Neoplasms

Pulmonary Nodules

Nathan Hinkle — Sat, 12 Sep 2026 05:00:00 +0000

Date Added:

September 12, 2026

Journal/Publication:

The New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

September 2, 2026

Issue:

Volume:

395

Pages:

894-905

URL:

Pulmonary Nodules

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

DOI: 10.1056/NEJMcp2515063

Keywords

pulmonary nodules

breathing difficulties

adenomatous hyperplasia

MeSH

Bronchoscopy

biopsy

Neoplasms

RPR Commentary: A review of the evaluation and management of pulmonary nodules. James W. Mold, MD, MPH

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Pulmonary nodules are classified as solid or subsolid, with subsolid nodules further classified as part-solid or pure ground-glass. Management strategies differ according to the type of nodule. A comparison of current and previous imaging studies, when available, is essential to assess the risk of the nodule being malignant. Solid nodules that have been stable for 2 years are considered to be benign, whereas subsolid nodules require a longer period of stability to be considered benign. Prediction models to stratify the risk of the nodule being malignant can be used to guide the management of solid nodules. Computed tomographic (CT) surveillance is indicated for low-risk nodules; positron-emission tomography–CT, biopsy, or both for intermediate-risk nodules; and surgical resection for selected high-risk nodules. Subsolid nodules are often slower growing than solid nodules but are associated with a higher risk of being malignant, especially if a solid component develops or progressively enlarges. Biopsy methods include transthoracic needle biopsy and navigational bronchoscopy. Optimal overall management balances timely diagnosis in persons who have cancer with the avoidance of unnecessary invasive procedures in persons who have benign disease.

Author/s:

Matthew E.J. Callister, Gerard Silvestri

Diagnosis and management of celiac disease

Megan George — Tue, 11 Nov 2025 14:35:21 +0000

Date Added:

November 11, 2025

Journal/Publication:

Canadian Medical Association Journal

Publication Date:

November 11, 2025

URL:

Diagnosis and management of celiac disease

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1503/cmaj.230091

Keywords

celiac disease

diet

Gluten-Free

MeSH

Protein Glutamine gamma Glutamyltransferase 2

A concise review of the diagnosis and management of patients with celiac disease. James W. Mold, MD, MPH

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Celiac disease is frequently undiagnosed, in part because of its highly variable clinical presentation.

Celiac disease can present with classic gastrointestinal symptoms (e.g., diarrhea, abdominal pain, bloating, weight loss), atypical or extraintestinal manifestations (e.g., anemia, osteoporosis, neurologic symptoms, infertility, fatigue) or asymptomatic presentations detected from screening.

The first-line serologic screening test measures tissue transglutaminase immunoglobulin A and should be conducted while the patient is consuming gluten.

Complications of celiac disease include nutritional deficiencies, osteoporosis, increased risk of viral infections and pneumonia, and, rarely, risk of malignancy.

Adherence to a lifelong, strict gluten-free diet with regular monitoring of disease activity and nutritional status is key for symptom management and to prevent complications.

Author/s:

Jedid-Jah Blom, Dominica Gidrewicz, Justine Turner, Donald R. Duerksen, M. Ines Pinto-Sánchez

Cognitive Behavioral Therapy for Insomnia in People With Chronic Disease: A Systematic Review and Meta-Analysis

Megan George — Tue, 23 Sep 2025 14:04:10 +0000

Date Added:

September 23, 2025

Journal/Publication:

JAMA Internal Medicine

Publication Date:

September 22, 2025

URL:

Cognitive Behavioral Therapy for Insomnia in People With Chronic Disease: A Systematic Review and Meta-Analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamainternmed.2025.4610

Keywords

PMID (1):

40982264

MeSH

sleep

Adult

Humans

sleep initiation and maintenance disorders

chronic pain

Sleep Latency

quality of life

Irritable Bowel Syndrome

Neoplasms

stroke

chronic disease

Cognitive Behavioral Therapy

This systematic review/meta-analysis confirms the benefits of cognitive behavioral therapy for patients with insomnia in the face of chronic health challenges. James W. Mold, MD, MPH

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Importance: Insomnia is highly prevalent among individuals with chronic disease (eg, chronic pain, cardiovascular disease, and cancer) and results in poorer disease outcomes and quality of life. Cognitive behavioral therapy for insomnia (CBT-I) is recommended as first-line treatment for insomnia. However, concerns remain about its applicability and efficacy in people with chronic disease.

Objective: To evaluate the nature, efficacy, and acceptability of CBT-I in adults with chronic disease, and to identify moderators of treatment outcomes.

Data sources: Systematic searches were conducted in PsycINFO, Medline, Embase, and CENTRAL from database inception to June 5, 2025. Additional records were identified from reference lists of relevant reviews and studies.

Study selection: Eligible studies were randomized clinical trials (RCTs) involving adults (aged ≥18 years) with chronic disease and insomnia. Studies using CBT-I with measured sleep outcomes were included.

Data extraction and synthesis: Two assessors extracted data from RCTs. Hedges g was used to calculate effect sizes, and random effects meta-analyses were conducted. Heterogeneity was assessed via I2. Subgroup analyses examined whether outcomes varied by delivery format, chronic condition type, or control group.

Main outcomes and measures: Primary outcomes included insomnia severity, sleep efficiency, and sleep onset latency. Secondary outcomes included treatment acceptability and adverse effects.

Results: Sixty-seven RCTs (5232 participants) met inclusion criteria, including chronic diseases such as cancer, chronic pain, irritable bowel syndrome, and stroke. CBT-I was associated with significantly improved outcomes for insomnia severity (g = 0.98; 95% CI, 0.81-1.16) and moderate effect sizes regarding sleep efficiency (g = 0.77; 95% CI, 0.63-0.91) and sleep onset latency (g = 0.64; 95% CI, 0.50-0.78). Subgroup analyses revealed some sample, treatment, and methodological moderators (eg, longer treatment yielded better outcomes for sleep efficiency and sleep onset latency). Satisfaction with CBT-I was high, with a mean dropout rate of 13.3%. Treatment-related adverse effects were rare.

Conclusions and relevance: This systematic review and meta-analysis showed that CBT-I demonstrated strong efficacy and acceptability in chronic disease populations, with moderate to large effect sizes that appear comparable to those in non-chronic disease populations. Efficacy of CBT-I was similar across a range of disease subgroups. Future research should explore the role and nature of treatment adaptations for specific populations and increase access to CBT-I in medical settings.

Author/s:

Amelia J. Scott, Ashleigh B. Correa, Madelyne A. Bisby

Adrenal Insufficiency in Adults: A Review

Megan George — Thu, 28 Aug 2025 18:23:08 +0000

Date Added:

August 28, 2025

Journal/Publication:

JAMA

Publication Date:

August 26, 2025

Issue:

334

Volume:

Pages:

714-725

URL:

Adrenal Insufficiency in Adults: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.5485

Keywords

PMID (1):

40522647

A review of what we know about adrenal insufficiency in adults. James W. Mold, MD, MPH

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Importance: Adrenal insufficiency is a syndrome of cortisol deficiency and is categorized as primary, secondary, or glucocorticoid induced. Although primary and secondary adrenal insufficiency are rare, affecting less than 279 per 1 million individuals, glucocorticoid-induced adrenal insufficiency is common.

Observations: Primary adrenal insufficiency, which involves deficiency of all adrenocortical hormones, is caused by autoimmune destruction, congenital adrenal hyperplasia, pharmacological inhibition (eg, high doses of azole antifungal therapy), infection (eg, tuberculosis, fungal infections), or surgical removal of adrenal cortical tissue. Secondary adrenal insufficiency is caused by disorders affecting the pituitary gland, such as tumors, hemorrhage, inflammatory or infiltrative conditions (eg, hypophysitis, sarcoidosis, hemochromatosis), surgery, radiation therapy, or medications that suppress corticotropin production, such as opioids. Glucocorticoid-induced adrenal insufficiency is caused by administration of supraphysiological doses of glucocorticoids. Patients with adrenal insufficiency typically present with nonspecific symptoms, including fatigue (50%-95%), nausea and vomiting (20%-62%), and anorexia and weight loss (43%-73%). Glucocorticoid-induced adrenal insufficiency should be suspected in patients who have recently tapered or discontinued a supraphysiological dose of glucocorticoids. Early-morning (approximately 8 am) measurements of serum cortisol, corticotropin, and dehydroepiandrosterone sulfate (DHEAS) are used to diagnose adrenal insufficiency. Primary adrenal insufficiency is typically characterized by low morning cortisol levels (<5 µg/dL), high corticotropin levels, and low DHEAS levels. Patients with secondary and glucocorticoid-induced adrenal insufficiency typically have low or intermediate morning cortisol levels (5-10 µg/dL) and low or low-normal corticotropin and DHEAS levels. Patients with intermediate early-morning cortisol levels should undergo repeat early-morning cortisol testing or corticotropin stimulation testing (measurement of cortisol before and 60 minutes after administration of cosyntropin, 250 µg). Treatment of adrenal insufficiency involves supplemental glucocorticoids (eg, hydrocortisone, 15-25 mg daily, or prednisone, 3-5 mg daily). Mineralocorticoids (eg, fludrocortisone, 0.05-0.3 mg daily) should be added for patients with primary adrenal insufficiency. Adrenal crisis, a syndrome that can cause hypotension and shock, hyponatremia, altered mental status, and death if untreated, can occur in patients with adrenal insufficiency who have inadequate glucocorticoid therapy, acute illness, and physical stress. Therefore, all patients with adrenal insufficiency should be instructed how to increase glucocorticoids during acute illness and prescribed injectable glucocorticoids (eg, hydrocortisone, 100 mg intramuscular injection) to prevent or treat adrenal crisis.

Conclusions and relevance: Although primary and secondary adrenal insufficiency are rare, glucocorticoid-induced adrenal insufficiency is a common condition. Diagnosis of adrenal insufficiency involves early-morning measurement of cortisol, corticotropin, and DHEAS. All patients with adrenal insufficiency should be treated with glucocorticoids and instructed how to prevent and treat adrenal crisis.

Author/s:

Anand Vaidya, James Findling, Irina Bancos

Human Papillomavirus Immunization in Rural Primary Care

Brian Desmarais — Thu, 20 Aug 2020 14:11:00 +0000

Date Added:

August 20, 2020

Journal/Publication:

American Journal of Preventive Medicine

Publication Date:

June 27, 2020

Issue:

Volume:

Pages:

377-385

URL:

Human Papillomavirus Immunization in Rural Primary Care

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/j.amepre.2020.03.018

MeSH

Papillomavirus Vaccines

Papillomaviridae

Papillomavirus Infections

Immunization Programs

Parents

vaccination

Surveys and Questionnaires

primary health care

An OKPRN-like study of high performing practices on HPV immunization. James W. Mold, MD, MPH

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Abstract

Introduction: Despite the safety and efficacy of the human papillomavirus vaccine, thousands are impacted by human papillomavirus and its related cancers. Rural regions have disproportionately low rates of human papillomavirus vaccination. Primary care clinics play an important role in delivering the human papillomavirus vaccine. A positive deviance approach is used to identify workflows, organizational factors, and communication strategies in rural clinics with higher human papillomavirus vaccine up-to-date rates. Positive deviance is a process by which exceptional behaviors and strategies are identified to understand factors that enable success.

Methods: Rural primary care clinics were rank ordered by human papillomavirus vaccine up-to-date rates using 2018 Oregon Immunization Program data, then recruited via purposive sampling of clinics in the top and bottom quartiles. Two study team members conducted previsit interviews, intake surveys, and 2-day observation visits with 12 clinics and prepared detailed field notes. Data were collected October-December 2018 and analyzed using a thematic approach January-April 2019.

Results: Four themes distinguished rural clinics with higher human papillomavirus vaccine up-to-date rates from those with lower rates. First, they implemented standardized workflows to identify patients due for the vaccine and had vaccine administration protocols. Second, they designated and supported a vaccine champion. Third, clinical staff in higher performing sites were comfortable providing immunizations regardless of visit type. Finally, they used clear, persuasive language to recommend or educate parents and patients about the vaccine's importance.

Conclusions: Positive deviance identified characteristics associated with higher human papillomavirus vaccine up-to-date rates in rural primary care clinics. These findings provide guidance for rural clinics to inform human papillomavirus vaccination quality improvement interventions.

Author/s:

Ferrara, Laura, K., Gunn, Rose, Dickinson, Caitlin, Stock, Isabel, Griffith-Weprin, Jennifer, Wiser, Amy, Hatch, Brigit, Fagnan, L.J., Carney, P.A., Davis, M.M.

Human Papillomavirus Immunization in Rural Primary Care

Brian Desmarais — Mon, 29 Jun 2020 17:01:39 +0000

Date Added:

June 29, 2020

Journal/Publication:

American Journal of Preventive Medicine

URL:

Human Papillomavirus Immunization in Rural Primary Care

Type:

Best Local Practices

Format:

Article

DOI (1):

https://doi.org/10.1016/j.amepre.2020.03.018

Keywords

vaccination

MeSH

Papillomavirus Infections

Papillomavirus Vaccines

The results might be helpful to practices trying to increase HPV immunization rates. James W. Mold, MD, MPH

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Not available.

Author/s:

Gunn, R., Ferrara, L.K., Dickinson, C., Fagnan, L.J., Carney, P.A., Davis, M.M.

Therapeutic use of cannabis and cannabinoids: an evidence mapping and appraisal of systematic reviews

John Bayhi — Mon, 03 Feb 2020 19:39:52 +0000

Date Added:

February 3, 2020

Journal/Publication:

BMC Complementary Medicine and Therapies

Publisher:

Springer Nature

Publication Date:

January 15, 2020

Issue:

Volume:

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1186/s12906-019-2803-2

Keywords

Another summary of what we know about the therapeutic effects of cannabinoids. The figures appear to be useful. James W. Mold, MD, MPH

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Background

Although cannabis and cannabinoids are widely used with therapeutic purposes, their claimed efficacy is highly controversial. For this reason, medical cannabis use is a broad field of research that is rapidly expanding. Our objectives are to identify, characterize, appraise, and organize the current available evidence surrounding therapeutic use of cannabis and cannabinoids, using evidence maps.

Methods

We searched PubMed, EMBASE, The Cochrane Library and CINAHL, to identify systematic reviews (SRs) published from their inception up to December 2017. Two authors assessed eligibility and extracted data independently. We assessed methodological quality of the included SRs using the AMSTAR tool. To illustrate the extent of use of medical cannabis, we organized the results according to identified PICO questions using bubble plots corresponding to different clinical scenarios.

Results

A total of 44 SRs published between 2001 and 2017 were included in this evidence mapping with data from 158 individual studies. We extracted 96 PICO questions in the following medical conditions: multiple sclerosis, movement disorders (e.g. Tourette Syndrome, Parkinson Disease), psychiatry conditions, Alzheimer disease, epilepsy, acute and chronic pain, cancer, neuropathic pain, symptoms related to cancer (e.g. emesis and anorexia related with chemotherapy), rheumatic disorders, HIV-related symptoms, glaucoma, and COPD. The evidence about these conditions is heterogeneous regarding the conclusions and the quality of the individual primary studies. The quality of the SRs was moderate to high according to AMSTAR scores.

Conclusions

Evidence on medical uses of cannabis is broad. However, due to methodological limitations, conclusions were weak in most of the assessed comparisons. Evidence mapping methodology is useful to perform an overview of available research, since it is possible to systematically describe the extent and distribution of evidence, and to organize scattered data.

Author/s:

Montero-Oleas, N, Arevalo-Rodriguez, I, Nunez-Gonzalez, S, Viteri-Garcia, A, Simancas-Racines, D

Association between vitamin D supplementation and mortality: systematic review and meta-analysis

Brian Desmarais — Mon, 30 Sep 2019 13:33:28 +0000

Date Added:

September 30, 2019

Journal/Publication:

BMJ

Publication Date:

August 12, 2019

URL:

Association between vitamin D supplementation and mortality: systematic review and meta-analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1136/bmj.l4673

Keywords

cancer

cancer mortality

vitamin D

Vitamin D3 supplimentation

MeSH

cardiovascular diseases

Outcome Assessment (Health Care)

Vitamin D3 supplementation appears to reduce cancer-related mortality. It is a little hard to tell whether it works regardless of initial 25OH VitD levels as this analysis suggests. James W. Mold, MD, MPH

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Abstract

OBJECTIVE:

To investigate whether vitamin D supplementation is associated with lower mortality in adults.

DESIGN:

Systematic review and meta-analysis of randomised controlled trials.

DATA SOURCES:

Medline, Embase, and the Cochrane Central Register from their inception to 26 December 2018.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES:

Randomised controlled trials comparing vitamin D supplementation with a placebo or no treatment for mortality were included. Independent data extraction was conducted and study quality assessed. A meta-analysis was carried out by using fixed effects and random effects models to calculate risk ratio of death in the group receiving vitamin D supplementation and the control group.

MAIN OUTCOME MEASURES:

All cause mortality.

RESULTS:

52 trials with a total of 75 454 participants were identified. Vitamin D supplementation was not associated with all cause mortality (risk ratio 0.98, 95% confidence interval 0.95 to 1.02, I2=0%), cardiovascular mortality (0.98, 0.88 to 1.08, 0%), or non-cancer, non-cardiovascular mortality (1.05, 0.93 to 1.18, 0%). Vitamin D supplementation statistically significantly reduced the risk of cancer death (0.84, 0.74 to 0.95, 0%). In subgroup analyses, all cause mortality was significantly lower in trials with vitamin D3 supplementation than in trials with vitamin D2 supplementation (P for interaction=0.04); neither vitamin D3 nor vitamin D2 was associated with a statistically significant reduction in all cause mortality.

CONCLUSIONS:

Vitamin D supplementation alone was not associated with all cause mortality in adults compared with placebo or no treatment. Vitamin D supplementation reduced the risk of cancer death by 16%. Additional large clinical studies are needed to determine whether vitamin D3 supplementation is associated with lower all cause mortality.

STUDY REGISTRATION:

PROSPERO registration number CRD42018117823.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Author/s:

Zhang, Y., Fang, F., Tang, J., Jia, L., Feng, Y., Xu, P., Faramand, A.

Severe Pulmonary Disease Associated with Electronic-Cigarette–Product Use — Interim Guidance

John Bayhi — Fri, 13 Sep 2019 12:52:13 +0000

Date Added:

September 13, 2019

Journal/Publication:

Morbidity and Mortality Weekly Report

Publisher:

U.S. Department of Health & Human Services / Centers for Disease Control and Prevention

Publication Date:

September 13, 2019

Issue:

Volume:

Pages:

787-790

URL:

Severe Pulmonary Disease Associated with Electronic-Cigarette–Product Use — Interim Guidance

Type:

Public Health Announcements

Format:

Article

DOI (1):

10.15585/mmwr.mm6836e2

Keywords

PMID (1):

31513561

MeSH

electronic nicotine delivery systems

volatile organic compounds

Neoplasms

Lung Diseases

centers for disease control and prevention (U.S.)

The latest information from the CDC on lung disease associated with vaping. James W. Mold, MD, MPH

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On September 6, 2019, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). As of August 27, 2019, 215 possible cases of severe pulmonary disease associated with the use of electronic cigarette (e-cigarette) products (e.g., devices, liquids, refill pods, and cartridges) had been reported to CDC by 25 state health departments. E-cigarettes are devices that produce an aerosol by heating a liquid containing various chemicals, including nicotine, flavorings, and other additives (e.g., propellants, solvents, and oils). Users inhale the aerosol, including any additives, into their lungs. Aerosols produced by e-cigarettes can contain harmful or potentially harmful substances, including heavy metals such as lead, volatile organic compounds, ultrafine particles, cancer-causing chemicals, or other agents such as chemicals used for cleaning the device (1). E-cigarettes also can be used to deliver tetrahydrocannabinol (THC), the principal psychoactive component of cannabis, or other drugs; for example, "dabbing" involves superheating substances that contain high concentrations of THC and other plant compounds (e.g., cannabidiol) with the intent of inhaling the aerosol. E-cigarette users could potentially add other substances to the devices. This report summarizes available information and provides interim case definitions and guidance for reporting possible cases of severe pulmonary disease. The guidance in this report reflects data available as of September 6, 2019; guidance will be updated as additional information becomes available.

Author/s:

Schier, JG, Meiman, JG, Layden, J, Mikosz, CA, VanFrank, B, King, BA, Salvatore, PP, Weissman, DN, Thomas, J, Melstrom, PC, Baldwin, GT, Parker, EM, Courtney-Long, EA, Krishnasamy, VP, Pickens, CM, Evans, ME, Tsay, SV, Powell, KM, Kiernan, EA, Marynak, KL, Adjemian, J, Holton, K, Armour, BS, England, LJ, Briss, PA, Houry, D, Hacker, KA, Reagan-Steiner, S, Zaki, S, Meaney-Delman, D, CDC 2019 Lung Injury Response Group

Effects of Aspirin on Risks of Vascular Events and Cancer According to Bodyweight and Dose: Analysis of Individual Patient Data from Randomised Trials

Jeffrey Wilson — Tue, 28 Aug 2018 19:33:50 +0000

Date Added:

September 26, 2018

Journal/Publication:

Lancet

Publisher:

Elsevier

Publication Date:

August 4, 2018

Issue:

10145

Volume:

392

Pages:

387-399

URL:

Effects of Aspirin on Risks of Vascular Events and Cancer According to Bodyweight and Dose: Analysis of Individual Patient Data from Randomised Trials

Type:

Meta-analyses, Reviews, and Guidelines, Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/S0140-6736(18)31133-4

Keywords

aspirin

cardiovascular events

cancer

PMID (1):

30017552

MeSH

disease, cardiovascular

aspirin

Neoplasms

This analysis of multiple large aspirin trials found that 81mg of aspirin was only effective for reducing the risk of cardiovascular events in patients weighing less than 70kg. Doses >325mg were effective in those weighing more than 70kg. While not definitive, this study suggests that aspirin’s effect is dose dependent. That may explain some of the contradictory findings from the various published trials.

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BACKGROUND:

A one-dose-fits-all approach to use of aspirin has yielded only modest benefits in long-term prevention of cardiovascular events, possibly due to underdosing in patients of large body size and excess dosing in patients of small body size, which might also affect other outcomes.

METHODS:

Using individual patient data, we analysed the modifying effects of bodyweight (10 kg bands) and height (10 cm bands) on the effects of low doses (≤100 mg) and higher doses (300-325 mg or ≥500 mg) of aspirin in randomised trials of aspirin in primary prevention of cardiovascular events. We stratified the findings by age, sex, and vascular risk factors, and validated them in trials of aspirin in secondary prevention of stroke. Additionally, we assessed whether any weight or height dependence was evident for the effect of aspirin on 20-year risk of colorectal cancer or any in-trial cancer.

RESULTS:

Among ten eligible trials of aspirin in primary prevention (including 117 279 participants), bodyweight varied four-fold and trial median weight ranged from 60·0 kg to 81·2 kg (p<0·0001). The ability of 75-100 mg aspirin to reduce cardiovascular events decreased with increasing weight (pinteraction=0·0072), with benefit seen in people weighing 50-69 kg (hazard ratio [HR] 0·75 [95% CI 0·65-0·85]) but not in those weighing 70 kg or more (0·95 [0·86-1·04]; 1·09 [0·93-1·29] for vascular death). Furthermore, the case fatality of a first cardiovascular event was increased by low-dose aspirin in people weighing 70 kg or more (odds ratio 1·33 [95% CI 1·08-1·64], p=0·0082). Higher doses of aspirin (≥325 mg) had the opposite interaction with bodyweight (difference pinteraction=0·0013), reducing cardiovascular events only at higher weight (pinteraction=0·017). Findings were similar in men and women, in people with diabetes, in trials of aspirin in secondary prevention, and in relation to height (pinteraction=0·0025 for cardiovascular events). Aspirin-mediated reductions in long-term risk of colorectal cancer were also weight dependent (pinteraction=0·038). Stratification by body size also revealed harms due to excess dosing: risk of sudden death was increased by aspirin in people at low weight for dose (pinteraction=0·0018) and risk of all-cause death was increased in people weighing less than 50 kg who were receiving 75-100 mg aspirin (HR 1·52 [95% CI 1·04-2·21], p=0·031). In participants aged 70 years or older, the 3-year risk of cancer was also increased by aspirin(1·20 [1·03-1·47], p=0·02), particularly in those weighing less than 70 kg (1·31 [1·07-1·61], p=0·009) and consequently in women (1·44 [1·11-1·87], p=0·0069).

INTERPRETATION:

Low doses of aspirin (75-100 mg) were only effective in preventing vascularevents in patients weighing less than 70 kg, and had no benefit in the 80% of men and nearly 50% of all women weighing 70 kg or more. By contrast, higher doses of aspirin were only effective in patients weighing 70 kg or more. Given that aspirin's effects on other outcomes, including cancer, also showed interactions with body size, a one-dose-fits-all approach to aspirin is unlikely to be optimal, and a more tailored strategy is required.

Author/s:

Rothwell, Peter M., Cook, Nancy R., Gaziano, J. Michael, Price, Jacqueline F., Blech, Jill F. F., Roncaglioni, Maria Carla, Morimoto, Takeshi, Mehta, Ziyah