Prediabetes Ups Odds for Myocardial Infarction

Among hospitalized patients, prediabetes—defined as an A1C between 5.7% and 6.4%— was linked with 41% higher odds for myocardial infarction (MI, OR 1.41, 95% CI 1.35-1.47), according to Geethika Thota, MBBS, and colleagues. In a model adjusted for multiple factors including sex, age, race, dyslipidemia, obesity, family history of MI, hypertension, diabetes, and nicotine dependence, the presence of prediabetes was still notably linked with a higher risk for MI (OR 1.25, 95% CI 1.20-1.31). Dr. Thota and team analyzed more than 1.7 million hospitalizations for patients admitted with a primary or secondary diagnosis of acute MI between 2016 and 2018. Among total patients, 1% had prediabetes, indicating a sample of 330,814 patients. “Prediabetes stood as an independent risk factor for MI, despite adjusting for all the wellestablished risk factors,” Dr. Thota explained. “Prediabetes is real. Don’t let the ‘pre’ fool anyone.” In addition, adjusted models showed that prediabetes was also associated with higher odds for undergoing percutaneous coronary intervention (OR 1.45, 95% CI 1.37-1.53) and coronary artery bypass grafting (OR 1.95, 95% CI 1.77-2.16). These findings suggest there is a high burden for macrovascular coronary artery disease correlated with prediabetes. “With our study, we would like to reinforce that it’s a wake-up call for the clinicians, as well as for patients.” Dr. Thota said. “[We need to] shift the focus to prevent prediabetes and not just diabetes.”

Hormone-Free Hot Flash Drug Offers Menopause Relief

Fezolinetant, a novel, nonhormonal treatment, was effective in subduing hot flashes linked with menopause, according to results from the phase III SKYLIGHT-2 trial. Genevieve NealPerry, MD, PhD, and colleagues conducted a study of 501 women with moderate-to-severe vasomotor symptoms (VMS). Compared with placebo, notable improvements in VMS frequency were observed through the first 12 weeks of treatment in both study doses: fezolinetant 30 mg, mean baseline-to-week 12 reduction -6.83 VMS/day; and fezolinetant 45 mg, mean baseline-to-week 12 reduction -7.50 VMS/day. During a 40-week extension phase, women in the placebo group who were re-randomized to either the 30 mg or 45 mg fezolinetant doses experienced the same drops in VMS frequency and severity as other treatment groups. Fezolinetant was also associated with an improvement in sleep disturbances, as reported by Patient-Reported Outcomes Measurement Information System Sleep Disturbance-Short Form 8b (PROMIS) Total Score. “From baseline to week 12, the 30 mg and 45 mg doses were tied to a 4.1-point and 5.5-point drop in PROMIS score, respectively,” the study authors wrote. “However, only the 45 mg dose was significantly better than placebo (3.4-point drop) at this time point. Through week 52, the 30 mg and 45 mg doses saw a 6.3-point and 5.7-point improvements in sleep score from baseline, respectively.” Fezolinetant was generally well-tolerated by patients, with headache as the most common adverse event.

No Major Thyroid Changes Following COVID-19 Vaccination

For people being treated for hypothyroidism, vaccination against COVID-19 proved safe, according to a population-based study. David Lui, MBBS, and colleagues conducted a populationbased study of 47,086 patients who continuously used levothyroxine for 3 or more months, among whom 11,353 received the inactive whole-virus CoronaVac vaccination, 12,310 received the BioNTech/Pfizer vaccination, and 23,423 were unvaccinated. Compared with unvaccinated individuals, those treated with levothyroxine did not see a significant risk for dose increases (HR 0.78, 95% CI 0.52-1.17) or reductions (HR 0.97, 95% CI 0.89-1.06) after receiving the mRNA vaccine.

In addition, people who received CoronaVac observed no significant increase (HR 0.74, 95% CI 0.48-1.06) or decrease (HR 0.97, 95% CI 0.90-1.04) in levothyroxine dose versus unvaccinated persons. Compared with unvaccinated individuals, no significant risk for ED visits or unscheduled hospitalizations following vaccination were observed. A sensitivity analysis was also performed and likewise found no differences when patients were stratified according to sex, age (≥65 vs <65), and pre-vaccination thyroid status. “Both inactivated and mRNA COVID-19 vaccination not associated with unstable thyroid status or an increased risk of adverse outcomes among patients treated for hypothyroidism,” Dr. Lui said during a press conference.

Diabetes Worsens Outcomes Only in Long-Term Metastatic Breast Cancer Survivors

For patients with metastatic breast cancer, diabetes negatively affected outcomes among long-term survivors only, explained Y.M. Melody Cheung, MBBS, and colleagues. Diabetes was not linked with any increase in mortality during 5-year follow-up (54% vs 56% without diabetes), according to results of a retrospective study of patients with metastatic breast cancer. “Time to next treatment for cancer was likewise similar, with 56% of both groups trying another treatment 1 year later,” Dr. Cheung said. “These data provide some reassurance that in the first 5 years, glycemic control may not be a major contributor to overall mortality or cancer progression in most individuals with metastatic breast cancer.” Compared with those with poor glycemic control (A1C >7%), subgroup analyses indicated that overall survival at year 5 also was not different between groups with good glycemic control (A1C ≤7%), with 69% of both groups surviving to year 5. Similarly, 58% and 53% of the good glycemic and poor glycemic control groups switched to another treatment by year 1, respectively. There was a trend toward worse survival with worse glucose control at year 5, however, when measured according to a random blood glucose (RBG) test. In patients with metastatic breast cancer who survived for more than 8 years, diabetes was notably linked with worse survival. A total of 67% of those with diabetes survived versus 87% of patients free of diabetes at the 10-year mark. It was likewise observed that 83% of patients with good glycemic control (RBG ≤180 mg/dL) achieved 10-year survival versus 63% of patients with poor glycemic control (RBG >180 mg/dL)

No Early Cardiovascular Risks With Testosterone Treatment

For patients with hypogonadism, testosterone treatment did not increase short- or medium-term risks for cardiovascular events, according to Channa Jayasena, PhD, and colleagues. In a systematic review and meta-analysis, the study team found that cardiovascular risks were similar between men in the testosterone group and those in the placebo group (7.5% vs 7.2%: OR 1.07, 95% CI, 0.81- 1.42). “The mortality rate among those on testosterone treatment was 0.4 percentage points lower the control group, but this difference was not statistically significant,” the study authors wrote. Factors not associated with risk for cardiovascular disease included patient age, smoking status, diabetes status, and baseline testosterone. Those in the testosterone treatment group experienced decreased HDL cholesterol compared with those in the placebo group (mean difference -0.06 nmol/L, 95% CI, -0.08 to -0.04). In the testosterone group versus the placebo group, both serum total cholesterol and triglycerides were also considerably lower (total cholesterol: mean difference-0.15 mmol/L, 95% CI, -0.20 to -0.10; triglycerides: mean difference -0.09 nmol/L, 95% CI, -0.18 to -0.00). The most common cardiovascular events in the testosterone and placebo groups included myocardial infarction (6.0% vs 9.1), coronary heart disease (19.9% vs 18.8%), arrhythmia (31.3% vs 26.7%), and heart failure (13.3% vs 15.9%).