Could the inflammation that drives psoriasis and other immune-linked illnesses be a major player in heart disease?

In a new study, certain psoriasis drugs appeared to help to keep arteries clear, suggesting such a link.

A sixth factor

“Classically a heart attack is caused by one of five risk factors: diabetes, hypertension, high cholesterol, family history or smoking,” explained study lead researcher Dr Nehal Mehta.

“Our study presents evidence that there is a sixth factor, inflammation,” she said.

Mehta heads the Laboratory of Inflammation and Cardiometabolic Diseases at the US National Heart, Lung, and Blood Institute (NHLBI) in Bethesda, Maryland.

Another cardiologist agreed the study could open doors to new research.

“The future of cardiovascular prevention may require a cholesterol reduction medication and an anti-inflammatory medication,” said Dr Guy Mintz, who directs heart health at Northwell Health’s Sandra Atlas Bass Heart Hospital in Manhasset, New York.

“These are exciting times in the area of cardiovascular prevention,” said Mintz, who wasn’t involved with the study.

Reducing fatty plaques

The new study involved 121 patients who had moderate to severe psoriasis and qualified for anti-inflammatory medicines called biologic therapies. These injected medicines are also used by people with immune-linked conditions such as lupus or rheumatoid arthritis, and include drugs such as Cimzia, Enbrel, Humira, Orencia and Remicade, among others.

All of these medicines work by helping to suppress pro-inflammatory immune system activity.

All participants enrolled in the new study were at low risk of heart disease at the beginning of the research.

Over a year of follow-up, the use of biologic therapy was associated with an 8% reduction in coronary artery plaque, the researchers said.

Specifically, use of biologic drugs appeared linked with a slowed build-up of fatty plaques in arteries. These are the plaques that can restrict blood flow and cause heart attacks and stroke.

The findings suggest that immunotherapies that treat inflammatory conditions might also help cut heart disease risk, Mehta and his colleagues reported.

An anti-inflammatory effect

The study authors pointed to prior research that tied psoriasis to the early development of high-risk “soft” arterial plaques. Biologic therapy might cut plaque formation, even in patients without other heart disease risk factors such as high cholesterol, blood sugar and blood pressure, they said.

“This appears to be an anti-inflammatory effect,” Mehta explained in an NHLBI news release. “In the absence of improvement in other cardiovascular risk factors, and without adding new cholesterol medications, patients’ soft plaque still improved.”

However, a cause-and-effect relationship isn’t clear from this type of study, so “the next steps should be randomized, controlled trials,” Mehta said.

Dr Michele Green is a dermatologist who treats psoriasis patients at Lenox Hill Hospital in New York City. She wasn’t involved in the new study, but said, “Treatments with biologics indeed shows great promise in treating cardiovascular disease.”

New research supports hypothesis

As for Mintz, he called the new research “exciting and important, because it highlights the importance of inflammation associated with psoriasis causing blockages in the arteries of the heart to progress.

“The best statin in the world can only lower cardiovascular events by approximately 40%,” Mintz pointed out. “So the question arises, what causes the other 60% of cardiovascular events?”

The new research “supports the hypothesis that inflammation contributes to cardiovascular disease,” he said. “Physicians need to become aware that inflammation should be considered in patient cardiovascular risk assessment.”

The study appears online in the journal Cardiovascular Research.

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It seems as though every day brings a new study on the merits – or the risks – of coffee. So what’s the real scoop?

If you like drinking coffee simply for the pleasure of it, Harvard University research has found that sipping up to six cups a day is probably safe. Remember: Those are 8-ounce cups with about 100 milligrams of caffeine and little added milk and sweetener. A cafe drink can pack the equivalent of three cups, plus the fat and calories from any add-ins, so tally it accordingly.

And it appears that coffee is not only “safe” to drink, it may also have actual health benefits, like protecting against diabetes, Parkinson’s and certain liver diseases. Coffee drinkers may also have a slightly lower risk of dying from heart disease compared to those who skip the java.

How can a cup o’ joe have such wide-ranging effects? Coffee is much more than caffeine, with hundreds of different compounds, any of which can lead to a positive health outcome.

Got the jitters?

While some studies have found an association between these benefits and drinking moderate amounts of coffee, even heavy coffee drinkers may benefit. A 2018 study published in JAMA Internal Medicine looked at 500 000 people who drank one to eight cups a day. Researchers found that heavy coffee drinking was associated with a lower risk of early death from all causes.

But keep in mind that it’s important to personalise research findings to your own situation. For instance, if you feel jittery during the day or have trouble getting quality sleep, you may be drinking too much coffee. Also, if you’re pregnant or have high blood pressure or diabetes, ask your doctor what’s safe for you.

The bottom line: Expect more coffee research down the road, but for now, for those who like it, there’s no need to think of coffee as an unhealthy habit anymore.

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A mind-altering medication related to the club drug Special K won US approval for patients with hard-to-treat depression, the first in a series of long-overlooked substances being reconsidered for severe forms of mental illness.

The nasal spray from Johnson & Johnson is a chemical cousin of ketamine, which has been used for decades as a powerful anaesthetic to prepare patients for surgery. In the 1990s, the medication was adopted as a party drug by the underground rave culture due to its ability to produce psychedelic, out-of-body experiences. More recently, some doctors have given ketamine to people with depression without formal FDA approval.

Feel-good brain chemical

The Food and Drug Administration approved Spravato as a fast-acting treatment for patients who have failed to find relief with at least two antidepressants. Up to 7.4 million American adults suffer from so-called treatment-resistant depression, which heightens the risk of suicide, hospitalisation and other serious harm, according to the FDA.

The drug will cost between $590 (±R8 380) and $885 (±R12 570) depending on the dosage and before various insurance discounts and rebates.

There have been no major pharmaceutical innovations for depression since the launch of Prozac and related antidepressants in the late 1980s. Those drugs target the feel-good brain chemical serotonin, and can take weeks or months to kick in.

Ketamine and J&J’s version work differently than those drugs, targeting a chemical called glutamate that is thought to restore brain connections that help relieve depression.

When the drug works, its effect is almost immediate. That speed “is a huge thing because depressed patients are very disabled and suffer enormously,” said Dr John Mann, a psychiatrist and researcher at Columbia University. If the drug doesn’t work, physicians can quickly switch to other options, he noted.

The FDA approved Spravato, known chemically as esketamine, based on study results that showed patients taking the drug experienced a bigger improvement in their depression levels than patients taking a sham treatment, when measured with a psychiatric questionnaire.

The drug is designed to be lower-dose and easier to use than ketamine, which is normally given as an intravenous infusion.

‘It’s a strong drug’

Robin Prothro, 60, began taking antidepressants more than 20 years ago. But she says none of the five medications she tried relieved the depression that has stymied her personal and professional life.

Since enrolling in a Spravato trial two years ago, Prothro says her depression has lifted and she’s returned to hobbies she abandoned years ago, like gardening.

She takes the drug every two weeks at her psychiatrist’s office while reclining in a comfortable chair.

“You can feel it coming on, it’s a strong drug,” she said, describing colours and shapes that drift before her eyes. “I just let the drug work. I close my eyes and my mind is amazingly quiet.”

The ketamine-like drug is the first of several psychoactive substances making their way through the US regulatory process as physicians search further afield for new therapies. Researchers are conducting late-stage trials of psilocybin, the active ingredient in magic mushrooms, and MDMA, a euphoria-inducing club drug, as potential treatments for depression and post-traumatic stress disorder.

“Substantially different agents are only rarely appearing from pharmaceutical companies or other laboratories,” said Dr Paul Summergrad, a psychiatrist at Tufts University. “That’s prompting people to investigate other compounds.”

Unlike ketamine, psilocybin and MDMA have no legal medical use. Classified in the same category as heroin and LSD, they are tightly restricted by the federal government. But the FDA’s approval of esketamine could smooth their path.

Abuse potential

Depression is among the leading causes of disability in the US and is being closely monitored by health authorities amid rising suicides nationwide. In 2017, the US suicide rate rose to 14 deaths per 100 000 people, the highest rate in at least 50 years, according to federal records.

Government officials haven’t suggested an explanation for the trend, though academic researchers point to the nation’s widening income gap, financial struggles and divisive politics.

J&J’s drug will be subject to a number of restrictions due to its abuse potential, side effects and lingering safety questions.

The drug will only be given by accredited specialists who must monitor patients for at least two hours after administration, due to its trippy, disorienting effects. Additionally, all patients will be tracked in a registry to monitor long-term safety and effectiveness.

The immediate impact of ketamine is thought to last just four to seven days and there’s no consensus yet on how long patients can benefit from ongoing treatment.

Still, there are few other options for patients who fail to respond to antidepressants. The most effective treatment in such cases, electroshock therapy, requires patients to be fully sedated and can cause persistent memory loss.

Safer and more accessible

Wall Street has high expectations for J&J’s medication, with analysts predicting more than $600 million (±R8.52 billion) in annual sales by 2022. But J&J will face competition in the marketplace.

A decades-old drug, ketamine is already used off-label to treat depression by some doctors. At least 150 clinics around the US provide treatment with various forms of the drug, which is available as a low-cost generic. Patients often pay hundreds or thousands of dollars for intravenous infusions of the drug over several weeks or months. Such therapies are generally not covered by insurance because they haven’t been approved as safe and effective by FDA regulators.

Some doctors plan to offer both ketamine and the new J&J drug.

Dr Steve Levine says having FDA-approved standards for dosing and administering the new drug should raise standards in the field and drive out some of the bad actors who are not qualified to treat depression.

“This is going to bring in some standards, regulation and it’s going to make it safer and more accessible to patients,” said Levine, who serves as vice president of the American Society of Ketamine Physicians, a group representing doctors, nurses and others using ketamine for treating depression or other non-approved uses.

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More people in England and Wales with severe hearing loss will be eligible for the devices.

The public is concerned about lack of staffing and waiting times, according to a long-running survey.

The risk is very low and drugs to treat menopause symptoms are safe and effective, doctors say.

Violent attacks are making treating the worst Ebola outbreak in the history of DR Congo even harder.

Some wetlands perform better under pressure. A new study revealed that when faced with sea-level rise, coastal wetlands respond by burying even more carbon in their soils.

Physicists have used a seven-qubit quantum computer to simulate the scrambling of information inside a black hole, heralding a future in which entangled quantum bits might be used to probe the mysterious interiors of these bizarre objects.

Esketamine nasal spray can reportedly work within 24 hours, but critics say more tests are needed.