Low-dose aspirin for prevention of cardiovascular mortality in patients with type 2 diabetes and chronic kidney disease: A real-world nationwide cohort study

AIMS/INTRODUCTION

Cardiovascular mortality risk is elevated among patients with diabetes and concurrent chronic kidney disease. However, controversy surrounds the use of aspirin for primary prevention within this population. This study aims to assess the effectiveness and safety of low-dose aspirin for primary prevention in patients with diabetes and pre-end-stage renal disease.

MATERIALS AND METHODS

This was a retrospective population-based cohort study using the National Health Insurance Research Database in Taiwan. The study included adults with type 2 diabetes who were enrolled in the pre-end-stage renal disease pay-for-performance program and had no atherosclerotic cardiovascular disease. We used propensity score analysis to control baseline characteristics between the two groups. Clinical outcomes including cardiovascular mortality, all-cause mortality, major bleeding, and renal disease progression were compared between patients who first received aspirin and those who did not.

RESULTS

Between January 2012 and December 2015, a total of 2,155 low-dose aspirin users and 6,737 nonaspirin users were identified. Following propensity score adjustment, aspirin use exhibited a comparable risk of cardiovascular death compared with nonaspirin users (adjusted hazard ratio [aHR] 1.12; 95% confidence interval [CI] 0.65-1.95; P = 0.681). The risk of all-cause mortality was similar between the two groups (aHR 1.07; 95% CI 0.92-1.24; P = 0.385). Similar risks were observed in terms of major bleeding and renal disease progression.

CONCLUSIONS

In patients with diabetes and pre-end-stage renal disease who lacked atherosclerotic cardiovascular disease, low-dose aspirin did not demonstrate a reduction in mortality. These findings do not support the use of aspirin for primary prevention in this high-risk population.

Treatment patterns of breast cancer patients in Georgia Medicaid: Are patterns different for BCCPTA women?

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Background: The Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) of 2000 allowed states to cover women diagnosed with breast, cervical, or pre-cancerous cervical conditions under Medicaid upon diagnosis and while “under treatment”. We investigate breast cancer treatment of patients enrolled under BCCPTA in Georgia.

Methods: Georgia Comprehensive Cancer Registry were linked to Medicaid enrollment files to identify 2,048 enrollees with a primary cancer of breast, of whom 1,046 were BCCPTA, 674 were disabled, and 328 were in ‘other’ Medicaid eligibility groups. Logistic regressions were used to estimate the odds of receiving: (1) lumpectomy, (2) mastectomy, and (3) other surgery in addition to (4) any drug regimen (hormonal or chemotherapy) and (5) radiation.

Results: Using descriptive data and after controlling for covariates, BCCPTA women are more likely to receive any treatment (OR = 4.71, [CI] = 2.48, 8.96), any drug regimen (OR = 3.58, [CI] =2.32, 5.51), any radiation (OR = 1.61, [CI] = 1.15, 2.24), and any ‘definitive’ surgery (OR = 2.52, [CI] = 1.74, 3.66) than the ‘other’ eligibility group. There are no significant differences in the receipt of a lumpectomy versus a mastectomy by eligibility group but BCCPTA women are more likely to receive more adjuvant follow-up.

Conclusions: The BCCPTA program in Georgia appears to create a quicker pathway for previously low-income uninsured women with breast cancer to access services and in turn, receive more treatment than women enrolled in more traditional, Medicaid eligibility groups. Yet, the overall rate of adjuvant therapy, whether radiation or hormonal/chemotherapy, appears to fall short of national criteria.

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L-Canavanine modulates cellular growth, chemosensitivity and P-glycoprotein substrate accumulation in cultured human tumor cell lines

L-Canavanine (L-CAV) is a naturally occurring L-arginine analog that induces the formation of non-functional proteins in a variety of organisms. Previous studies have shown that L-CAV is cytotoxic for several human tumor cell lines. In this study, we have evaluated the cytotoxicity of L-CAV for both parental and multi-drug resistant (MDR) human tumor cells. We have also determined the effect of L-CAV exposure on cellular expression and activity of the MDR P-glycoprotein (P-gp) membrane efflux pump, and the effect of L-CAV on cellular accumulation of P-gp substrates. The effect of pre-treatment with non-cytotoxic doses of L-CAV on cellular sensitivity to ten standard antineoplastic agents was also evaluated, in order to assess the chemosensitization potential of L-CAV. 3-(4,5-Dimethylthiazol-)2,5-diphenyl tetrazolium bromide (MTT) cytotoxicity assays revealed that the MDR variants of human uterine sarcoma and leukemic cells were equally sensitive to L-CAV as compared with their respective parental controls. Although the presence of free L-CAV in the uptake media did not influence cellular accumulation of P-gp substrates, cells cultured for 72 h in 250 microM L-CAV accumulated from 16 to 23% less P-gp substrate than untreated controls. Although L-CAV-cultured sarcoma cells accumulated 17% less doxorubicin (DOX) than untreated controls, they were three times more sensitive to its cytotoxic effects. L-CAV-treated cells were also significantly more sensitive to cisplatin, 5-fluorouracil, mitoxantrone and bleomycin than were untreated controls. Indirect immunofluorescence revealed that 72-h exposure to as much as 1000 microM L-CAV did not alter cellular expression of P-gp. These studies suggest that L-CAV may be equally cytotoxic for both parental and MDR tumor cells, and that L-CAV neither induces the expression of, nor is a substrate for, P-gp. The observation that L-CAV pre-treatment reduces cellular accumulation of DOX, yet sensitizes tumor cells to DOX and other DNA-targeting antineoplastic drugs, suggests a role for L-CAV as a chemosensitizer for the chemotherapy of cancer.

Epidemiology of subacute sclerosing panencephalitis

The Subacute Sclerosing Panencephalitis Registry has compiled data from 453 instances of SSPE occurring in the United States from 1960 through 1976. The mean annual incidence during this period was 3.5 per 10 million persons under 20 years of age, 2.3 times higher for males than females, and 4.0 times higher for whites than blacks. Although the long-term pattern of incidence is unknown, the incidence of reported SSPE declined dramatically from 1970 to 1976. There are marked geographic variations of SSPE activity within the United States and also a higher incidence for children from farms (9.4 per 10 million persons under 20) compared with children from other rural domiciles (3.7 per 10 million), suburban children (2.9 per 10 million), and inner-city children (1.6 per 10 million). Available epidemiologic evidence suggests that some extrinsic factor, unrelated to measles or measles vaccine, is important in the pathogenesis of the disease.