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We know that reducing LDL cholesterol, often by using a statin, helps reduce someone’s heart disease risk. Now that so-called ‘remnant cholesterol’ is being added to the calculations, what can be done about it? Johns Hopkins cardiologist Seth Martin says, not much at this point.

Martin: When we think about what we can do in preventive cardiology to help people, prevent heart attacks, prevent strokes, prevent mortality, so much of our evidence is around LDL cholesterol. When it comes to remnant cholesterol or triglycerides it’s still an area that we don’t have as much evidence around what we can do to help. With LDL cholesterol we have in addition to diet and exercise have statins, we’ve had a number of therapies  come out that show a benefit. We don’t have that same level of evidence for remnant cholesterol so it’s an emerging risk factor, but then the next question is well what can we do about that risk?  :34

Martin says it may still be helpful to know the numbers, however. At Johns Hopkins, I’m Elizabeth Tracey.

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You’ve probably already heard about total cholesterol and its cousins HDL and LDL, especially if you see a cardiologist. Now a new term called remnant cholesterol is entering the conversation, with a recent study concluding that it can increase accuracy in predicting heart disease risk. Seth Martin, a cardiologist at Johns Hopkins, explains.

Martin: This term ‘remnant cholesterol,’ has been used to basically capture the risk associated with triglyceride rich remnant lipoprotein. Another circulating substance that’s bad is triglycerides or blood fats. One way to capture the risk associated with them is remnant cholesterol. So this is very closely tied to triglyceride levels, but this is a new way of looking at things. The idea here is to take non-HDL and then subtract LDL cholesterol    :31

Martin says some people may already be seeing remnant cholesterol in their lab results. At Johns Hopkins, I’m Elizabeth Tracey.

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People who were obese who had bariatric surgery developed about half the number of cancers ten years later than did obese people who didn’t have the surgery, a recent study found. Kimmel Cancer Center director William Nelson at Johns Hopkins says questions remain.

Nelson: It hints that perhaps weight control might affect the propensity to develop cancer. If you cared enough about your weight to undergo an operation, one argument is that you care enough about the rest of your health to not smoke, to pursue appropriate aged cancer screening, to get blood pressure controlled, to make sure your blood sugar was better controlled, and all of those things could explain the reduced cancer risk. With that caveat it’s interesting, it’s not proven.  :28

Nelson says it is known that bariatric surgery improves diabetes and cardiovascular disease risk and that there is an association between obesity and some types of cancer, but further research is needed to establish a link with surgery and reduced cancer risk. At Johns Hopkins, I’m Elizabeth Tracey.

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Obesity is known to increase cancer risk, so if someone who is very overweight has bariatric surgery, does their risk for cancer decline? Kimmel Cancer Center director William Nelson at Johns Hopkins describes a new study that examines this question.

Nelson: They looked at folks who had undergone bariatric surgery and they matched them up to five fold the number of people who were also obese who didn’t have the surgery. They then went and looked at how many people got cancers that could reasonably be ascribed to obesity as a causative risk factor. Thirteen kinds of cancer. By ten years after the surgery 2.9% of the folks had developed cancer, after surgery as compared to 4.8% if you didn’t have the surgery.   :30

Nelson notes that deaths from cancer among people who were obese followed a similar pattern, with those who had had bariatric surgery experiencing fewer cancer deaths. He says these results must be confirmed however before bariatric surgery can be recommended for this purpose. At Johns Hopkins, I’m Elizabeth Tracey.

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Surgery is sometimes the only treatment needed for colorectal cancer, while at other times additional chemotherapy is also required. Now a new study shows that a blood test looking for cancer DNA can help identify the one in five people who may need chemo. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, explains.

Nelson: If you’re giving everyone that treatment only to go after 20% it’s going to be a hard numbers game. So what these folks tried to do is to use a blood test for DNA from the colorectal cancer that’s swimming around in the bloodstream. They did a randomized trial, more than 450 patients, either to get the additional chemotherapy, so called adjuvant chemotherapy based on the preference of the physician, 28% of them got that treatment. Versus, use this test if the colorectal cancer circulating DNA was gone, then they opted not to give the treatment.  :34

Nelson says outcomes were good for the folks who got the blood test. At Johns Hopkins, I’m Elizabeth Tracey.

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A genetic form of colorectal cancer responds to treatment with a type of cancer drug known as an immune checkpoint inhibitor extremely well, a new study reveals. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, reviews the study.

Nelson: Since the inherited defect they had often presents an opportunity to use one of these immune checkpoint inhibitors and the one they used was called dostarlimab, so they got this drug as their only treatment before surgery. They wanted to see how well it worked and they wanted to go back in and rebiopsy and see if it wasn’t working why not. Much to their surprise it didn’t work very well, it worked incredibly well. All twelve of the people they treated so far, and the trial is ongoing, they’re accruing more people to it, had basically all the cancer disappear.  :31

Nelson notes that follow up so far is only several months, so additional time must pass to see how durable this stellar result remains. At Johns Hopkins, I’m Elizabeth Tracey.

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Chemical groups called methyl groups can be removed from DNA by certain drugs used to treat cancer, but now a new study raises the possibility that in some people, such treatments unleash genes known to worsen cancer. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, explains.

Nelson: Some of the overmethylation is the way cancers stop genes that would otherwise be like the brakes on a car, so the cancer can just keep growing and growing. There are some drugs that interfere with the placing of these marks, so you reduce the number of methylation marks, hopefully unleashing the brake genes and you slow down cancer growth. This paper reports on two cohorts of patients who are treated with these kinds of drugs, and 30-40% of them it looks like there’s a gene that gets turned on at a higher level that might be generally dangerous.  :32

Nelson says careful genetic monitoring while treatment is underway may be the best strategy for detecting such an outcome. At Johns Hopkins, I’m Elizabeth Tracey.