BACKGROUND: A persistent mortality gap exists between males and females in the United States. We describe temporal, age-specific, cause-specific trends in mortality with respect to sex differences. METHODS: Data from ind...BACKGROUND: A persistent mortality gap exists between males and females in the United States. We describe temporal, age-specific, cause-specific trends in mortality with respect to sex differences. METHODS: Data from individuals with national death certificate data from 2000 to 2023 available in CDC WONDER were collected. We estimated sex-specific age-adjusted mortality rates (AAMR) and years of potential life lost (YPLL) by 5-year age groups, year, and cause of death. Excess mortality was defined as the difference between male and female AAMR and YPLL for each subgroup. RESULTS: Males exhibited higher AAMR than females from 2000 to 2023. Despite excess male AAMR decreasing from 291 per 100,000 in 2000 to 216 in 2014, excess YPLL remained stable. After approximately 2014, excess YPLL mirrored excess AAMR trends and increased markedly, reaching 8.1 million years in 2023-a burden concentrated in younger and middle-aged men. External causes of death were the largest contributors to excess YPLL in men aged 25-44, while circulatory diseases dominated among men over 55. CONCLUSIONS: Excess male mortality is persistently elevated in cardiovascular causes and increasingly concentrated in external causes in young and middle-aged males. Prevention and care strategies targeted to these drivers may reduce the gap. Results may be influenced by death certificate misclassification, competing risks of death changing over time, and differences in race/ethnicity subgroups.
BACKGROUND: Residual perfusion defects are frequently observed on follow-up ventilation-perfusion (V/Q) scans after acute pulmonary embolism, yet their prognostic relevance remains uncertain. We assessed the prevalence,...BACKGROUND: Residual perfusion defects are frequently observed on follow-up ventilation-perfusion (V/Q) scans after acute pulmonary embolism, yet their prognostic relevance remains uncertain. We assessed the prevalence, predictors, and clinical implications of residual perfusion defects after acute pulmonary embolism. METHODS: We conducted a retrospective cohort study of consecutive patients hospitalized with confirmed acute pulmonary embolism (2012-2024) who underwent baseline and follow-up V/Q scintigraphy. Patients were categorized by perfusion recovery or persistent residual perfusion defects. Clinical, laboratory, imaging, and outcome data were compared. Multivariable logistic regression identified independent predictors of residual perfusion defects. RESULTS: Among 325 patients (median age 62 years; 47% male), residual perfusion defects persisted in 235 (72%) at a mean follow-up of 3 months. Residual perfusion defects were associated with older age, bilateral and higher-risk pulmonary embolism, and deep vein thrombosis. Patients with residual perfusion defects had higher inflammatory and thrombotic biomarkers and more pronounced right ventricular dysfunction with elevated pulmonary pressures. Independent predictors included prior venous thromboembolism (OR 7.61), intermediate-high/high-risk pulmonary embolism (OR 3.66), older age, and elevated C-reactive protein, whereas major provoking factors were protective. Dyspnea and mortality did not differ between groups. Notably, chronic thromboembolic pulmonary disease or pulmonary hypertension occurred exclusively in patients with residual perfusion defects. CONCLUSIONS: Residual perfusion defects are common after acute pulmonary embolism and mark a more severe initial disease phenotype. While not associated with early clinical outcomes, their presence identifies patients at risk for chronic thromboembolic complications, supporting a targeted follow-up imaging strategy.
BACKGROUND: Declining in smoking prevalence may not correlate with reduced economic burden. This study aimed to estimate Hong Kong's economic burden of smoking using actual territory-wide public healthcare expenditure da...BACKGROUND: Declining in smoking prevalence may not correlate with reduced economic burden. This study aimed to estimate Hong Kong's economic burden of smoking using actual territory-wide public healthcare expenditure data. METHODS: This retrospective cohort study included adult public healthcare service users in the Hong Kong Hospital Authority healthcare system, with recorded smoking status between 1 January 2008 and 31 December 2012, and follow-up until 31 December 2022. Participants were classified into never-smokers, ex-smokers or current smokers. Outcomes were costs associated with general and specialist outpatient clinics (GOPC, SOPC), accident and emergency services (A&E), and hospitalization. A generalized linear model with log link function and fine stratification weighting evaluated differences in annual average costs per person for each healthcare service. RESULTS: Among the 1,571,065 individuals analyzed, 14.3% were current smokers, 11.9% ex-smokers, and 73.8% never-smokers. Smoking was associated with significantly higher annual average costs per person for SOPC, A&E, and hospitalization. Current smokers, compared to never-smokers, had a relative risk of 1.19 for SOPC, 1.40 for A&E, and 1.57 for hospitalization. Sex-specific analyses showed higher cost multipliers for women than men for SOPC, A&E and hospitalization. Additional annual cost of overall public healthcare services associated with smoking was projected at USD725.66 and USD336.30 million for current smokers and ex-smokers, respectively, accounting for 0.27% of Hong Kong's GDP and 7.46% of total healthcare expenditures in 2023. CONCLUSIONS: Smoking imposes substantial economic burdens in Hong Kong despite its low smoking prevalence. Accurate estimation of this burden is critical for advancing tobacco control measures.
Each year, over 600,000 ischemic strokes occur in the US, one-fourth of which are recurrent. Although preventive strategies have advanced, recurrent events remain common, highlighting the need for antithrombotic regimens...Each year, over 600,000 ischemic strokes occur in the US, one-fourth of which are recurrent. Although preventive strategies have advanced, recurrent events remain common, highlighting the need for antithrombotic regimens that minimize ischemic and bleeding risks. In patients with minor ischemic stroke or high-risk Transient Ischemic Attack (TIA), early dual antiplatelet therapy (DAPT) followed by monotherapy significantly reduces early ischemic stroke recurrence, with greatest benefit within first 21 days (5.2% versus 7.8%; HR, 0.66; 95% CI, 0.56-0.77). Beyond this window, ischemic benefit diminishes and bleeding risk increases (0.3% versus 0.2%; HR, 1.28; 95% CI, 0.58-2.81). For cardioembolic stroke, particularly with atrial fibrillation, direct oral anticoagulants (DOACs) are favored over vitamin K antagonists, offering superior efficacy and safety (5.2% versus 5.9%; odds ratio [OR] 0.85; 95% CI, 0.74-0.99) and major bleeding (5.36% versus 6.16%; OR, 0.86; 95% CI, 0.78-0.99). However, antithrombotic optimization remains challenging-especially in adherence, risk stratification, and patient selection. Emerging strategies, including low-dose anticoagulant-antiplatelet combinations and Factor XIa inhibitors, aim to preserve antithrombotic benefit while reducing bleeding.
Migraine is a prevalent and disabling neurological condition that benefits from multimodal care. While a growing number of migraine therapies have become available, migraine remains the leading cause of disability among...Migraine is a prevalent and disabling neurological condition that benefits from multimodal care. While a growing number of migraine therapies have become available, migraine remains the leading cause of disability among adults under the age of 50 years. The unmet burden of migraine is likely due to several elements such as stress, sleep, diet, and activity. Additionally, comorbidities involving the gastrointestinal, cardiovascular, and immunological systems can often worsen migraine disability. An integrative medicine approach has potential to synergistically address these elements while providing whole person migraine care. In Part 1 of this article, we provided an overview of migraine and updates on pharmacological and procedural care. This section, Part 2, reviews evidence-based behavioral, complementary, and neuromodulation approaches for migraine within an integrative healthcare model. Emerging therapies, including digital interventions and gut-brain axis modulation, highlight evolving directions in care. An integrative, patient-centered approach that combines these modalities within coordinated healthcare systems may improve outcomes, enhance quality of life, and reduce long-term burden for individuals with migraine.
BACKGROUND: Eosinophils are involved in inflammatory and thrombotic processes relevant to cardiovascular disease, but long-term implications of persistent eosinophil deficiency remain unclear. METHODS: We conducted a ret...BACKGROUND: Eosinophils are involved in inflammatory and thrombotic processes relevant to cardiovascular disease, but long-term implications of persistent eosinophil deficiency remain unclear. METHODS: We conducted a retrospective matched cohort study using a nationwide electronic health record database. Adults with chronic idiopathic eosinopenia (≥3 consecutive eosinophil counts ≤ 0.05 × 10⁹/L within 2 years) were matched 1:2 to individuals with persistently normal eosinophil counts. Cox models evaluated incident cardiovascular outcomes. RESULTS: The cohort included 11,754 individuals with chronic eosinopenia and 23,508 matched controls (mean age 41.0 ± 16.2 years; 77.7% female). Over a mean follow-up of 14.8 ± 3.8 years, eosinopenia was associated with lower incidence of ischemic heart disease, myocardial infarction, coronary revascularization, cerebrovascular events, and peripheral vascular disease, but a higher incidence of pericarditis. CONCLUSIONS: Chronic idiopathic eosinopenia was associated with a lower long-term risk of several atherosclerotic cardiovascular outcomes. Although causality cannot be inferred, findings suggest a role for eosinophil-related pathways in cardiovascular disease and provide reassurance regarding the cardiovascular safety of therapies that reduce eosinophil levels.
BACKGROUND: Sodium glucose co-transporter-2 inhibitors (SGLT2i) impact on cardiovascular and renal events are well-documented; however, the effects on all-cause and cause-specific mortality have remained inconsistent acr...BACKGROUND: Sodium glucose co-transporter-2 inhibitors (SGLT2i) impact on cardiovascular and renal events are well-documented; however, the effects on all-cause and cause-specific mortality have remained inconsistent across available trials. We aim to evaluate the relationship between SGLT2i and all-cause, and cause specific mortality in patients with diabetes mellitus, heart failure, or chronic kidney disease. METHODS: A systematic literature search on electronic databases for relevant randomized controlled trials (RCTs) from inception until September 10, 2025 was performed. Risk ratios (RRs) with corresponding 95% confidence intervals (CIs) were calculated using a random-effects model. RESULTS: A total of 18 RCTs including 95,913 patients were analyzed. SGLT2 inhibitors did not significantly reduce overall all-cause mortality compared with control (RR: 0.92 [95% CI, 0.80-1.05]), although a significant reduction was observed in older (>65 years) adults (RR: 0.93 [95% CI, 0.87-0.98]). Non-cardiovascular mortality was neutral overall (RR: 0.94 [95% CI, 0.86-1.02]) but was reduced in younger (<65 years) participants (RR: 0.87 [95% CI, 0.78-0.96]). SGLT2i use was associated with significant reductions in cardiovascular mortality (RR: 0.86 [95% CI, 0.81-0.92]) and renal mortality (RR: 0.31 [95% CI, 0.11-0.90]), with consistent effects across age and follow-up subgroups for cardiovascular mortality. CONCLUSION: SGLT2i significantly reduce cardiovascular and renal mortality across patients with diabetes mellitus, heart failure, and chronic kidney disease, cementing their role as cornerstone cardiorenal therapy. Notably, subgroup analyses further suggest potential all-cause mortality benefit in older adults and non-cardiovascular mortality benefit in younger patients. These findings, though exploratory, carry meaningful implications for personalizing SGLT2i therapy across the lifespan.
Cervical disc herniation is a common cause of neck pain and neurologic symptoms with presentations ranging from asymptomatic to debilitating radiculopathy or myelopathy. Symptoms may arise when a vertebral disc herniates...Cervical disc herniation is a common cause of neck pain and neurologic symptoms with presentations ranging from asymptomatic to debilitating radiculopathy or myelopathy. Symptoms may arise when a vertebral disc herniates, causing inflammation and compression of the nerve root or spinal cord. Risk factors are multifactorial and including age, genetics, cardiometabolic and behavioral factors, occupational biomechanics, and trauma. Accurate diagnosis requires patient history, neurological findings, provocative maneuvers, and imaging. The majority of cases improve with nonsurgical care including medication, physical therapy, and activity modification. Surgical evaluation is indicated for cases involving myelopathy, progressive neurologic deficits, or chronic/treatment-refractory symptoms.
BACKGROUND: Lymphedema is a prevalent yet underserved condition. Expanding diagnostic and therapeutic options have increased interest in multidisciplinary care. This study examines clinical characteristics and geographic...BACKGROUND: Lymphedema is a prevalent yet underserved condition. Expanding diagnostic and therapeutic options have increased interest in multidisciplinary care. This study examines clinical characteristics and geographic patterns of lymphedema care within a multidisciplinary lymphatic center. METHODS: A retrospective review included all patients evaluated for edema at the BIDMC Lymphatic Center between January 2018 and December 2023. The multidisciplinary team was comprised of cardiovascular medicine, radiology, plastic surgery, and physical therapy. A RedCap registry captured demographics, clinical characteristics, imaging and surgeries. Patients were stratified by edema etiology as primary or secondary lymphedema, or non-lymphatic edema. Bivariate and geospatial analyses assessed differences across groups and geographic access to care. RESULTS: Of the total 2,031 participants, 76% were female, with a mean age of 60 years (±15.2) and BMI of 33.6 kg/m (±10.7). The average duration of edema symptoms at evaluation was 9.47 years (±11.8). Secondary lymphedema was the most common etiology (n=1,104, 54%) andoften due to cancer (54%) or chronic venous disease (23%). Lymphatic imaging was performed in 549 patients (27%). Of those 549, lymphoscintigraphy (83%) and MRI (69%) were most common. Only 149 patients (11%) underwent surgery. Residing out-of-state was associated with longer symptom duration at initial evaluation (12.3 vs 9.1 years, P < 0.0001) and higher surgical rates (16.6% vs 6%, P < 0.001) compared to residing in-state. CONCLUSIONS: In this large, single-center description, over one-third of patients did not have lymphedema. Lymphatic imaging was frequently performed, though few underwent surgery. Geographic barriers delayed evaluation and increased surgical intervention, emphasizing the need for broader access to multidisciplinary lymphatic care.
OBJECTIVES: Antiphospholipid antibodies (aPL) are markers of increased morbidity and mortality in patients with antiphospholipid syndrome. However, the prognostic significance of aPL positivity in hospitalized patients w...OBJECTIVES: Antiphospholipid antibodies (aPL) are markers of increased morbidity and mortality in patients with antiphospholipid syndrome. However, the prognostic significance of aPL positivity in hospitalized patients without antiphospholipid syndrome remains unclear. This real-world study evaluated the independent clinical implications of aPL positivity in a large hospitalized population. METHODS: We conducted a retrospective cohort study of 4,801 hospitalized patients who underwent aPL testing at Sheba Medical Center between 2006 and 2018, after excluding patients with antiphospholipid syndrome or systemic lupus erythematosus. The patients were classified as either aPL-positive or aPL-negative. Primary outcomes were all-cause mortality over 10 years and all-cause readmission within one year of discharge. Associations between individual aPL isotypes, titers, and outcomes were also examined. RESULTS: During follow-up, aPL-positive patients experienced significantly higher long-term mortality (HR = 1.40) and one-year readmission rates (HR = 1.25) compared with aPL-negative patients. These findings remained robust after multivariable adjustment. Mortality was specifically associated with the presence of lupus anticoagulant (HR = 1.82), anti-cardiolipin IgG antibodies (HR = 1.66), and low-titer IgM antibodies against β2-glycoprotein I (HR = 1.36) and cardiolipin (HR = 1.49). CONCLUSIONS: In this large real-world cohort, antiphospholipid antibody positivity during hospitalization was independently associated with increased mortality and readmission. Lupus anticoagulant and anticardiolipin IgG showed the strongest associations with adverse outcomes, while low-titer IgM antiphospholipid antibodies were also associated with increased mortality. These findings indicate that antiphospholipid antibody positivity identifies a high-risk subgroup among hospitalized patients.
BACKGROUND: This study was conducted to examine whether a "weekend effect" exists in internal medicine departments of a large tertiary medical center in Israel. METHODS: We conducted a retrospective cohort study of patie...BACKGROUND: This study was conducted to examine whether a "weekend effect" exists in internal medicine departments of a large tertiary medical center in Israel. METHODS: We conducted a retrospective cohort study of patients > 18 admitted to internal medicine wards at Tel Aviv Sourasky Medical center from 2015 to 2023. Admissions were classified as weekday (Sunday-Thursday) or weekend (Friday-Saturday) based on admission day. The primary outcome was in-hospital mortality. Multivariable logistic regression models were used to adjust for age, sex, and comorbidity burden. Subgroup analyses were performed by diagnostic category. RESULTS: A total of 155,713 admissions were examined, out of which 35,512 (22.8%) occurred on weekends and 120,201 (77.2%) on weekdays. Weekend admissions were associated with a small increase in unadjusted risk of mortality (8.5% versus 8%, P = 0.003). However, after adjustment for covariates the association diminished and did not reach statistical significance (aOR 1.03 CI 0.99-1.08, P = .1). The only diagnosis group with higher weekend-associated mortality was the hematologic/oncologic group (aOR 1.42, 95% CI 1.07-1.82; P = .005), driven predominantly by patients presenting with severe thrombocytopenia. CONCLUSIONS: In a well-resourced tertiary-care setting in Israel, weekend admission to internal medicine wards was not independently associated with short-term mortality. However, diagnostic subgroup analyses suggest certain patient populations may remain at increased risk during weekend admissions.