TTHealthWatch is a weekly podcast from Texas Tech. In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine in Baltimore, and Rick Lange, MD, president of Texas Tech Health El Paso, look at the top medical stories of the week.
This week’s topics include a genetic treatment for hypercholesterolemia, cannabis and hyperemesis, reducing the risk of dementia, and a newer anti-inflammatory for polymyalgia rheumatica treatment (PMR).
Program notes:
0:38 Polymyalgia rheumatica treatment
1:35 Antibody targets interleukin-17A
2:35 Remission started at 12 weeks and was durable to 52 weeks
3:11 Cannabis and hyperemesis syndrome
4:11 Cannabis-related emergency department (ED) visits
5:11 Prior to the new coding didn’t link
6:05 Gene inhibition of PCSK9
7:05 Encased in a nanoparticle
8:11 Three vascular risk factors and dementia
9:11 Stratified by age, sex, APOE status
10:13 13 additional dementia-free years
11:58 End
Transcript:
Elizabeth: What are the three things you can do to avoid developing dementia?
Rick: Gene editing for individuals with high cholesterol.
Elizabeth: What are the risks of using a lot of cannabis?
Rick: And a newer anti-inflammatory agent for an inflammatory disease.
Elizabeth: That’s what we’re talking about this week on TTHealthWatch, your weekly look at the medical headlines from Texas Tech University Health Sciences Center in El Paso. I’m Elizabeth Tracey, a Baltimore-based medical journalist.
Rick: And I’m Rick Lange, president of Texas Tech Health El Paso.
Elizabeth: All right, Rick. That last one was so inscrutable that I’m going to have to turn straight to the New England Journal of Medicine and ask for an explanation.
Rick: All right. Well, Elizabeth, I hoped it would pique your interest because this will be the first time I think in our 20-plus years of recording podcasts we’ve actually talked about this inflammatory condition. It’s called polymyalgia rheumatica. It’s the second most common idiopathic inflammatory rheumatic disease after rheumatoid arthritis.
It affects people primarily over the age of 50, predominantly women. It’s associated with bursitis and tendinitis in the back, shoulders, pelvic girdle that causes severe, intense pain and stiffness. It can also involve the artery that leads to the brain, causing giant cell arteritis, which can actually cause a stroke. Treatment for this consists of steroids. A significant number, at least half of these individuals, will have a recurrence despite the steroids.
There is an anti-inflammatory antibody called secukinumab [Cosentyx] that has been used for other inflammatory conditions. It particularly targets an inflammatory molecule called interleukin-17A, the same one that’s elevated with polymyalgia rheumatica. Can we use this to help decrease steroid use in individuals that have recurrent polymyalgia rheumatica?
Three hundred eighty-one patients had recurrent polymyalgia rheumatica despite being on steroids. A third of the individuals continued on the steroids and then they had two different doses of the secukinumab. Those that received the secukinumab were twice as likely to get off their steroids and twice as likely to have complete remission of their symptoms and a decrease in their anti-inflammatory markers.
Elizabeth: PMR, of course, we’ve heard a lot about it over the years, particularly with aging. And, gosh, that temporal artery biopsy for giant cell arteritis still makes me flinch whenever I think about having to have something like that. I’m wondering about how durable this response was. How long did the study go on?
Rick: The study went on for 52 weeks. They were treated for 12 weeks and then the remission started at 12 weeks and lasted for another 40 weeks after that. So it looks like it’s pretty durable.
Elizabeth: And what about side effects?
Rick: No difference between secukinumab and the placebo. The most common side effects were nasopharyngitis, some hypersensitivity reactions, very uncommon, urinary tract infections, and occasional fungal infection. Again, not serious.
Elizabeth: And are these similar to the same constellation of side effects that’s seen in other populations who are treated with this?
Rick: It is very similar. It’s a drug that’s available. It’s been used in thousands of patients and now we’re applying it to a different condition.
Elizabeth: And we love those things. When you can multipurpose something that we already have a lot of experience with, that’s the best case.
Let’s turn from here to MMWR, the Morbidity and Mortality Weekly Report. Let me just add parenthetically that this has been having a rather scattered publication record for about the last year or so. And this is an interesting report. It is trends in emergency department visits involving cannabis hyperemesis syndrome identified using a new diagnosis code.
Cannabis hyperemesis syndrome, just what it sounds like, abbreviated CHS, it’s characterized by cyclical nausea and vomiting. It’s associated with frequent cannabis use. The CDC has just examined these trends after implementation of a new specific ICD-10 diagnosis code that was implemented on Oct. 1, 2025.
So what they looked at was all of this data from emergency departments all over the country involving cannabis-related ED visits, also having this hyperemesis syndrome. After they changed the code, these ED visits increased from 3.35 per 10,000 ED visits to 11.26, so almost a fourfold increase after the code was changed.
They noticed that there were a much higher proportion of these kinds of ED visits among persons aged 15 to 24 years and among females, also more pronounced among some demographic groups after the code implementation. While this is a real syndrome and they are saying that it’s likely under-recognized in both adolescent and adult populations, I have to say that I am a bit skeptical about this because it appears to be based just on this change in the ICD code.
Rick: Oh, exactly right. There wasn’t a fourfold increase from September of 2025 to October of 2025. But prior to the new coding, you selected a code that said, oh, this person is vomiting a lot, and a second code that said, oh, this person uses cannabis. If you didn’t code those things correctly, you never identified it. But now they’re saying specifically, let’s identify those that have continued long-duration cannabis use causing it. So that fourfold increase, as you said, is related all to coding. Here’s, I think, what it does. It educates physicians to look for it.
Elizabeth: Yes. And, of course, cannabis products have really dramatically changed. One of the things they note is that emerging evidence indicates that symptom onset can occur much sooner than was previously estimated, including in the first year of cannabis use.
Rick: When you look at hyperemesis and cannabis strength, there doesn’t seem to be a correlation. Now, the duration of cannabis use and the frequency, there is a correlation. Many individuals now have hyperemesis using it less frequently.
Elizabeth: Let’s turn back to the New England Journal.
Rick: We’ve, over the course of the last 5 years, talked a lot about using PCSK9 inhibitors to treat hypercholesterolemia. People that have a lot of PCSK9 in their bloodstream have a very high cholesterol. If you can inhibit that, you get more LDL receptors, lower cholesterol, and a lower risk of heart disease and stroke. We have three that are FDA approved for injectable forms. We talked about a recent oral inhibitor, which is available now. It would be nice if we could just change the gene altogether. Instead of inhibiting it, we could stop it from being produced.
And that’s exactly what this study did. It is a phase I study of 35 patients that all had hypercholesterolemia despite being on statin or other lipid-lowering agents. They randomized them to either receive placebo or ascending doses of this gene-editing technique. They have this protein that can edit the gene so that it prevents PCSK9 from being produced. That particular protein is encased in a nanoparticle, which has a receptor that binds to the liver. It’s taken up into the liver. This gene-editing tool goes to the gene that makes PCSK9, nicks it, stops it from being produced, and then ascending doses of it.
There was a dose-dependent reduction in LDL cholesterol. At the higher doses, they could inhibit LDL production by about 85% or 90%. Those results were durable for at least 1 year in the 15 of 35 patients, so this could be really interesting.
Elizabeth: And so it’s always interesting to me, of course, when we start messing around with gene function, what else gets impacted when that happens?
Rick: Yeah. And they’ve done extensive studies in animals on this to show that it targets the liver and it did not have any off-target side effects. And you’re right, that’s a major concern. So now they need to extend this to a larger number of patients over a longer period of time. And so if we can lower LDL cholesterol earlier in life for this technique, and it’s durable and safe, this could reduce the risk of heart attack and stroke by somewhere between 50% and 75%.
Elizabeth: No doubt we’ll be watching.
Finally, let’s turn to Neurology. And this is a look at midlife vascular risk burden and dementia-free survival years. This is using data from a study called ARIC, the Atherosclerosis Risk in Communities neurocognitive study that’s been underway for quite a while, to estimate dementia-free survival from age 55 to 95 years, according to midlife vascular risk burden.
They had participants who were alive and dementia free at 55 years of age and had visit to their second visit as part of the study measurement of diabetes, hypertension, and current smoking. They looked at this vascular risk burden, which was defined as the count of these risk factors. And then dementia was identified in this cohort through cognitive assessments, informant interviews, and continuous surveillance through 2022. They also looked at their analyses stratified by sex, race, and apolipoprotein E status.
So they had 12,000-plus participants, a median follow-up of 26.3 years. During that time, they had just over 3,000 of their participants develop dementia. Over 5,000 died dementia-free. Compared with zero risk factors, three risk factors, unsurprisingly, were associated with higher hazards of dementia, almost a threefold increased risk, and death without dementia, almost a sixfold increased risk. Higher vascular burden was associated with fewer dementia-free survival years.
They also showed that women live longer dementia-free than men and Black participants had shorter dementia-free survival than white participants. So in conclusion, they determined that maintaining optimal midlife vascular health was associated with almost 13 additional dementia-free survival years.
Rick: Yeah. I mean, you want to survive longer, you’d prefer to survive without dementia. As you noted, these vascular risk factors — hypertension, diabetes, and cigarette smoking — contributed significantly to the survival, not only of individuals, but survival without dementia. There are a number of other risk factors. And so if they looked at these three only and determined that about 65% of the dementia was attributed to these risk factors, controlling your blood pressure, not having diabetes, and not cigarette smoking can increase your dementia-free survival by 13 years in individuals over the age of 55, that’s pretty remarkable.
Elizabeth: It’s pretty amazing, and they’re all within our control, largely. And so it sounds like, gosh, we really need to get after this and get after it early.
I was daunted by the statistic that they provide in here that about 42% of U.S. middle-aged adults will potentially develop dementia during their lifetime. They also look at, as we age, gosh, the likelihood that we’re going to develop dementia is really pretty good, especially if we get to be 90 years old or so.
Rick: Yeah. Because we’re living longer, and that’s one goal, but you want to live longer and lead a healthy life with your cognition intact. And as you mentioned, Elizabeth, these were vascular factors that were ascertained at age 55. If we start even earlier, the results should be even more spectacular.
Elizabeth: On that note then, that’s a look at this week’s medical headlines from Texas Tech. I’m Elizabeth Tracey.
Rick: And I’m Rick Lange. Y’all listen up and make healthy choices.
Elizabeth: And start early.
