration status. Researchers analyzed death certificates of all California residents aged 25 and older who died of natural causes between 2016 and 2023 in California. Death certificates indicate a person’s country of birth and whether they have a valid social security number, so by combining these two factors, the team classified individuals as either U.S.-born, those who appeared to be documented immigrants, or immigrants who may have been undocumented.

Across these immigration statuses and a range of other factors—like sex, age, race/ethnicity, educational attainment level, and occupation type—the team then looked for differences in pandemic-era survival outcomes. They modeled absolute and relative excess mortality from March 2020 through May 2023, based on baseline mortality from the pre-pandemic period and incorporation of seasonal variables.

The findings showed a very clear gradient in pandemic survival outcomes within most of the sociodemographic subgroups examined. Immigrants who were potentially undocumented generally had the worst outcomes, while immigrants who appeared to be documented survived at markedly higher rates, and U.S.-born people had the best outcomes. Of all subgroups, the hardest hit by excess pandemic deaths were Latino essential workers who were potentially undocumented. They experienced a staggering 91% increase in deaths over pre-pandemic levels. In contrast, the white U.S.-born subgroup experienced only an 8% increase in death.

“It’s clear from these findings that some subgroups had a very different experience in the pandemic than others, and that’s especially surprising since there were many pandemic-era policies in California that were intended to provide universal protection, like lockdowns and free testing,” Riley said. “Even in the face of those protections, risk was not experienced equally. Mortality was clearly stratified by immigration status, and that should raise alarms.”

Understanding the unique public health risks immigrants face

The new paper discusses possible explanations for the inequities that researchers found. Undocumented immigrants were more likely to work in jobs where they faced heightened risk of workplace exposure to COVID-19, and they also lacked access to benefits like paid sick leave, public medical insurance, and unemployment insurance, which were all critical determinants of health during the pandemic.

Additionally, the stress undocumented immigrants experience from the threat of arrest, detention, and deportation affects their immune systems in ways that may put them at greater risk of severe disease from infections like COVID-19. Fear of potentially revealing one’s immigration status can also dissuade people from seeking emergency medical care or reporting health related safety violations in the workplace.

In the aftermath of the pandemic, California and other states expanded Medicaid access to undocumented immigrants, which Riley’s findings suggest could potentially help reduce the death toll of a similar future pandemic. But these policies are now being rolled back amid budget woes and shifting federal policy. And new Trump Administration policies, like increasingly aggressive immigration enforcement tactics and the removal of prohibitions against immigration enforcement in health care settings, could actually worsen the next public health crisis.

To better protect the health of our communities, Riley recommends that undocumented immigrants be more fully included in public safety net and disaster response programs.

“Overall, these findings really make me think about the role that immigrant exclusion in our society plays in exposure risk for infectious diseases and delays in receiving health care that can make the difference between death and survival,” she said. “There are very close connections between how we enforce immigration policy and the health of families across our communities. We really need to be thinking about how we can expand access to things like worker protections, health insurance, and paid leave, so that everyone is truly protected.”