Uncategorized

• New research finds that people with type 2 diabetes, who take semaglutide, may be less likely to develop certain forms of cancer.
• The researchers studied 13 cancers linked to obesity. They found that people on semaglutide had a decreased risk of developing 10 of these cancers.
• Experts say that more research is needed.

New research published July 5 in the journal of the American Medical Association has found evidence that the use of semaglutide medications, like Ozempic and Wegovy may help reduce the risk of obesity-associated cancers in people with type 2 diabetes.

Reduced risk of 10 obesity-linked cancers

In the study, researchers studied 13 cancers linked to obesity.

They found people taking semaglutide had less risk of developing 10 of these obesity-associated cancers. These cancers included esophageal, colorectal, endometrial, gallbladder, kidney, liver, ovarian, and pancreatic cancer, plus meningioma and multiple myeloma. 

However, semaglutide was not linked to a significantly reduced risk of developing thyroid, stomach, or breast cancer.

Yoni Resnick, PharmD, the director of pharmacy clinical services with New England Cancer Specialists, says that these results are encouraging.

“It’s exciting to see that, there might be…some smoke as it relates to these medications, potentially reducing the risk of some cancers that have historically been statistically related to obesity,” Resnick said.

The study, which pulled from the medical data of 1,651,452 patients across 13 years, compared those with type 2 diabetes who had been prescribed a GLP-1, insulin, or metformin.

Jennie Stanford, MD an obesity medicine physician for InteliHealth, who previously worked within the University of Pittsburgh Medical Centre system, said we’re just starting to understand how GLP-1 drugs can impact your health.

“I think we’re at the tip of the iceberg when it comes to understanding the benefits of the GLP-1 receptor agonists,” Stanford said. “As we learn more and more about what they’re able to do, I think we’ll be able to see possibilities for using them in dementia, in obesity-associated cancers and other medical problems that are linked back to the same underlying mechanism.”

One of the study’s authors, Lindsey Wang, a student at the Center for Science, Health, and Society, Case Western Reserve University School of Medicine, Cleveland, Ohio said that people using semaglutide did not have a lower risk among all obesity-associated cancers.

“Most notably, we saw a decrease [of] significant risk across most gastrointestinal cancers. So, that goes all the way from your esophagus down to your colon. This is pretty interesting because these cancers usually have a poor prognosis after you are diagnosed with it,” Wang said. “Something that did surprise us a little was that we found no association between using these GLP-1 RA’s [receptor agonists] and your breast cancer risk, which was contrary to our initial expectation.”

Up to 65% reduced risk of certain cancers

The research team found that people with type 2 diabetes on GLP-1 drugs compared to those on insulin had reduced risk of multiple cancers including the following.

• 65% reduced risk of gallbladder cancer
• 63% reduced risk of meningioma
• 59% reduced risk of pancreatic cancer
• 53% reduced risk of a type of liver cancer called hepatocellular carcinoma.
• 48% reduced risk of ovarian cancer
• 46% reduced risk of colorectal cancer
• 41% reduced risk of multiple myeloma
• 40% reduced risk of esophageal cancer
• 26% reduced risk of endometrial cancer
• 24% reduced risk of kidney cancer.

The team behind the study concluded that more research, including pre-clinical and clinical trials, are needed to build on these findings

Stanford says that one finding that jumped out at her was the decreased risk of gallbladder cancer. 

“We know that obesity is a huge factor in gallbladder disease,” Stanford said. “So think about that in terms of gallstones and gallbladder function, but it stands to reason that that would occur for gallbladder cancer as well.”

Wang, an undergraduate student says the research group she belongs to at Ohio’s Case Western University are now looking at GLP-1 agonists and their role when it comes to cancer outcomes.

GLP-1 drugs to combat cancer?

Resnick says that these findings, should they be confirmed by further research, may make a difference in his oncology practice’s high risk group. He also says that these GLP-1 medications are becoming a more common talking point among oncologists. 

“You can leverage this kind of data that says, obesity is directly associated with…this group of cancers,” Resnick said. “By offering this type of weight reduction medication as compared to other types of medications… You’re reducing the risk for cancer, thus improving the overall health of the population, cutting healthcare costs, all of those well-known talking points.”

Takeaway

New research published in has found evidence that the use of semaglutide medications, like Ozempic may help reduce the risk of obesity-associated cancers in people with type 2 diabetes.

• Semaglutide, the active ingredient in Ozempic and Wegovy, is associated with a rare blinding disease, according to new research.
• The condition, known as non-arteritic anterior ischemic optic neuropathy (NAION), causes sudden blindness due to a lack of blood flow to the optic nerve.
• Despite the findings, the study does not demonstrate a causal link between the drug and NAION.

Semaglutide, the blockbuster drug used in Ozempic and Wegovy, has been linked to a rare blinding disease.

Patients with type 2 diabetes and obesity who take semaglutide appear to be at greater risk of nonarteritic anterior ischemic optic neuropathy (NAION) compared to those prescribed a non GLP-1 drug. NAION is a condition that causes sudden blindness, typically in one eye, due to a lack of blood flow to the optic nerve. There is no known treatment for the condition.

The findings, presented in the journal JAMA Ophthalmology, are compelling, but experts caution that they are preliminary and observational. The findings do not demonstrate a causal link between the drug and NAION. Nonetheless, with the massive popularity of semaglutide, it is important for both doctors and patients to be aware of the potential risk.

“I am going to start mentioning this as a caution to a patient, but I’m not going to say that because you’re obese and you have diabetes and you’re taking this medication, that you’re going to go blind,” Yin Allison Liu, MD, PhD, an Associate Professor of Neuro-Ophthalmology at University of California Davis, told Healthline. She wasn’t affiliated with the study.

NAION is an elusive condition with little known about its exact cause.

“Ischemic optic neuropathy is very common in older diabetic patients that have vasculopathic risk factors, although its pathogenesis is completely not understood,” Nicholas J. Volpe, MD, a neuro-ophthalmologist and Chairman of the Department of Ophthalmology at Northwestern University’s Feinberg School of Medicine, told Healthline. Volpe wasn’t involved in the research.

Up to 8 times greater risk of rare blinding condition

Researchers at Massachusetts General Brigham utilized patient data to look for any retrospective correlation between semaglutide and NAION over one year. They investigated two cohorts, each representing one of the FDA-approved indications for semaglutide: obesity and type 2 diabetes. In total the records of nearly 17,000 patients were included in the study. 

Of those patients, 710 had type 2 diabetes and 979 were overweight or obese.

Among patients with type 2 diabetes, the average age was 59 years old and more than half were female. The age of patients in the overweight or obese group skewed younger, an average of 47 years old, and was 72% female.

The study authors asked a simple question: were patients in this group more or less likely to develop NAION if they were prescribed semaglutide or a non-GLP-1 medication?

They found a clear signal.

Patients with type 2 diabetes were more than four times as likely to have a diagnosis NAION; patients with obesity were more than eight times as likely.

Over the one-year period, there were 17 incidences (8.9%) of NAION among those taking semaglutide in the diabetes cohort, but only six (1.8%) among those taking a non-GLP-1 drug. The results were even more pronounced among overweight and obese patients: 20 NAION events (6.7%) occurred in those taking semaglutide, compared to just 3 (0.8%) for those who did not. Whether these events were connected to semaglutide or were confounded by the higher risks associated with obesity and type-2 diabetes is not clear.

Volpe reiterated to Healthline that although the findings demonstrate an association, much more research is needed.

“It does not establish causality. It does not establish danger. It does not do anything besides call attention to this and the potential need for us to think about this and study it more carefully,” he said.

Patients and healthcare providers should discuss the risks and benefits of any medication in the context of an individual’s personal circumstances and medical history.

“If I were a patient that wanted to take this type of medication, I would not hesitate based on this study, thinking that I’m going to go blind,” said Volpi.

What is NAION?

NAION (nonarteritic anterior ischemic optic neuropathy)is a rare blinding disease that causes sudden blindness in one eye, often after waking. It is caused by a lack of blood flow (ischemia) to the optic nerve, which connects the eye to the brain. The condition is rare, only occurring in 2-10 per 100,000 people. It is the second most common cause of blindness due to optic nerve damage behind glaucoma.

The cause or pathogenesis of NAION is still not well understood, although it is generally believed to be associated with vasculopathic risk factors including diabetes, hypertension, and high cholesterol.

“Despite knowing about this disease for 75 years, it was first described or recognized in the 1950s, we as neuro-ophthalmologists have never firmly established that only people with high blood pressure get this disorder or only people with diabetes,” said Volpe.

The most significant risk factor for NAION is an anatomical condition known as “disc-at-risk” or cupless optic nerve: when the structure of the eye itself causes crowding of the optic nerve fibers.

“With this condition, the blood flow or oxygen delivery into the eyes can be relatively at risk when we have other confounding factors,” said Liu.

More controversial evidence has suggested that other common medications, including antihypertensives (specifically, those taken before bedtime) and erectile dysfunction drugs known as PDE5 Inhibitors may also be associated with NAION.

While a serious complication, NAION is a rare condition and little is known about the causes. “We know about as much about the pathogenesis of this condition today as we did 31 years ago when I did my neuro-ophthalmology fellowship,” said Volpi.

The bottom line

In an observational retrospective study, researchers found that patients with type 2 diabetes or obesity who were taking semaglutide were more likely to develop a rare blinding condition than those taking a non-GLP-1 drug.

The condition, known as non-arteritic anterior ischemic optic neuropathy (NAION), causes sudden blindness in one eye, often upon waking in the morning.

Experts told Healthline that the findings are still early and do not demonstrate causality. Patients should consult with their healthcare provider about the risks and benefits of prescribed medications.

• Teva Pharmaceuticals is launching the first-ever generic GLP-1 drug in the United States.
• Victoza, originally approved by the FDA in 2010 for diabetes, is part of the same class of drugs that includes Ozempic, Wegovy, and Zepbound.
• Experts say they welcome the generic formulation but expressed concerns about price and effectiveness.

Teva Pharmaceuticals announced the launch of a generic form of Victoza (liraglutide), the first-ever generic GLP-1 drug to be made available in the United States.

Glucagon-like peptide-1 receptor agonists (otherwise known as GLP-1s or GLP-1 RAs) are a class of incretin drugs that mimic the body’s natural hormones to help treat diabetes and obesity. Other blockbuster drugs in this class include semaglutide (sold under the brand names Ozempic and Wegovy) and tirzepatide (sold under the brand names Mounjaro and Zepbound.

The latter is considered a “dual agonist” because it activates two receptors: GLP-1 and GIP.

The drugs have proven to be exceptionally effective, particularly for weight loss, with some patients losing up to 25% of their body weight. They’ve also been shown to have many other beneficial effects, including lowering A1C and improving cardiovascular outcomes.

However, the popularity of the drugs has spiraled out of control at times, leading to shortages and supply chain issues in the US and abroad. The common practice of using diabetes medications like Ozempic and Mounjaro “off label” for cosmetic weight loss has led to some diabetes patients being forced to ration their supplies or switch drugs entirely.

“By launching an authorized generic for Victoza, we are providing patients with type 2 diabetes another option for this important treatment…We are providing the first generic GLP-1 product to the US marketplace, demonstrating once again our ability to sustain a generics powerhouse,” Ernie Richardsen, a Senior Vice President of Teva Pharmaceuticals, said in a statement.

The arrival of a GLP-1 generic drug provides reasons to be hopeful for doctors and patients alike, but there are also caveats.

How doctors are reacting to Teva’s announcement

Dr. Caroline Apovian, MD, a Professor of Medicine at Harvard Medical School and the co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital, told Healthline that the approval was “another step in the right direction.”

But, she quickly followed that with some immediate concerns about cost.

“My big question for Teva is how much are you going to charge for it?” she said.

Dr. Sun Kim, MD, an Associate Professor of Endocrinology at Stanford Medicine, told Healthline that while she’s excited about an additional treatment option, she also has concerns.

“The prices that I have seen for Teva’s liraglutide are high, especially given that liraglutide is injected once daily (vs. weekly) and generally inferior to higher doses of liraglutide and tripeptide weekly,” she told Healthline.

Healthline contacted Teva about the cost of their generic but did not receive a response.

According to The Guardian, the wholesale acquisition cost (WAC) of the generic will be 13.6% lower than Victoza.

A two-pack of injection pens is estimated to cost around $470, while a three-pack will cost around $700. A spokesperson for Teva told The Guardian that “WAC pricing does not account for the price discounts offered to customers and is not reflective of our final net price.”

How effective is Victoza compared to other GLP-1 drugs?

Another notable issue pointed out by experts is that Victoza isn’t as effective as novel GLP-1s. The FDA originally approved Victoza for diabetes in 2010, followed by Saxenda (also liraglutide) for obesity in 2014.

“I think no one would dispute that liraglutide, while effective for lowering glucose and weight, is inferior to higher doses of semaglutide and tirzepatide,” said Kim.

Head-to-head clinical trials have consistently demonstrated that the latest batch of GLP-1 drugs perform better.

The STEP 8 randomized clinical trial compared semaglutide and liraglutide and found that patients taking semaglutide lost significantly more weight (15%) than those taking liraglutide (6%).

Tirzepatide has proven even more effective in a clinical trial, with patients losing 20% of their body weight.

The SUSTAIN 10 trial, another head-to-head trial between semaglutide and liraglutide, found that while both lowered A1C, semaglutide had better results, resulting in a decrease of 1.7% compared to 1% for liraglutide.

While shortages of other GLP-1 drugs remain, Teva’s generic Victoza is a welcome addition to the market.

However, for some patients, the price tag and lower effectiveness compared to novel agents could remain a barrier for many.

The bottom line

The first-ever generic GLP-1 drug is being launched in the United States by Teva Pharmaceuticals.

GLP-1 drugs, which include the blockbuster diabetes and obesity medications Wegovy and Zepbound, are touted for their effectiveness but are expensive and often in short supply.

Experts told Healthline that while they welcome the generic GLP-1, they still have concerns about its cost and overall effectiveness compared to newer GLP-1 drugs.

• An investigational drug called lerodalcibep lowered low-density lipoprotein (LDL) cholesterol, or “bad” cholesterol, by 50% or more, a new study showed.
• The year-long clinical trial included people who were unable to lower their LDL cholesterol enough using statins.
• Lerodalcibep is not yet approved by the FDA, but two other drugs in this class were approved by the agency in 2015.

An investigational drug lowered low-density lipoprotein (LDL) cholesterol, or “bad” cholesterol, in people who were unable to lower their LDL cholesterol enough using statins.

Researchers say the results support the use of lerodalcibep as a treatment for people with existing cardiovascular disease or who are at high or very high risk of cardiovascular disease.

Most people in the study who received once-monthly injections of lerodalcibep were able to reduce their LDL cholesterol level by 50% or more. They also met target levels for LDL cholesterol recommended by current guidelines.

The results of the clinical trial were published July 3 in JAMA Cardiology.

Statins and other cholesterol-lowering meds

Around 10% of American adults have high cholesterol, according to the Centers for Disease Control and Prevention. 

However, only about half who could benefit from a cholesterol-lowering medicine are currently taking one, the agency said. This increases their risk of heart attack, stroke and other major cardiovascular problems.

Medications available for treating high cholesterol include statins, which have been available since the 1980s, and the newer PCSK9 inhibitors.

PCSK9 inhibitors target a protein in the liver called proprotein convertase subtilisin kexin 9, or PCSK9. 

“PCSK9 inhibitors improve the ability of your liver to take up cholesterol particles from the blood and process them,” said Yu-Ming Ni, MD, cardiologist and lipidologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, Calif. “The result is a significant reduction in cholesterol levels.”

The FDA approved two PCSK9 inhibitors in 2015: alirocumab (Praluent) and evolocumab (Repatha). Both are given by injection under skin, every 2 to 4 weeks. Lerodalcibep is not yet approved by the FDA.

“[Approved PCSK9 inhibitors] work really well to lower cholesterol. Sometimes even better than the statins that we typically give for cholesterol lowering,” Ni told Healthline.

Also, “patients don’t get too many side effects from PCSK9 inhibitors,” he said. “The only downside is that they can be a little expensive for some patients, depending on insurance.”

PCSK9 inhibitors may be used for patients who have been unable to lower their cholesterol enough using statins. In this case, a PCSK9 inhibitor would be prescribed alongside a statin.

However, people who can’t tolerate the side effects of statins may take only a PCSK9 inhibitor, said Ni.

Reductions in cholesterol and other lipids

The new study included 922 adults who were taking the highest dose of a statin that they could tolerate, but still hadn’t lowered their LDL cholesterol to the target level recommended by guidelines.

The average age of participants was 65 years and 45% were female. Overall, 88% of people finished the clinical trial.

People were randomly assigned to receive either monthly injections of lerodalcibep or a non-acting placebo for 52 weeks.

After one year, 90% of people who received lerodalcibep reduced their LDL cholesterol by 50% or more, and met the recommended LDL cholesterol targets.

On average, people who received lerodalcibep reduced their LDL cholesterol by 56% after 52 weeks and 69.5% after 60 weeks. They also saw reductions in apolipoprotein B, apolipoprotein(a) and triglycerides.

“This is crucial, as both apolipoprotein B and high lipoprotein(a) levels are a significant risk factor for cardiovascular disease,” said Jacqueline Hollywood, MD, cardiologist with Hackensack University Medical Center, “and we currently have limited treatment options for lipoprotein(a).”

The study results also show that lerodalcibep was well tolerated, with similar adverse events as the placebo.

The main difference was that reactions at the injection site occurred more frequently in people who received lerodalcibep (6.9%) compared to those in the placebo group (0.3%). These reactions were mild or moderate in severity.

Larger, long-term studies needed

Given the benefits of FDA-approved PCSK9 inhibitors, Ni said it is good to see a new drug that works in a similar manner as those. 

“In this trial, we can see that lerodalcibep lowers LDL cholesterol by a very similar amount [as those other drugs],” he said.

He pointed out that prior studies of FDA-approved PCSK9 inhibitors show that these drugs can also reduce the risk of cardiovascular events such as heart attack and stroke.

However, he cautions that additional longer-term studies would be needed to show whether lerodalcibep has a similar effect on cardiovascular risk.

“Cholesterol-lowering drugs that were very promising have surprised us before,” said Ni. “So I think it’s really important that we continue on to that next step [of additional studies].”

Hollywood highlighted that one limitation of the study is that it included a relatively small number of participants. In spite of that, people in the study had “a wide range of cardiovascular disease risk factors,” she told Healthline, “suggesting the drug could benefit a diverse population.”

One group that the drug may help are people with atherosclerosis, a condition in which plaques build up in the arteries, which can increase the risk of heart attack and stroke. 

By lowering cholesterol and inflammation, the drug may prevent the formation of new plaques, said Hollywood, although additional studies are needed to confirm this potential benefit.

“Overall, the study provides promising evidence for the potential of lerodalcibep in cardiovascular disease treatment,” she said.

Takeaway

In a year-long clinical trial, participants were randomly assigned to receive either the PCSK9 inhibitor lerodalcibep or a non-acting placebo. People in the study were unable to lower their LDL cholesterol, or bad cholesterol, using statins.

The majority of people who received lerodalcibep saw reductions in their LDL cholesterol of 50% or more, and met LDL cholesterol targets set by guidelines.

People who received lerodalcibep also saw reductions in triglycerides and other lipids linked to an increased risk of heart attack and stroke. Lerodalcibep was well tolerated, with similar adverse effects as placebo. The main side effects of the drug were those that occurred at the injection site.

• A new study that tracked diet and cognitive ability across seven decades found that individuals with a healthier diet had better cognitive outcomes over time.
• The research involved a cohort of more than 3,000 individuals living in the UK born in 1946.
• The findings suggest that eating a healthy diet consistently in childhood and midlife is important to maintaining brain health in old age.

Diet is an important part of keeping your brain sharp as you age. New research indicates that the earlier you start eating healthy, the better.

In a first-of-its-kind study, researchers tracked the diet and eating habits of more than 3,000 individuals living in the UK and correlated it with their cognitive ability for seven decades. Those who had the highest-quality diets tended to have better cognitive ability over time compared to their peers who ate unhealthy diets.

“Cognitive decline can begin at age 65. But, there’s this long latency period, maybe 10 to 15 years prior to symptoms showing up, that those brain changes can already be happening. So our thinking was that diet much earlier than age 65 might be an important factor in what’s happening in our later life cognition. And our preliminary findings suggest that may be the case,” Kelly Cara, PhD, a recent graduate of the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University and author of the research, told Healthline.

Cara presented her findings this week at NUTRITION 2024, the annual meeting of the American Society for Nutrition. The findings have not yet been published in a scientific journal and are considered preliminary.

Nonetheless, they are compelling and have practical implications for anyone concerned about maintaining brain health through diet. Experts say eating a diet rich in fruits and vegetables, fish, and whole grains — such as the Mediterranean diet — is a good place to start.

“The findings are consistent with similar studies and truly exemplify the importance that diet plays early in life to impact health (in this case, cognitive health) later in life,” said Kristin Kirkpatrick, MS RD, a nutritionist at the Cleveland Clinic, and co-author of Regenerative Health. She was not affiliated with the study.

Seven decades of research suggests healthy diets boost brain health

Cara’s work is based on data from the Medical Research Council’s National Survey of Health and Development, which has collected health and medical information from British citizens for nearly 100 years.

The research looked at one specific cohort of 3,059 individuals born in 1946 and evenly split between men and women. Those alive today are 78 years old and are still involved in the study.

Members of the cohort reported their dietary information at five separate points (age 4, 36, 43, 53, and 63). They also recorded cognitive ability, based on standard testing, seven times during that time span, between age 8 and 69.

“I have never seen any cohort that has dietary measures as early as this cohort, where diet was first assessed at age four, and then again throughout middle adulthood and now into the later life years,” said Cara.

Diet was assessed using a standard measure known as the Healthy Eating Index (HEI), which factors in 13 different components, including fruits, vegetables, whole grains, added sugars, and more to create a composite score of an individual’s diet. 

The assessments also used diaries and took place over several days rather than just a single day, creating a more detailed picture of an individual’s diet quality.

“We have a better indication of what that person’s habitual diet was at that time, instead of just a single measure taken, we’re able to kind of average across those multiple days, essentially to represent their diet in that decade,” said Cara.

Those who ate healthier diets, particularly in mid-life (during the survey at age 43), were associated with better cognitive ability through age 69. Specifically, 47% of those with the lowest quality diets also had the worst cognitive outcomes. On the other hand, 48% of individuals with the highest quality diet also had the best cognitive outcomes.

“This means general ability across language and memory and reaction time and visual processing, all of those things,” said Cara.

Foods and diet types that support a healthy brain

The right foods can support your brain health by reducing oxidative stress and slowing age-related mental decline.

“Brain” foods are often high in antioxidants and healthy fats, such as berries, nuts, and fatty fish, including:

• Pumpkin seeds
• Coffee
• Salmon
• Herring
• Sardines
• Walnuts

“Focus on colorful fruits and vegetables in the diet (aim for at least 6 colors every single day), a serving of leafy greens daily, and limit alcohol and ultra-processed foods. If you do not enjoy fatty fish, then consider omega-3 supplementation as well,” said Kirkpatrick.

Both Cara and Kirkpatrick emphasize the importance of diet as a whole rather than thinking about specific individual components. Eating healthy over a lifetime is about consistency and finding the right balance of what works for you.

“The idea here is that if I can be inspired by knowing that what I eat today actually does have an impact on how my future might look in terms of my cognition, that might be one more reason that I can say this is worth doing,” said Cara.

The bottom line

A first-of-its-kind study tracked dietary information and cognitive ability in more than 3,000 individuals across seven decades.

Researchers found that those who tended to have higher-quality diets also showed better cognitive ability across time compared to those with an unhealthy diet.

Experts say that thinking about diet holistically and eating a diet rich in fruits, vegetables, whole grains, and fish, such as the Mediterranean diet, is important for brain health.

• The CDC issued an advisory warning doctors and public health authorities to be vigilant as cases of dengue fever rise globally.
• Dengue is transmitted by the Aedes mosquito, and there is no cure. Severe cases, which are rare, can be life threatening.
• As global temperatures rise, experts and the CDC expect the mosquitoes’ territory to expand and dengue cases to increase.

As cases of dengue fever rise worldwide, the Centers for Disease Control and Prevention (CDC) issued an advisory for physicians, public health authorities, and the public in the United States to be alert to the trend.  

So far in 2024, cases of dengue fever in countries in the Americas have reached record-breaking levels, with more than 9.7 million reported cases — twice the number for the entire year in 2023 (4.6 million). Puerto Rico declared a public health emergency in March after the World Health Organization declared one in December 2023.

In the mainland U.S., 745 cases have been identified in travelers in the first six months of the year, which is higher than normal. There are no vaccines for anyone who has not previously had a dengue infection, and there is one vaccine for children between the ages of 9 and 16 who have been infected, but the manufacturer has discontinued production due to a lack of demand. In Puerto Rico, for example, available doses are expected to expire in 2026.

There are four strains of dengue, all carried by the Aedes mosquito, which generally lives in tropical and subtropical regions. The hotter and wetter months of the year are typically when cases of dengue peak, but as global temperatures rise, the CDC says, cases will most likely increase each year.

What does dengue fever look like?

Symptoms depend on the severity of the disease. Around 75% of people with dengue fever will not experience symptoms.

Mild symptoms may include a sudden fever of around 104°F (40°C) and one or more of the following:

• aching muscles and joints
• rash
• pain behind the eyes
• nausea and vomiting
• facial flushing
• sore throat
• headache
• red eyes

Symptoms usually last between 2–7 days, and most people feel better after one week. The fever typically persists for at least 24 hours and may spike again.

Between 0.5% and 5% of cases become severe and can be life threatening.

In this instance, the fever typically falls to 99.5 to 100.4°F (37.5 to 38°C). Anywhere between a day and a week later, additional symptoms include:

• abdominal pain or tenderness
• vomiting at least three times in 24 hours
• bleeding from the nose or gums
• vomiting blood
• blood in the stool
• fatigue
• feeling restless or irritable
• changes in temperature from very hot to very cold
• cold, clammy skin
• a weak and rapid pulse
• a reduced difference between systolic and diastolic blood pressure

Who is at risk for dengue fever?

There are currently four known strains of the Dengue virus, and there is no cure, so essentially, anyone bitten by a mosquito carrying the virus could catch it.

Dr. David Cutler, MD, board certified family medicine physician at Providence Saint John’s Health Center in Santa Monica, CA, told Healthline that those at highest risk of severe dengue, which can result in death, are infants under 1, pregnant people, adults over 65, or those with underlying medical conditions like hypertension, diabetes, asthma, chronic kidney disease, chronic liver disease, peptic ulcer disease or other gastritis, obesity, or anyone receiving anticoagulation medications.

“Treating dengue requires supportive care as there is no cure for this disease. Monitoring fever, hydration status and blood tests are important for detecting any signs of the disease becoming critical. Controlling fever, preventing dehydration and restricting disease spread through mosquito control are the most important measures to managing dengue,” said Dr. Cutler.

“Preventing [the] spread of disease, especially in young children, requires that everyone sleep under a mosquito net. Insect repellents are also an important preventive measure. Emptying and cleaning standing water containers deprives mosquitoes of places to breed. Screens on windows and doors will help prevent mosquitoes from entering the home,” Dr. Cutler explained.

Dr. Jessica Tuan, MD, an infectious diseases specialist at Yale Medicine, told Healthline that traveling to areas where dengue is most prominent also puts people at risk for exposure.

“Those who have traveled to dengue-endemic areas are at highest risk for acquiring dengue. Dengue is endemic in tropical areas including Africa, the Americas, Southeast Asia, Eastern Mediterranean region, and the Western Pacific. Areas with frequent or continuous dengue transmission include Puerto Rico, U.S. Virgin Islands, American Samoa, Republic of Marshall Islands, Federated States of Micronesia, Republic of Palau,” Dr. Tuan said.

“Take measures to prevent mosquito bites, including using mosquito repellent, for those traveling to or living in dengue-endemic areas. The Advisory Committee on Immunization Practices recommends the dengue vaccine, Dengvaxia, for children 9–16 years old with prior laboratory-confirmed dengue virus infection and living in areas with frequent or continuous dengue transmission,” she added.

Can dengue mutate like the coronavirus?

Dr. James Shepherd, MD, an infectious diseases specialist at Yale Medicine, told Healthline that the dengue virus cannot mutate the way the COVID-19 virus has simply because there’s no cure for it.

“As there is no treatment there is no selection for treatment resistance. Is that a possibility in the near future? Not without development of new treatments to select resistance. There may be selection by human and mosquito host factors and evolution of viral pathogens is a natural process but there are no significant changes in the virus correlating with human disease that I am aware of,” Dr. Shepherd said.

Dr. Shepherd added that as the CDC expects more cases of dengue due to rising global temperatures, finding some sort of antiviral medication might be possible.

“As Aedes mosquitoes spread northwards with rising global temperatures dengue outbreaks are becoming more common in more temperate, richer countries and this presents a greater incentive for drug companies to spend on new antiviral drug development,” Dr. Shepherd said.

• A new study has found that Wegovy helped women lose more weight than men.
• Metabolism, fat patterns, social pressures, or genetics might explain the difference.
• However, both experienced the same improvement in heart failure symptoms.
• It is thought that obesity might cause the type of heart failure studied.
• Experts say Wegovy could potentially reduce women’s risk of death from heart disease.

A new study published in the Journal of the American College of Cardiology found the GLP-1 drug Wegovy (semaglutide) helped females living with heart failure with preserved ejection fraction (HFpEF) lose more weight than their male counterparts.

Heart failure is a medical condition in which the heart can no longer pump blood as efficiently as it should. Those with HFpEF have hearts that pump normally but are stiff, so they can’t function the way they should.

There is growing evidence that HFpEF is caused by obesity. However, females have a greater risk of developing this condition.

The study also reported that while females lost more weight, both males and females experienced about the same improvement in their heart failure symptoms.

Wegovy causes greater weight loss but not more benefit

The study, which included two trials, involved 1,145 people with HFpEF. Some had diabetes, while others did not.

About half the study participants were females. Upon analysis of the data, it was found that they had a higher body mass index (BMI) as well as worse heart failure symptoms.

They were also less likely to have abnormal heart rhythm or coronary artery disease in comparison to the males.

People in the study were given either 2.4 milligrams of Wegovy or a placebo once per week. This treatment extended over a period of one year (52 weeks).

The researchers reported that the females lost a larger percentage of their body weight over the course of the study (9.6% versus 7.2%),

However, the benefits to their heart failure symptoms appeared to be virtually the same. Both males and females improved by about 7.5 points on a 100-point scale.

According to reporting by Reuters, the scientists found this outcome to be “surprising” since they expected to see greater improvements in symptoms with more weight loss.

Why Wegovy might help females lose more weight

Dr. John Lowe, a Physician at Restore Care, commented on the study, saying that this difference between the sexes could be explained by metabolism as well as hormonal profiles.

“As a general rule, females have more fat in their bodies, and it is distributed in a different way, which may respond to the mechanisms of action of this medication better,” he said.

Lowe went on to point out that research has shown that females often react differently in weight loss trials due to “diverse prompting factors and social pressures.”

“[T]hese factors could increase the chances of adherence to treatment protocols and lifestyle changes, thus enhancing this drug’s effectiveness,” he suggested.

Lowe added that pharmacogenomics studies show that genetic variations can also affect how individuals react to a medication. This might account for the differences, he said.

How Wegovy might reduce the risk of heart disease in females

Dr. Michael O. McKinney, a physician and nutritionist with Healthy Outlook, commented on the study, saying that obesity is a major risk factor for developing cardiovascular disease.

Additionally, heart disease is the leading cause of death for males and females.

“Wegovy could play a central role in mitigating this risk through weight reduction for women suffering from obesity,” he said. “Losing weight helps to mitigate several cardiovascular risk factors such as decreased blood pressure levels, cholesterol and inflammation.”

McKinney went on to discuss the fact that weight loss in females living with obesity and heart disease can improve the management of their condition as well as reverse some of the consequences of carrying excess pounds.

“[I]f it works better in women than men, then Wegovy could be an amazing strategy for such patients toward effective control of their body weight, thereby reducing the chances of them having heart problems in the future,” he said.

McKinnney further described the findings of the study as “promising,” especially for females in at-risk groups.

“This means that targeting efficient strategies toward achieving what would optimize female physiological functions will highly contribute to a better health system by reducing mortality rates due to heart disease among women,” he concluded.

Takeaway

A new study has found that females with obesity and heart failure with preserved ejection fraction lost more weight than males when using the GLP-1 drug Wegovy.

Both males and females experienced improvements in their heart failure symptoms. However, neither group did better than the other.

Experts say the differences in weight loss between males and females could be due to variations in metabolism, fat distribution, social pressures, or genetics.

However, given the fact that females living with obesity are more prone to this type of heart disease and heart disease is the number one killer for all people, Wegovy has the potential to help reduce the risk of heart disease-related death.

• Stressing out about finding ways to relax can increase anxiety, leading to feeling “stresslaxed.”
• Health experts say there are several ways you can avoid or overcome feeling “stresslaxed.”
• Chronic stress can increase a number of health risks, including high blood pressure, heart attack, and stroke.

Recognizing you are stressed and need to relax is a good step toward helping yourself.

However, when finding ways to de-stress adds more stress to your life, you may end up feeling “stresslaxed,” a counterproductive effect that can lead to a vicious cycle of increased anxiety and worry.

“This term refers to the phenomena or experience of people who are in an anxious or stressed state trying to calm down and feel more relaxed by forcing themselves to take a break or unwind,” Dr. Michael Schirripa, psychiatrist, podcast host, and author of the upcoming novel Mindhunt, told Healthline.

When people force themselves to relax, they can become more anxious, and they may worry more about how well or efficiently they are actually able to relax.

The clinical term for “stresslaxed” is relaxation-induced anxiety, said Deborah Serani, Psy.D., professor at Adelphi University and author of the award-winning book, “Living with Depression.”

“Research suggests that if you already struggle with generalized anxiety or overthinking, you may be more prone to stresslaxing. Other evidence says individuals with stresslaxing struggles may also experience panic attacks in addition to their stress and anxiety. And then there are others who may become depressed because they can’t relax freely,” she told Healthline.

Does the brain resist forced relaxation?

In many ways, the brain resists forced relaxation, particularly the part of the brain called the amygdala, which is always searching for danger.

“We need to remember that our brains are always ‘on’ and are actually designed to be worried. After all, that anxiety can keep us alive as we are always aware of potential dangers that may threaten us,” Schirripa said.

People who live with anxiety, worry, and ruminations have difficulties with cognitive control, meaning they find it hard to put certain thoughts “on hold,” said Serani.

“Along a different line, there are some people who may need to stay busy because subconsciously, being calm, having space, and experiencing ease may give rise to negative thoughts or memories of traumatic experiences,” she added.

Why is it hard for some people to relax?

Schirripa said people find it difficult to relax due to external pressures and internal dynamics.

External pressures, such as work, study, family, and other commitments, can make people feel like they are constantly “switched on” to the outside world and are at the beck and call of others.

“They can then feel obligated to meet the demands of these outside influences, and as such, this can lead to a perception that they are not allowed to actually have any downtime or a space to relax that is just for themselves,” Schirripa said.

Serani noted that work time and leisure time no longer have definitive boundaries.

“Long ago, the workday ended at 5 pm and the weekends were for rest and relaxation, and on Sundays, stores were closed, which helped to make home time and relaxation easier to do. These predictable guidelines just don’t exist anymore,” she said.

Furthermore, technology, access, and other modern conveniences have blurred the lines of work and play, leading to what sociologist Dalton Conley of Princeton University coined “Weisure” (the merging of work and leisure activities).

“So, it becomes very hard to carve out relaxation time,” Serani said.

Internal dynamics that affect the ability to relax include feeling the drive to keep active and not giving oneself permission to slow down and relax.

“Sometimes people worry that if they are relaxed, that they will be bored or, alternatively, by slowing down and relaxing, there can be a fear that they will need to focus too much on the thoughts or feelings going on inside them,” said Schirripa.

Are there long-term consequences of not being able to properly relax?

Chronic stress has been connected to high blood pressure, which can lead to heart attacks and strokes, fatigue, ulcers, headaches, backaches, difficulty concentrating, and irritability.

“Depression and anxiety can surge, as can social, relational, and interpersonal difficulties when you don’t stop and smell the roses,” said Serani.

Not being able to properly switch off and relax can “reset” the nervous system to function at an overly stimulated level, added Natalie Christine Dattilo, PhD, clinical psychologist, founder of Priority Wellness, and instructor at Harvard Medical School.

“Over time, this can make it more difficult to elicit a relaxation response,” she told Healthline. “I meet with people who tell me they feel agitated, on edge, and anxious ‘from the neck down,’ but don’t describe feeling mentally anxious at all…which for me is an indication that we need to actively reset their default activation state through intentional relaxation practice.”

Strategies to help you relax

When trying to relax, Dattilo said first realize that relaxation is not as passive an activity as people have been led to believe, and it doesn’t come naturally to some people.

“I think one of the main reasons some people find it hard to relax is because it’s actually a skill we need to practice on a regular basis in order to fully experience its beneficial effects,” said Dattilo.

Often, people confuse relaxation with “zoning out.”

“This can certainly give our brain a break, but the real goal of relaxation is to ‘downshift’ our nervous system,” Dattilo said.

Downshifting happens through an active process designed to elicit the “relaxation response,” the physiological opposite of the fight-or-flight response.

“It counteracts the negative effects of stress and returns our nervous system to a homeostatic balance,” she said. 

Triggering the relaxation response can be done through visualization, muscle relaxation, massage, breathing techniques, meditation, prayer, and yoga.

Try the following tips to set relaxation in motion.

• Set boundaries between work and home life. “Also, consider powering down from technology early each night. Make self-care a priority and learn how to manage this every day,” said Serani.
• Practice the Benson Relaxation Method, which involves sitting in a comfortable position, closing your eyes, intentionally relaxing all the muscles, beginning at your feet and working up to your head, breathing slowly, for 20 minutes. “This will likely feel a little challenging or forced at first, so maybe start with 5 minutes and gradually work your way up,” said Dattilo.
• Focus on a “done” list to recall what you’ve already accomplished. “Thinking about the to-do list perches you in the future, keeping you from being in the moment,” said Serani. “Highlighting your done list will aid in celebrating your finished chores and encourage relaxation. A done list helps you linger in the past.”
• Engage in 5-minute meditation. “Studies show that even 5 minutes of deep breathing, silence, and restfulness can enhance mental and physical functioning,” Serani said. If you can go for more time meditating, consider a guided meditation with an app, or simply rest, nap, or enjoy some solitude, she said.
• Feed your senses and ground yourself by using the “5,4,3,2,1 Technique” to reduce anxiety so you can relax more readily. “Ask yourself to find 5 things you can see, 3 things you can hear, 4 things you can touch, 2 things you can smell, and 1 thing you can taste,” said Serani.

• Many Americans 60 years and older still take aspirin for the primary prevention of cardiovascular disease, even though guidelines have changed.
• Aspirin can put individuals at an increased risk of bleeding and anemia and is not right for everyone.
• In the last five years, guidelines for aspirin and primary CVD prevention have shifted, but many Americans still appear unaware of them.

Older adults are still likely to take a daily, low dose aspirin for the primary prevention of cardiovascular disease, even though doing so carries significant risks.

Using aspirin to ward off heart attack and stroke used to be a no-brainer. Doctors previously recommended it for both primary and secondary prevention of cardiovascular disease.

However, following the results of three major aspirin trials in 2018, guidance around aspirin has shifted. It is generally no longer recommended for individuals who have not had a heart attack or stroke. However, it is still recommended for patients who have already experienced a cardiovascular event and are trying to prevent another from occurring.

Aspirin no longer carries a blanket recommendation because of the potential risks it carries, particularly bleeding risk and anemia. 

Both the American Heart Association and the United States Preventive Services Taskforce have changed their guidelines in recent years to indicate that aspirin isn’t right for all patients and does carry risks. Despite these changes, new data reveals that many Americans who should not be taking daily aspirin still are, particularly those at the highest risk for harm.

In a research letter published in the Annals of Internal Medicine, researchers found that 18.5 million Americans aged 60 or older, about one in three, were still using aspirin for primary prevention of CVD. Many of them, about 3.3 million, were doing so without medical advice.

“This practice was supported by evidence prior to 2018. It naturally takes some time for new data to percolate and reach physicians and patients and for these to translate into changes in management. Potentially, there may also be a component of lack of awareness and hesitancy to change medical management,” Mohak Gupta, MD, a Cardiology Fellow at Houston Methodist Hospital and First Author of the letter, told Healthline.

Older Americans continue to take aspirin

Gupta’s research utilized self-reported health data between 2012 and 2021. The sample of 186,425 American adults is a snapshot of the US population, representative of roughly 150 million people. More than half the participants were women, and about one-third were non-white.

Compared to ten years ago, fewer adults are using aspirin for the primary prevention of CVD, but the number is still high. The number of adults without CVD who reported using aspirin was 14.4%, down from 20.6% in 2021.

However, when stratified by age, a different picture emerges: for adults 70 and older, 38% are still using aspirin. That’s important because bleeding risks become more prominent with age.

“The older adults are the most vulnerable since they are at higher risk of bleeding. They take more medications, and that can have more drug interactions with aspirin potentially causing more risk of bleeding,” Parul M. Goyal, MD, an Associate Professor of Medicine and Director of Medicine for Seniors at Vanderbilt University Medical Center who wasn’t affiliated with the study, told Healthline.

The study authors write that their findings have real-world implications: despite changing regulations, there is a disparity or knowledge gap about these changes among patients, particularly older ones. Patients and healthcare providers must have serious conversations about the risks and benefits of daily aspirin use.

“Doctors should engage in risk-benefit discussions with patients using aspirin for primary prevention, especially for adults 60 years of age and older, and discontinue aspirin where appropriate– such as in older patients, those at high bleeding risk,” said Gupta.

Why recommendations for daily aspirin use have changed

A trio of studies in 2018 represented a seismic shift in the perception of aspirin for primary CVD prevention. Those studies, the ASCEND trial, the ASPREE trial, and the ARRIVE trial, looked at the risks and benefits of aspirin in different patient populations, including those with diabetes and the elderly. The trials highlighted the potential danger of bleeding events, especially in otherwise healthy individuals, and helped to reshape aspirin recommendations.

In 2019, the American Heart Association issued updated recommendations for aspirin, indicating that while aspirin is still “well established” for secondary prevention of CVD, using it for primary prevention is “controversial.”

Three years later, in 2022, the United States Preventive Services Taskforce updated its own recommendations from 2016. 

“The USPSTF recommends against initiating low-dose aspirin use for the primary prevention of CVD in adults 60 years or older,” said the statement.

“When we’re talking about primary prevention patients, there’s a little bit more risk-benefit consideration. Are we more likely to prevent that first heart attack or stroke, or are we more likely to actually cause a major bleeding episode using aspirin?” Donald Lloyd-Jones, MD, past President of the American Heart Association and Professor of Preventive Medicine at Northwestern University’s Feinberg School of Medicine, told Healthline.

“In secondary prevention, it’s crystal clear: you should be on aspirin, period,” he added.

Aspirin and bleeding risk: what to know

Aspirin is a blood-thinner, meaning that it has anticoagulant or antiplatelet properties, which make it difficult for blood to clot. These properties are useful for preventing heart attack and stroke but can cause other health issues, namely increased bleeding risk.

“The kind of bleeding that led to the change in guidelines was all kinds of bleeding. So it is falling and hitting your head, but it’s a lot of spontaneous bleeding in the stomach,” Eleanor Levin, MD, a Clinical Professor of Cardiovascular Medicine at Stanford Medicine, told Healthline.

For older adults, falling can be a serious health concern. When combined with an increased bleeding risk due to aspirin, you have a potentially fatal mixture.

“You have to consider again, in older people at risk of falls and head trauma, and increased intracranial bleeding, that if they haven’t had a stroke before, that you’re putting them at risk for bleeding,” said Levin.

A 2023 study based on the ASPREE trial also found that a daily low dose aspirin put patients ages 65 years and older at a 20% higher risk of anemia.

Anemia is a condition in which your body doesn’t produce enough healthy red blood cells to transport the necessary amount of oxygen, leading to shortness of breath, dizziness, and headaches.

Experts contacted by Healthline said that patients and doctors should have an informed conversation about the risks and benefits of taking aspirin for the primary prevention of CVD. 

Lloyd-Jones also cautioned that if you have been taking aspirin, even if you’re doing so without medical advice, you should consult a doctor before stopping. Doing so can lead to an increased risk of cardiovascular events.

“This paper should not make anyone stop any medication. It should make people talk to their doctor about why they are taking aspirin,” he said.

The bottom line

Many older Americans continue to take a daily low-dose aspirin for the primary prevention of cardiovascular disease, even though it may put them at increased risk of bleeding.

In the past five years, recommendations have changed around taking aspirin to prevent CVD in individuals who have never had a heart attack or stroke previously.

Experts say that patients should have a detailed conversation about the risks and benefits of taking aspirin as primary prevention for CVD to identify if they would be a good candidate.

Dr Shreya Singhal is a junior doctor working in West London, as well as being a keen backpacker. She has worked in Infectious Diseases and General Practice and shares her top tips for people looking to travel this summer. With lots …