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Background Hyperkalaemia is a barrier to achieving optimal, guideline-directed treatment with renin–angiotensin–aldosterone system inhibitors (RAASis) in patients with chronic kidney disease (CKD) and/or heart failure (HF). This study describes the association between hyperkalaemia-related RAASi treatment reduction and the number of hospitalized days in patients with CKD and/or HF in Sweden and Japan. Methods Using data from health registers and hospital medical records, patients with CKD and/or HF currently receiving RAASis who experienced an index hyperkalaemia episode were identified and categorized as having maintained or reduced RAASi treatment post-index; propensity score matching (1:1) was applied to balance the groups in terms of baseline characteristics. Changes in the number of all-cause, CKD- and HF-related hospitalized days per patient-year during 6 months pre- versus post-index and the number of days alive and out of hospital (DAOH) during 6 months post-index were described. Results Overall, 20 824 and 7789 patients were included from Sweden and Japan, respectively, 42% and 38% of whom reduced their RAASi treatment after the index hyperkalaemia episode. During the 6 months post-index, all-cause hospitalization increased by 18.2 days [95% confidence interval (CI) 17.0–19.2] per person-year in Sweden and 17.9 days (95% CI 17.4–18.5) per person-year in Japan among patients with reduced RAASi treatment compared with increases of 9.4 days (95% CI 8.6–10.4) and 8.5 days (95% CI 8.0–9.0) per person-year, respectively, among patients with maintained RAASi treatment. The mean DAOH was 121.5 [standard deviation (SD) 75.0] in Sweden and 141.7 (SD 54.5) in Japan among patients with reduced RAASi treatment compared with 154.0 (SD 51.3) and 157.5 (SD 31.6), respectively, among patients with maintained RAASi treatment. Conclusion Patients whose RAASi treatment was reduced after a hyperkalaemia episode had more hospitalized days and fewer DAOH compared with patients whose RAASi treatment was maintained. [ABSTRACT FROM AUTHOR]

Food pantry stigma among college students has been documented as an issue that impacts the utilization of resources but has not been deeply investigated. The objective of this study was to explore sources of food pantry stigma to identify different strategies to encourage food pantry use, which has the potential to positively alter methods on campuses. This mixed-methods study was a branched (separate questions and responses from both food pantry users and nonusers), 51-item, online, Qualtrics survey that sampled randomly selected students from a rural university (n = 3,000) and recruited using flyers posted in food pantries on campus. Reported results include demographic characteristics, use of on-campus food pantries, a validated food insecurity questionnaire, food pantry self-stigma, and an adapted measure of selfstigma of seeking help, and affirming or nonaffirming qualitative measures of food pantry stigma. Sentiment and keyword analyses were conducted by two researchers to analyze qualitative data to identify factors that influence food pantry stigma from food pantry users and nonusers. Quantitative data were analyzed with descriptive statistics. Qualitative data determined areas of stigma and aligned with the descriptive statistics on self-stigma and help-seeking measures. Among survey participants (n = 594), 35.7% of food-insecure students did not use food pantries. Users (M = 23.12, SD = 9.06) reported higher perceptions of food pantry stigma than nonusers (M = 15.79, SD = 3.85). Of the food pantry nonusers (n = 461), 322 identified the presence of stigma (69.85%). Sixty-six food pantry users (n = 97) identified the presence of stigma (68.04%). The keyword analysis highlighted potential influences of food pantry stigma among all participants including power hierarchy, financial burden, embarrassment, and feeling superfluous. This study highlights influences of stigma and places an emphasis on changing current approaches in campus food pantry implementation and dissemination. Future studies could investigate the barriers and solutions to current messaging and implementation of campus food pantries utilizing implementation science experts and frameworks. [ABSTRACT FROM AUTHOR]

Objective: To quantify the potential advantages of using 10 year risk prediction models for cardiovascular disease, in combination with risk thresholds specific to both age and sex, to identify individuals at high risk of cardiovascular disease for allocation of statin treatment., Design: Prospective open cohort study., Setting: Primary care data from the UK Clinical Practice Research Datalink GOLD, linked with hospital admissions from Hospital Episode Statistics and national mortality records from the Office for National Statistics in England, 1 January 2006 to 31 May 2019., Participants: 1 046 736 individuals (aged 40-85 years) with no cardiovascular disease, diabetes, or a history of statin treatment at baseline using data from electronic health records., Main Outcome Measures: 10 year risk of cardiovascular disease, calculated with version 2 of the QRISK cardiovascular disease risk algorithm (QRISK2), with two main strategies to identify individuals at high risk: in strategy A, estimated risk was a fixed cut-off value of ≥10% (ie, as per the UK National Institute for Health and Care Excellence guidelines); in strategy B, estimated risk was ≥10% or ≥90th centile of age and sex specific risk distributions., Results: Compared with strategy A, strategy B stratified 20 241 (149.8%) more women aged ≤53 years and 9832 (150.2%) more men aged ≤47 years as having a high risk of cardiovascular disease; for all other ages the strategies were the same. Assuming that treatment with statins would be initiated in those identified as high risk, differences in the estimated gain in cardiovascular disease-free life years from statin treatment for strategy B versus strategy A were 0.14 and 0.16 years for women and men aged 40 years, respectively; among individuals aged 40-49 years, the numbers needed to treat to prevent one cardiovascular disease event for strategy B versus strategy A were 39 versus 21 in women and 19 versus 15 in men, respectively., Conclusions: This study quantified the potential gains in cardiovascular disease-free life years when implementing prevention strategies based on age and sex specific risk thresholds instead of a fixed risk threshold for allocation of statin treatment. Such gains should be weighed against the costs of treating more younger people with statins for longer., Competing Interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: support from British Heart Foundation (BHF), BHF Cambridge Centre for Research Excellence, National Institute for Health and Care Research (NIHR) Cambridge Biomedical Research Centre, Chinese Scholarship Council, NIHR Blood and Transplant Research Unit (BTRU) in Donor Health and Genomics, NIHR BTRU in Donor Health and Behaviour, and Innovative Medicines Initiative-2 Joint Undertaking for the submitted work; MA is an employee of AstraZeneca; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work., (Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Nicotinamide adenine dinucleotide (NAD) is essential for many enzymatic reactions, including those involved in energy metabolism, DNA repair and the activity of sirtuins, a family of defensive deacylases. During aging, levels of NAD + can decrease by up to 50% in some tissues, the repletion of which provides a range of health benefits in both mice and humans. Whether or not the NAD + precursor nicotinamide mononucleotide (NMN) extends lifespan in mammals is not known. Here we investigate the effect of long-term administration of NMN on the health, cancer burden, frailty and lifespan of male and female mice. Without increasing tumor counts or severity in any tissue, NMN treatment of males and females increased activity, maintained more youthful gene expression patterns, and reduced overall frailty. Reduced frailty with NMN treatment was associated with increases in levels of Anerotruncus colihominis, a gut bacterium associated with lower inflammation in mice and increased longevity in humans. NMN slowed the accumulation of adipose tissue later in life and improved metabolic health in male but not female mice, while in females but not males, NMN increased median lifespan by 8.5%, possible due to sex-specific effects of NMN on NAD + metabolism. Together, these data show that chronic NMN treatment delays frailty, alters the microbiome, improves male metabolic health, and increases female mouse lifespan, without increasing cancer burden. These results highlight the potential of NAD + boosters for treating age-related conditions and the importance of using both sexes for interventional lifespan studies.