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importanceupper gastrointestinal bleeding is common after myocardial infarction.objectiveto determine whether routine screening for helicobacter pylori infection during hospitalization for myocardial infarction reduces bleeding events and improves clinical outcomes.design, setting, and participantsa nationwide, open-label, 2-period, 2-sequence, cluster randomized, crossover clinical trial using a clinical

backgroundsaphenous vein graft (svg) failure remains a substantial challenge after coronary artery bypass graft (cabg). ldl cholesterol (ldl-c) is a causal risk factor for atherosclerosis, but its role in svg failure is not well established. we evaluated whether early initiation of intensive ldl-c lowering with evolocumab could reduce svg failure.methodsnewton-cabg cardiolink-5 was a multicentre, double-blind

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backgroundaspirin monotherapy is recommended indefinitely for patients with established coronary artery disease (cad). the aim of this individual patient level meta-analysis was to provide a comprehensive evaluation of the comparative efficacy and safety of clopidogrel versus aspirin monotherapy in patients with established cad, most of whom had undergone percutaneous coronary intervention or had acute

dubbed “the stephen fry of radiology” by his friend and colleague paul mccoubrie, the witty, kindly polymath barry kelly bridged the gap between the humanities and natural sciences in a unique and compelling way. as well as being an outstanding radiologist, kelly wove “art, poetry and literature, history, philosophy, and medicine into mesmerising talks—all studded with his trademark humour,” according

salisbury says that the nhs 10 year plan lacks details on implementation and raises concerns that general practitioners will leave the nhs, that continuity of patient care is fragmented, and that an employee model will prevail over the “independent contractor” general practice.1 i have …

across the world, schools are banning smartphones. chris stokel-walker investigates what evidence exists for and against such restrictions there are certain health maxims we know and trust, that have become entrenched over time and with the weight of overwhelming scientific evidence. too much sugar and salt is bad for your health. not getting enough exercise can harm you. brush your teeth twice a day

doctor and olympic gold medallist imogen grant tells elgan manton-roseblade what she’s learnt from juggling a career in medicine with rowing for team gb between a surgical foundation training job and “at least daily” rowing training, imogen grant has a hectic schedule. in july she had one particularly busy day, racing at the henley royal regatta in the morning before rushing to work a hospital shift

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backgroundthe optimal timing of complete revascularisation for patients with st-segment elevation myocardial infarction (stemi) and multivessel coronary artery disease remains unclear. we aimed to assess whether immediate complete revascularisation was non-inferior to staged complete revascularisation during the index admission.methodswe conducted an open-label, randomised, non-inferiority trial at

backgrounddrug-coated devices are frequently used in coronary and peripheral interventions, but their effect on amputation risk in peripheral artery disease is unclear. we assessed whether drug-coated devices affect the rate of above-ankle amputation in patients with chronic limb-threatening ischaemia undergoing infrainguinal endovascular revascularisation.methodsthe swedish drug-elution trial in peripheral

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backgrounddrug-coated devices are widely used to reduce restenosis after lower limb revascularisation in patients with peripheral artery disease, but their effect on patient-centred outcomes remains unclear. we assessed the effect of paclitaxel-coated devices on clinically important outcomes in patients with intermittent claudication undergoing infrainguinal endovascular revascularisation.methodsthe

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backgroundalthough intensive blood pressure control is recommended by major guidelines, its overall benefit–harm balance remains uncertain. in particular, it is unclear how net clinical benefit varies by blood pressure target and patient characteristics. we aimed to quantify the benefit–harm trade-offs of intensive blood pressure control versus standard blood pressure control.methodswe conducted a

importancethe benefits of fractional flow reserve (ffr)–guided complete coronary revascularization in patients with non–st-segment elevation myocardial infarction (nstemi) and multivessel disease remain unclear.objectiveto compare ffr-guided complete revascularization of nonculprit lesions vs culprit-only revascularization in patients with nstemi and multivessel disease.design, setting, and participantsthis

importanceheart failure with preserved ejection fraction (hfpef) is a major cause of hospitalization, often occurring in patients with cardiometabolic comorbidities such as obesity and type 2 diabetes. although early trials of semaglutide and tirzepatide have shown promising results in improving symptoms, those findings were based on few clinical events, leaving treatment recommendations uncertain

backgroundinfluenza vaccination is widely recommended to prevent death and serious illness in vulnerable people, including those with heart failure. however, the randomised evidence to support this practice is limited and few people are vaccinated in many parts of the world. we aimed to determine whether influenza vaccination can improve the outcome of patients after an episode of acute heart failure

backgroundthe effects of β-blocker therapy on clinical outcomes in patients with myocardial infarction and mildly reduced (40–49%) left ventricular ejection fraction (lvef) are largely unknown. four recently conducted randomised trials tested the efficacy of β blockers after a recent myocardial infarction in patients without reduced lvef (lvef ≥40%). however, none were individually powered to assess

backgroundfollowing completion of the victoria trial, vericiguat was approved for the treatment of worsening heart failure with reduced ejection fraction (hfref) and received a class iib recommendation in european and north american guidelines. the subsequent victor trial evaluated the use of vericiguat in patients with hfref and no recent worsening. we aimed to assess the effect of vericiguat on clinical

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backgroundvericiguat is indicated to reduce the risk of cardiovascular death and hospitalisation for heart failure in patients with heart failure and reduced ejection fraction (hfref) following a recent worsening event. the aim of the victor trial was to assess the effect of vericiguat in patients with hfref without recent heart failure worsening.methodsin this double-blind, placebo-controlled, phase

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recent years have seen the emergence of academic sleuths, also known as research integrity sleuths, who devote time to detecting misconduct in academic research publications. the origin of the word “sleuth” has been traced back to a norwegian word for a track or trail, slōð, but its earlier indoeuropean roots have not been documented. i hypothesise a root, sleis, related to leis, also thought to have

importancerespiratory syncytial virus (rsv) infection is linked to elevated cardiovascular risk, particularly in individuals with preexisting cardiovascular disease (cvd). a bivalent rsv prefusion f protein (rsvpref) vaccine was recently approved for preventing rsv-related lower respiratory tract illness, but its effectiveness against cardiovascular outcomes has not been evaluated in a randomized trial

heart failure remains one of the 21st century's greatest unmet clinical and public health challenges. heart failure is a highly prevalent chronic condition that affects approximately 55 million people worldwide. although heart failure can be prevented, the global burden of this condition continues to grow, fuelled by an ageing population, improved survival after myocardial infarction, and increasing

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this series paper highlights the substantial progress made in understanding and preventing heart failure after acute myocardial infarction. improving global standards of care for management of acute myocardial infarction with timelier reperfusion has led to stepwise reductions in risk of incident heart failure. landmark clinical trials have established the role of renin–angiotensin–aldosterone system

the substantial and growing prevalence of heart failure, which remains the leading cause of preventable hospitalisation worldwide, has brought heart failure prevention into sharp focus. although this condition has historically been characterised by impaired cardiac function, mounting evidence has underscored its complex and multisystem pathobiology. epidemiological studies have indicated that other

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backgroundwe aimed to quantify the blood pressure-lowering efficacy of antihypertensive drugs and their combinations from the five major drug classes.methodswe conducted a systematic review and meta-analysis of randomised, double-blind, placebo-controlled trials involving adult participants randomly assigned to receive angiotensin-converting enzyme inhibitors, angiotensin ii receptor blockers, β blockers

backgrounda paucity of evidence regarding use of endoscopic sinus surgery and antibiotics in managing chronic rhinosinusitis has contributed to a five-times variation in endoscopic sinus surgery rates, as well as variation in the use of antibiotics. the main aim of the present trial was to compare the clinical effectiveness of endoscopic sinus surgery or 3 months of clarithromycin treatment alongside

backgroundsystematic analyses of global health trends can provide an accurate narrative of progress and challenges. we analysed the impact of changing age-specific mortality (epidemiology) and age structure (demography) on crude death rates (cdrs) and causes of death with large or rising mortality to inform the third lancet commission on investing in health.methodsdata from the world population prospects

a study of over 1.2 million children found no links between aluminum-adjuvanted childhood vaccines and over 50 chronic diseases, including neurological, autoimmune and allergic conditions.

when health is subordinated to market forces, deregulation, and austerity, the burden falls on vulnerable communities, write alejandra sánchez cabezas and juan franco since javier milei became argentina’s president in december 2023, his government has been systematically dismantling the country’s public health system.1 we’re not witnessing simply administrative decline or technical adjustment: it is

public health and human rights are inseparable, and academic freedom is vital to democratic resilience, write veljko stojanović and colleagues on 1 november 2024 the roof of a railway station collapsed in novi sad, serbia, claiming 16 lives. this avoidable tragedy sparked a nationwide civic awakening. students mobilised across the country, demanding that construction companies, local officials, and

this medical news article discusses a new finding that respiratory viral infections can trigger the proliferation of dormant breast cancer cells in the lungs.