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Anchor lead: Is inflammation the culprit when it comes to heart attacks? Elizabeth Tracey reports

Reducing inflammation after someone has a heart attack may reduce their risk for having a second, with a new drug for a particular target possibly helpful in doing so, an industry-sponsored study concludes. Michael Blaha, a preventive cardiologist at Johns Hopkins, says science supports the strategy.

Blaha: The science is really pushing the idea now that atherosclerosis is an inflammatory condition, and those of us that have atherosclerosis are chronically inflamed. But if you can disrupt the inflammatory cascade you might be able to disrupt the propagation of atherosclerosis. That’s what these drugs are trying to do. So we give statins after a heart attack which both lower cholesterol and inflammation. But some patients still have very high levels of inflammation despite the statin after the heart attack. And these are the patients that this clinical trial targeted.  :31

Blaha says as with all health conditions, prevention is really the best strategy, with ways to reduce risk well-known. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can reducing inflammation help heart attack survivors? Elizabeth Tracey reports

Reducing inflammation after someone has a heart attack has been attempted for some time using various medications. Now a new one targeting another pathway may prove helpful, according to industry reported results from a trial known as CANTOS. Michael Blaha, a preventive cardiologist at Johns Hopkins, comments.

Blaha: I’m really excited about the CANTOS study, which for the first time has shown that an anti-inflammatory drug, given after a heart attack, may reduce the risk of future heart attacks. And this is a big win for biology because it shows that modulating the inflammatory cascade actually has effects on atherosclerosis and heart disease and not just things like rheumatoid arthritis or other inflammatory conditions.  :28

Blaha says further results from the trial should provide a clearer picture of the benefits of this approach, and at least will likely identify another target for reducing someone’s risk of a second heart attack. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Do e-cigarettes lead to attempts to quit cigarettes altogether? Elizabeth Tracey reports

Smoking cessation rates in the US have increased, federal data reported recently show, with some attributing the switch to e-cigarettes as a major contributing factor. Yet many questions about the purported benefits of e-cigarettes remain. That’s according to Enid Neptune, a lung expert at Johns Hopkins.

Neptune: We’ll see a lot of correlation that can show that e-cigs are good or that e-cigs are bad. But what we want to know about are behaviors, we want to know about doses, we want to know about dual use, durable cessation versus short term cessation, how long people continue to use e-cigarettes after they’ve stopped or after they’ve reduced their conventional cigarette use. And we want to know the partitioning across different age groups.  :29

Neptune says so-called ‘harm reduction’ is not a persuasive argument for using any tobacco product on a regular basis. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Should lawmakers be persuaded by so-called reduced risk tobacco products? Elizabeth Tracey reports

Are smokeless tobacco products okay to use? The FDA is grappling with this issue as tobacco product manufacturers ask for a designation called ‘modified risk’ from the agency. Enid Neptune, a lung expert at Johns Hopkins, frames up the arguments manufacturers are using.

Neptune: It’s already known and established, smokeless tobacco less toxic, less harmful than conventional cigarettes, combustible cigarettes and cigars. No one would debate that fact, but they use it in a way that I think is problematic because they use that comparison to support the use of these products, as, and they never quite say it, but what they want to say is these products are safe. And that’s a term that cannot be assigned to these products because they’re less toxic than conventional cigarettes and cigars.   :33

Neptune notes that health risks of smokeless tobacco products are emerging, and that use of any tobacco products at all should not be promoted. At Johns Hopkins, I’m Elizabeth Tracey.

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iStock_000014270773_MediumThis week’s topics include antibody depletion for kidney transplantation, a way to reverse dabigatran, the costs of board certification, and opioid use in the US population.

Program notes:

0:43 Fees for medical specialty board
1:45 Over $3000
2:46 Kidney transplantation and reducing antibodies
3:45 Enzyme to deplete
4:50 Enzyme cleaves all four classes of IgG
5:28 Reversing dabigatran
6:29 People on dabigatran who were bleeding or needed surgery
7:30 How many people take prescription opioids?
8:30 Should this be a national emergency?
9:30 Must address on a national level
10:35 End

Related blog: https://podblog.blogs.hopkinsmedicine.org/2017/08/04/improving-kidney-transplants/

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Anchor lead: What is the best strategy for managing men with low risk prostate cancer? Elizabeth Tracey reports

The majority of men with low risk prostate cancer really do not benefit from having their prostate gland removed, but may suffer harms such as sexual dysfunction and urinary incontinence as a result. That’s according to a recent study with 19 years of follow up. Ballantine Carter, a prostate cancer expert at Johns Hopkins, says men should be offered active surveillance.

Carter: Surveillance required careful monitoring, usually prostate biopsies are done every two to five years. When we started our program here we were doing biopsies annually because we really didn’t understand the natural history of prostate cancer. Now we know a lot more about it and biopsies don’t need to be done as often and the follow up often involves PSAs, usually every three to six months, and a rectal exam at least annually. So it’s not a real intensive monitoring but people do need to be monitoring carefully.  :32

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What can 20 years of follow up tell us about low risk prostate cancer? Elizabeth Tracey reports

Men who have low risk prostate cancer really don’t need to have their prostate gland removed, a study with almost 20 years of follow up published in the New England Journal of Medicine has shown. Ballantine Carter, a prostate cancer expert at Johns Hopkins, describes the findings.

Carter: Overall the study demonstrates very clearly what we already know, that men who don’t have aggressive cancer should be monitored, with what today we refer to as active surveillance. It also demonstrates that there are some men who can benefit from surgery. And those are men with more aggressive disease. So I think the take home message from this trial is if you get diagnosed with what we refer to as a low grade or low risk prostate cancer, then the first thing you should be asking is do I need to be treated?   :30

Carter says the study also confirmed the risks of prostate removal, including sexual dysfunction and urinary incontinence. At Johns Hopkins, I’m Elizabeth Tracey.

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