Effectiveness and safety of continuous low-molecular-weight heparin versus switching to direct oral anticoagulants in cancer-associated venous thrombosis.

Given the existing uncertainty regarding the effectiveness and safety of switching from low-molecular-weight heparin (LMWH) to direct oral anticoagulants (DOACs) in patients with cancer-associated venous thrombosis (CAT), we conducted a comprehensive population-based cohort study utilizing electronic health database in Hong Kong. A total of 4356 patients with CAT between 2010 and 2022 were included, with 1700 (39.0%) patients switching to DOAC treatment. Compared to continuous LMWH treatment, switching to DOACs was associated with a significantly lower risk of hospitalization due to venous thromboembolism (HR: 0.49 [95% CI = 0.35-0.68]) and all-cause mortality (HR: 0.67 [95% CI = 0.61-0.74]), with no significant difference in major bleeding (HR: 1.04 [95% CI = 0.83-1.31]) within six months. These findings provide reassurance regarding the effectiveness and safety of switching from LMWH to DOACs among patients with CAT, including vulnerable patient groups.

Associations between meat consumption and all-cause and cause-specific mortality in middle-aged and older adults with frailty.

OBJECTIVES: This study aimed to explore the associations between different types of meat consumption and mortality risk among people with frailty. DESIGN: Longitudinal study. SETTING AND PARTICIPANTS: We included 19,913 physically frail participants from the UK Biobank. MEASUREMENTS: We used the validated brief food frequency questionnaire (FFQ) to measure meat consumption. Baseline diet data from 2006 to 2010 were collected, and participants were followed up until March 23, 2021. Cox proportional hazards regression models were conducted to examine the associations of meat consumption with mortality risk. RESULTS: We identified 3,622 all-cause deaths, 1,453 cancer deaths, and 1,663 cardiovascular deaths during a median follow-up time of 11.2 years. Higher consumption of unprocessed poultry (per 25 g/day increment) was associated with a lower risk of all-cause mortality (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.75-0.88), cancer mortality (HR 0.84, 95% CI 0.74-0.96), and cardiovascular mortality (HR 0.72, 95% CI 0.63-0.81). Consumption of unprocessed red meat had a U-shaped relationship with mortality. Moderate consumption of unprocessed red meat 1.0-1.9 times/week was associated with a 14% (95% CI: 3 %-24%) lower risk of all-cause mortality than the lowest consumption frequency group (0-0.9 times/week). The hazard of cancer and CV mortality was also lower in the 1.0-1.9 times/week group, though the associations were not statistically significant. More frequent consumption of processed meat was associated with an increased risk of all-cause mortality (HR 1.20, 95% CI 1.07-1.34) and cardiovascular mortality (HR 1.20, 95% CI 1.02-1.42). Fish consumption was not associated with all types of mortality. CONCLUSIONS: Higher consumption of processed meat, not fish, was associated with increased all-cause and cardiovascular mortality. In contrast, higher consumption of unprocessed poultry and moderate consumption of unprocessed red meat was associated with reduced all-cause, cancer, and cardiovascular mortality. These findings warrant further investigation to establish optimal dietary patterns for frail individuals.

Associations between healthy lifestyle and mortality across different social environments: a study among adults with frailty from the UK Biobank.

BACKGROUND: Among people living with frailty, adherence to a healthy lifestyle may be a low-cost and effective strategy to decrease frailty-induced health risks across different social environments. METHODS: We included 15 594 frail participants at baseline from the UK Biobank study. We used four lifestyle factors to create a composite healthy lifestyle score and 17 social factors to construct a polysocial score. We classified the lifestyle score into two levels (unhealthy and healthy) and the polysocial score into three levels (low, intermediate and high). We used Cox regression to determine the association of each lifestyle factor and lifestyle score with all-cause mortality, respectively. We also examined the associations across polysocial score categories. We evaluated the joint association of the lifestyle score and the categorical polysocial score with all-cause mortality. RESULTS: During up to 14.41 follow-up years, we documented 3098 all-cause deaths. After multivariable adjustment, we found a significant association between not smoking and adequate physical activity with all-cause mortality across polysocial score categories, respectively. We also found a significant association between a healthy diet and all-cause mortality among frail participants living in an intermediate social environment. A healthy lifestyle was associated with a lower all-cause mortality risk across polysocial score categories, especially among those with a low polysocial score. CONCLUSIONS: Adherence to a healthy lifestyle, particularly not smoking, adequate physical activity and a healthy diet, may provide a feasible solution to decreasing mortality risk among frail adults across different social environments, especially for those in the socially disadvantaged group.