From Health Risks To Diet Myths, 6 Things You Didn’t Know About Blood Type


Blood

For something so intrinsically a part of us, it seems there’s plenty we’re in the dark about when it comes to our blood type. Indeed, according to various surveys, anywhere from 35 to 50 percent of people in the Western world just plain don’t know what their type even is.

That’s why we here at Medical Daily have decided to pull back the curtain and lay down some interesting factoids about blood types and their continuing, if sometimes overexaggerated, importance to our lasting health. Click on the slideshow above to check them out.

view the slideshow:http://www.medicaldaily.com/blood-type-misconceptions-health-risks-food-myths-387071

ICU Opioid Admissions, Deaths Rising


In-hospital opioid overdose deaths among intensive care patients in the United States have increased by a rate of 0.5% each month since 2009, and ICUs across the country are feeling the strain of dealing with a rising number of heroin and prescription opioid overdose patients, researchers reported here.

A review of billing codes data involving 4.9 million ICU admissions at more than 200 hospitals in 44 states showed a 46% increase in ICU admissions for opioid overdoses during the 6-year period between 2009 and 2015, and an 86% increase in opioid deaths.

The finding points to a need for more coordinated and uniform nationally recognized strategies for treating heroin and prescription overdoses in the ICU, critical care physician Jennifer P. Stevens, MD, of Beth Israel Deaconess Medical Center, Boston, said Monday.

Stevens is scheduled to present the study findings at ATS 2016, the international meeting of the American Thoracic Society.

“What this means is that the opioid-use epidemic has probably reached a new level of crisis, and that despite everything we do in the ICU to keep patients alive, including ventilation, acute dialysis, life support and around-the-clock care, we are not seeing an improvement in mortality,” Stevens said.

Stevens and colleagues analyzed data from hospitals across the country affiliated with Vizient (formerly the University Health System Consortium), and their final cohort included 17.6 million hospital adult admissions.

Both opioid overdose-related hospital admissions and ICU admissions increased, with ICU admissions for opioid overdoses increasing from 45 patients per 10,000 ICU admissions in 2009 to 65 patient per 10,000 ICU admissions in 2015.

The rate of acute dialysis in opioid overdose patients also increased in ICUs, while the rate of mechanical ventilation seems to have remained steady, Stevens said.

The observational data do not explain why mortality among patients who enter ICUs with opioid overdoses is rising, and data on the use of opioid-reversing drugs by first responders prior to hospital arrival or by emergency department personnel were not available.

Pulmonary and critical care specialist Dean Schaufnagel, MD, of the University of Illinois at Chicago, who was not involved with the study, said patients who are admitted to or dying in ICUs from opioid overdoses are most likely those who have been found late and may have been comatose for a while.

“They are resuscitated, but there may be brain damage or other very serious issues ,” he said.

Schaufnagel, who is a past president of ATS, said changing clinicians’ views about how they manage their patients’ pain is critical to addressing the prescription opioid overdose epidemic in the U.S.

“The thinking a decade or so ago was that doctors had no right to allow patients to be in pain,” he said. “When I had a wisdom tooth taken out a few years ago they gave me a big bottle of Tylenol with codeine and there was a refill. That was part of this mindset of making sure patients had no pain. This was well meaning, but that thinking backfired.”

Aspirin Therapy Fails to Reduce ARDS


Initiating aspirin therapy to emergency room patients at risk of lung injury does not influence the chance that these patients will experience acute respiratory distress syndrome(ARDS), researchers reported here.

The development of ARDS occurred within 7 days in 20 of 195 patients (10.3%) assigned to aspirin and in 17 of 195 patients (8.7%) presenting in the emergency room (P=0.53), reported Daryl Kor, MD, of the Mayo Clinic in Rochester, Minn.

n presenting their research at the annual meeting of the American Thoracic Society, additionally, Kor and colleagues reported no statistically significant differences in ventilator-free days, in length of stay in the intensive care unit, in hospital length of stay, in 28-day survival, or in bleeding events. The study was published online in the Journal of American Medical Association simultaneously with its presentation here.
“Among at-risk patients presenting to the emergency department, the use of aspirin compared with placebo did not reduce the risk of ARDS at 7 days,” Kor reported. “The findings of this Phase 2b trial do not support continuation to a larger Phase 3 trial.”
Patients who were included in the trial received a loading dose of aspirin 325 mg, followed by daily 81 mg doses within 24 hours of emergency department presentation and continued to hospital day 7, discharge, or death. The median age of the patients was 57 years, and 48% of the patients included in the study were women. Patients were evaluated on the basis of the Lung Injury Prediction Score — with a score of 4 or greater the threshold for the aspirin therapy.
The researchers suggested that aspirin might make a difference in outcomes “based on the body of existing experimental data demonstrating alterations in platelet function during the development of ARDS. Platelet activation, aggregation, and sequestration, as well as modulation of anti-inflammatory lipid mediators, including leukotrienes, thromboxane, and prostaglandins,have all been implicated as important mediators of ARDS progression and severity. Aspirin directly modifies these mechanistic pathways, making it a plausible preventive and therapeutic measure in this setting.”
But in the clinical trial, treatment with aspirin didn’t improve outcomes.
Ventilator-free days through day 28 were 24.9 among the patients on aspirin; 25.2 among those on placebo (P=0.72).
Intensive care unit length of stay was 5.2 days among patients treated with aspirin; 5.4 days among patients who received placebo (P=0.87).
Hospital length of stay was 8.8 days among the aspirin-treated patients; 9.0 days among those on placebo (P=0.79).
Survival at 28 days was 90% for both cohorts (P=0.92).
One-year estimated survival was 73% among the patients on aspirin and 75% among the placebo patients (P=0.79).
No statistically significant differences were found in measures of safety. Eleven patients or 5.6% of those on aspirin experienced bleeding events compared with 5 patients or 2.6% of patients on placebo (P=0.13).

Kor reported that the trial results were likely shaped by a less than expected rate of ARDS in the population. The rate of 9.5% was far lower than the predicted 18% rate, he reported. “In addition to the lower than expected rate of ARDS, low rates of mechanical ventilation, acute kidney injury, and mortality suggest that the enrolled study population may have had a more modest overall severity of illness than what was anticipated at study onset,” the researchers stated. “As a result, the external validity of our findings in a cohort of critically ill patients with greater severity of illness remains unclear. Still, the results of this trial appear robust and consistent between the clinical and biomarker outcome measures.”
In an editorial that accompanied the study in JAMA, John Reilly, MD, instructor in medicine, and Jason Christie, MD, professor of medicine at the University of Pennsylvania, wrote:
“The attributable mortality associated with ARDS in the setting of critical illness is controversial, but ARDS is associated with increased length of intensive care unit stay, duration of ventilatory support, and poor long-term function and neurocognitive outcomes.
“Preventing ARDS is a worthy goal; however, ARDS is not a patient-centered outcome, nor a validated surrogate outcome for patient-centered outcomes,” they suggested. “Additionally, preventing ARDS does not ensure either improved survival or post-hospitalization quality of life. It is possible that an intervention may decrease ARDS risk but actually increase mortality.
“For example, if aspirin reduced ARDS incidence but resulted in significant bleeding complications or other unforeseen effects, the therapy should be avoided. Alternatively, an immunomodulatory therapy that reduces ARDS risk also may reduce pathogen clearance in patients with sepsis, resulting in overall negative effects.
“Conventional ARDS trials have chosen mortality as a primary outcome. In an ARDS prevention trial with mortality of 9%, as seen in the LIPS-A study, conducting a larger trial with sufficient power to detect mortality effects would be excessively expensive and likely infeasible.
“Ideally, future trials would both aim to prevent ARDS but also focus on mortality, functional status, or hospital costs in a population selected to be at highest risk and most likely to respond to a specific therapy,” they suggested.

Can We Measure Love With Neuroscience?


in love

This question originally appeared on Quora. Answer by Yohan John, PhD in cognitive neural systems from Boston University. 

We can try! Social neuroscience is the sub-field of neuroscience that attempts to understand the particularly social behaviors that humans exhibit. Love may be the best example of this sort of behavior.

In order to study a neural phenomenon in humans, we first need to have what is known as an “operational” definition of that phenomenon. A working definition of love needs to be made in terms of non-neural observables. We use this definition to determine whether a person loves someone or something. We might choose a combination of factors like elevated heart rate or smiling or pupil dilation. But these are indirect measures themselves. Ultimately we are better off using questionnaires: it’s best to just ask a person who or what they love.

Once we have a working definition of love, we can begin to study it experimentally. We can record a person’s neural signals while they are looking at a picture of a loved one. We might use fMRI, EEG, MEG, PET, or some other method. We could also use methods that track the levels of some neurochemical in the blood.

We can’t just measure what happens in a person’s nervous system when they are looking at a loved one. This measurement is meaningless unless we compare it with some baseline. So we also need to make measurements of a “non-love” or neutral state. These measurements are known as controls. By comparing our neural love patterns with our neural “meh” patterns, we can start to see what is neurally different about love compared with other mental states.

Using these kinds of techniques, we have collected various pieces of information. They don’t really add up to a neural theory of love, but they are tentative steps in that direction. Here are a few examples from an article in Psychology Today: “What Neuroscience Tells Us About Being in Love.”

  • Love seems to activate the ventral tegmental area, which contains neurons that release the neurotransmitter dopamine. Dopamine is not the “pleasure chemical,” but it has been associated with reward, punishment, addiction, learning, novelty, surprise, salience, and other phenomena.
  • Love may cause a drop in serotonin levels. Serotonin is not the “bliss chemical.” In fact, serotonin remains a very poorly understood neurotransmitter.
  • Love may cause reduced activity in the prefrontal cortex (PFC) and in the amygdala. The PFC is a large and multifaceted brain region that is involved in all sorts of things, including decision-making, cognition, attention, emotion, and planning. The amygdala is a crucial hub of the emotional system, and is particularly involved in fear processing.
  • Love may affect men’s and women’s brains differently. In men, the visual cortex may be relatively more activated by love. In women, the hippocampus — a key part of the brain’s memory system — may be more activated by love.

Remember, these are just examples, and not an exhaustive survey of the literature. Also, note that I used words like “seems,” and “may.” This is because social neuroscience is perhaps the most tricky sub-field of neuroscience. Many research findings seem inconsistent with each other, and attempts to replicated them often fail. Moreover, we can’t really confirm most of these findings in laboratory animals, since it will always be controversial to attribute complex human emotions to organisms that cannot speak for themselves. So take these points with a very large pinch of salt. Some of these neural “signatures” of love may actually be giving us an incorrect or incomplete picture. Everyone knows that love is complicated, so we should expect that it will be among the most difficult things to understand from a neural perspective.

 

Statins Don’t Halt CVD Onset in Diabetic Older Women


Being on statin therapy did not significantly reduce atherosclerotic cardiovascular disease (ASCVD) risk in postmenopausal women newly diagnosed with type 2 diabetes, according to a new analysis of Women’s Health Initiative (WHI) data.

Women not on statins at the time of their diabetes diagnosis had a hazard ratio of 1.42 for ASCVD compared with women without diabetes (95% CI 1.28-1.58), according to a research team led by Yunsheng Ma, MD, PhD, of the University of Massachusetts Medical School in Worcester.

For women on statins when diagnosed, the increase in risk compared with nondiabetic women was only slightly smaller (HR 1.39, 95% CI 1.12-1.74). The risk difference between the two diabetic groups was not significant (P=0.89), Ma and colleagues reported in the European Journal of Epidemiology.

Ma and colleagues said they had thought that statin treatment might blunt the increased ASCVD risk associated with diabetes, but the study results did not bear that out.

“The major finding in this large, prospective observational study on community-dwelling postmenopausal women was that regardless of statin use, postmenopausal women with new-onset diabetes had a significantly increased risk of ASCVD,” Ma and colleagues wrote.

“Overall, statin use has benefit for ASCVD risk,” Ma said in an email to MedPage Today. “However, if we can reduce statin-related diabetes, the benefit will be increased. Therefore, we have to emphasize the importance of prevention, monitoring, and detection of diabetes in postmenopausal women including those on statin medication. Development of a new line of lipid-lowering medication without elevated blood glucose would be helpful as well.”

Ma and colleagues analyzed data on more than 120,000 WHI participants ages 50-79. Participants did not have cardiovascular disease or diabetes at baseline. Mean follow-up was 13.6 years.

Incident diabetes was self-reported by the women annually. Statin use was determined at enrollment and at regular yearly intervals throughout the study. The study’s primary endpoint was atherosclerotic cardiovascular events, which was self-reported annually and adjudicated by blinded physicians. Secondary endpoints included myocardial infarction, stroke, and cardiovascular death.

The investigators used incident diabetes and statin use as time-varying covariates in a Cox regression model analysis.

Results were similar when they analyzed myocardial infarction, stroke, and cardiovascular death as separate outcomes. For example, in the nonstatin-treated group, the hazard ratio for myocardial infarction was 1.38 versus nondiabetic participants (95% CI 1.17-1.62) compared with 1.52 (95% CI 1.12-2.07) in the statin-treated group (P=0.55 for comparison).

A chief limitation of the study was that baseline data on blood lipid levels and glucose measurements were incomplete, and that no data on these measurements were available during follow-up, so that they were not included in the adjusted analysis, Ma and colleagues noted. Self-reporting of incident diabetes and cardiovascular events was also a potential source of bias.

In addition, “when interpreting the present results, one should be mindful that our observational study analysis does not directly estimate the efficacy of statins on ASCVD risk in those with and without diabetes, for which the clinical trials are a superior source of information,” Ma and colleagues said.

Another important limitation is that the study results cannot be generalized to men, Ma told MedPage Today. “[O]ur results are applicable for postmenopausal women; study of a male population is needed,” he said.

Huge Clinical Trial Program Announced for HF Drug


Novartis announced today an enormous clinical trial program with its promising but slow-starting heart failure drug valsartan/sacubitril (Entresto). The company said it would perform 40 clinical trials with the drug in the next 5 years.

The Fortifying Heart Failure clinical evidence and patient quality of life (FortiHFy) program will include investigators and patients from more than 50 countries. The program will almost certainly dwarf all previous clinical programs in heart failure.

“The FortiHFy program reinforces our long-term commitment to improving heart failure treatment for as many people as possible,” said Vas Narasimhan, the global head of drug development and the chief medical officer of Novartis, in a press release. “The outcomes of these trials will increase our understanding of heart failure, the patient population who may benefit from Entresto, and could potentially support applications to regulatory authorities.”

Despite a highly successful result in the pivotal PARADIGM-HF trial and rapid approval of the drug in most major markets, Entresto has struggled to gain acceptance in the marketplace. In a recent editorial, Milton Packer, MD, the co-principal investigator of PARADIGM-HF, criticized the slow uptake of the drugs. One contributing factor, he said, was the lengthy delay between the completion of clinical trials and the update of guidelines. Updated heart failure guidelines are expected to be announced this weekend in conjunction with the beginning of the large European Heart Failure meeting in Florence, Italy.

Novartis had previously announced the PARAGON-HF trial, which is studying Entresto in heart failure patients with with preserved ejection fraction and is expected to be completed in 2019. Other trials announced by Novartis include PARADISE-MI, in post-MI patients, and TRANSITION, examining in-hospital initiation of Entresto following hospitalization for acute decompensation.

SPRINT: Lower BP Goals Better for Elderly


For people age 75 and older, a blood pressure goal under 120 mm Hg systolic substantially lowered the risk of major cardiovascular events and death from any cause without increasing risks, a SPRINT sub-analysis showed.

Compared with a goal of less than 140 mm Hg, intensive treatment yielded a 34% relatively lower risk of the composite primary endpoint of nonfatal myocardial infarction or other acute coronary syndrome, nonfatal stroke, nonfatal acute decompensated heart failure, and death from cardiovascular causes (2.59% versus 3.85%, hazard ratio 0.66, 95% CI 0.51-0.85).

All-cause mortality likewise was 33% reduced by intensive treatment over a median follow-up of 3.14 years (73 versus 107 deaths, respectively; HR 0.67 [95% CI 0.49-0.91]).

The number needed to treat was 27 to prevent one composite endpoint event and 41 to forestall one death over that period, Jeff D. Williamson, MD, MHS, of Wake Forest School of Medicine in Winston-Salem, N.C., and colleagues reported online in the Journal of the American Medical Association and at the American Geriatrics Society meeting in Long Beach, Calif.

Although safety has been the major concern holding back aggressive treatment for older adults, SPRINT showed a nearly identical 48.4% versus 48.3% rate of serious adverse event rates between the intensive and standard treatment groups for the participants 75 and older.

“Small increases in incidence of hypotension, syncope, or acute changes in renal function were observed, but these appeared to be more than offset by the large benefits of treatment,” noted an accompanying editorial by Aram V. Chobanian, MD, of Boston University.

“Everybody is afraid of treating these people; they don’t want them to keel over or have some untoward event,” Joseph L. Izzo MD, of New York’s University at Buffalo, toldMedPage Today. The SPRINT data “pretty strongly refute that concept that these older people who have very high risk for debilitating strokes can’t be treated effectively. It is not a good idea to gauge therapy based on the age of the patient.”

Although the event rates were higher with increasing frailty across the board, the intervention improved outcomes in every frailty stratum (P=0.84 for interaction). Results were similar considering gait speed as a marker of frailty.

Likewise, serious adverse events were more common with greater frailty but did not differ significantly by treatment group across frailty strata. The analysis included 2,636 participants age 75 and older (mean of 79.9, and 37.9% were women), randomized to a systolic treatment goal of less than 120 or less than 140 mm Hg.

The high adverse effect rate in both groups was not surprising for this age group, John Bisognano, MD, PhD, of New York’s University of Rochester Medical Center and president of the American Society of Hypertension, told MedPage Today. “The incidence of adverse events is really not anything to worry about.”

He predicted that the findings would change practice.

“If [patients] are having side effects, we’re not going to push through them. But we will push a little harder on blood pressure,” he said. “We do a lot of other heroic things for elderly people, but this is a standard therapy that can have a big effect. We can’t ignore that data.”

Izzo agreed: “Remember that you’re going to be more likely to prevent an event by treating somebody who is 80 than you are by treating somebody who is 40, because the event rate is so much higher in people 80 years old — Age being the number one cardiovascular risk factor.”

There are important caveats to keep in mind in applying SPRINT to practice, such as the exclusion of patients with prior stroke, diabetes, or serious frailty, or those who are institutionalized, trial investigator Suzanne Oparil, MD, of the University of Alabama at Birmingham, had cautioned earlier in the week regarding another subanalysis on frailty.

Izzo, though, noted that a study on people in long-term care facilities is unlikely to be finished and suggested that the findings of a good risk-to-benefit ratio would likely generalize to those elderly people as well. It would take “a leap of faith, but how big a leap is it? Not much, not to me,” he said.

Also, there were measures taken to ensure the safety of the approach, Oparil toldMedPage Today. “When the drugs were titrated to get to the goal, people were seen every month. Within the first 6 months, some people were seen every month — and that’s more than some doctors would want to do.”

She urged clinicians to:

  • Be patient with titrating drugs.
  • Monitor blood pressure, electrolytes, serum potassium, kidney function, and standing blood pressures.
  • Measure blood pressure in the same way that SPRINT did, “with a device that’s programmed to take the blood pressure after a lag time of 5 minutes.”

Chobanian concluded that even if it is challenging for clinicians, “the important results reported … cannot be discounted, and unless unexpected adverse effects are observed on further examination of the trial data, then major changes in treatment goals for patients 75 years or older with hypertension will be warranted.”

Absorbable Vascular Closure Device Safe


A vascular closure device without sutures or collagen plugs may be safer than traditional cut-down or suture-based closure devices, according to the FRONTIER II study.

At 12 months, there were no complications associated with the deployment of the Vivasure PerQseal closure device, which involves a synthetic implant that bioabsorbs within 180 days. Ultrasound and CT also showed no clinically-significant vascular changes over follow-up, nor were there any cases of stenosis or distal emboli.

Arne Schwindt, MD, of Germany’s St. Franziskus Hospital, reported a 97% rate of technical success as well. He emphasized the “low learning curve” involved in deployment, which he claimed takes less than a minute.
This device “offers a safe and dependable alternative to open surgical closure, suture-mediated or collagen plug devices for the percutaneous closure of large hole femoral arteriotomies,” Schwindt told the audience at the annual EuroPCR meeting.
“This looks really great. It’s nice to see we’re making progress with large bore closure devices,” said panelist Ted E. Feldman, MD, of Illinois’ Evanston Hospital.
FRONTIER II included 58 patients who underwent large bore femoral percutaneous access for transcatheter aortic valve replacement, endovascular aneurysm repair, or thoracic endovascular aortic repair. A total of 66 closures from eight European centers were analyzed by Schwindt’s group.
The PerQSeal is designed for large arteriotomies ranging from 12 to 24 French. Delivered over a wire, it is also fully absorbable by 6 months, leaving no scar in the arterial wall. Europe gave it the CE mark earlier this year.

When prompted by discussion panelist Ganesh Manoharan, MBBCh, MD, of Royal Victoria Hospital, Ireland, Schwindt said that exclusion criteria do exist for the PerQSeal. “Duplex scanning of the groin to see if the femoral artery is bigger than 7 mm is crucial,” he noted, or else the device won’t align properly. Similarly, patients should not have front wall calcification, the rough surface of which is not compatible with the device.
Following another question by the panel, Schwindt clarified that he had not encountered the need for subsequent re-access after vascular closure, but he recommended duplex-controlled punctures just in case.

No Elevated Heart Risk in IBD


Findings differ from what’s seen in other inflammatory diseases

Patients with inflammatory bowel disease (IBD) had no increased risk for acute myocardial infarction (MI) compared with the general population — or even with patients with other chronic inflammatory conditions, a researcher reported here.

Among hospitalizations included in the National Inpatient Sample from 2000 to 2011, 1.3% of patients with IBD were admitted for MI compared with 3.2% of the general population (P<0.001), according toEdward L. Barnes, MD, of Brigham and Women’s Hospital in Boston, and colleagues.

 They also had fewer MI hospitalizations than did patients with systemic lupus erythematosus (SLE), whose admission rate was 2.3%, or rheumatoid arthritis (RA), with a rate of 3%, he reported at the annual Digestive Disease Week.

“In some studies, IBD has been linked with increased cardiovascular risks, including coronary artery disease and MI, yet traditional risk factors such as hyperlipidemia, obesity, and hypertension are less common among patients with IBD and questions remain regarding the true prevalence of events such as MI among this population,” Barnes said in a poster session.

To address this question, he and his colleagues identified 567,438 hospitalizations among IBD patients and 78,121,000 admissions for the general population during the study period.

Comparisons of patients with and without IBD demonstrated that IBD patients were younger (51.6 vs 57, P<0.001), and had significantly less hyperlipidemia (12.6% vs 18.4%, P<0.001), diabetes (12.4% vs 20.6%, P<0.001), and hypertension (26.9% vs 34.9%, P<0.001). They also had lower rates of obesity (4.7% vs 6.7%, P<0.001).

In an unadjusted model, the risk for MI among patients with IBD was 0.42 (95% CI 0.41-0.43) compared with the general population, Barnes reported.

And in a multivariate analysis that adjusted for risk factors including age, sex, race/ethnicity, hyperlipidemia, hypertension, obesity, Charlson comorbidity index, insurance, and tobacco use, the odds ratio for MI among patients with IBD was 0.54 (95% CI 0.52-0.55), Barnes reported.

In an additional unadjusted analysis, the risk for MI was lower among IBD patients than among those with SLE or RA:

  • SLE: OR 1.74 (95% CI 1.69-1.80)
  • RA: OR 2.32 (95% CI 2.26-2.38)

Risks were also lower in an adjusted multivariate analysis:

  • SLE: OR 1.72 (95% CI 1.67-1.77)
  • RA: OR 1.45 (95% CI 1.41-1.49)

As to why there shouldn’t be a similar risk for MI and CAD among patients with IBD compared with diseases such as SLE and RA that also are characterized by systemic inflammation, Barnes explained toMedPage Today that in patients with the latter two diseases, the cytokine/chemokine pattern seems to favor a risk on the arterial side, conferring a higher MI/CAD risk. In contrast, in the IBD population, the higher risk is for venous events.

For instance, it’s been shown that patients with IBD have a higher baseline rate than the general population for deep vein thrombosis (0.93% vs 0.66%, P<0.001) and pulmonary embolism (0.89% vs 0.76%,P<0.001). Moreover, they also less often had preventive surgery such as coronary artery bypass grafts (0.33% vs 0.94%, P<0.001).

“This is a hypothesis at this point,” Barnes noted. “It isn’t just systemic inflammation that leads to cardiovascular risk in diseases such as lupus, rheumatoid arthritis, and IBD. There appear to be differences in cytokines involved in the chronic inflammation.”

Greater Ca Risk With Late Colonoscopy After Positive FIT


Patients who delayed getting colonoscopies longer than 6 months after a positive fecal immunochemical test (FIT) showed significantly greater risks of being diagnosed with colorectal cancer when they finally did have the procedures, a researcher said here.

But the groups at highest risk were not those that might have been expected, according to Douglas Corley, MD, PhD, of Kaiser Permanente’s research division in Oakland, Calif., who reported the study at Digestive Disease Week (DDW).

Among some 71,000 Kaiser Permanente members who underwent colonoscopies after positive FIT, those who had the procedures after 6-12 months were at significantly increased risk of a colorectal cancer diagnosis (odds ratio 1.3, P<0.05) relative to those having colonoscopies within 30 days of the positive FIT (considered no delay).

Those undergoing colonoscopies beyond 1 year were at even greater risk, Corley said, with an OR of 2.4 (P<0.05) relative to the group with no delay.

The increased risk with delayed colonoscopy were mainly reflected in advanced-stage disease, he stated. In those undergoing colonoscopies more than a year after positive FIT, the ORs for diagnosis with stage III and IV cancers were 2.6 and 4.3, respectively, relative to the no-delay group.

John Vargo, MD, MPH, of the Cleveland Clinic, who was not involved with the study, said it was among the most important presented at DDW this year on colorectal cancer detection and prevention.

He said it confirmed what is usually believed: “earlier is better” when it comes to diagnosing colorectal cancer in high-risk patients.

Corley said his group went into the study with a number of hypotheses about the reasons for delay and how they might be reflected in cancer diagnoses. One was that individuals with multiple comorbidities would be more inclined to delay having a colonoscopy, and would therefore be more likely to be diagnosed with cancer.

But in fact the researchers found the opposite: when long delays occurred, the highest risks were in individuals with few comorbid conditions. In some cases, the increase in risk was enormous.

For diagnosis of colorectal cancer among those with Charlson comorbidity scores of 2 or more, risks were about the same irrespective of time between FIT and colonoscopy, even when it went beyond a year. For those with Charlson scores of 0 or 1, however, the OR reached 5 for those ages 50-60 and almost 14 for those ages 61-75 when colonoscopy occurred more than a year after FIT relative to the no-delay group.

The same pattern, but magnified, was seen for advanced cancers. Delays of a year or more were associated with OR of 25 at ages 50-60 and OR 45 at ages 61-75 (all P<0.05).

“We don’t have a complete explanation” for these subgroup results, Corley said.

Other potential confounders for which the group had data — sex, body mass index, race/ethnicity, previous FIT history, or screening year — did not affect the results. Nor did the patterns change when the reference group was expanded to include those having colonoscopies up to 90 days after FIT.

Asked during the question period about the factors underlying the delays, Corley responded that this was not practical to address in the study. But, he added, in his “personal experience,” there numerous reasons for patients to wait to have colonoscopies.

Some may have difficulty getting time off from work; or a patient may be having coronary interventions and needs to “come off Plavix” before undergoing another procedure.

“It’s kind of a hodgepodge of things,” he said.

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