Federal Practitioner

Key clinical point: Improved survival among children vs adults with hepatocellular carcinoma (HCC) despite greater fibrolamellar histology prevalence and positive lymph node number and similar metastasis rates is a likely result of a more aggressive surgical approach.

Major finding: Although children vs adults had a higher prevalence of fibrolamellar HCC (32% vs 9%) and number of positive lymph nodes (35% vs 17%; P  =  .02) and comparable metastasis rates (30% vs 28%; P  =  .47), they had significantly better 1-year (81% vs 70%) and 5-year (55% vs 48%) overall survival and surgical intervention (74% vs 62%) rates (all P < .001).

Study details: This study stratified the data of 1520 patients with grade ≥1 HCC from the National Cancer Database by age: <21 years (children; n = 244) and 21-40 years (young adults; n = 1276).

Disclosures: No source of funding was reported. SJ Commander declared receiving financial support from several sources.

Source: Commander SJ et al. Improved survival and higher rates of surgical resection associated with hepatocellular carcinoma in children as compared to young adults. Int J Cancer. 2022 (Jul 16). Doi:  10.1002/ijc.34215

Key clinical point: Improved survival among children vs adults with hepatocellular carcinoma (HCC) despite greater fibrolamellar histology prevalence and positive lymph node number and similar metastasis rates is a likely result of a more aggressive surgical approach.

Major finding: Although children vs adults had a higher prevalence of fibrolamellar HCC (32% vs 9%) and number of positive lymph nodes (35% vs 17%; P  =  .02) and comparable metastasis rates (30% vs 28%; P  =  .47), they had significantly better 1-year (81% vs 70%) and 5-year (55% vs 48%) overall survival and surgical intervention (74% vs 62%) rates (all P < .001).

Study details: This study stratified the data of 1520 patients with grade ≥1 HCC from the National Cancer Database by age: <21 years (children; n = 244) and 21-40 years (young adults; n = 1276).

Disclosures: No source of funding was reported. SJ Commander declared receiving financial support from several sources.

Source: Commander SJ et al. Improved survival and higher rates of surgical resection associated with hepatocellular carcinoma in children as compared to young adults. Int J Cancer. 2022 (Jul 16). Doi:  10.1002/ijc.34215

Key clinical point: Improved survival among children vs adults with hepatocellular carcinoma (HCC) despite greater fibrolamellar histology prevalence and positive lymph node number and similar metastasis rates is a likely result of a more aggressive surgical approach.

Major finding: Although children vs adults had a higher prevalence of fibrolamellar HCC (32% vs 9%) and number of positive lymph nodes (35% vs 17%; P  =  .02) and comparable metastasis rates (30% vs 28%; P  =  .47), they had significantly better 1-year (81% vs 70%) and 5-year (55% vs 48%) overall survival and surgical intervention (74% vs 62%) rates (all P < .001).

Study details: This study stratified the data of 1520 patients with grade ≥1 HCC from the National Cancer Database by age: <21 years (children; n = 244) and 21-40 years (young adults; n = 1276).

Disclosures: No source of funding was reported. SJ Commander declared receiving financial support from several sources.

Source: Commander SJ et al. Improved survival and higher rates of surgical resection associated with hepatocellular carcinoma in children as compared to young adults. Int J Cancer. 2022 (Jul 16). Doi:  10.1002/ijc.34215

Key clinical point: The combination of sorafenib adjuvant therapy and radiofrequency ablation (RFA) offers better survival outcomes than RFA alone in patients with recurrent hepatocellular carcinoma (RHCC) within Milan criteria after curative resection of primary HCC.

Major finding: Patients receiving RFA plus sorafenib vs RFA alone had significantly higher 1- and 3-year overall survival (97.7% vs 93.1%; P  =  .018 and 83.7% vs 61.3%; P < .001, respectively) and tumor-free survival (90.8% vs 67.8% and 49.0% vs 28.0%, respectively; both P < .001) rates.

Study details: This multicenter, retrospective study included 174 propensity score-matched pairs of adult patients with RHCC within Milan criteria who did or did not receive sorafenib after RFA.

Disclosures: This study was sponsored by the National Natural Science Foundation of China. The authors declared no conflicts of interest.

Source: Zhou Q et al. Sorafenib as adjuvant therapy following radiofrequency ablation for recurrent hepatocellular carcinoma within Milan criteria: A multicenter analysis. J Gastroenterol. 2022 (Jul 11). Doi: 10.1007/s00535-022-01895-3

Key clinical point: The combination of sorafenib adjuvant therapy and radiofrequency ablation (RFA) offers better survival outcomes than RFA alone in patients with recurrent hepatocellular carcinoma (RHCC) within Milan criteria after curative resection of primary HCC.

Major finding: Patients receiving RFA plus sorafenib vs RFA alone had significantly higher 1- and 3-year overall survival (97.7% vs 93.1%; P  =  .018 and 83.7% vs 61.3%; P < .001, respectively) and tumor-free survival (90.8% vs 67.8% and 49.0% vs 28.0%, respectively; both P < .001) rates.

Study details: This multicenter, retrospective study included 174 propensity score-matched pairs of adult patients with RHCC within Milan criteria who did or did not receive sorafenib after RFA.

Disclosures: This study was sponsored by the National Natural Science Foundation of China. The authors declared no conflicts of interest.

Source: Zhou Q et al. Sorafenib as adjuvant therapy following radiofrequency ablation for recurrent hepatocellular carcinoma within Milan criteria: A multicenter analysis. J Gastroenterol. 2022 (Jul 11). Doi: 10.1007/s00535-022-01895-3

Key clinical point: The combination of sorafenib adjuvant therapy and radiofrequency ablation (RFA) offers better survival outcomes than RFA alone in patients with recurrent hepatocellular carcinoma (RHCC) within Milan criteria after curative resection of primary HCC.

Major finding: Patients receiving RFA plus sorafenib vs RFA alone had significantly higher 1- and 3-year overall survival (97.7% vs 93.1%; P  =  .018 and 83.7% vs 61.3%; P < .001, respectively) and tumor-free survival (90.8% vs 67.8% and 49.0% vs 28.0%, respectively; both P < .001) rates.

Study details: This multicenter, retrospective study included 174 propensity score-matched pairs of adult patients with RHCC within Milan criteria who did or did not receive sorafenib after RFA.

Disclosures: This study was sponsored by the National Natural Science Foundation of China. The authors declared no conflicts of interest.

Source: Zhou Q et al. Sorafenib as adjuvant therapy following radiofrequency ablation for recurrent hepatocellular carcinoma within Milan criteria: A multicenter analysis. J Gastroenterol. 2022 (Jul 11). Doi: 10.1007/s00535-022-01895-3

Key clinical point: Baseline hepatitis B virus (HBV) DNA levels are not associated with the clinical outcomes of patients with HBV-related hepatocellular carcinoma (HCC) treated with anti-programmed cell death protein 1 (anti-PD-1)-based immunotherapy.

Major finding: Baseline HBV DNA levels were not significantly associated with the overall survival (adjusted hazard ratio [aHR] 0.77; P  =  .59) or progression-free survival (aHR 0.68; P  =  .098).

Study details: This single-center retrospective observational study included 217 patients with advanced HBV-related HCC who received ≥1 dose of anti-PD-1 therapy.

Disclosures: This study was supported by the National Natural Science Foundation of China and Medical Science and Technology Research Project of Health Commission of Henan Province. The authors declared no conflicts of interest.

Source: An M et al. Association of hepatitis B virus DNA levels with overall survival for advanced hepatitis B virus-related hepatocellular carcinoma under immune checkpoint inhibitor therapy. Cancer Immunol Immunother. 2022 (Jul 30). Doi: 10.1007/s00262-022-03254-w

Key clinical point: Baseline hepatitis B virus (HBV) DNA levels are not associated with the clinical outcomes of patients with HBV-related hepatocellular carcinoma (HCC) treated with anti-programmed cell death protein 1 (anti-PD-1)-based immunotherapy.

Major finding: Baseline HBV DNA levels were not significantly associated with the overall survival (adjusted hazard ratio [aHR] 0.77; P  =  .59) or progression-free survival (aHR 0.68; P  =  .098).

Study details: This single-center retrospective observational study included 217 patients with advanced HBV-related HCC who received ≥1 dose of anti-PD-1 therapy.

Disclosures: This study was supported by the National Natural Science Foundation of China and Medical Science and Technology Research Project of Health Commission of Henan Province. The authors declared no conflicts of interest.

Source: An M et al. Association of hepatitis B virus DNA levels with overall survival for advanced hepatitis B virus-related hepatocellular carcinoma under immune checkpoint inhibitor therapy. Cancer Immunol Immunother. 2022 (Jul 30). Doi: 10.1007/s00262-022-03254-w

Key clinical point: Baseline hepatitis B virus (HBV) DNA levels are not associated with the clinical outcomes of patients with HBV-related hepatocellular carcinoma (HCC) treated with anti-programmed cell death protein 1 (anti-PD-1)-based immunotherapy.

Major finding: Baseline HBV DNA levels were not significantly associated with the overall survival (adjusted hazard ratio [aHR] 0.77; P  =  .59) or progression-free survival (aHR 0.68; P  =  .098).

Study details: This single-center retrospective observational study included 217 patients with advanced HBV-related HCC who received ≥1 dose of anti-PD-1 therapy.

Disclosures: This study was supported by the National Natural Science Foundation of China and Medical Science and Technology Research Project of Health Commission of Henan Province. The authors declared no conflicts of interest.

Source: An M et al. Association of hepatitis B virus DNA levels with overall survival for advanced hepatitis B virus-related hepatocellular carcinoma under immune checkpoint inhibitor therapy. Cancer Immunol Immunother. 2022 (Jul 30). Doi: 10.1007/s00262-022-03254-w

Key clinical point: Compared with transcatheter arterial chemoembolization (TACE), hepatic arterial infusion chemotherapy (HAIC) offers better efficacy in patients with advanced hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT) without significantly compromising safety.

Major finding: Patients receiving HAIC vs TACE had a significantly longer median overall survival (11.2 vs 9.0 months; P  =  .010) and progression-free survival (5.6 vs 2.0 months; P  =  .006) and a higher objective response rate (56.8% vs 18.2%; P < .001). No treatment‐related grade 4/5 adverse events were reported.

Study details: This was a propensity score‐matched cohort study including 44 pairs of adult patients with advanced HCC and PVTT who underwent HAIC with oxaliplatin plus raltitrexed or TACE.

Disclosures: This study was supported by the Guiding Project of Science and Technology Program of Fujian Province, China.

Source: Chen S, Yuan B, et al. Hepatic arterial infusion oxaliplatin plus raltitrexed and chemoembolization in hepatocellular carcinoma with portal vein invasion: A propensity score-matching cohort study. J Surg Oncol. 2022 (Jul 20). Doi: 10.1002/jso.27023

Key clinical point: Compared with transcatheter arterial chemoembolization (TACE), hepatic arterial infusion chemotherapy (HAIC) offers better efficacy in patients with advanced hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT) without significantly compromising safety.

Major finding: Patients receiving HAIC vs TACE had a significantly longer median overall survival (11.2 vs 9.0 months; P  =  .010) and progression-free survival (5.6 vs 2.0 months; P  =  .006) and a higher objective response rate (56.8% vs 18.2%; P < .001). No treatment‐related grade 4/5 adverse events were reported.

Study details: This was a propensity score‐matched cohort study including 44 pairs of adult patients with advanced HCC and PVTT who underwent HAIC with oxaliplatin plus raltitrexed or TACE.

Disclosures: This study was supported by the Guiding Project of Science and Technology Program of Fujian Province, China.

Source: Chen S, Yuan B, et al. Hepatic arterial infusion oxaliplatin plus raltitrexed and chemoembolization in hepatocellular carcinoma with portal vein invasion: A propensity score-matching cohort study. J Surg Oncol. 2022 (Jul 20). Doi: 10.1002/jso.27023

Key clinical point: Compared with transcatheter arterial chemoembolization (TACE), hepatic arterial infusion chemotherapy (HAIC) offers better efficacy in patients with advanced hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT) without significantly compromising safety.

Major finding: Patients receiving HAIC vs TACE had a significantly longer median overall survival (11.2 vs 9.0 months; P  =  .010) and progression-free survival (5.6 vs 2.0 months; P  =  .006) and a higher objective response rate (56.8% vs 18.2%; P < .001). No treatment‐related grade 4/5 adverse events were reported.

Study details: This was a propensity score‐matched cohort study including 44 pairs of adult patients with advanced HCC and PVTT who underwent HAIC with oxaliplatin plus raltitrexed or TACE.

Disclosures: This study was supported by the Guiding Project of Science and Technology Program of Fujian Province, China.

Source: Chen S, Yuan B, et al. Hepatic arterial infusion oxaliplatin plus raltitrexed and chemoembolization in hepatocellular carcinoma with portal vein invasion: A propensity score-matching cohort study. J Surg Oncol. 2022 (Jul 20). Doi: 10.1002/jso.27023

Key clinical point: Heavy alcohol intake and ALDH2 rs671 polymorphism are associated with a significantly increased risk for hepatocellular carcinoma (HCC) development in patients with hepatitis B virus (HBV)-related cirrhosis.

Major finding: Alcohol intake amount (>160 vs 80-160 g/day: adjusted hazard ratio [aHR] 1.78; P  =  .04) and ALDH2 rs671 polymorphism (GA/AA vs GG genotype: aHR 5.61; P < .001) were significantly associated with an increased incidence of HCC.

Study details: This retrospective cohort study enrolled 1515 patients with cirrhosis due to heavy alcoholism or HBV infection.

Disclosures: This study was sponsored by the Ministry of Science and Technology, Taiwan, E-Da Hospital-National Taiwan University Hospital Joint Research Program, and others.

Source: Tsai MC et al. Association of heavy alcohol intake and ALDH2 rs671 polymorphism with hepatocellular carcinoma and mortality in patients with hepatitis B virus–related cirrhosis. JAMA Netw Open. 2022;5(7):e2223511 (Jul 25). Doi: 10.1001/jamanetworkopen.2022.23511

Key clinical point: Heavy alcohol intake and ALDH2 rs671 polymorphism are associated with a significantly increased risk for hepatocellular carcinoma (HCC) development in patients with hepatitis B virus (HBV)-related cirrhosis.

Major finding: Alcohol intake amount (>160 vs 80-160 g/day: adjusted hazard ratio [aHR] 1.78; P  =  .04) and ALDH2 rs671 polymorphism (GA/AA vs GG genotype: aHR 5.61; P < .001) were significantly associated with an increased incidence of HCC.

Study details: This retrospective cohort study enrolled 1515 patients with cirrhosis due to heavy alcoholism or HBV infection.

Disclosures: This study was sponsored by the Ministry of Science and Technology, Taiwan, E-Da Hospital-National Taiwan University Hospital Joint Research Program, and others.

Source: Tsai MC et al. Association of heavy alcohol intake and ALDH2 rs671 polymorphism with hepatocellular carcinoma and mortality in patients with hepatitis B virus–related cirrhosis. JAMA Netw Open. 2022;5(7):e2223511 (Jul 25). Doi: 10.1001/jamanetworkopen.2022.23511

Key clinical point: Heavy alcohol intake and ALDH2 rs671 polymorphism are associated with a significantly increased risk for hepatocellular carcinoma (HCC) development in patients with hepatitis B virus (HBV)-related cirrhosis.

Major finding: Alcohol intake amount (>160 vs 80-160 g/day: adjusted hazard ratio [aHR] 1.78; P  =  .04) and ALDH2 rs671 polymorphism (GA/AA vs GG genotype: aHR 5.61; P < .001) were significantly associated with an increased incidence of HCC.

Study details: This retrospective cohort study enrolled 1515 patients with cirrhosis due to heavy alcoholism or HBV infection.

Disclosures: This study was sponsored by the Ministry of Science and Technology, Taiwan, E-Da Hospital-National Taiwan University Hospital Joint Research Program, and others.

Source: Tsai MC et al. Association of heavy alcohol intake and ALDH2 rs671 polymorphism with hepatocellular carcinoma and mortality in patients with hepatitis B virus–related cirrhosis. JAMA Netw Open. 2022;5(7):e2223511 (Jul 25). Doi: 10.1001/jamanetworkopen.2022.23511

Key clinical point: The excellent 10-year post-liver transplant (LT) outcomes in patients with hepatocellular carcinoma (HCC) successfully downstaged to within Milan criteria (MC) substantiate the validity of the national downstaging policy.

Major finding: At 10 years after LT, patients with HCC always within MC, those with HCC downstaged before LT, and those with HCC unsuccessfully downstaged/progressed beyond MC during LT had survival rates of 61.5%, 52.1%, and 43.3%, respectively, and recurrence rates of 13.3%, 20.6%, and 41.4%, respectively.

Study details: This retrospective cohort study analyzed the prospective data of 2645 adult patients with HCC who underwent LT at 5 US academic centers.

Disclosures: This study was sponsored by the US Department of Defense, Samuel Waxman Cancer Research Foundation, Spanish National Health Institute, and Cancer Research UK, among others. Two authors reported receiving grants or a board of directors’ honoraria from various sources.

Source: Tabrizian P et al. Ten-year outcomes of liver transplant and downstaging for hepatocellular carcinoma. JAMA Surg. 2022 (Jul 20). Doi: 10.1001/jamasurg.2022.2800

Key clinical point: The excellent 10-year post-liver transplant (LT) outcomes in patients with hepatocellular carcinoma (HCC) successfully downstaged to within Milan criteria (MC) substantiate the validity of the national downstaging policy.

Major finding: At 10 years after LT, patients with HCC always within MC, those with HCC downstaged before LT, and those with HCC unsuccessfully downstaged/progressed beyond MC during LT had survival rates of 61.5%, 52.1%, and 43.3%, respectively, and recurrence rates of 13.3%, 20.6%, and 41.4%, respectively.

Study details: This retrospective cohort study analyzed the prospective data of 2645 adult patients with HCC who underwent LT at 5 US academic centers.

Disclosures: This study was sponsored by the US Department of Defense, Samuel Waxman Cancer Research Foundation, Spanish National Health Institute, and Cancer Research UK, among others. Two authors reported receiving grants or a board of directors’ honoraria from various sources.

Source: Tabrizian P et al. Ten-year outcomes of liver transplant and downstaging for hepatocellular carcinoma. JAMA Surg. 2022 (Jul 20). Doi: 10.1001/jamasurg.2022.2800

Key clinical point: The excellent 10-year post-liver transplant (LT) outcomes in patients with hepatocellular carcinoma (HCC) successfully downstaged to within Milan criteria (MC) substantiate the validity of the national downstaging policy.

Major finding: At 10 years after LT, patients with HCC always within MC, those with HCC downstaged before LT, and those with HCC unsuccessfully downstaged/progressed beyond MC during LT had survival rates of 61.5%, 52.1%, and 43.3%, respectively, and recurrence rates of 13.3%, 20.6%, and 41.4%, respectively.

Study details: This retrospective cohort study analyzed the prospective data of 2645 adult patients with HCC who underwent LT at 5 US academic centers.

Disclosures: This study was sponsored by the US Department of Defense, Samuel Waxman Cancer Research Foundation, Spanish National Health Institute, and Cancer Research UK, among others. Two authors reported receiving grants or a board of directors’ honoraria from various sources.

Source: Tabrizian P et al. Ten-year outcomes of liver transplant and downstaging for hepatocellular carcinoma. JAMA Surg. 2022 (Jul 20). Doi: 10.1001/jamasurg.2022.2800

Key clinical point: The excellent 10-year post-liver transplant (LT) outcomes in patients with hepatocellular carcinoma (HCC) successfully downstaged to within Milan criteria (MC) substantiate the validity of the national downstaging policy.

Major finding: At 10 years after LT, patients with HCC always within MC, those with HCC downstaged before LT, and those with HCC unsuccessfully downstaged/progressed beyond MC during LT had survival rates of 61.5%, 52.1%, and 43.3%, respectively, and recurrence rates of 13.3%, 20.6%, and 41.4%, respectively.

Study details: This retrospective cohort study analyzed the prospective data of 2645 adult patients with HCC who underwent LT at 5 US academic centers.

Disclosures: This study was sponsored by the US Department of Defense, Samuel Waxman Cancer Research Foundation, Spanish National Health Institute, and Cancer Research UK, among others. Two authors reported receiving grants or a board of directors’ honoraria from various sources.

Source: Tabrizian P et al. Ten-year outcomes of liver transplant and downstaging for hepatocellular carcinoma. JAMA Surg. 2022 (Jul 20). Doi: 10.1001/jamasurg.2022.2800

Key clinical point: The excellent 10-year post-liver transplant (LT) outcomes in patients with hepatocellular carcinoma (HCC) successfully downstaged to within Milan criteria (MC) substantiate the validity of the national downstaging policy.

Major finding: At 10 years after LT, patients with HCC always within MC, those with HCC downstaged before LT, and those with HCC unsuccessfully downstaged/progressed beyond MC during LT had survival rates of 61.5%, 52.1%, and 43.3%, respectively, and recurrence rates of 13.3%, 20.6%, and 41.4%, respectively.

Study details: This retrospective cohort study analyzed the prospective data of 2645 adult patients with HCC who underwent LT at 5 US academic centers.

Disclosures: This study was sponsored by the US Department of Defense, Samuel Waxman Cancer Research Foundation, Spanish National Health Institute, and Cancer Research UK, among others. Two authors reported receiving grants or a board of directors’ honoraria from various sources.

Source: Tabrizian P et al. Ten-year outcomes of liver transplant and downstaging for hepatocellular carcinoma. JAMA Surg. 2022 (Jul 20). Doi: 10.1001/jamasurg.2022.2800

Key clinical point: The excellent 10-year post-liver transplant (LT) outcomes in patients with hepatocellular carcinoma (HCC) successfully downstaged to within Milan criteria (MC) substantiate the validity of the national downstaging policy.

Major finding: At 10 years after LT, patients with HCC always within MC, those with HCC downstaged before LT, and those with HCC unsuccessfully downstaged/progressed beyond MC during LT had survival rates of 61.5%, 52.1%, and 43.3%, respectively, and recurrence rates of 13.3%, 20.6%, and 41.4%, respectively.

Study details: This retrospective cohort study analyzed the prospective data of 2645 adult patients with HCC who underwent LT at 5 US academic centers.

Disclosures: This study was sponsored by the US Department of Defense, Samuel Waxman Cancer Research Foundation, Spanish National Health Institute, and Cancer Research UK, among others. Two authors reported receiving grants or a board of directors’ honoraria from various sources.

Source: Tabrizian P et al. Ten-year outcomes of liver transplant and downstaging for hepatocellular carcinoma. JAMA Surg. 2022 (Jul 20). Doi: 10.1001/jamasurg.2022.2800

Key clinical point: Lenvatinib combined with transarterial chemoembolization (LEN-TACE) is more effective than LEN alone as the first-line therapy for advanced hepatocellular carcinoma (HCC).

Major finding: After a 17.0-month median follow-up, the LEN-TACE vs LEN group had a significantly longer median overall survival (17.8 vs 11.5 months; hazard ratio [HR] 0.45; P < .001) and progression-free survival (10.6 vs 6.4 months; HR 0.43; P < .001) and higher objective response rate (54.1% vs 25.0%; P < .001).

Study details: Findings are from a multicenter, phase 3 trial, LAUNCH, that included 338 adult patients with treatment-naive primary or initial recurrent advanced HCC after surgery who were randomly assigned to receive LEN-TACE (n = 170) or LEN monotherapy (n = 168).

Disclosures: This study was supported by Science and Technology Innovation 2030 Major Projects, China, among others. One author declared serving as a consultant/advisor for and receiving honoraria and research funding from GenomiCare.

Source: Peng Z et al. Lenvatinib combined with transarterial chemoembolization as first-line treatment for advanced hepatocellular carcinoma: A phase III, randomized clinical trial (LAUNCH). J Clin Oncol. 2022 (Aug 3). Doi: 10.1200/JCO.22.00392

Key clinical point: Lenvatinib combined with transarterial chemoembolization (LEN-TACE) is more effective than LEN alone as the first-line therapy for advanced hepatocellular carcinoma (HCC).

Major finding: After a 17.0-month median follow-up, the LEN-TACE vs LEN group had a significantly longer median overall survival (17.8 vs 11.5 months; hazard ratio [HR] 0.45; P < .001) and progression-free survival (10.6 vs 6.4 months; HR 0.43; P < .001) and higher objective response rate (54.1% vs 25.0%; P < .001).

Study details: Findings are from a multicenter, phase 3 trial, LAUNCH, that included 338 adult patients with treatment-naive primary or initial recurrent advanced HCC after surgery who were randomly assigned to receive LEN-TACE (n = 170) or LEN monotherapy (n = 168).

Disclosures: This study was supported by Science and Technology Innovation 2030 Major Projects, China, among others. One author declared serving as a consultant/advisor for and receiving honoraria and research funding from GenomiCare.

Source: Peng Z et al. Lenvatinib combined with transarterial chemoembolization as first-line treatment for advanced hepatocellular carcinoma: A phase III, randomized clinical trial (LAUNCH). J Clin Oncol. 2022 (Aug 3). Doi: 10.1200/JCO.22.00392

Key clinical point: Lenvatinib combined with transarterial chemoembolization (LEN-TACE) is more effective than LEN alone as the first-line therapy for advanced hepatocellular carcinoma (HCC).

Major finding: After a 17.0-month median follow-up, the LEN-TACE vs LEN group had a significantly longer median overall survival (17.8 vs 11.5 months; hazard ratio [HR] 0.45; P < .001) and progression-free survival (10.6 vs 6.4 months; HR 0.43; P < .001) and higher objective response rate (54.1% vs 25.0%; P < .001).

Study details: Findings are from a multicenter, phase 3 trial, LAUNCH, that included 338 adult patients with treatment-naive primary or initial recurrent advanced HCC after surgery who were randomly assigned to receive LEN-TACE (n = 170) or LEN monotherapy (n = 168).

Disclosures: This study was supported by Science and Technology Innovation 2030 Major Projects, China, among others. One author declared serving as a consultant/advisor for and receiving honoraria and research funding from GenomiCare.

Source: Peng Z et al. Lenvatinib combined with transarterial chemoembolization as first-line treatment for advanced hepatocellular carcinoma: A phase III, randomized clinical trial (LAUNCH). J Clin Oncol. 2022 (Aug 3). Doi: 10.1200/JCO.22.00392

Symptoms of six common cardiovascular diseases (CVD) – acute coronary syndromes, heart failure, valvular disorders, stroke, rhythm disorders, and peripheral vascular disease – often overlap and may vary over time and by sex, the American Heart Association noted in a new scientific statement.

“Symptoms of these cardiovascular diseases can profoundly affect quality of life, and a clear understanding of them is critical for effective diagnosis and treatment decisions,” Corrine Y. Jurgens, PhD, chair of the writing committee, said in a news release.

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This scientific statement is a “compendium detailing the symptoms associated with CVD, similarities or differences in symptoms among the conditions, and sex differences in symptom presentation and reporting,” said Dr. Jurgens, associate professor at Connell School of Nursing, Boston College.

The new statement was published online in Circulation.

The writing group noted that measuring CVD symptoms can be challenging because of their subjective nature. Symptoms may go unrecognized or unreported if people don’t think they are important or are related to an existing health condition.

“Some people may not consider symptoms like fatigue, sleep disturbance, weight gain, and depression as important or related to cardiovascular disease. However, research indicates that subtle symptoms such as these may predict acute events and the need for hospitalization,” Dr. Jurgens said.
 

ACS – chest pain and associated symptoms

The writing group noted that chest pain is the most frequently reported symptom of ACS and has often been described as substernal pressure or discomfort and may radiate to the jaw, shoulder, arm, or upper back.

The most common co-occurring symptoms are dyspnea, diaphoresis, unusual fatigue, nausea, and lightheadedness. Women are more likely than men to report additional symptoms outside of chest pain.

As a result, they have often been labeled “atypical.” However, a recent AHA advisory notes that this label may have been caused by the lack of women included in the clinical trials from which the symptom lists were derived.

The writing group said there is a need to “harmonize” ACS symptom measurement in research. The current lack of harmonization of ACS symptom measurement in research hampers growth in cumulative evidence.

“Therefore, little can be done to synthesize salient findings about symptoms across ischemic heart disease/ACS studies and to incorporate evidence-based information about symptoms into treatment guidelines and patient education materials,” they cautioned. 
 

Heart failure

Turning to heart failure (HF), the writing group noted that dyspnea is the classic symptom and a common reason adults seek medical care.

However, early, more subtle symptoms should be recognized. These include gastrointestinal symptoms such as upset stomach, nausea, vomiting, and loss of appetite; fatigue; exercise intolerance; insomnia; pain (chest and otherwise); mood disturbances (primarily depression and anxiety); and cognitive dysfunction (brain fog, memory problems).

Women with HF report a wider variety of symptoms, are more likely to have depression and anxiety, and report a lower quality of life, compared with men with HF.

“It is important to account for dyspnea heterogeneity in both clinical practice and research by using nuanced measures and probing questions to capture this common and multifaceted symptom,” the writing group said.

“Monitoring symptoms on a spectrum, versus present or not present, with reliable and valid measures may enhance clinical care by identifying more quickly those who may be at risk for poor outcomes, such as lower quality of life, hospitalization, or death,” Dr. Jurgens added.

“Ultimately, we have work to do in terms of determining who needs more frequent monitoring or intervention to avert poor HF outcomes,” she said.
 

Valvular heart disease

Valvular heart disease is a frequent cause of HF, with symptoms generally indistinguishable from other HF causes. Rheumatic heart disease is still prevalent in low- and middle-income countries but has largely disappeared in high-income countries, with population aging and cardiomyopathies now key drivers of valve disease.

In the absence of acute severe valve dysfunction, patients generally have a prolonged asymptomatic period, followed by a period of progressive symptoms, resulting from the valve lesion itself or secondary myocardial remodeling and dysfunction, the writing group said. 

Symptoms of aortic valve disease often differ between men and women. Aortic stenosis is typically silent for years. As stenosis progresses, women report dyspnea and exercise intolerance more often than men. Women are also more likely to be physically frail and to have a higher New York Heart Association class (III/IV) than men. Men are more likely to have chest pain.

“Given the importance of symptom assessment, more work is needed to determine the incremental value of quantitative symptom measurement as an aid to clinical management,” the writing group said.
 

Stroke

For clinicians, classic stroke symptoms (face drooping, arm weakness, speech difficulty), in addition to nonclassic symptoms, such as partial sensory deficit, dysarthria, vertigo, and diplopia, should be considered for activating a stroke response team, the group says.

A systematic review and meta-analysis revealed that women with stroke were more likely to present with nonfocal symptoms (for example, headache, altered mentality, and coma/stupor) than men, they noted.

To enhance public education about stroke symptoms and to facilitate the diagnosis and treatment of stroke, they say research is needed to better understand the presentation of stroke symptoms by other select demographic characteristics including race and ethnicity, age, and stroke subtype.

Poststroke screening should include assessment for anxiety, depression, fatigue, and pain, the writing group said.
 

Rhythm disorders

Turning to rhythm disorders, the writing group wrote that cardiac arrhythmias, including atrial fibrillation (AFib), atrial flutter, supraventricular tachycardia, bradyarrhythmia, and ventricular tachycardia, present with common symptoms.

Palpitations are a characteristic symptom of many cardiac arrhythmias. The most common cardiac arrhythmia, AFib, may present with palpitations or less specific symptoms (fatigue, dyspnea, dizziness) that occur with a broad range of rhythm disorders. Chest pain, dizziness, presyncope/syncope, and anxiety occur less frequently in AFib, the group said.

Palpitations are considered the typical symptom presentation for AFib, yet patients with new-onset AFib often present with nonspecific symptoms or no symptoms, they pointed out.

Women and younger individuals with AFib typically present with palpitations, whereas men are more commonly asymptomatic. Older age also increases the likelihood of a nonclassic or asymptomatic presentation of AFib.

Despite non-Hispanic Black individuals being at lower risk for development of AFib, research suggests that Black patients are burdened more with palpitations, dyspnea on exertion, exercise intolerance, dizziness, dyspnea at rest, and chest discomfort, compared with White or Hispanic patients.

Peripheral vascular disease

Classic claudication occurs in roughly one-third of patients with peripheral arterial disease (PAD) and is defined as calf pain that occurs in one or both legs with exertion (walking), does not begin at rest, and resolves within 10 minutes of standing still or rest.

However, non–calf exercise pain is reported more frequently than classic claudication symptoms. Women with PAD are more likely to have nonclassic symptoms or an absence of symptoms.

Assessing symptoms at rest, during exercise, and during recovery can assist with classifying symptoms as ischemic or not, the writing group said.

PAD with symptoms is associated with an increased risk for myocardial infarction and stroke, with men at higher risk than women.

Similar to PAD, peripheral venous disease (PVD) can be symptomatic or asymptomatic. Clinical classification of PVD includes symptoms such as leg pain, aching, fatigue, heaviness, cramping, tightness, restless legs syndrome, and skin irritation.

“Measuring vascular symptoms includes assessing quality of life and activity limitations, as well as the psychological impact of the disease. However, existing measures are often based on the clinician’s appraisal rather than the individual’s self-reported symptoms and severity of symptoms,” Dr. Jurgens commented.
 

Watch for depression

Finally, the writing group highlighted the importance of depression in cardiac patients, which occurs at about twice the rate, compared with people without any medical condition (10% vs. 5%).

In a prior statement, the AHA said depression should be considered a risk factor for worse outcomes in patients with ACS or CVD diagnosis.

The new statement highlights that people with persistent chest pain, people with HF, as well as stroke survivors and people with PAD commonly have depression and/or anxiety. In addition, cognitive changes after a stroke may affect how and whether symptoms are experienced or noticed.

While symptom relief is an important part of managing CVD, it’s also important to recognize that “factors such as depression and cognitive function may affect symptom detection and reporting,” Dr. Jurgens said.

“Monitoring and measuring symptoms with tools that appropriately account for depression and cognitive function may help to improve patient care by identifying more quickly people who may be at higher risk,” she added.

The scientific statement was prepared by the volunteer writing group on behalf of the AHA Council on Cardiovascular and Stroke Nursing; the Council on Hypertension; and the Stroke Council. The research had no commercial funding. The authors reported no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Symptoms of six common cardiovascular diseases (CVD) – acute coronary syndromes, heart failure, valvular disorders, stroke, rhythm disorders, and peripheral vascular disease – often overlap and may vary over time and by sex, the American Heart Association noted in a new scientific statement.

“Symptoms of these cardiovascular diseases can profoundly affect quality of life, and a clear understanding of them is critical for effective diagnosis and treatment decisions,” Corrine Y. Jurgens, PhD, chair of the writing committee, said in a news release.

Copyright pixelheadphoto/Thinkstock

This scientific statement is a “compendium detailing the symptoms associated with CVD, similarities or differences in symptoms among the conditions, and sex differences in symptom presentation and reporting,” said Dr. Jurgens, associate professor at Connell School of Nursing, Boston College.

The new statement was published online in Circulation.

The writing group noted that measuring CVD symptoms can be challenging because of their subjective nature. Symptoms may go unrecognized or unreported if people don’t think they are important or are related to an existing health condition.

“Some people may not consider symptoms like fatigue, sleep disturbance, weight gain, and depression as important or related to cardiovascular disease. However, research indicates that subtle symptoms such as these may predict acute events and the need for hospitalization,” Dr. Jurgens said.
 

ACS – chest pain and associated symptoms

The writing group noted that chest pain is the most frequently reported symptom of ACS and has often been described as substernal pressure or discomfort and may radiate to the jaw, shoulder, arm, or upper back.

The most common co-occurring symptoms are dyspnea, diaphoresis, unusual fatigue, nausea, and lightheadedness. Women are more likely than men to report additional symptoms outside of chest pain.

As a result, they have often been labeled “atypical.” However, a recent AHA advisory notes that this label may have been caused by the lack of women included in the clinical trials from which the symptom lists were derived.

The writing group said there is a need to “harmonize” ACS symptom measurement in research. The current lack of harmonization of ACS symptom measurement in research hampers growth in cumulative evidence.

“Therefore, little can be done to synthesize salient findings about symptoms across ischemic heart disease/ACS studies and to incorporate evidence-based information about symptoms into treatment guidelines and patient education materials,” they cautioned. 
 

Heart failure

Turning to heart failure (HF), the writing group noted that dyspnea is the classic symptom and a common reason adults seek medical care.

However, early, more subtle symptoms should be recognized. These include gastrointestinal symptoms such as upset stomach, nausea, vomiting, and loss of appetite; fatigue; exercise intolerance; insomnia; pain (chest and otherwise); mood disturbances (primarily depression and anxiety); and cognitive dysfunction (brain fog, memory problems).

Women with HF report a wider variety of symptoms, are more likely to have depression and anxiety, and report a lower quality of life, compared with men with HF.

“It is important to account for dyspnea heterogeneity in both clinical practice and research by using nuanced measures and probing questions to capture this common and multifaceted symptom,” the writing group said.

“Monitoring symptoms on a spectrum, versus present or not present, with reliable and valid measures may enhance clinical care by identifying more quickly those who may be at risk for poor outcomes, such as lower quality of life, hospitalization, or death,” Dr. Jurgens added.

“Ultimately, we have work to do in terms of determining who needs more frequent monitoring or intervention to avert poor HF outcomes,” she said.
 

Valvular heart disease

Valvular heart disease is a frequent cause of HF, with symptoms generally indistinguishable from other HF causes. Rheumatic heart disease is still prevalent in low- and middle-income countries but has largely disappeared in high-income countries, with population aging and cardiomyopathies now key drivers of valve disease.

In the absence of acute severe valve dysfunction, patients generally have a prolonged asymptomatic period, followed by a period of progressive symptoms, resulting from the valve lesion itself or secondary myocardial remodeling and dysfunction, the writing group said. 

Symptoms of aortic valve disease often differ between men and women. Aortic stenosis is typically silent for years. As stenosis progresses, women report dyspnea and exercise intolerance more often than men. Women are also more likely to be physically frail and to have a higher New York Heart Association class (III/IV) than men. Men are more likely to have chest pain.

“Given the importance of symptom assessment, more work is needed to determine the incremental value of quantitative symptom measurement as an aid to clinical management,” the writing group said.
 

Stroke

For clinicians, classic stroke symptoms (face drooping, arm weakness, speech difficulty), in addition to nonclassic symptoms, such as partial sensory deficit, dysarthria, vertigo, and diplopia, should be considered for activating a stroke response team, the group says.

A systematic review and meta-analysis revealed that women with stroke were more likely to present with nonfocal symptoms (for example, headache, altered mentality, and coma/stupor) than men, they noted.

To enhance public education about stroke symptoms and to facilitate the diagnosis and treatment of stroke, they say research is needed to better understand the presentation of stroke symptoms by other select demographic characteristics including race and ethnicity, age, and stroke subtype.

Poststroke screening should include assessment for anxiety, depression, fatigue, and pain, the writing group said.
 

Rhythm disorders

Turning to rhythm disorders, the writing group wrote that cardiac arrhythmias, including atrial fibrillation (AFib), atrial flutter, supraventricular tachycardia, bradyarrhythmia, and ventricular tachycardia, present with common symptoms.

Palpitations are a characteristic symptom of many cardiac arrhythmias. The most common cardiac arrhythmia, AFib, may present with palpitations or less specific symptoms (fatigue, dyspnea, dizziness) that occur with a broad range of rhythm disorders. Chest pain, dizziness, presyncope/syncope, and anxiety occur less frequently in AFib, the group said.

Palpitations are considered the typical symptom presentation for AFib, yet patients with new-onset AFib often present with nonspecific symptoms or no symptoms, they pointed out.

Women and younger individuals with AFib typically present with palpitations, whereas men are more commonly asymptomatic. Older age also increases the likelihood of a nonclassic or asymptomatic presentation of AFib.

Despite non-Hispanic Black individuals being at lower risk for development of AFib, research suggests that Black patients are burdened more with palpitations, dyspnea on exertion, exercise intolerance, dizziness, dyspnea at rest, and chest discomfort, compared with White or Hispanic patients.

Peripheral vascular disease

Classic claudication occurs in roughly one-third of patients with peripheral arterial disease (PAD) and is defined as calf pain that occurs in one or both legs with exertion (walking), does not begin at rest, and resolves within 10 minutes of standing still or rest.

However, non–calf exercise pain is reported more frequently than classic claudication symptoms. Women with PAD are more likely to have nonclassic symptoms or an absence of symptoms.

Assessing symptoms at rest, during exercise, and during recovery can assist with classifying symptoms as ischemic or not, the writing group said.

PAD with symptoms is associated with an increased risk for myocardial infarction and stroke, with men at higher risk than women.

Similar to PAD, peripheral venous disease (PVD) can be symptomatic or asymptomatic. Clinical classification of PVD includes symptoms such as leg pain, aching, fatigue, heaviness, cramping, tightness, restless legs syndrome, and skin irritation.

“Measuring vascular symptoms includes assessing quality of life and activity limitations, as well as the psychological impact of the disease. However, existing measures are often based on the clinician’s appraisal rather than the individual’s self-reported symptoms and severity of symptoms,” Dr. Jurgens commented.
 

Watch for depression

Finally, the writing group highlighted the importance of depression in cardiac patients, which occurs at about twice the rate, compared with people without any medical condition (10% vs. 5%).

In a prior statement, the AHA said depression should be considered a risk factor for worse outcomes in patients with ACS or CVD diagnosis.

The new statement highlights that people with persistent chest pain, people with HF, as well as stroke survivors and people with PAD commonly have depression and/or anxiety. In addition, cognitive changes after a stroke may affect how and whether symptoms are experienced or noticed.

While symptom relief is an important part of managing CVD, it’s also important to recognize that “factors such as depression and cognitive function may affect symptom detection and reporting,” Dr. Jurgens said.

“Monitoring and measuring symptoms with tools that appropriately account for depression and cognitive function may help to improve patient care by identifying more quickly people who may be at higher risk,” she added.

The scientific statement was prepared by the volunteer writing group on behalf of the AHA Council on Cardiovascular and Stroke Nursing; the Council on Hypertension; and the Stroke Council. The research had no commercial funding. The authors reported no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Symptoms of six common cardiovascular diseases (CVD) – acute coronary syndromes, heart failure, valvular disorders, stroke, rhythm disorders, and peripheral vascular disease – often overlap and may vary over time and by sex, the American Heart Association noted in a new scientific statement.

“Symptoms of these cardiovascular diseases can profoundly affect quality of life, and a clear understanding of them is critical for effective diagnosis and treatment decisions,” Corrine Y. Jurgens, PhD, chair of the writing committee, said in a news release.

Copyright pixelheadphoto/Thinkstock

This scientific statement is a “compendium detailing the symptoms associated with CVD, similarities or differences in symptoms among the conditions, and sex differences in symptom presentation and reporting,” said Dr. Jurgens, associate professor at Connell School of Nursing, Boston College.

The new statement was published online in Circulation.

The writing group noted that measuring CVD symptoms can be challenging because of their subjective nature. Symptoms may go unrecognized or unreported if people don’t think they are important or are related to an existing health condition.

“Some people may not consider symptoms like fatigue, sleep disturbance, weight gain, and depression as important or related to cardiovascular disease. However, research indicates that subtle symptoms such as these may predict acute events and the need for hospitalization,” Dr. Jurgens said.
 

ACS – chest pain and associated symptoms

The writing group noted that chest pain is the most frequently reported symptom of ACS and has often been described as substernal pressure or discomfort and may radiate to the jaw, shoulder, arm, or upper back.

The most common co-occurring symptoms are dyspnea, diaphoresis, unusual fatigue, nausea, and lightheadedness. Women are more likely than men to report additional symptoms outside of chest pain.

As a result, they have often been labeled “atypical.” However, a recent AHA advisory notes that this label may have been caused by the lack of women included in the clinical trials from which the symptom lists were derived.

The writing group said there is a need to “harmonize” ACS symptom measurement in research. The current lack of harmonization of ACS symptom measurement in research hampers growth in cumulative evidence.

“Therefore, little can be done to synthesize salient findings about symptoms across ischemic heart disease/ACS studies and to incorporate evidence-based information about symptoms into treatment guidelines and patient education materials,” they cautioned. 
 

Heart failure

Turning to heart failure (HF), the writing group noted that dyspnea is the classic symptom and a common reason adults seek medical care.

However, early, more subtle symptoms should be recognized. These include gastrointestinal symptoms such as upset stomach, nausea, vomiting, and loss of appetite; fatigue; exercise intolerance; insomnia; pain (chest and otherwise); mood disturbances (primarily depression and anxiety); and cognitive dysfunction (brain fog, memory problems).

Women with HF report a wider variety of symptoms, are more likely to have depression and anxiety, and report a lower quality of life, compared with men with HF.

“It is important to account for dyspnea heterogeneity in both clinical practice and research by using nuanced measures and probing questions to capture this common and multifaceted symptom,” the writing group said.

“Monitoring symptoms on a spectrum, versus present or not present, with reliable and valid measures may enhance clinical care by identifying more quickly those who may be at risk for poor outcomes, such as lower quality of life, hospitalization, or death,” Dr. Jurgens added.

“Ultimately, we have work to do in terms of determining who needs more frequent monitoring or intervention to avert poor HF outcomes,” she said.
 

Valvular heart disease

Valvular heart disease is a frequent cause of HF, with symptoms generally indistinguishable from other HF causes. Rheumatic heart disease is still prevalent in low- and middle-income countries but has largely disappeared in high-income countries, with population aging and cardiomyopathies now key drivers of valve disease.

In the absence of acute severe valve dysfunction, patients generally have a prolonged asymptomatic period, followed by a period of progressive symptoms, resulting from the valve lesion itself or secondary myocardial remodeling and dysfunction, the writing group said. 

Symptoms of aortic valve disease often differ between men and women. Aortic stenosis is typically silent for years. As stenosis progresses, women report dyspnea and exercise intolerance more often than men. Women are also more likely to be physically frail and to have a higher New York Heart Association class (III/IV) than men. Men are more likely to have chest pain.

“Given the importance of symptom assessment, more work is needed to determine the incremental value of quantitative symptom measurement as an aid to clinical management,” the writing group said.
 

Stroke

For clinicians, classic stroke symptoms (face drooping, arm weakness, speech difficulty), in addition to nonclassic symptoms, such as partial sensory deficit, dysarthria, vertigo, and diplopia, should be considered for activating a stroke response team, the group says.

A systematic review and meta-analysis revealed that women with stroke were more likely to present with nonfocal symptoms (for example, headache, altered mentality, and coma/stupor) than men, they noted.

To enhance public education about stroke symptoms and to facilitate the diagnosis and treatment of stroke, they say research is needed to better understand the presentation of stroke symptoms by other select demographic characteristics including race and ethnicity, age, and stroke subtype.

Poststroke screening should include assessment for anxiety, depression, fatigue, and pain, the writing group said.
 

Rhythm disorders

Turning to rhythm disorders, the writing group wrote that cardiac arrhythmias, including atrial fibrillation (AFib), atrial flutter, supraventricular tachycardia, bradyarrhythmia, and ventricular tachycardia, present with common symptoms.

Palpitations are a characteristic symptom of many cardiac arrhythmias. The most common cardiac arrhythmia, AFib, may present with palpitations or less specific symptoms (fatigue, dyspnea, dizziness) that occur with a broad range of rhythm disorders. Chest pain, dizziness, presyncope/syncope, and anxiety occur less frequently in AFib, the group said.

Palpitations are considered the typical symptom presentation for AFib, yet patients with new-onset AFib often present with nonspecific symptoms or no symptoms, they pointed out.

Women and younger individuals with AFib typically present with palpitations, whereas men are more commonly asymptomatic. Older age also increases the likelihood of a nonclassic or asymptomatic presentation of AFib.

Despite non-Hispanic Black individuals being at lower risk for development of AFib, research suggests that Black patients are burdened more with palpitations, dyspnea on exertion, exercise intolerance, dizziness, dyspnea at rest, and chest discomfort, compared with White or Hispanic patients.

Peripheral vascular disease

Classic claudication occurs in roughly one-third of patients with peripheral arterial disease (PAD) and is defined as calf pain that occurs in one or both legs with exertion (walking), does not begin at rest, and resolves within 10 minutes of standing still or rest.

However, non–calf exercise pain is reported more frequently than classic claudication symptoms. Women with PAD are more likely to have nonclassic symptoms or an absence of symptoms.

Assessing symptoms at rest, during exercise, and during recovery can assist with classifying symptoms as ischemic or not, the writing group said.

PAD with symptoms is associated with an increased risk for myocardial infarction and stroke, with men at higher risk than women.

Similar to PAD, peripheral venous disease (PVD) can be symptomatic or asymptomatic. Clinical classification of PVD includes symptoms such as leg pain, aching, fatigue, heaviness, cramping, tightness, restless legs syndrome, and skin irritation.

“Measuring vascular symptoms includes assessing quality of life and activity limitations, as well as the psychological impact of the disease. However, existing measures are often based on the clinician’s appraisal rather than the individual’s self-reported symptoms and severity of symptoms,” Dr. Jurgens commented.
 

Watch for depression

Finally, the writing group highlighted the importance of depression in cardiac patients, which occurs at about twice the rate, compared with people without any medical condition (10% vs. 5%).

In a prior statement, the AHA said depression should be considered a risk factor for worse outcomes in patients with ACS or CVD diagnosis.

The new statement highlights that people with persistent chest pain, people with HF, as well as stroke survivors and people with PAD commonly have depression and/or anxiety. In addition, cognitive changes after a stroke may affect how and whether symptoms are experienced or noticed.

While symptom relief is an important part of managing CVD, it’s also important to recognize that “factors such as depression and cognitive function may affect symptom detection and reporting,” Dr. Jurgens said.

“Monitoring and measuring symptoms with tools that appropriately account for depression and cognitive function may help to improve patient care by identifying more quickly people who may be at higher risk,” she added.

The scientific statement was prepared by the volunteer writing group on behalf of the AHA Council on Cardiovascular and Stroke Nursing; the Council on Hypertension; and the Stroke Council. The research had no commercial funding. The authors reported no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Hypertension is a global problem that affects poorer countries as much as it affects more affluent ones, a new study suggests.

A cross-sectional study of some 1.2 million adults in low- and middle-income countries (LMICs) found that overall, rates of hypertension were similar across all levels of education and wealth.

The one outlier was Southeast Asia. There, higher levels of education and household wealth were associated with a greater prevalence of hypertension, but the absolute difference was small.

However, the authors of the study caution that hypertension may increasingly affect adults in the lowest socioeconomic groups as LMICs develop economically.

The study is published online  in the Journal of the American College of Cardiology.
 

Assumptions about hypertension are wrong

“We found that the differences in hypertension prevalence between education and household wealth groups were small in most low- and middle-income countries, so the frequent assumption that hypertension mostly affects the wealthiest and most educated groups in low-and middle-income countries appears to be largely untenable,” senior author Pascal Geldsetzer, MD, MPH, PhD, assistant professor of medicine at Stanford (Calif.) University, told this news organization.

High blood pressure is sometimes assumed to be a result of “Westernized” lifestyles characterized by a high intake of calorie-dense foods and salt and low physical activity. As a result, the condition is frequently thought of as mainly afflicting wealthier segments of society in LMICs, which may in part be responsible for the low degree of funding and attention that hypertension in LMICs has received thus far, Dr. Geldsetzer said.

Traditionally, other global health issues, particularly HIV, tuberculosis, and malaria, have received the lion’s share of government funding. Hypertension, thought to be a condition affecting more affluent countries because it is associated with obesity and a sedentary lifestyle, was ignored, he said.

Knowing the socioeconomic gradients associated with hypertension in LMICs and how these may change in the future is important for policy makers, Dr. Geldsetzer added.

Led by Tabea K. Kirschbaum, MD, Heidelberg Institute of Global Health, University of Heidelberg, Germany, the researchers examined hypertension prevalence by education and household wealth from 76 LMICs in 1,211,386 participants and assessed whether the effect was modified by the country’s gross domestic product (GDP).

Their analysis included 76 surveys, of which 58 were World Health Organization Stepwise Approach to Surveillance surveys. The median age of the participants was 40 years, and 58.5% were women.

Overall, hypertension prevalence tended to be similar across all educational and household wealth levels and across countries with lower and higher GDPs, although there were some “negligible” country and regional variations.

Treatment rates with blood pressure–lowering drugs for participants who had hypertension were higher in countries with higher GDPs.

Women were more likely to be taking medication than were men.

In some countries, the proportion of individuals taking blood pressure–lowering medication was higher in wealthier households.

In Southeast Asia, however, there was a strong association found between the prevalence of hypertension and higher household wealth levels. Compared with the least wealthy, the risk ratio for the wealthiest was 1.28 (95% confidence interval, 1.22-1.34). A similar association was found for education levels as well.

Education was negatively associated with hypertension in the Eastern Mediterranean. Rates were higher among men than among women.

In an accompanying editorial, Yashashwi Pokharel, MBBS, MSCR, from Wake Forest School of Medicine, Winston-Salem, N.C., and colleagues write:

“Now that we know that hypertension prevalence is not different in the poorest, the least educated, or the least economically developed countries, compared with their wealthier and educated counterparts, we should develop, test, and implement effective strategies to enhance global equity in hypertension care.”

Dr. Pokharel told this news organization that, despite the study’s limitations including heterogeneous data, measurement techniques, and blood pressure monitor use across countries, the signal is loud and clear.

“We urgently need to focus on turning off the faucet by addressing the major determinants of increasing hypertension burden, including the sociocultural and political determinants,” he said. “In this regard, setting funding priorities by donors for hypertension, capacity building, and testing and scaling effective population level hypertension prevention and treatment strategies, developed together with local stakeholders, can have a long-lasting effect. If we perpetuate the neglect, we will ineffectively spend more time mopping up the floor.”

Dr. Geldsetzer is a Chan Zuckerberg Biohub investigator. Dr. Pokharel reports no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Hypertension is a global problem that affects poorer countries as much as it affects more affluent ones, a new study suggests.

A cross-sectional study of some 1.2 million adults in low- and middle-income countries (LMICs) found that overall, rates of hypertension were similar across all levels of education and wealth.

The one outlier was Southeast Asia. There, higher levels of education and household wealth were associated with a greater prevalence of hypertension, but the absolute difference was small.

However, the authors of the study caution that hypertension may increasingly affect adults in the lowest socioeconomic groups as LMICs develop economically.

The study is published online  in the Journal of the American College of Cardiology.
 

Assumptions about hypertension are wrong

“We found that the differences in hypertension prevalence between education and household wealth groups were small in most low- and middle-income countries, so the frequent assumption that hypertension mostly affects the wealthiest and most educated groups in low-and middle-income countries appears to be largely untenable,” senior author Pascal Geldsetzer, MD, MPH, PhD, assistant professor of medicine at Stanford (Calif.) University, told this news organization.

High blood pressure is sometimes assumed to be a result of “Westernized” lifestyles characterized by a high intake of calorie-dense foods and salt and low physical activity. As a result, the condition is frequently thought of as mainly afflicting wealthier segments of society in LMICs, which may in part be responsible for the low degree of funding and attention that hypertension in LMICs has received thus far, Dr. Geldsetzer said.

Traditionally, other global health issues, particularly HIV, tuberculosis, and malaria, have received the lion’s share of government funding. Hypertension, thought to be a condition affecting more affluent countries because it is associated with obesity and a sedentary lifestyle, was ignored, he said.

Knowing the socioeconomic gradients associated with hypertension in LMICs and how these may change in the future is important for policy makers, Dr. Geldsetzer added.

Led by Tabea K. Kirschbaum, MD, Heidelberg Institute of Global Health, University of Heidelberg, Germany, the researchers examined hypertension prevalence by education and household wealth from 76 LMICs in 1,211,386 participants and assessed whether the effect was modified by the country’s gross domestic product (GDP).

Their analysis included 76 surveys, of which 58 were World Health Organization Stepwise Approach to Surveillance surveys. The median age of the participants was 40 years, and 58.5% were women.

Overall, hypertension prevalence tended to be similar across all educational and household wealth levels and across countries with lower and higher GDPs, although there were some “negligible” country and regional variations.

Treatment rates with blood pressure–lowering drugs for participants who had hypertension were higher in countries with higher GDPs.

Women were more likely to be taking medication than were men.

In some countries, the proportion of individuals taking blood pressure–lowering medication was higher in wealthier households.

In Southeast Asia, however, there was a strong association found between the prevalence of hypertension and higher household wealth levels. Compared with the least wealthy, the risk ratio for the wealthiest was 1.28 (95% confidence interval, 1.22-1.34). A similar association was found for education levels as well.

Education was negatively associated with hypertension in the Eastern Mediterranean. Rates were higher among men than among women.

In an accompanying editorial, Yashashwi Pokharel, MBBS, MSCR, from Wake Forest School of Medicine, Winston-Salem, N.C., and colleagues write:

“Now that we know that hypertension prevalence is not different in the poorest, the least educated, or the least economically developed countries, compared with their wealthier and educated counterparts, we should develop, test, and implement effective strategies to enhance global equity in hypertension care.”

Dr. Pokharel told this news organization that, despite the study’s limitations including heterogeneous data, measurement techniques, and blood pressure monitor use across countries, the signal is loud and clear.

“We urgently need to focus on turning off the faucet by addressing the major determinants of increasing hypertension burden, including the sociocultural and political determinants,” he said. “In this regard, setting funding priorities by donors for hypertension, capacity building, and testing and scaling effective population level hypertension prevention and treatment strategies, developed together with local stakeholders, can have a long-lasting effect. If we perpetuate the neglect, we will ineffectively spend more time mopping up the floor.”

Dr. Geldsetzer is a Chan Zuckerberg Biohub investigator. Dr. Pokharel reports no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Hypertension is a global problem that affects poorer countries as much as it affects more affluent ones, a new study suggests.

A cross-sectional study of some 1.2 million adults in low- and middle-income countries (LMICs) found that overall, rates of hypertension were similar across all levels of education and wealth.

The one outlier was Southeast Asia. There, higher levels of education and household wealth were associated with a greater prevalence of hypertension, but the absolute difference was small.

However, the authors of the study caution that hypertension may increasingly affect adults in the lowest socioeconomic groups as LMICs develop economically.

The study is published online  in the Journal of the American College of Cardiology.
 

Assumptions about hypertension are wrong

“We found that the differences in hypertension prevalence between education and household wealth groups were small in most low- and middle-income countries, so the frequent assumption that hypertension mostly affects the wealthiest and most educated groups in low-and middle-income countries appears to be largely untenable,” senior author Pascal Geldsetzer, MD, MPH, PhD, assistant professor of medicine at Stanford (Calif.) University, told this news organization.

High blood pressure is sometimes assumed to be a result of “Westernized” lifestyles characterized by a high intake of calorie-dense foods and salt and low physical activity. As a result, the condition is frequently thought of as mainly afflicting wealthier segments of society in LMICs, which may in part be responsible for the low degree of funding and attention that hypertension in LMICs has received thus far, Dr. Geldsetzer said.

Traditionally, other global health issues, particularly HIV, tuberculosis, and malaria, have received the lion’s share of government funding. Hypertension, thought to be a condition affecting more affluent countries because it is associated with obesity and a sedentary lifestyle, was ignored, he said.

Knowing the socioeconomic gradients associated with hypertension in LMICs and how these may change in the future is important for policy makers, Dr. Geldsetzer added.

Led by Tabea K. Kirschbaum, MD, Heidelberg Institute of Global Health, University of Heidelberg, Germany, the researchers examined hypertension prevalence by education and household wealth from 76 LMICs in 1,211,386 participants and assessed whether the effect was modified by the country’s gross domestic product (GDP).

Their analysis included 76 surveys, of which 58 were World Health Organization Stepwise Approach to Surveillance surveys. The median age of the participants was 40 years, and 58.5% were women.

Overall, hypertension prevalence tended to be similar across all educational and household wealth levels and across countries with lower and higher GDPs, although there were some “negligible” country and regional variations.

Treatment rates with blood pressure–lowering drugs for participants who had hypertension were higher in countries with higher GDPs.

Women were more likely to be taking medication than were men.

In some countries, the proportion of individuals taking blood pressure–lowering medication was higher in wealthier households.

In Southeast Asia, however, there was a strong association found between the prevalence of hypertension and higher household wealth levels. Compared with the least wealthy, the risk ratio for the wealthiest was 1.28 (95% confidence interval, 1.22-1.34). A similar association was found for education levels as well.

Education was negatively associated with hypertension in the Eastern Mediterranean. Rates were higher among men than among women.

In an accompanying editorial, Yashashwi Pokharel, MBBS, MSCR, from Wake Forest School of Medicine, Winston-Salem, N.C., and colleagues write:

“Now that we know that hypertension prevalence is not different in the poorest, the least educated, or the least economically developed countries, compared with their wealthier and educated counterparts, we should develop, test, and implement effective strategies to enhance global equity in hypertension care.”

Dr. Pokharel told this news organization that, despite the study’s limitations including heterogeneous data, measurement techniques, and blood pressure monitor use across countries, the signal is loud and clear.

“We urgently need to focus on turning off the faucet by addressing the major determinants of increasing hypertension burden, including the sociocultural and political determinants,” he said. “In this regard, setting funding priorities by donors for hypertension, capacity building, and testing and scaling effective population level hypertension prevention and treatment strategies, developed together with local stakeholders, can have a long-lasting effect. If we perpetuate the neglect, we will ineffectively spend more time mopping up the floor.”

Dr. Geldsetzer is a Chan Zuckerberg Biohub investigator. Dr. Pokharel reports no relevant financial relationships.

A version of this article first appeared on Medscape.com.