Reconsidering the inclusion of Ladapo's work in the meta-analysis: Validity concerns and implications

This is a response to Marchand & Masoud's response letter regarding my criticism "Response to Dr. Somovilla del Saz's letter to the editor regarding "Risk of all-cause and cardiac-related mortality after vaccination against COVID-19: A meta-analysis of self-controlled case series studies."" The response is a defense of the initial criticism to the paper regarding the validity of the inclusion of Ladapo´s paper.

Questionable robustness in the findings of a meta-analysis

Marchand and colleagues conducted a meta-analysis examining COVID vaccine effects on all-cause and cardiac-related mortality. Findings aligned with previous research, showing no association with all-cause mortality. However, cardiac-related mortality exhibited a 6% increase post-vaccination. Concerns arise from reliance on a non-peer-reviewed study (Ladapo, 2022) influencing results significantly. Sensitivity analyses were lacking, undermining result robustness, particularly in gender-specific outcomes. Adherence to PRISMA guidelines for transparency and thoroughness could strengthen conclusions. This study underscores vaccine safety scrutiny, yet the influence of biased sources and absence of sensitivity testing warrant careful consideration.

Time-dependent cognitive and somatic symptoms of depression as predictors of new cardiac-related events in at-risk patients: the UPBEAT-UK cohort

BACKGROUND

Evidence suggests that somatic rather than cognitive depressive symptoms are risk factors for recurrent cardiac events in at-risk patients. However, this has never been explored using a time-dependent approach in a narrow time-frame, allowing a cardiac event-free time-window.

METHODS

The analysis was performed on 595 participants [70.6% male, median age 72 (27-98)] drawn from the UPBEAT-UK heart disease patient cohort with 6-monthly follow-ups over 3 years. Depressive symptomatology was measured using the Patient Health Questionnaire-9 (PHQ-9) (four somatic, five cognitive items). New cardiac events (NCEs) including cardiac-related mortality were identified by expert examination of patient records. Analyses were performed using Cox proportional hazard models with delayed entry, with time-dependent depressive dimensions and covariates measured 12-18 months (median: 14.1, IQR: 3.5) prior to the event, with a 12-month cardiac event-free gap.

RESULTS

There were 95 NCEs during the follow-up [median time-to-event from baseline: 22.3 months (IQR: 13.4)]. Both the somatic (HR 1.12, 95% CI 1.05-1.20, p = 0.001) and cognitive dimensions (HR 1.11, 95% CI 1.03-1.18, p = 0.004) were time-dependent risk factors for an NCE in the multi-adjusted models. Specific symptoms (poor appetite/overeating for the somatic dimension, hopelessness and feeling like a failure for the cognitive dimension) were also significantly associated.

CONCLUSION

This is the first study of the association between depressive symptom dimensions and NCEs in at-risk patients using a time-to-event standardised approach. Both dimensions considered apart were independent predictors of an NCE, along with specific items, suggesting regular assessments and tailored interventions targeting specific depressive symptoms may help to prevent NCEs in at-risk populations.

Risk of cardiac-related mortality in stage IIIA-N2 non-small cell lung cancer: Analysis of the Surveillance, Epidemiology, and End Results (SEER) database

Background

In this study, we aimed to investigate the association between postoperative radiotherapy (PORT) and cardiac‐related mortality in patients with stage IIIA‐N2 non‐small cell lung cancer (NSCLC) using the Surveillance, Epidemiology, and End Results (SEER) database.

Methods

The United States (US) population based on the SEER database was searched for cardiac‐related mortality among patients with stage IIIA‐N2 NSCLC. Cardiac‐related mortality was compared between the PORT and Non‐PORT groups. Accounting for mortality from other causes, Fine and Gray's test compared cumulative incidences of cardiac‐related mortality between both groups. Univariate and multivariate analysis were performed using the competing risk model.

Results

From 1988 to 2016, 7290 patients met the inclusion criteria: 3386 patients were treated with PORT and 3904 patients with Non‐PORT. The five‐year overall incidence of cardiac‐related mortality was 3.01% in the PORT group and 3.26% in the Non‐PORT group. Older age, male sex, squamous cell lung cancer, earlier year of diagnosis and earlier T stage were independent adverse factors for cardiac‐related mortality. However, PORT use was not associated with an increase in the hazard for cardiac‐related mortality (subdistribution hazard ratio [SHR] = 0.99, 95% confidence interval [CI]: 0.78–1.24, p = 0.91). When evaluating cardiac‐related mortality in each time period, the overall incidence of cardiac‐related mortality was decreased over time. There were no statistically significant differences based on PORT use in all time periods.

Conclusions

With a median follow‐up of 25 months, no significant differences were found in cardiac‐related mortality between the PORT and Non‐PORT groups in stage IIIA‐N2 NSCLC patients.