Category: 8. Health

Demonstrating that the best solution is not always a multistage approach, a new trial shows catheter ablation is superior to a combination of antiarrhythmic drugs and lifestyle changes — weight loss, more exercise, and alcohol reduction — when treating atrial fibrillation (AF) in patients who also have obesity.

The PRAGUE-25 trial, led by Pavel Osmancik, MD, PhD, with the Cardiocenter at Charles University in Prague, found catheter ablation was roughly twice as effective in an intention-to-treat analysis at controlling AF at the 1-year mark compared with a combination of antiarrhythmic drugs and lifestyle modification (73% vs 34.6%).

A “referral to [catheter ablation] in this population should not be delayed until the patient loses weight,” according to the researchers, who published their findings online on June 30 in the Journal of the American College of Cardiology simultaneously with a presentation at theNew York Valves 2025 Conference.

Obesity: A Strong Predictor of AF

AF, the most common sustained heart arrhythmia, affects about 60 million people worldwide. Obesity is one of its strongest predictors. An increase in BMI of 5 has been linked with a 19%-29% higher incidence of the rhythm disorder.

The PRAGUE trial was a randomized, noninferiority trial conducted in five centers in the Czech Republic. Patients that were included had symptomatic AF (paroxysmal, persistent, or long-standing persistent) and a BMI of 30 to 40.

Patients were randomly assigned 1:1 either to receive catheter ablation (n = 100) or a combination of medication and lifestyle changes (n = 103) from May 2021 to November 2023. Baseline characteristics were balanced, according to the researchers.

After randomization, all patients had a baseline cardiopulmonary exercise test, echocardiography, quality of life analysis, blood biochemistry testing, and a baseline 7-day electrocardiographic Holter recording.

Patients in the catheter ablation group underwent ablation within 6 weeks of randomization. Lifestyle modification was started within 4 weeks after randomization and was managed by teams of dietary specialists and physiotherapists, rather than cardiologists.

Patients in the combination therapy group lost significantly more weight at 12 months (about 6 kg, P < .001 compared to 0.35 kg in the other group), and that weight loss was maintained through the 24-month follow-up. The weight loss goal in this trial was 10%, an ambitious target in the period, especially given the physical limitations associated with AF.

Ramesh Hariharan, MD, cardiac electrophysiologist at UTHealth Houston and Memorial Hermann Health, Houston, who was not part of the study, said much of this research was conducted before the widespread use of GLP-1 receptor agonists, and those medications may help current patients achieve greater weight loss faster.

But even with greater weight loss, Hariharan said, the new findings reinforce the idea that no option alone is enough. Lifestyle changes and medicines need to accompany ablation, not replace it, he said, “otherwise we’re going to end up doing [ablations] more frequently.”

What’s more, technology has improved in the last year with nonthermal pulsed field ablation, which offers “far fewer collateral damage complications” and results in a 45-minute procedure “compared to a 2- to 4-hour procedure before. It has made ablation a lot easier.”

Gregory M. Marcus, MD, MAS, associate chief of cardiology for research at 
UCSF Health, San Francisco, said the evidence “is already definitive that catheter ablation is superior to antiarrhythmic drugs, and there is evidence that successful lifestyle change can reduce the burden of atrial fibrillation.” But this trial is the first to show a head-to-head comparison of ablation with a combination of antiarrhythmic drugs and lifestyle changes.

Marcus said he is not convinced the findings exclude the possibility some in this patient population may still be able to treat their AF without ablation.

“For an obese, very sedentary person who drinks too much alcohol, those are, at least theoretically, the prime candidates for lifestyle modification as a way to effectively treat their Afib,” he said.

One important lesson, Marcus said, is that this adds to the growing evidence that when considering the population at large with AF, “on average, catheter ablation is pretty definitively the most effective way to reduce the chance of atrial fibrillation recurrence.”

But some of the most interesting results were in the group who underwent lifestyle modification, he said. In addition to weight loss and improved exercise capacity, they experienced a statistically significant decrease in hemoglobin A1c concentrations of 1.4 mmol/L compared with an increase of 2.5 mmol/L in patients who received catheter ablation. “Those are things that will prolong life and will also improve quality of life,” he said.

“Whether we’re going to do an ablation or not,” Marcus added, “we should always counsel our atrial fibrillation patients about healthy lifestyle management. There are other things to life besides atrial fibrillation.”

The study authors and Hariharan reported no relevant financial disclosures. Marcus is a consultant and was a co-founder of the startup InCarda Therapeutics, which is investigating a novel therapy for the treatment of acute AF.

Marcia Frellick is an independent, Chicago-based healthcare journalist and a regular contributor to Medscape.

Researchers at Virginia Tech’s Fralin Biomedical Research Institute are developing a method to deliver creatine directly to the brain using focused ultrasound. The technique is being investigated as a potential intervention for children with creatine transporter deficiency, a condition that can impair speech, memory, and learning.

Creatine plays a role in cellular energy production and neurotransmitter regulation, making it critical not only for muscle but also brain function. While oral supplements often improve muscle mass in patients with creatine deficiency, they do not consistently address neurological symptoms, in part because creatine has difficulty crossing the blood-brain barrier.

“Creatine is very crucial for energy-consuming cells in skeletal muscle throughout the body, but also in the brain and in the heart,” says Chin-Yi Chen, a research scientist working on the project.

Ultrasound delivery to bypass the blood-brain barrier

The research is led by assistant professor Cheng-Chia “Fred” Wu, who studies therapeutic focused ultrasound, a noninvasive technique that uses sound waves to temporarily open the blood-brain barrier. The goal is to allow beneficial compounds, like creatine, to reach brain tissue without damaging surrounding cells.

The project, supported by a $30,000 grant from the Association for Creatine Deficiencies, builds on Wu’s broader work using ultrasound to improve drug delivery for pediatric brain cancer. His collaboration with Dr. Seth Berger of Children’s National Hospital led to the idea of applying the same method to treat creatine deficiency.

“Through the partnership between Virginia Tech and Children’s National Hospital, I was able to present our work in focused ultrasound at the Children’s National Research & Innovation Campus,” says Wu. “There, I met Dr. Seth Berger, a medical geneticist, who introduced me to creatine transporter deficiency. Together, we saw the promise that focused ultrasound had to offer.”

Collaboration supports early-stage translational research

Both Virginia Tech and Children’s National have been named Centers of Excellence by the Focused Ultrasound Foundation, a designation that supports collaborative research bridging lab studies and clinical applications. Chen’s initial work will focus on whether creatine can be successfully delivered across the blood-brain barrier and restore normal brain mass in lab models.

“It was a moment that made me really excited — that I had found a lab where I could move from basic research to something that could help patients,” says Chin-Yi Chen. “When Fred asked me, ‘Are you interested in this project?’ I said, ‘Yes, of course.’”

Fitness coach Navneeth Ramprasad, on April 11, shared an Instagram post and explained how avoiding healthy foods can worsen diabetes in your parents. “If your parents are diabetic and you’re not giving them these 5 foods every day, be prepared to spend a lot more on medical bills in a few years, especially the last one. Let’s be real: Most Indian households are still eating the same food that made us the diabetes capital of the world,” Navneeth added.

According to him, here are five foods that your parents must consume every day, if they are diabetic.

1. Fresh coconut and almonds

First thing in the morning, instead of tea or coffee. The healthy fats stabilise blood sugar, reduce morning crashes, and support brain health. Have 2 pieces of coconut and 5 soaked almonds. That’s it. Also read | Diabetes: 7 high-fibre foods that can prevent blood sugar spikes

2. Oats, Greek yoghurt and berries

For breakfast, instead of dosa, idly, or toast. Low GI carbs + protein + fiber + antioxidants = no sugar spikes and longer fullness.

3. Millet khichdi, sprouts and cooked veggies

For lunch, instead of white rice, sambar, and papad. Use foxtail millet or quinoa with moong dal, add steamed sprouts, and a bowl of high fiber veggies. Balanced plate = fiber, protein, slow carbs, and better post-lunch sugar control.

4. Tofu or tempeh for dinner

High-protein, low-carb, and essential for reversing insulin resistance. Add veggies, stir-fry or grill — just don’t end the day with wheat rotis alone.

5. Pumpkin seeds, just before bedtime (9–9:30 PM)

Prevents midnight sugar dips, supports sleep and magnesium levels. 1 small spoon (not more) of raw or lightly roasted seeds is perfect for diabetics who wake up tired or with sugar crashes at night. Also read | Smart eating for diabetes: Nutritionist-approved diet tips to keep your blood sugar in check

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.

A UCSF analysis has found that the newer generation of much more effective diabetes medications are reaching only a fraction of the patients who are recommended to take them based on new guidelines.

Type 2 diabetes (T2D), a condition in which the body can’t use insulin to clear sugar from the bloodstream, affects 1 in 10 Americans. It comes with grave health risks, including cardiovascular and kidney disease.

The study assessed medications that patients received within a year of T2D diagnosis. During the period under review – 2014 to 2022 – groups like the American Diabetes Association and the American Heart Association began encouraging the use of newer medications over some older, less effective ones.

The analysis, which is based on more than 40,000 records from the University of California Health Data Warehouse, found some encouraging results. 

The use of sodium-glucose cotransporter 2 (SGLT2) inhibitors or glucagon-like peptide 1 (GLP-1) receptor agonists – two newer categories of drugs – increased, particularly among patients with cardiovascular or kidney disease.

Meanwhile, the use of sulfonylureas – a category of diabetes drug with severe side effects, now seen as a last resort in treatment – declined. And the use of metformin and insulins, the classic medications for diabetes, declined slightly. 

Still, by 2022, just 20% T2D patients were receiving GLP-1 drugs within a year of diagnosis, and less than 15% of patients were receiving SGLT2 drugs – reflecting a gap between what the professional guidelines recommend and the care that patients are receiving.

The researchers gave several reasons for why this might be. One is that GLP-1 drugs, like Wegovy and Ozempic, are expensive, and insurance doesn’t always cover them. Another is that not every provider knows that leading organizations recommend prescribing GLP-1 and SGLT2 drugs, like Jardiance or Farxiga, for T2D from the moment of diagnosis. 

Some of the most devastating consequences of diabetes come from its effects on the heart and kidney, and thankfully, we now have drugs that target those effects head on. But to maximize the benefit for the many hundreds of thousands of patients in the U.S., we need to increase access to these drugs and make sure that clinicians understand just how beneficial they are.” 

Jonathan Watanabe, PharmD, MS, PhD, the senior author of the study

A prospective cohort study led by Yang Shao, PhD, president and CEO of Geneseeq Technology Inc. and professor at Nanjing Medical University, Nanjing, published in Nature Medicine, on a blood test capable of simultaneously detecting 13 types of cancer. The test demonstrated high sensitivity and specificity and was able to identify early-stage cancers that often go unnoticed during routine screenings.

Traditional cancer screening methods are often invasive, expensive, and time-consuming, which can reduce patient adherence. In addition, several cancers — such as pancreatic cancer — are typically asymptomatic in their early stages and progress rapidly, with no established screening protocols currently available.

This prompted the development of less invasive approaches, such as multi-cancer early detection (MCED) blood tests that can detect a cancer signal from circulating cell-free DNA. These simple blood tests analyze plasma cell-free DNA using genetic and fragmentomic-based features from whole genome sequencing to simultaneously detect multiple cancer types. Although promising, current MCED tests still have relatively low sensitivity, typically less than 60%. Experts, including those from the American Cancer Society, cautioned that widespread use could create a false sense of reassurance and potentially deter patients from following up with standard screenings.

Researchers have developed an MCED blood test that detects 13 cancers: breast, cervical, colorectal, endometrial, esophageal, gastric, liver, lung, ovarian, pancreatic, prostate, biliary tract, and lymphoma. These cancers account for 66.6% of all new cases and 74% of cancer-related deaths worldwide. The test uses two main classifiers: the detection-of-cancer classifier, tasked with confirming the presence of cancer, and the tissue-of-origin classifier, responsible for pinpointing the primary site of malignancy by analyzing and integrating feature frameworks, including copy number variations, fragment size coverage, fragment size distribution, nucleosome footprint, and fragment-based methylation.

To develop the test, researchers analyzed 6553 blood samples, 3076 from patients with cancer and 3477 from healthy individuals, divided into a training dataset of 4807 samples and an internal validation dataset of 1746 samples.

Independent validation was performed using a prospectively enrolled cohort of 1465 participants in an age-matched fashion, comprising 732 patients with cancer and 733 non-cancer individuals between April and November 2021. In the third ongoing phase, 3724 asymptomatic adults aged 45-75 years in the Jinling cohort underwent both complete physical examinations and the MCED test in June 2023.

Positive Results

In independent validation, the MCED test showed an overall sensitivity of 87.4% and specificity of 97.8%. The sensitivity was particularly high for certain cancer types, such as 100% for liver and biliary tract cancer, 94.5% for lung cancer, and 82.3% for colorectal cancer. Even cancers that are difficult to diagnose early, such as pancreatic and ovarian cancers, showed a sensitivity of 76.9% for pancreatic cancer and 90.5% for ovarian cancer. Breast cancer had the lowest sensitivity at 63.8%.

The test was effective in detecting early-stage disease, with a sensitivity of 79.3% for stage I and 86.9% for stage II cancer. This increased to 92.4% for stage III and 97.1% for stage IV. When considering the top two tissue origin predictions, the accuracy increased to 90.7% for the internal set and 91.7% for the independent set. It performed best in identifying cancers of the colon-rectum, lungs, and liver but was less accurate for pancreatic and stomach cancers, correctly identifying the origin in 50% or fewer cases.

In a prospective screening cohort of asymptomatic individuals, the MCED test identified 23 of 43 cancer cases within 1 year, with an overall sensitivity of 53.5%. When limited to the 13 cancers that the test was designed to detect, the sensitivity increased to 62.1%. Most of these cases (93%) were early-stage cancers (stage 0, I, or II). The specificity remained high at 98.1%, with a positive predictive value (PPV) of 25% and a negative predictive value of 99.4%.

Notably, 8 of the 23 positive patients who received a positive MCED result had their cancers undetected through physical examination, and 4 had cancers for which there is currently no recommended screening, highlighting the potential of the MCED test to effectively detect cancers that would otherwise have gone undetected.

“Our study demonstrated high sensitivity, highlighting our classifier’s ability to detect cancer cases, even in populations with lower disease prevalence. This underscores the capacity of our classifier to effectively detect incident cancer cases under real-world screening conditions, facilitated by comprehensive physical examinations,” the authors concluded.

These findings suggest that the MCED test could be a valuable complement to existing screening methods, particularly for cancers without routine early detection tools. The ability to detect early-stage pancreatic and ovarian cancers is particularly promising. However, broader validation across diverse populations, cost-effectiveness analyses, and studies on the psychological impact of screening outcomes are critical before widespread clinical implementation.

One key limitation was that the PPV achieved was 25% for the MCED test, which was lower than the 38% reported in the PATHFINDER study published in 2023.

“The PATHFINDER trial enrolled participants with a higher cancer prevalence and utilized the MCED test results to trigger diagnostic workup, systematically investigating participants with positive test results, thus inherently enriching their cohort for cancer diagnoses within the workup pathway. Conversely, the Jinling study adopted a standardized comprehensive physical examination for all participants as the primary screening modality, independent of MCED test outcomes and within the context of lower cancer prevalence,” the researchers noted.

However, the absolute number of false positives in the Jinling study was low (20 of 3724 participants, or 0.54%). False-positive results can lead to unnecessary anxiety, further invasive diagnostic procedures, and potentially inappropriate treatment for patients. The researchers emphasized the need to improve the sensitivity of the MCED test for very early-stage cancers while reducing false positives.

This story was translated from Univadis Italy. 

Scientists at the National Institutes of Health (NIH) have found that two common types of hormone therapy may alter breast cancer risk in women before age 55. Researchers discovered that women treated with unopposed estrogen hormone therapy (E-HT) were less likely to develop the disease than those who did not use hormone therapy. They also found that women treated with estrogen plus progestin hormone therapy (EP-HT) were more likely to develop breast cancer than women who did not use hormone therapy. Together, these results could help to guide clinical recommendations for hormone therapy use among younger women.

The two hormone therapies analyzed in the study are often used to manage symptoms related to menopause or following hysterectomy (removal of uterus) or oophorectomy (removal of one or both ovaries). Unopposed estrogen therapy is recommended only for women who have had a hysterectomy because of its known association with uterine cancer risk.

Hormone therapy can greatly improve the quality of life for women experiencing severe menopausal symptoms or those who have had surgeries that affect their hormone levels. Our study provides greater understanding of the risks associated with different types of hormone therapy, which we hope will help patients and their doctors develop more informed treatment plans.”

Katie O’Brien, Ph.D., lead author of NIH’s National Institute of Environmental Health Sciences (NIEHS)

The researchers conducted a large-scale analysis that included data from more than 459,000 women under 55 years old across North America, Europe, Asia, and Australia. Women who used E-HT had a 14% reduction in breast cancer incidence compared to those who never used hormone therapy. Notably, this protective effect was more pronounced in women who started E-HT at younger ages or who used it longer. In contrast, women using EP-HT experienced a 10% higher rate of breast cancer compared to non-users, with an 18% higher rate seen among women using EP-HT for more than two years relative to those who never used the therapy.

According to the authors, this suggests that for EP-HT users, the cumulative risk of breast cancer before age 55 could be about 4.5%, compared with a 4.1% risk for women who never used hormone therapy and a 3.6% risk for those who used E-HT. Further, the association between EP-HT and breast cancer was particularly elevated among women who had not undergone hysterectomy or oophorectomy. That highlights the importance of considering gynecological surgery status when evaluating the risks of starting hormone therapy, the researchers noted.

“These findings underscore the need for personalized medical advice when considering hormone therapy,” said NIEHS scientist and senior author Dale Sandler, Ph.D. “Women and their health care providers should weigh the benefits of symptom relief against the potential risks associated with hormone therapy, especially EP-HT. For women with an intact uterus and ovaries, the increased risk of breast cancer with EP-HT should prompt careful deliberation.”

The authors noted that their study is consistent with previous large studies that documented similar associations between hormone therapy and breast cancer risk among older and postmenopausal women. This new study extends those findings to younger women, providing essential evidence to help guide decision-making for women as they go through menopause.

What can contribute to heart attack risk?

Dr Dhirendra Singhania, principal consultant of interventional cardiology at Yashoda Super Speciality Hospitals in Kaushambi, said in June 30 interview with NDTV that the ‘major causes of risk in heart attacks are steroids, lack of sleep, and hormonal therapies, especially for women’.

He said, “Everyone, whether a celebrity or a common man, if they are not following the rules of the body, they will have problems. In celebrities, they all try to maintain their body for fit appearances. Many times, we don’t know what they do to achieve that. Lack of sleep has been known as a cardiac risk factor – many celebrities are awake for almost the whole night at times.”

Highlighting the importance of approaching anti-ageing treatments with caution, and prioritising your health and safety, Dr Singhania added, “Steroids, drug overdoses, and hormonal therapies for women, such as hormone replacement therapy (HRT for menopause) and oral contraceptives, can contribute to heart attack risk.”

Be cautious with anti-ageing treatments

Before trying any anti-ageing treatments, it’s essential to consult a qualified doctor, especially if you have heart conditions or other health issues. In a May 2025 interview with HT Lifestyle, a dermatologist explained non-invasive skin treatments, the ideal age to start them, signs of ageing, and who should avoid these treatments in a complete guide. Click here to know what she said.

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.

A new study from UCLA Health has uncovered how inflammation in brain blood vessels exacerbates damage in vascular dementia and demonstrated that targeting this process with a repurposed drug can promote brain repair and functional recovery in mice.

Published in Cell, the research combines laboratory and human data to pinpoint a critical signaling pathway that could lead to the first effective treatment for this understudied form of dementia.

Vascular dementia is the second leading cause of dementia. This disease co-occurs with Alzheimer’s disease in the leading cause of dementia, termed “mixed dementia.” There is no drug therapy that promotes recovery in vascular dementia. A key problem in this disease is that the brain damage expands from initial areas, to become larger over time. The UCLA team sought to identify what happens in the brain in these areas of expansion. To do this, the researchers identified all the molecules that communicate among the cells of the brain adjacent to the dementia lesions, and which ones are abnormally up or down in the disease compared to normal brain. By doing this both in laboratory models of vascular dementia and in human brain, the UCLA team was able to precisely identify the “interactome” in vascular dementia – all the molecules that signal or interact in the cells at risk.

We reasoned that the cell in the brain areas in which the disease expands will lose their normal signaling with each other. In other words, the cell-to-cell interaction is disturbed in a toxic way in vascular dementia. We set out to identify these cell-to-cell interactions or the “interactome” in vascular dementia.” 

Dr. S. Thomas Carmichael, study’s lead author and professor and chair Neurology at the David Geffen School of Medicine at UCLA

One molecular system jumped out as potentially significant. This system communicates between blood vessel cells and adjacent brain inflammatory cells, termed microglia. In vascular dementia, the CD39 (an enzyme) and the adenosine A3 receptor (A3AR) are downregulated together in these two cell types, synergistically by aging and vessel ischemic lesion. Because vascular dementia is a disease of aging, this double finding – a downregulation with both disease and aging – signaled a possibly significant role. CD39 generates through several steps the molecule adenosine, which binds to A3AR, and modifies inflammation, downregulating some of its harmful effects. 

To test this CD39/A3AR system as a possible drug target for treating vascular dementia, the group utilized a drug that is in clinical trials for psoriasis. When given to mice in a model of vascular dementia, this drug promoted repair of brain tissue and recovery of memory and gait functions.

“The most exciting finding was that delayed intervention still worked,” said lead author Dr. Min Tian, a postdoctoral scholar at UCLA Health. “This is crucial because vascular dementia is often diagnosed late. By targeting the crosstalk between blood vessels and brain cells, we’re addressing the root cause of damage, not just masking symptoms.”

While the results are promising, further studies are needed before human trials can begin. The team is now optimizing dosing and exploring biomarkers to track the therapy’s effectiveness.

The study, “Deconstructing the Intercellular Interactome in Vascular Dementia with Focal Ischemia for Therapeutic Applications,” will be online in Cell, June 30, 2025, and includes collaborators from UCLA’s neurology, pathology, neurobiology, physiology and psychiatry departments. Funding was provided by the National Institutes of Health, Ressler Family Foundation, The Dr. Miriam and Sheldon G. Adelson Medical Research Foundation, UCLA Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, including support from the Steffy Family Trust.