In the News
Aspirin use best for those with high coronary calcium
An X-ray test commonly used to assess hardening of the arteries could help doctors decide whether the benefits of taking aspirin to prevent a first heart attack or stroke outweigh the risks of bleeding from its use, UT Southwestern research suggests. The findings, published online today in JAMA Cardiology, could give doctors and patients more concrete guidelines for making this important decision.
Due to its anti-clotting properties, aspirin is widely prescribed as a preventive measure to patients who have already had cardiovascular events, such as a heart attack or ischemic stroke. However, aspirin’s role in primary prevention – averting first heart attacks and strokes – has been unclear, explains study leader Amit Khera, M.D., professor of internal medicine and director of the Preventive Cardiology Program at UTSW.
Home-time metric needed to judge hospital readmissions
Two new studies suggest Medicare’s system of penalizing hospitals if too many patients are readmitted within 30 days should also look at whether the patients were well enough to remain in their home during that time. “The current readmission penalty has been a matter of debate,” says Ambarish Pandey, M.D., first author of the study published today in JAMA Cardiology, as well as of an earlier study published in Circulation in July.
Physicians face barriers to voting
Two new UT Southwestern studies published this week report some surprising findings: Only half of practicing physicians are registered to vote, and the most common obstacle faced by resident physicians is the lack of time to vote. The researchers say finding ways to increase voter participation among doctors is critical as the nation tackles health care issues. “There’s always been a minority of physicians involved as advocates or elected officials. Now, more people are becoming interested in getting involved in health policy. Voting is a fundamental way of being engaged,” says Arthur Hong, M.D., assistant professor of population and data sciences in the department of internal medicine and an author of both studies. “Doctors who were already registered actually voted more often than the general population.”
Revised clinical trial rules during COVID-19
The COVID-19 pandemic has led to new rules and expectations for cancer clinical trials. Following guidance from federal agencies, institutions such as UT Southwestern’s Harold C. Simmons Comprehensive Cancer Center led efforts to adapt clinical trial operations. To protect patient safety, changes such as utilizing remote consents, conducting telehealth study visits, and shipping oral study treatment to patients’ homes have streamlined the cancer clinical trial participation process.
“With COVID-19, we’ve seen more changes to clinical trial practices than at any other time in my career,” says David Gerber, M.D., a professor of internal medicine at UTSW, associate director of clinical research in the Simmons Cancer Center, and first author of an article on the survey results that were published online this month in the Journal of the National Comprehensive Cancer Network. “My hope is that this whole ordeal leads to long-term simplification of the clinical research process.”
Why the dose matters
When used to manage infections, the drug itraconazole is generally given at a single, fixed dose to all patients. But determining the correct dosage of the drug to help treat cancer isn’t that simple, new research by UT Southwestern suggests.
“What this means going forward is that, in future studies of itraconazole for the treatment of cancer, it may be important to check each patient’s drug level and tailor the dose,” says David Gerber, M.D., a professor of internal medicine and population and data sciences at UTSW and first author of the new paper, published online in the journal Clinical Cancer Research. “In this context, there’s no one-size-fits-all dose,” notes Gerber, also Associate Director of Clinical Research in the Harold C. Simmons Comprehensive Cancer Center.
Obesity could increase vulnerability to COVID-19
Conditions related to obesity, including inflammation and leaky gut, leave the lungs of obese patients more susceptible to COVID-19 and may explain why they are more likely to die from the disease, UTSW scientists say in a new article published online in eLife. They suggest that drugs used to lower inflammation in the lungs could prove beneficial to obese patients with the disease.
Several pre-existing conditions have been shown to increase the risk of COVID-19 severity, including obesity and Type 2 diabetes – two conditions that often go hand-in-hand, says Philipp Scherer, Ph.D., director of the Touchstone Center for Diabetes Research and a professor of internal medicine and cell biology at UT Southwestern.
Scherer and his colleagues, including Manasi Shah, M.D., an endocrinology fellow at UTSW, and Ilja L. Kruglikov, Ph.D., Dr.Sci., a researcher at Wellcomet GmbH in Karlsruhe, Germany, explore this phenomenon in the new opinion piece.
Generic cholesterol drugs save Medicare billions of dollars
The switch from brand name to generic cholesterol medications that occurred between 2014 and 2018 has saved Medicare billions of dollars, even as the number of people on cholesterol-lowering drugs has increased, UT Southwestern scientists have calculated. Their data, published in the journal JAMA Cardiology, suggest that policymakers and clinicians could help cut Medicare costs even further by switching more patients to generic drugs.
“One of the most important contributors to our health care costs is expenditure on prescription drugs,” says Ambarish Pandey, M.D., a cardiologist and assistant professor of internal medicine at UTSW. “The switch to generics is an effective strategy to cut the costs incurred by health systems.”
Best practices detailed for mail-in colon cancer screenings
A program that asks patients to mail in stool samples to screen for colon cancer is an effective way to expand screenings to underserved and underinsured communities and offers an alternative to in-person testing during the pandemic, according to a study conducted by UT Southwestern.
In an article published recently in CA: A Cancer Journal for Clinicians, UT Southwestern physicians identified nine best practices for effective mail-in screening campaigns, which can take the place of invasive, unpopular colonoscopies.
“This project is succeeding in making cancer screenings less invasive and more widely available. Serendipitously, it now has the added benefit of being yet another way to keep people out of hospitals and clinics during pandemic shutdowns,” says Amit Singal, M.D., an author of the study, professor of internal medicine and population and data sciences, medical director of the Liver Tumor Program, and clinical chief of hepatology at UT Southwestern.
Roger H. Unger, M.D., 1924-2020
Roger H. Unger, M.D., a longtime Professor of Internal Medicine, a preeminent authority on glucagon and the development of diabetes, and the founding Director of the Touchstone Center for Diabetes Research at UT Southwestern Medical Center, died Aug. 22. He was 96.
Over a 64-year career at UT Southwestern, Unger elucidated the role of glucagon and insulin in regulating blood glucose in both normal and diabetic individuals. His leadership helped to establish UT Southwestern as a leading clinical and research center for the accurate diagnosis and effective treatment of conditions related to the endocrine system.
“Dr. Unger was a visionary endocrinologist who helped shape research and clinical practice in the field for more than 60 years,” says Daniel K. Podolsky, M.D., President of UT Southwestern. “His outstanding contributions in endocrinology and metabolism set the foundation for many of the important discoveries in these areas. He was at the forefront of identifying the essential role of glucagon in the pathogenesis of diabetes, and he introduced the concept of lipotoxicity, the process by which an overaccumulation of fat products causes tissue damage responsible for Type 2 diabetes and metabolic syndrome.”
Arterial plaque is better at predicting heart attack than stroke
The amount of calcified plaque in the heart’s arteries is a better predictor of future heart attacks than of strokes, with similar findings across sex and racial groups, according to new research from UT Southwestern.
The study, published today in Circulation: Cardiovascular Imaging, is the first to examine the predictive value of recently recommended coronary artery calcium (CAC) score categories for heart attacks and strokes. Using two population-based, multiethnic cohorts, the researchers evaluated how well the amount of calcium detected by a CT scan of the heart predicted whether white, Black, and Hispanic men and women would have a stroke or a heart attack in the next 10 years.
“In our study, there was a twofold greater risk of heart attack than stroke at CAC levels at or above 100,” a score indicating moderate to high levels of calcified plaque, says Parag Joshi, M.D., a cardiologist and assistant professor of internal medicine at UT Southwestern and senior author of the study. “That held true for Black, white, and Hispanic men and women.”