Reviews & Analysis

Observational studies suggest that statin treatment has a fracture-preventive effect; however, there is only limited supporting evidence from randomized controlled trials. Now, results from the JUPITER trial show that rosuvastatin treatment does not reduce the risk of fractures and, further, that levels of high sensitivity C-reactive protein are not associated with fracture risk.

Aromatase inhibitors are the most effective agents for preventing breast cancer; however, their use is associated with bone loss and an increased risk of fractures. Sestak and colleagues show that administration of an oral bisphosphonate prevents aromatase-inhibitor-induced bone loss in postmenopausal women with osteopenia or osteoporosis who are at high risk of breast cancer.

A landmark article by The Cancer Genome Atlas Research network describes the genetic landscape of papillary thyroid carcinoma (PTC). This study identifies oncogenic driver lesions, highlights molecular pathways that drive cancer formation and defines clinically relevant disease subtypes. These findings have far-reaching implications with respect to molecular diagnosis and targeted therapies for PTC.

Vitamin D deficiency is a global health concern, which might affect the pathogenesis of diabetes mellitus. Previous studies suggest vitamin D has some potential in the treatment of type 2 diabetes mellitus. A new combined genetic study and meta-analysis reveals conflicting results regarding the effects of circulating levels of vitamin D on type 2 diabetes mellitus risk.

Familial hypercholesterolaemia is caused by mutations in genes that code for proteins involved in cholesterol metabolism. Patients heterozygous for mutations in LDLR respond to statin treatment, whereas individuals with homozygous LDLR mutations do not. PCSK9 inhibitors have been developed for treating familial hypercholesterolaemia, and results are promising for patients with either heterozygous or homozygous familial hypercholesterolaemia.

Numerous studies have evaluated the use of low-dose aspirin (LDA) to reduce rates of pre-eclampsia and adverse perinatal outcomes in women considered at risk of pre-eclampsia. A new study recommends that these women should receive LDA after 12 weeks of gestation to reduce the rates of pre-eclampsia, preterm birth and fetal growth restriction.

Endocrine and metabolic pathways are a rich ground in which to examine the prognostic significance of biomarkers of cardiovascular risk. Whereas numerous biomarkers for prediction of cardiovascular disease have emerged in the past decade, far fewer have transitioned into clinical practice. Will growth hormone fulfill its potential?

The race to generate β cells from stem cells has taken another big turn. We can already generate definitive endoderm from human embryonic stem cells and functional insulin-producing cells from transplanted pancreatic progenitors. Now, differentiating glucose-responsive insulin-producing cells in vitro that function like adult human β cells has been achieved.

The treatment of patients with acromegaly has progressed to encompass multimodal strategies that can include selective transsphenoidal adenomectomy, radiotherapy and somatostatin analogues. As a result, disease control and survival of these patients has improved.

Availability of longitudinal data on the evolution of thyroid nodules and how this progression is influenced by changes in iodine intake is limited. A systematic 11-year follow-up study in Danish adults offers new insights into the relationships between thyroid nodularity, age and iodine intake.

Shortening of leukocyte telomeres is considered a molecular marker for ageing and is suggested to be linked with increased risk of cardiovascular and metabolic disease. A large population-based study with 6 years of follow-up by Révész and colleagues reveals that short telomeres, at both baseline and during follow-up, are associated with an increased risk of metabolic abnormalities.

A large-scale study with 5.24 million participants has found statistically significant associations between increased BMI and 17 of 22 frequent cancers. The strongest associations were observed for cancers of the endometrium, kidney, gallbladder and uterus. Questions remain as to whether several of the weaker associations reported in this study reflect genuinely causal relationships.

The prevalence of type 2 diabetes mellitus (T2DM) is increasing in young Asian adults; however, little is known about the associated clinical characteristics and the prevalence of complications. A recent Asia-wide prospective cohort study has revealed poor metabolic control in patients with young-onset T2DM, indicating more efficient health-care strategies are warranted to manage this vulnerable population.

The recently published HPS2–THRIVE study has shown that the addition of extended release niacin to statin therapy in patients with well-controlled levels of LDL cholesterol does not reduce the risk of cardiovascular events and might even increase harm. Consequently, the use of niacin to increase levels of HDL cholesterol is not recommended.

Polycystic ovary syndrome (PCOS) is associated with anovulatory infertility. Many clinicians focus on the use of assisted reproductive technologies other than medical induction of ovulation. A new study demonstrating that the aromatase inhibitor letrozole is superior to clomiphene citrate (the current first-line therapy) for ovulation induction in women with PCOS returns attention to this area.

Vitamin D administration lowers blood pressure in animal models, but findings from studies in humans are inconsistent. Vimaleswaran and colleagues used a Mendelian randomization approach to show that alleles associated with increased plasma levels of 25-hydroxyvitamin D₃ are associated with a reduced risk of hypertension, suggesting a causal relationship in humans.

Of late, clinical trial data, meta-analyses and observational studies have caused concern that the use of calcium supplements might increase the risk of myocardial infarction and stroke. A new meta-analysis suggests that there is no problem with calcium supplements, but as the analysis includes controversial data omitted from previous analyses, the debate will continue.

The evidence base for the efficacy of insulin pump therapy in type 2 diabetes mellitus (T2DM) has been inconsistent to date. However, a recent large-scale randomized controlled trial comparing pump treatment with multiple daily insulin injections in patients with poorly controlled T2DM has shown substantial improvement in glycaemic control with pump therapy.

The prevalence of the metabolic syndrome has increased in tandem with that of obesity. The metabolic syndrome is associated with structural and functional cerebral damage. A new study confirms the association between the metabolic syndrome and reduced brain volume in the absence of diabetes mellitus. Here, we highlight how vascular dysfunction potentially contributes to this brain damage.

Defining follicular thyroid lesions with indeterminate cytology as either benign or malignant without surgery is an important clinical challenge. Maia and colleagues integrated the Thyroid Imaging and Data Reporting System with the Bethesda System for malignancy risk classification; their report suggests that this method leads to increased diagnostic accuracy with direct clinical implications.