Adults with cancer are at risk for complications from vaccine-preventable diseases, yet vaccine adherence in this population remains poorly characterized. This cross-sectional study used the National Health Interview Survey 2019 to 2023 to examine trends in influenza, pneumococcal, and shingles vaccines among adults aged ≥50 years with cancer. Of the 6,533 respondents included, only 30.6% (95% confidence interval [CI; 29.3%, 31.9%]) reported receiving all three recommended vaccines. Factors associated with lower vaccination adherence included younger age (odds ratio [OR] comparing ages ≥75 to 50 to 64 years 5.39; 95% CI [4.70, 6.18]), male sex (OR 0.81; 95% CI [0.73, 0.90]), Black (OR 0.59; 95% CI [0.47, 0.73]) or Hispanic race/ethnicity (OR 0.69; 95% CI [0.52, 0.92]), Medicaid insurance (OR 0.79; 95% CI [0.65, 0.96]), and lower educational attainment (OR 0.65; 95% CI [0.58, 0.73]). Preventable disease vaccination remains subpar in the adult cancer population, and further efforts including targeted interventions are necessary to improve preventative health efforts in these patients.
Publications
2026
BACKGROUND AND AIMS: Heart failure with preserved ejection fraction (HFpEF) is increasingly recognized as a syndrome of reserve dysfunction. However, integrated assessment of biventricular (LV/RV) volumetric reserve under physiological stress remains underexplored. We aimed to investigate whether exercise cardiac magnetic resonance (Ex-CMR) can reveal distinct volumetric reserve profiles across the HFpEF spectrum.
METHODS: In this retrospective analysis of a prospective observational, multicentre study, supine ergometer Ex-CMR was performed in HFpEF patients across early to advanced stages (stage B, exercise-induced, stage C), along with healthy controls and a non-cardiac dyspnoea (NCD) group. Percentage changes in LV/RV end-diastolic (ΔEDV%) and end-systolic volumes (ΔESV%) from rest to stress defined EDV reserve and ESV reserve, respectively. Ventricular efficiency index (EI) was defined as ΔEDV%-ΔESV%; biventricular EI as LVEI + RVEI. Group comparisons were performed using ANOVA and post hoc testing. Multivariable general linear model analyses adjusted for age, sex, BMI, and exercise response. A composite phenotyping assessment incorporating all four key reserve parameters was explored.
RESULTS: Among 140 participants (40 healthy, 27 NCD, and 73 HFpEF), all HFpEF subgroups showed impaired LVEDV reserve and reduced LVEI (P < .0001). LVESV reserve was impaired only in stage C (P < .0001). Exercise-induced RV dysfunction was a hallmark of HFpEF with pulmonary hypertension (P < .0001). Biventricular EI declined progressively with advancing HFpEF stage (P < .0001) and was significantly lower in NYHA > II (P = .0006). Six distinct reserve phenotypes emerged.
CONCLUSION: Ex-CMR-based assessment of LV/RV volumetric reserve reveals progressive biventricular dysfunction across HFpEF stages and supports biventricular volumetric reserve-based phenotyping for characterizing HFpEF pathophysiology.
KEY QUESTION: Can the integration of left and right ventricular end-diastolic and end-systolic volume reserve under physiological stress reveal distinct profiles across the HFpEF spectrum and enhance our understanding of its haemodynamic heterogeneity?
KEY FINDINGS: Non-invasive assessment of biventricular volumetric reserve, along with their intra- and interventricular interactions using exercise CMR, revealed a significant, stepwise deterioration across HFpEF subgroups, worsening with NYHA class > II. Exercise CMR enabled composite volumetric reserve-based phenotyping and identified six distinct reserve phenotypes.
TAKE HOME MESSAGE: Biventricular volumetric reserve assessment is feasible through exercise CMR and may support future precision therapy strategies.
Although a Dietary Approaches to Stop Hypertension (DASH) eating plan has been shown to lower blood pressure (BP) in Black adults, this intervention has not been tested in individuals who were being actively treated for hypertension. In this study, we conducted a randomized clinical trial (GoFreshRx) to test whether local groceries ordered with the assistance of a dietitian to align with the DASH diet might lower BP among Black adult residents of Boston communities with few grocery stores who were being actively treated for hypertension. Individuals whose systolic blood pressure (SBP) was 120 mmHg to <150 mmHg despite active hypertension treatment were randomized either to 12 weeks of weekly home-delivered DASH groceries with dietitian counseling or to receiving three US$500 stipends every 4 weeks. The primary outcome was research clinic-measured SBP measured at 3 months. Secondary outcomes were diastolic blood pressure (DBP) and low-density lipoprotein cholesterol (LDL-c) levels. Maintenance of health effects was assessed at 3 months after the intervention. Of 176 participants (mean age 60.1 (s.d., 11.5) years; 80.7% female), 173 were available for SBP measurement at 3 months. Mean (s.d.) baseline SBP/DBP was 130.5 (7.0)/77.8 (8.9) mmHg. At 3 months, SBP changed by -7.0 mmHg in the DASH groceries group and by -2.0 mmHg in the self-directed group (intergroup difference: -5.0 mmHg; 95% confidence interval: -8.0 to -1.9; P = 0.002). Moreover, compared to the self-directed group, 3 months of DASH groceries changed DBP by -1.8 mmHg (-3.6 to -0.1) and LDL-c by -7.0 mg dl-1 (-13.6 to -0.5). In prespecified analyses, the beneficial effects of DASH grocery delivery on SBP and DBP were partially maintained 3 months after the intervention had concluded. Nutrient-targeted grocery ordering appears to be a useful strategy to improve longer-term cardiometabolic health. ClinicalTrials.gov registration: NCT05393232 .
OBJECTIVES: Because it is unknown whether breakfast frequency and timing are associated with long-term risk of incident myocardial infarction (MI) and coronary artery disease (CAD) among older adults, this study aimed to assess relationships between breakfast frequency/timing and MI/CAD risk among older adults and determine whether they depend on sex or cardiometabolic risk factors.
DESIGN AND SETTING: Prospective cohort study of older American adults.
PARTICIPANTS AND MEASUREMENTS: Weekly breakfast frequency and usual daily breakfast time were assessed by questionnaire in 4070 adults aged ≥ 65 years from the Cardiovascular Health Study who were prospectively followed for up to 26 years. Cause-specific hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated from multivariable-adjusted Cox proportional hazards models.
RESULTS: During follow-up, 1617 CAD cases were documented (795 MI cases). Although consuming breakfast 7 days/week (85.3%) and 'breaking-fast' between 07:00 and 09:00am (72.6%) were both associated with higher education and socioeconomic status, being married, not smoking, and consuming fruits and vegetables, neither breakfast frequency nor breakfast timing was associated with risk of CAD or MI in males, females, or altogether. In pre-specified analyses, compared with participants who ate breakfast daily, those who did not eat breakfast daily had an HR for MI of 0.66 (95% CI: 0.43, 1.02) if their body mass index (BMI) was ≥30 kg/m2 and of 1.17 (0.91, 1.51) if their BMI was <30 kg/m2 (interaction p = 0.02). Compared with participants whose breakfast time was 07:00-09:00, those who broke their fast before 07:00 had an HR for CAD of 1.40 (1.02, 1.93) if they had type 2 diabetes and of 1.19 (1.03, 1.38) if they had high fasting insulin at baseline.
CONCLUSION: Breakfast frequency and timing were not associated with either higher or lower risk of MI and CAD in these older adults. Although a priori stratification by cardiometabolic risk factors may have revealed potential trends, the findings must be confirmed in a larger study.
BACKGROUND: In observational studies, blood pressure (BP) variability has been independently associated with adverse cardiovascular disease outcomes. The Dietary Approaches to Stop Hypertension (DASH) diet and sodium reduction lower BP and cardiovascular risk, but their effects on BP variability (BPV) are uncertain.
METHODS: This study assessed the effects of dietary patterns (DASH vs. Control) and sodium intake (higher vs. lower) on BPV, using both office and 24-h ambulatory BP measurements in the DASH and DASH-Sodium trials. In primary analyses, week-to-week office BPV and 24-h ambulatory BPV were quantified using variation independent of the mean (VIM). Between-group comparisons were performed using t-tests; interactive effects between dietary patterns and sodium intake were assessed using multivariate linear regression models.
RESULTS: In pooled analyses of both trials, there was no difference in week-to-week systolic BPV (difference in systolic VIM: 0.49, 95% CI -0.05-1.03) or 24-h systolic BPV (difference in systolic VIM: 0.37, 95% CI -0.13-0.87) between the DASH and Control diet groups. In the DASH-Sodium trial, VIM at higher and lower sodium levels did not differ (e.g. difference in VIM for week-to-week systolic BP: 0.31, 95% CI -0.10-0.72). No significant combined or interactive effects of diet and sodium level on BPV were observed.
CONCLUSION: While the DASH diet and reduced sodium intake lower absolute BP levels, these dietary interventions do not significantly affect BPV. These findings suggest that the BP-related benefits of the DASH diet and sodium reduction likely result from reducing absolute BP rather than reducing BPV.