Publications

AIMS: Prediabetes and left ventricular hypertrophy (LVH) are common risk factors in adults with hypertension. Whether their coexistence, particularly in the presence of subclinical myocardial injury or stress (malignant LVH), confers a heightened stroke risk is unknown.

MATERIAL AND METHODS: We analysed 8367 hypertensive adults without diabetes or prior stroke (mean age: 68 ± 9.4 years, 36.8% women, 39.8% with prediabetes) from the Systolic Blood Pressure Intervention Trial (SPRINT). Prediabetes was defined as fasting plasma glucose 100-125 mg/dL. Malignant LVH was defined as electrocardiographic LVH (Cornell voltage product > 2436 mm·ms) with elevated high-sensitivity cardiac troponin I (≥ 6 ng/L in men, ≥ 4 ng/L in women) or N-terminal pro-B-type natriuretic peptide (≥ 125 pg/mL). The primary outcome was incident stroke. Cox proportional hazards models estimated hazard ratios (HRs) across categories of glycemic status and malignant LVH.

RESULTS: During a median follow-up of 3.3 years, 116 participants developed stroke. Compared with normoglycemic individuals without malignant LVH, adjusted HRs for stroke were 1.37 (95% CI, 0.88-2.12) for prediabetes alone, 1.94 (95% CI, 1.06-3.53) for malignant LVH alone, and 3.07 (95% CI, 1.66-5.70) for both prediabetes and malignant LVH. The stroke risk was also elevated for prediabetes combined with LVH plus myocardial injury (HR, 3.71; 95% CI, 2.00-6.88) or myocardial stress (HR, 2.84; 95% CI, 1.44-5.58). Results were consistent using alternate LVH definitions.

CONCLUSIONS: Among hypertensive adults, the coexistence of prediabetes and malignant LVH substantially increased stroke risk. Integrating metabolic status with cardiac biomarkers may improve cerebrovascular risk stratification.

The association between circulating soluble klotho (s-klotho) levels and hip fracture risk is uncertain. We assessed this relationship in 4428 older adults followed for a median of 11.8 years, during which 602 hip fractures occurred. In the overall cohort, s-klotho levels were marginally but not significantly associated with hip fracture risk (hazard ratio (HR) per standard deviation increase, 0.92; 95% CI, 0.83-1.01; p = 0.075). In exploratory analyses, participants in the highest 5% of s-klotho levels (> 1615.2 pg/ml) exhibited a substantially lower risk of hip fracture (adjusted HR, 0.48; 95% CI, 0.27-0.85; p = 0.01), suggesting a threshold effect in which only very high s-klotho concentrations are associated with reduced risk. This finding may help explain inconsistencies in prior studies.

BACKGROUND: Chronic nonspecific low back pain (CNSLBP) is the most common chronic condition worldwide. Although recommended in several clinical guidelines, high-quality double-blind studies supporting the evidence for acupuncture remain limited.

OBJECTIVE: This study aims to test the efficacy of penetrating acupuncture for CNSLBP using double-blind needles that blind both the acupuncturist and the participant, which provides the most rigorous methodology for acupuncture trials to date.

METHODS: This study was a randomized double-blind (acupuncturist-patient) placebo-controlled trial conducted at the Tokyo Ariake University of Medical and Health Sciences Acupuncture Clinic. Seventy-five adult participants with CNSLBP were randomized to genuine penetrating, skin-touch placebo, and no-touch placebo needles that do not touch the skin. Consistent with prior studies and clinical practice, acupoints on the bladder meridian were mainly used. The study has 2 primary outcomes: an objective outcome and a subjective outcome. The primary objective outcome is the flexion-relaxation phenomenon, an index associated with low back pain, assessed using surface electromyography (sEMG) recordings of the bilateral lumbar erector spinae muscles and hamstrings. The primary subjective outcome is pain intensity measured using a visual analog scale (VAS) before and after the intervention.

RESULTS: The Ethics Committee approved the study protocol of Tokyo Ariake University of Medical and Health Sciences in April 2018 (approval number: 0246). This study started in July 2018 and was completed in March 2025.

CONCLUSIONS: This trial used a double-blind design and objective outcome measures to rigorously evaluate the efficacy of acupuncture for CNSLBP.

BACKGROUND: Cardiovascular disease is a risk factor for severe COVID-19 (ie, hospitalization or death). Whether better cardiovascular health (CVH) is associated with lower risk of severe COVID-19 among adults without cardiovascular disease is unknown. We aimed to test if the American Heart Association's Life's Essential 8 (LE8) metric and its components were associated with severe COVID-19 in the C4R (Collaborative Cohort of Cohorts for COVID-19 Research) consortium.

METHODS: Participants with cardiovascular disease were excluded. Two waves of questionnaires, events surveillance, and a serosurvey identified COVID-19 infections. Associations of incident severe COVID-19 with continuous LE8, categorical LE8 (low [<50], moderate [50 to <80], and high [≥80] CVH), and individual LE8 components, were tested in adjusted cause-specific hazards models.

RESULTS: Among 29 740 participants in 9 cohorts (mean age, 66±14 years; 61% women; 35% White race; 22% Black race; 34% Hispanic ethnicity), there were 681 severe COVID-19 cases between March 1, 2020, and February 28, 2023. There was a 20% lower hazard of severe COVID-19 per each 1-SD higher LE8 (adjusted hazard ratio [aHR], 0.80 [95% CI, 0.73-0.88]). Relative to low CVH, high CVH was associated with lower risk of severe COVID-19 (aHR, 0.54 [95% CI, 0.37-0.78]); this was not seen for moderate CVH (aHR, 0.81 [95% CI, 0.64-1.04]). Of LE8 components, better physical activity, body mass index, blood pressure, and sleep were associated with a lower hazard of severe COVID-19.

CONCLUSIONS: Better CVH was associated with lower severe COVID-19 risk among cardiovascular disease-free adults. Whether CVH optimization could mitigate adverse risk from COVID-19 and other harmful viruses warrants further investigation.

OBJECTIVE: We examined the prevalence and patterns of complementary health approaches (CHA) use and interest in CHA research participation among COSMOS older adults.

METHODS: We conducted cross-sectional analyses of the COSMOS Study 2024 survey that asked participants about their use of and research interest in six CHA categories (manual therapies, mind-body therapies, herbal products, acupuncture, spiritual practices, and cannabis/psychedelics). We compared key baseline sociodemographic, lifestyle, and clinical characteristics between CHA users and non-users overall, and for each CHA category. We used multivariable logistic regression models to estimate the odds of CHA use in the past 12 months and ever in lifetime.

RESULTS: Of the 16,144 participants who responded (median age, 77.5 y), 58.8% and 76.4% indicated using CHA at least once in the past 12 months and ever in lifetime, respectively, and 50.4% reported interest in participating in CHA research. The highest prevalence of recent use was observed for spiritual practices (38.6%; 95% CI, 37.8- 39.3) and lifetime use for manual therapies (51.9%; 95% CI, 51.2-52.7). A history of falls or depression was linked to higher odds of recent and lifetime CHA use.

CONCLUSIONS: The high prevalence of selected CHA highlights the need to identify evidence gaps for safety, harm, and public health impact for new focused research studies. Limited generalizability to more diverse and medically underserved populations underscores the need for continued integrative health research.

OBJECTIVE: This study pilot tested a novel Decision Aid (DA) that clarifies the impact of multimorbidity on Lung Cancer Screening (LCS) risks and benefits. Outcomes of interest include LCS knowledge, disposition to complete LCS, decisional conflict and confidence.

METHODS: Evaluation scales were administered before and after DA exposure to 50 patients with smoking history; 70% of them having moderate or severe multimorbidity.

RESULTS: LCS Knowledge Measure scores improved (median 3 vs. 5 on scale 0-12, p < 0.0001). Scores of Decisional Conflict subscale related to feeling uninformed improved (median 3.5 vs. 3 on scale 0-15, p = 0.03). Overall Decisional Conflict (median 16 vs. 16 on scale 0-80), Stage of Decision Making (median 4 vs. 4 on scale 1-4), and share of participants disposed to complete LCS (86% vs. 84%) were similar.

CONCLUSION: Exposure to a DA tailored to individuals with multimorbidity was associated with improved knowledge of LCS. Further investigation is needed to evaluate the DA efficacy in patients with higher baseline decisional conflict and lower baseline confidence.

INNOVATION: A novel DA presenting information on the impact of comorbidities on LCS risks and benefits was found to hold potential for better supporting the decision-making of patients with multimorbidity.

BACKGROUND: While clinical trials (CTs) are crucial for advancing healthcare, public knowledge remains limited. Individuals with cancer may be more engaged with experimental treatments than those with other chronic conditions like cardiovascular disease (CVD). Whether CVD patients have comparable CT knowledge, and how this varies by sociodemographic factors, remains unclear.

OBJECTIVES: To examine CT knowledge variation between individuals with cancer and CVD and identify sociodemographic correlates of knowledge within CVD population.

METHODS: HINTS is a nationally representative survey of U.S. adults aged ≥18 years. Participants self-reported cancer history, CVD status, and CT knowledge. Logistic regression assessed associations between disease status and CT knowledge, adjusting for sociodemographic and health factors. Within CVD group, variables with P < 0.25 in univariable models were retained in multivariable model. Analyses applied sampling weights.

RESULTS: Among a weighted sample (n = 3772) representing ∼250 million (mean [SD] age, 57 [17.0] years; 50% women), 6% reported cancer and 8% CVD. CT knowledge was 61% in CVD and cancer groups; 35% of CVD group were low-income. In adjusted models, CT knowledge among cancer-only (OR 1.09, 95%CI 0.70-1.68) and CVD-only (OR 1.26, 95%CI 0.73-2.18) groups did not differ significantly from adults without CVD or cancer. Among CVD population, lower income participants (OR 0.24, 95%CI 0.06-0.98) had significantly lower odds of CT knowledge.

CONCLUSION: Most adults with CVD and cancer lacked CT knowledge, underscoring need for broader education. Reduced income was independently associated with diminished knowledge, suggesting targeted efforts may benefit underserved patients and expand access to innovative therapies.