Sharon Smith

Pembrolizumab has shown significantly better efficacy than platinum doublet chemotherapy in patients with programmed cell death ligand 1 (PD-L1) strongly positive (tumor proportion score ≥ 50%) non–small-cell lung cancer (NSCLC). However, the predictors of response to pembrolizumab have not yet been fully elucidated for patients with PD-L1 strongly positive NSCLC. We retrospectively analyzed 145 patients who had been treated with pembrolizumab for PD-L1 strongly positive (TPS ≥ 50%) NSCLC without an EGFR (epidermal growth factor receptor) mutation or ALK rearrangement from February 2017 to March 2020. Various clinical characteristics, including Eastern Cooperative Oncology Group performance status, treatment line, PD-L1 expression, C-reactive protein level, neutrophil/lymphocyte ratio, and metastatic sites, and the clinical outcome of pembrolizumab treatment were examined. Patients with higher PD-L1 expression (≥ 75%; n = 90) had a higher objective response rate (ORR) and longer prog...

The coronavirus disease 2019 (COVID-19) pandemic has upended every aspect of life as we know it. Its effect on the health-care system has been uniquely profound, laying bare the shortcomings of our systems and processes, while at the same time creating new opportunities by rapid adaptation and utilization of available technology. Patients with end-stage kidney disease (ESKD) requiring dialysis are considered a vulnerable group with the potential for severe COVID because of their immunosuppressed status and multiple comorbidities. Patients who receive hemodialysis in the in-center setting have been significantly affected by the COVID-19 pandemic because of the specific logistics involved (need to travel to their dialysis units and receive dialysis in a communal setting, typically 3 times a week), thus increasing their risk of exposure. Although patients on home dialysis are usually able to avoid such exposure, they face their own unique challenges. In this review, we will discuss the c...

Pre-pregnancy cardiovascular risk factors are highly prevalent and are associated with adverse maternal and fetal outcomes, according to a research letter published in the European Journal of Preventive Cardiology. Researchers pooled individual-level data for 18.6 million pregnancies to examine the impact of four pre-pregnancy cardiovascular risk factors (BMI <18.5 kg/m2 or >24.9 kg/m2 , smoking, hypertension, and diabetes) on maternal and neonatal morbidity and mortality. More than 60% of women had at least one pre-pregnancy cardiovascular risk factor (52.50%, 7.30%, 0.30%, and 0.02% had one, two, three, and four, respectively). Women with one or more risk factors had less receipt of prenatal care, higher prevalence of multiparity, and higher prevalence of prior spontaneous or induced pregnancy loss compared with women with no risk factors. Consistent and marked graded associations were seen between greater pre-pregnancy risk factor burden and higher risk of adverse maternal and...

Twenty-year experience from a single center suggests that most athletes with long QT syndrome (LQTS) can safely return to play, according to a study published in the Journal of the American College of Cardiology, to coincide with the annual meeting of the Heart Rhythm Society. Investigators examined the prevalence and outcomes of athletes with sudden cardiac deathpredisposing genetic heart diseases (GHDs), particularly LQTS, after their return to play in a retrospective study. The EMRs of 672 athletes with GHD were reviewed, including 494 athletes with LQTS who were given return-to-play approval. The study team found that 16.0% of the 494 athletes with LQTS were symptomatic before diagnosis and 11.7% had an implantable cardioverter defibrillator. There was no GHD-sports-associated mortality in 2,056 combined years of follow-up. One or more non-lethal LQTS-associated breakthrough cardiac events occurred in 29 patients (5.9%). Fifteen of these (3.0%) were athletes at the time of the brea...

In a report published in the Journal of the American College of Cardiology, an expert consensus decision pathway (ECDP) was presented for the management of atherosclerotic cardiovascular disease (ASCVD) risk reduction in patients with persistent hypertriglyceridemia. The authors developed consensus recommendations for lifestyle intervention and pharmacologic management of high-risk patients with mild-to-moderate and severe hypertriglyceridemia. The ECDP relates to four populations of patients with persistent hypertriglyceridemia: those with established ASCVD, those with diabetes mellitus and additional risk factors, high-risk primary prevention patients, and those with severe hypertriglyceridemia. Factors to consider include evaluation and management of secondary causes, optimization of diet and lifestyle interventions, implementation of statin therapy and optimization of adherence, optimization of glycemic control, monitoring response to therapy and adherence, and conducting clinician...

Participation of women in cardiovascular clinical trials is suboptimal, and barriers need to be identified and addressed, according to a paper published in the Journal of the American College of Cardiology. Noting that women in general, and particularly minority women, are still underrepresented in most clinical cardiology trials, researchers identified barriers for low enrollment and retention from patient, clinician, research team, study design, and system perspectives, including differential care represented by lower rates of referral and less aggressive care for women with heart disease. For example, women with heart failure are less likely than men to be referred to a cardiologist and therefore, may be less likely to receive care from clinicians recruiting for trials. Furthermore, older adults are disproportionately underrepresented in many trials, compounding the underrepresentation of women since disease prevalence is higher in women of older ages. The study team also found that...

A study found that risk for coronary heart disease was more than two-fold higher for smokers versus non-smokers among Black patients. Black patients who smoke are twice as likely to develop coronary heart disease (CHD) compared with patients who don’t, according to results from an analysis of data from the Jackson Heart Study. The First Close Look at Smoking & CHD in Black Patients The study, which was published in the Journal of the American Heart Association and supported by the National Heart, Lung, and Blood Institute and the National Institute of Minority Health and Health Disparities, constitutes the first close look at the relationship between smoking and CHD for this population, the National Institutes of Health (NIH) noted in a press release. The study was led by Adebamike A. Oshunbade, MD, MPH, of the Department of Medicine at the University of Mississippi Medical Center. For their analysis, Dr. Oshunbade and colleagues pulled data on 4,432 participants with no histor...