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Insulin resistance detected by routine triglyceride-glucose (TyG) index can flag people with early Alzheimer’s who are four times more likely to present rapid cognitive decline, according to new research presented at the European Academy of Neurology (EAN) Congress 2025.1
Neurologists at the University of Brescia reviewed records for 315 non-diabetic patients with cognitive deficits, including 200 with biologically confirmed Alzheimer’s disease. All subjects underwent an assessment of insulin resistance using the TyG index and a clinical follow-up of 3 years. When patients were divided according to TyG index, those in the highest third of the Mild Cognitive Impairment AD subgroup deteriorated far more quickly than their lower-TyG peers, losing >2.5 points on the Mini Mental State Examination per year (hazard ratio 4.08, 95% CI 1.06-15.73). No such link appeared in the non-AD cohort.
“Once mild cognitive impairment is diagnosed, families always ask how fast it will progress,” said lead investigator Dr. Bianca Gumina. “Our data show that a simple metabolic marker available in every hospital laboratory can help identify more vulnerable subjects who may be suitable candidates for targeted therapy or specific intervention strategies.”
While insulin resistance has been linked to the onset of Alzheimer’s disease, its role in how quickly the condition progresses has received less attention. This study aimed to fill that gap by focusing on its impact during the prodromal mild cognitive impairment (MCI) stage, when patients follow highly variable trajectories. The researchers used the TyG index, which offers a low-cost, routinely available surrogate for insulin resistance, to explore whether metabolic dysfunction could help predict the pace of cognitive decline after diagnosis.
In AD specifically, insulin resistance is believed to impair neuronal glucose uptake, promote amyloid accumulation, disrupt the blood-brain barrier, and fuel inflammation – pathways that are less relevant or differently regulated in other neurodegenerative diseases.
“We were surprised to see the effect only in the Alzheimer’s spectrum and not in other neurodegenerative diseases,” Dr. Gumina noted. “It suggests a disease-specific vulnerability to metabolic stress during the prodromal window, when interventions may still change the trajectory.”
The researchers at University of Brescia, led by Professor Padovani and Professor Pilotto, found that high TyG was also associated with blood-brain barrier disruption and cardiovascular risk factors, yet it showed no interaction with the APOE ε4 genotype, indicating that metabolic and genetic risks may act through distinct pathways.2
Identifying high-TyG patients could refine enrolment for anti-amyloid or anti-tau trials and prompt earlier lifestyle or pharmacological measures to improve insulin sensitivity. The researchers are currently investigating whether TyG levels also track with neuroimaging biomarkers to aid earlier detection and stratification.
“If targeting metabolism can delay progression, we will have a readily modifiable target that works alongside emerging disease-modifying drugs,” concluded Dr. Gumina.
References: Gumina B., Galli A., Tolassi C. et al. The Triglyceride-Glucose Index as Predictor of Cognitive Decline in Alzheimer’s Spectrum Disorders. Presented at the European Academy of Neurology (EAN) Congress 2025; 23 June 2025; Helsinki, Finland. Padovani A., Galli A., Bazzoli E., et al. (2025). The role of insulin resistance and APOE genotype on blood-brain barrier integrity in Alzheimer’s disease. Alzheimer’s & Dementia. Advance online publication. https://doi.org/10.1002/alz.14556

6 minutes agoShareSaveSmitha MundasadHealth reporterShareSaveGetty ImagesPrescriptions for Mounjaro jabs, to help people lose weight, will be available at GP surgeries in England from today – but only for those who meet very strict criteria.NHS England says while the long-term plan is for the jabs to be more widely available, a staggered approach is needed to reach those most at need, manage GPs’ workload and NHS resources.Some GP practices are already warning patients who do not meet the criteria that they should not book appointments to discuss the jabs right now. Pharmacy trade organisations say they are concerned that demand for Mounjaro from GPs will outstrip supply. Mounjaro, or tirzepatide, is a weekly injection that was initially licensed to help treat type 2 diabetes, but is now also prescribed to help those with obesity lose weight. The medicine makes you feel fuller so you eat less. In clinical trials, people taking it lost 20% of their body weight.Who is eligible for Mounjaro from GPs right now?According to NHS England, the first group of patients who will be able to get the jab from their GP or a community clinic, will be those most in need.This is people with:a BMI of 40 or over (or 37.5 if from a minority ethnic background) and four out of five of the following conditions: type 2 diabetes, high blood pressure, heart and vascular disease, high cholesterol and obstructive sleep apnoea People will also get “wrap-around” care – including support with exercising and following a healthy diet, for example.But prescriptions for the drug will not necessarily be available from all local GPs. In some cases, they will come from other primary care services.NHS England says people should check their integrated care board (ICB) website for more information. (That’s the organisation that is responsible for planning the health services for a local population). Dr Claire Fuller, co-national medical director of primary care at NHS England, says greater access to weight-loss drugs will make a “significant difference to the lives of people” living with obesity and experiencing severe ill health. “This is an important next step in the rollout of weight-loss drugs, with community-based services now able to offer this treatment from today,” she said. But some GP practices have issued notices on their websites saying very few patients on their lists will qualify for the medicine straight away and if anyone doesn’t meet the criteria, they should not book an appointment.Other weight loss services like workshops and apps are available, the messages say. One GP surgery asked for patience while community services are set up. Will I get Mounjaro if I meet the criteria? It is unlikely all patients who want Mounjaro and meet the criteria, will get it straight away, according to the trade association for large pharmacies, the Company Chemists’ Association.Chief executive Malcolm Harrison said although the medicines are likely to “transform the lives” of millions, “it is unlikely that the planned GP provision will be sufficient to meet patient demand”.And weight loss jabs are relatively new in healthcare terms. Some GPs and other other healthcare staff need training in how to offer them safely and appropriately. Mounjaro also requires monthly check-ups for patients during the first few months of taking it, making this a labour intensive process for doctors.Surgeries will also be looking at their capacity to provide the wrap-around care needed alongside the injection. Then there will be those who can’t take Mounjaro right now – for example, women who are pregnant, trying to become pregnant or breastfeeding. People who have had certain conditions – like pancreatitis or certain thyroid tumours should not take the drug either. Individuals will need to have a chat with their GP or clinic to weigh up the potential side-effects too. Where else is Mounjaro available? Mounjaro has been available in specialist NHS weight loss clinics since March.Wegovy, also known as semaglutide, is another weight loss jab which works in a similar way. It can be prescribed to certain groups of people under the care of specialist NHS weight loss management clinics.Both medicines can also be bought privately.Dr Claire Fuller, of NHS England, says not everyone will be eligible for weight loss drugs.”It’s important that anyone who is worried about the impact of their weight on their health discusses the range of NHS support available with their healthcare professional,” she explained.When can I get Mounjaro if I don’t fit the criteria right now? Interim guidance from NHS England suggests Mounjaro will be available to some 220,000 people over the next three years. Their current plan suggests it may be available in phases:June 2026: expanded to include people with a BMI of 35 to 39.9 who have four out of five conditions listed aboveApril 2027: also offered to people with a BMI of 40 and above who have just three out of five conditions listed aboveThe health watchdog, NICE, will then take stock of how the rollout has been going and decide if it is the right to time to offer it to more people with obesity. Around 3.4 million people are likely to be eligible over the next 12 years, estimates suggest. What about the rest of the UK? Mounjaro is available through specialist weight management services in the NHS in Wales. The Welsh government is considering other arrangements, including involving primary care, in the future. In Northern Ireland, a new regional obesity management service will be introduced gradually over the next few years, with a community-based service where patients will have access to lifestyle support and obesity medication if appropriate. Very few people are currently being prescribed drugs for weight loss on the NHS in Scotland, research by BBC Scotland News has established. In Scotland, health boards make decisions on which medicines are available in their areas.

35 minutes agoShareSaveJennifer McKiernanShareSaveEPAHealth Secretary Wes Streeting has said there is no budget for an assisted dying service, which MPs narrowly backed in a landmark vote on Friday.Streeting, who was one of the most senior opponents of the legislation, posted a lengthy message on his Facebook page explaining why he voted against the legislation.Among other reasons, he said there was already a lack of access to high quality end-of-life care on top of tightened finances within the NHS, which could add to the pressure faced by dying patients. Streeting said he would “make sure that we do a good job with it for the country” if the legislation becomes law, but he worried MPs had made the wrong choice.The government remains neutral on the bill, which cleared the Commons with a majority of 23 votes on Friday and will now be scrutinised by the House of Lords. MPs were given a free vote on Friday.Campaigners in favour of the bill say it will give terminally ill adults the choice on how they want to die and prevent painful deaths, but critics argue it risks people being coerced into seeking an assisted death.In his post, Streeting quoted former Labour prime minister Gordon Brown’s position that “there is no effective freedom to choose if the alternative option… is not available”, referring to sufficient end-of-life care provisions.Streeting wrote: “The truth is that creating those conditions will take time and money. “Even with the savings that might come from assisted dying if people take up the service – and it feels uncomfortable talking about savings in this context to be honest – setting up this service will also take time and money that is in short supply. “There isn’t a budget for this. Politics is about prioritising. It is a daily series of choices and trade-offs. I fear we’ve made the wrong one.”The MP for Ilford North pledged to work “constructively” on technical aspects of the legislation as it progresses through Parliament and stressed he had enormous respect for the bill’s supporters.An impact assessment on the policy published in May provided a financial analysis of the costs and savings involved.It said that in the first six months, savings for the NHS could range from around £919,000 to £10.3m.That figure included hospital care, primary and community care, hospice, medicines and other care costs that someone choosing an assisted death would not need.By the time the system had been running for ten years, savings could range from £5.84m to £59.6m.The assessment found there would be costs too. Staffing an assisted dying service could cost in excess of £10m a year within a decade, while training costs in the first six months alone could be over £11m.As peers prepare to examine the Terminally Ill Adults (End of Life) Bill, assisted dying campaigner Dame Esther Rantzen told BBC Radio 4’s Today programme on Saturday that Lords had a duty to perform but that it should not extend to overturning the will of the Commons.”Their job is to scrutinise, to ask questions, but not to oppose,” she said.”So yes, people who are adamantly opposed to this Bill, and they have a perfect right to oppose it, will try and stop it going through the Lords, but the Lords themselves, their duty is to make sure that law is actually created by the elected chamber, which is the House of Commons who have voted this through.”Dame Esther said she was resigned to the fact her own terminal cancer would probably progress to the point she will “buzz off to Zurich” to use the Dignitas clinic before the bill becomes law.Crossbencher Baroness Tanni Grey-Thompson, a Paralympian and opponent of the plans, told BBC Breakfast she hoped more safeguards could be introduced in the coming months.”We’re getting ready for it to come to the Lords and from my personal point of view, about amending it to make it stronger,” she said.”We’ve been told it’s the strongest bill in the world, but to be honest, it’s not a very high bar for other legislation, so I do think there are a lot more safeguards that could be put in.”Another opponent, the Conservative peer and disability rights campaigner Lord Shinkwin, said he believed the bill needed “forensic scrutiny”. “The margin yesterday was so close that many MPs would appreciate the opportunity to look at this again in respect of safeguards as they relate to those who feel vulnerable, whether that’s disabled people or older people,” he added.The bill could still run out of parliamentary time if it is held up in the Lords, but the Labour MP who steered it through the Commons as a Private Member’s Bill, Kim Leadbeater, said: “I would be upset to think that anybody was playing games with such an important and such an emotional issue”.

Resistance to colistin, a potent antibiotic, is on the rise. In 2016, researchers discovered that colistin resistance could be transferred laterally among microbes. Researchers have isolated genes that confer colistin resistance from imported seafood purchased from markets in Atlanta, Ga. The findings suggest imported seafood could promote the spread of transmissible colistin resistance.Colistin is a potent, last-resort antibiotic, used only to treat people with dangerous, life-threatening bacterial infections that have developed resistance to other drugs. But it’s not foolproof. Worldwide, resistance to colistin is spreading, further diminishing treatment options and putting infected people at higher risk.
Researchers from the University of Georgia recently identified a way that colistin resistance genes are spreading: Imported seafood. In a new study, microbiologist Issmat Kassem, Ph.D., and his group have reported the first isolation of colistin-resistance genes in bacteria found in imported shrimp and scallops, purchased from 8 food markets around Atlanta, Ga. Kassem will be presenting the findings this week in Los Angeles at ASM Microbe 2025, the annual meeting of the American Society for Microbiology. An accompanying paper will be published in the ASM journal mSphere.
“We love our seafood,” Kassem said. Many people don’t know that most seafood consumed in the U.S. is imported, he said, including about 90% of shrimp. Imported seafood is screened for contaminants but the process doesn’t catch everything, especially antimicrobial resistance genes. “The bacteria that were carrying colistin resistance genes are not normally screened.” Kassem and his group also found that some of the resistance genes are carried on plasmids — round bits of genetic material that can be transmitted from bacteria to bacteria.
Antimicrobial resistant infections kill hundreds of thousands of people globally every year, and antimicrobial resistance is a rising public health menace. Colistin was first introduced in the 1950s to treat infections by pathogenic Gram-negative bacteria, but it takes a heavy toll on patients, including increased risk of damage to the nerves and kidneys. It was discontinued in the U.S. in the 1980s. However, Kassem noted, other countries continued to use it in agricultural settings, both to treat infections and to promote animal growth. Colistin was eventually reintroduced to human medicine because it was one of the few options available to treat certain bacterial infections. The World Health Organization categorizes colistin as a high priority critically important antibiotic, which means it is an essential option for treating serious human infections.
In 2016, researchers discovered a mobile colistin resistant gene, or mcr, that was “mobile” because it could be transferred via lateral transmission, in plasmids passed among bacteria. Before then, Kassem said, researchers believed colistin resistance was inherited, not shared, “which means it could not jump between different bacteria.”
Researchers have now identified at least 10 mcr genes and many alleles, or variations. Kassem, who has been studying antimicrobial resistance for 2 decades, suspected it might spread through the importing and exporting of food.
“Our food is sourced from different places,” he said. “If you go out to lunch today, your plate might have ingredients from 6, 7, 8 countries. Some countries do not have strict regulations for using antibiotics in food animal production, so imported food can be a vehicle for transmission of resistance.” In previous work, his group found mcr genes in samples from wastewater in Georgia; they also found the bacterial host that was carrying the plasmid containing the genes. It wasn’t normally screened in food coming into the United States, he said. In studies published since then, researchers have found mcr genes in plasmids elsewhere.
When they screened seafood purchased from markets in Georgia, they found the same bacterial host, the same plasmids and the same genes that they’d previously identified in wastewater. “The good news is that we didn’t find it in locally produced seafood,” Kassem said.
He cautioned that the group identified 1 source of colistin resistance, but there could be other, and they’re likely spreading. “We live in a very connected world,” he said. “We move a lot, we travel a lot, our food travels, and we are going to spread whatever emerges, even across national borders. So, it’s important to invest in monitoring systems and expand them and collaborate, especially on the global level, on the issue of antimicrobial resistance.”

Temperatures in Central Park are forecast to soar into the high 90s on Monday and Tuesday, but it will feel like it’s 105 degrees outside.It’s going to be hot and sticky in New York City on Sunday as temperatures are expected to soar into the 90s in the first heat wave of the season.Monday and Tuesday are expected to be even hotter. Many locations in the metro area will likely climb into the high 90s and potentially break 100 degrees. High temperatures would normally range from 80 to 85 this time of the year.The National Weather Service issued an extreme heat warning, the highest level of heat alert, for the city, from noon on Sunday through 8 p.m. on Tuesday.The stifling weather is predicted to create life-threatening conditions, particularly for older people and anyone without access to air-conditioning.“Heat like this can kill,” New York City Emergency Management said on social media. “It is the deadliest weather hazard we face.”Temperatures are forecast to peak on Monday and Tuesday.Sunday will be the start of what could be a record-setting heat wave for the New York City metro area.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

He was a chiropractor by training, but in a remote part of West Texas with limited medical care, Kiley Timmons had become a first stop for whatever hurt. Ear infections. Labor pains. Oil workers who arrived with broken ribs and farmers with bulging discs. For more than a decade, Kiley, 48, had seen 20 patients each day at his small clinic located between a church and a gas station in Brownfield, population 8,500. He treated what he could, referred others to physicians and prayed over the rest.It wasn’t until early this spring that he started to notice something unfamiliar coming through the door: aches that lingered, fevers that wouldn’t break, discolored patches of skin that didn’t make sense. At first, he blamed it on a bad flu season, but the symptoms stuck around and then multiplied. By late March, a third of his patients were telling him about relatives who couldn’t breathe. And then Kiley started coughing, too.His wife, Carrollyn, had recently tested positive for Covid, but her symptoms eased as Kiley’s intensified. He went to a doctor at the beginning of April for a viral panel, but every result came back negative. The doctor decided to test for the remote possibility of measles, since there was a large outbreak spreading through a Mennonite community 40 miles away, but Kiley was vaccinated.“I feel like I’m dying,” Kiley texted a friend. He couldn’t hold down food or water. He had already lost 10 pounds. His chest went numb, and his arms began to tingle. His oxygen was dropping dangerously low when he finally got the results.“Positive for measles,” he wrote to his sister, in mid-April. “Just miserable. I can’t believe this.”Twenty-five years after measles was officially declared eliminated from the United States, this spring marked a harrowing time of rediscovery. A cluster of cases that began at a Mennonite church in West Texas expanded into one of the largest outbreaks in a generation, spreading through communities with declining vaccination rates as three people died and dozens more were hospitalized from Mexico to North Dakota. Public health officials tracked about 1,200 confirmed cases and countless exposures across more than 30 states. People who were contagious with measles boarded domestic flights, shopped at Walmart, played tuba in a town parade and toured the Mall of America.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Prevention and treatment campaigns are not adequately targeting the particular needs of the 50+ years age group.
Indeed, between 2000 and 2016, the number of adults aged 50 years and older living with HIV in sub-Saharan Africa doubled. At present, their HIV prevalence is exceeding that of younger adults.
By 2040, one-quarter of people living with HIV in Africa will be aged 50 years and older; tailored awareness and treatment campaigns are pressing.
Dr Luicer Olubayo, a researcher at the Sydney Brenner Institute for Molecular Bioscience (SBIMB) at Wits University and the first author of a study published in The Lancet Healthy Longevity journal, which investigated HIV in older people in Kenya and South Africa, noted that perceptions on who acquires HIV are limited. “We often think of HIV as a disease of younger people. It doesn’t help that intervention campaigns are mainly targeted at the youth.”
Moreover, older adults are less likely to believe that they can get HIV. This misconception is pervasive and has consequences for reaching global targets to achieve UNAIDS’ 95-95-95 targets by 2030 (95% of people living with HIV know their status, 95% of people who know their status are on treatment, and 95% have a suppressed viral load).
“While HIV prevalence among individuals over 50 years of age is similar to or even exceeds that of younger adults, HIV surveys focus on younger individuals, leaving considerable gaps in understanding HIV prevalence, incidence and treatment outcomes in older populations,” says Associate Professor F. Xavier Gómez-Olivé, at the MRC/Wits-Agincourt Research Unit.
Stigma remains a barrier to treatment
The uptake of HIV testing among older adults is poor, which delays diagnosis and limits access to care. This is, indeed, one of the signifiers of the pervasiveness of stigma surrounding the disease.

“We know that there is significant social stigma related to HIV infection. This is why understanding HIV-related stigma in older adults remains crucial as a way to inform interventions to support older people’s mental health and overall well-being,” says Olubayo.
Interventions could focus on repeated testing, the use of pre-exposure prophylaxis (PrEP), and campaigns to increase awareness and reduce infections among the elderly.
“HIV can be managed alongside other chronic conditions, too, since HIV is managed as a long-term illness,” says Gómez-Olivé.
Non-communicable diseases, such as hypertension, diabetes, and obesity, have dramatically increased in sub-Saharan Africa, particularly among older people. HIV treatment and intervention can be included in the healthcare ecosystem of long-term illnesses.
Apart from stigma, a complex interplay of factors shapes HIV risk
The study shows that age, education, gender, and where people live all affect their risk of HIV. Even though more people now have access to HIV treatment, older adults — especially in rural areas — still face significant challenges in preventing HIV, such as low education levels and gender inequality.

Widowed women had the highest HIV rate (30.8%). This may be due to losing a partner to HIV, stigma, and a greater risk of unsafe behaviours like transactional sex and limited power to negotiate condom use. People without formal education and those with low income also had higher rates of HIV infection.
The benefit of longitudinal data to make decisions
An important added value of this study is the provision of longitudinal insights into the HIV epidemic among older adults in sub-Saharan Africa. “Our study is beneficial in that older populations are under-represented, and not much is known about them over time. What changes are occurring? We have to answer these kinds of questions. With longitudinal data, we can look at the effectiveness of antiretroviral therapy coverage in older people,” says Gómez-Olivé.
The study used data collected in urban Kenya and in urban and rural sites across South Africa during two data collection waves: 2013-2016 and 2019-2022.
Throughout a decade of research, the team has been gaining a deeper understanding of this ageing HIV epidemic. Numerous important insights about HIV in older populations have been achieved, and research gaps are being covered.
Data for the study were drawn from the Africa Wits-INDEPTH Partnership for Genomic Research (AWI-Gen) from adults aged 40 years and older. AWI-Gen is a multicentre, longitudinal cohort study conducted at six research centres in four sub-Saharan African countries (South Africa, Kenya, Burkina Faso, and Ghana) to investigate various health determinants.

Researchers from Tokyo Metropolitan University have created a new way of telling “aged” human cells apart from younger ones using electric fields. While key markers have been found for these “senescent” cells, current methods require biochemical “labels” which are difficult to apply and affect the cells themselves, making them difficult to study. The new method is label-free and less damaging. The team aims to diversify the method, extending it to other cell types.
Aging starts at the cellular level. As we get older, aged or “senescent” cells accumulate in our body. Not only have these cells lost much of their original function, but they continue to emit compounds which trigger inflammation. There is a growing body of evidence for how they play a part in aging-related conditions like arterial hardening, Alzheimer’s disease, and type 2 diabetes.
To understand and treat such ailments, scientists need to come to grips with how senescent cells affect our physiology. Naturally, this starts with identifying which of our cells are senescent, and which are not. Unfortunately, existing methods rely on selective “labeling,” e.g. the attachment of a fluorescent molecule to specific compounds known to be present in aged cells. Not only is this time-consuming and complex, but the process itself can change the properties of the very thing scientists want to study.
To get around this issue, a team led by Assistant Professor Ippei Yagi from Tokyo Metropolitan University has come up with an entirely different approach to identifying senescent cells. Instead of chemical labels, they put cells under an alternating electric field. This causes a slight rearrangement of charge, where one end of the cell is more positively charged than the other. When the electric field is not uniform over space, the cell migrates; in the case of an alternating field, the cell wanders backwards and forwards between the electrodes. As the frequency of the field is changed, the motion of the cell changes significantly at a value known as the cutoff frequency. The method, known as frequency-modulated dielectrophoresis (FM-DEP), aims to characterize cell type by measuring this value.
The team focused their efforts on human dermal fibroblasts, an important part of connective tissue in the skin. When they tested senescent cells against younger ones, they found that there was a marked difference in their cutoff frequencies. These changes come about from changes in the fatty (lipid) molecules which make up the membrane of the cells. Importantly, FM-DEP is rapid, easy to apply, and label-free.
The new method is not only a convenient tool for research into aging, but may see application to regenerative medicine, and drug screening. The team hope to apply FM-DEP to other cell types as well, as a versatile new approach to cell identification.
This work was supported by JSPS KAKENHI Grant Numbers JP23K28453 and JP23KK0260.

In a follow up investigation into the multibillion dollar drug ticagrelor, The BMJ has uncovered fresh concerns, this time in key platelet studies used in its FDA approval.
For more than a decade, ticagrelor (Brilinta in the US and Brilique in Europe) has been recommended for patients with acute coronary syndrome — a range of conditions related to sudden reduced blood flow to the heart.
Last December, an investigation by The BMJ found serious data integrity problems in the landmark clinical trial (PLATO) that was used to gain worldwide approval for ticagrelor, calling into question the drug’s advantage over cheaper rivals.
Now, as generic versions of the drug prepare to launch this year, The BMJ has expanded its investigation, looking at two key platelet studies that AstraZeneca claimed explained ticagrelor’s ability to treat acute coronary syndrome successfully.
It finds that the “primary endpoint” results (the trial’s key measurement) for both clinical trials were inaccurately reported in the leading cardiology journal Circulation, and reveals that more than 60 of 282 readings from platelet machines used in the trials were not present in US Food and Drug Administration (FDA) datasets.
What’s more, one active trial investigator never became a study author, while one author told The BMJ he was not involved in the trial, and most investigators, including the principal investigator, were unreachable or declined to be interviewed.
Victor Serebruany, an adjunct faculty member at Johns Hopkins University and ticagrelor’s most renowned critic, told The BMJ that “there are episodes of skyrocketing rebound and profound platelet inhibition after ticagrelor making patients prone to thrombosis or bleeding. If doctors had known what happened in these trials, they would never have started using ticagrelor.”
Circulation and AstraZeneca did not respond to a request for comment.
Serebruany added: “It’s been obvious for years that there is something wrong with the data. That the FDA’s leadership could look past all these problems — on top of the many problems their own reviewers identified and are now being discovered by The BMJ — is unconscionable. We all need to know how and why that happened.”

19 minutes agoShareSaveRuth CleggHealth and wellbeing reporterShareSaveGetty ImagesIt could apparently change the shape of my face, add pounds to my midriff, and even make my hair fall out. I feel like warnings about cortisol – a stress hormone I know very little about – have hijacked my social media accounts. I see posts advising me to drink a cortisol cocktail – a blend of orange juice, coconut water and sea salt, take a range of different supplements, and massage lavender balm into my temples.Not knowing how high my cortisol levels are makes it difficult to know whether or not I need to lower them, but now I think about it my cheeks do seem a touch more puffy than usual and my jeans have started to feel a bit tight.Getty ImagesCortisol is one of several hormones that help control how our body responds to stress. Produced by the adrenal glands, it plays a vital role in everything we do – from making sure we wake up in the morning, to being able to fall asleep at night.Without it we would die – but it’s a fine balance. Too much cortisol can also cause a plethora of health problems. So, if I’m stressed, and my body is creaking under the strain of too much cortisol, how do I fix that?I pick up my phone, and start scrolling through my socials. Advice on one of the first posts that pops up is to turn my phone off – it’s a big stressor. And, by the way, stop doomscrolling.I didn’t know about my cortisol levels 10 minutes ago – now I can feel them rising.”It is very likely that we do live with higher levels of cortisol in our systems,” John Wass, Professor of Endocrinology at the University of Oxford, says, “partly because there is much more stress in the world, we can never switch off for a start.”With smartphones, you can’t get a moment’s peace.”But Prof Wass questions the direct link often being made on social media, between cortisol levels and changes in our body, describing that as “misleading”.”All these changes – weight gain, face swelling – there can be so many other reasons – a bad night’s sleep, certain medications, too much salt, too much alcohol for instance,” he says. “It’s highly unlikely that cortisol levels alone are to blame – it’s a complex picture.”Emma Lynch/BBCAs the managing director of a small technology company, in her late 20s Jasleen Kaur Carroll was at the top of her game. But she struggled to switch off and work became her life. Eventually things became so intense – with Jasleen feeling under constant pressure – that she experienced burnout, complete physical, mental and emotional exhaustion.”I began to feel like a zombie, like everything around me was failing,” the 33-year-old from London explains. “But I would tell myself, ‘I am Jas, I am strong, I can keep going.'”Jasleen turned to social media for advice on how to destress and lower her cortisol levels.”You name it, I tried it,” she says. “The cortisol cocktail, Ashwagandha tablets, turmeric, black pepper supplements, lavender balm on my forehead – anything.”But nothing worked. Jasleen’s body began to shut down, and the stress she was under triggered a flare-up of an autoimmune condition she has called lupus, where the immune system spirals out of control and starts to mistakenly target healthy cells.”I lost so much weight, I had severe joint pains, I was struggling to breathe because I had liquid around my lungs,” she says. “I was also warned about trying to have a baby because of how poorly I was.”JASLEEN KAUR CARROLLWhile in hospital receiving treatment for lupus, Jasleen realised that instead of trying to fix herself using social media hacks she had to stop, take time out and get help.”I was trying to fight all the symptoms of stress,” she says. “Instead, I needed to tackle the cause.” By having therapy she worked through trauma she had experienced in childhood and began to practice mindfulness – something which taught her to live more in the moment.”Stress is a wonderful thing,” says therapist Neil Shah, who runs the Stress Management Society. “Hormones like adrenaline and cortisol are vital to keep us safe from a perceived threat.”The problems come when we perceive threats everywhere – and that’s not helped by the 24/7 society we live in.”Neil advised Jasleen to try standing outdoors, barefoot on grass. Jasleen wasn’t convinced – but she decided to give it a go.”At that point I would have tried anything,” she says.A day after speaking to Jasleen, I’m on a video call with a mindfulness coach from Breathworks, a charity which specialises in pain and stress management. There are 12 other participants, who all want to learn how to manage stress levels and improve their overall health.Some studies suggest activities like mindfulness can have a positive effect on cortisol levels, helping to regulate the stress response system.Being focussed on the moment, rather than caught up in the past or looking to the future can also help change the structure of the brain and improve stress resilience, studies have shown.Best of weekend picksMy mindfulness coach Karen Liebenguth has a warm, soothing voice. I’m sceptical when she tells me to hold a raisin and look, feel, smell, listen and – eventually – put it in my mouth.By the time I chew it, I begin to understand that I am mindfully eating. My only thought is the raisin and its taste and texture. And, for the first time that day, my whole focus is on the present moment.Psychology professor and stress resilience expert David Creswell says mindfulness is one of several techniques found to help some individuals lower cortisol levels – and exercise, journalling, nurturing close relationships, and cognitive behaviour therapy (CBT) can also all help too.”Interestingly, each technique is training us to sometimes sit with discomfort,” Prof Creswell says. “They are like little mini stressors – which might help us deal with the big stressors life throws at us.”Experts warn some social media “quick fixes” not only fail to address the real issues many people might be experiencing, but can also prevent those who need medical treatment seeking help.”We are often fed simplistic solutions to a complex and potentially more serious problem,” wellbeing expert Professor Sir Cary Cooper explains.He seems taken aback when I tell him the ingredients in the cortisol cocktail I often see being touted on social media.”I mean, it’s not going to do any harm,” he says, “but it’s certainly not going to bring your cortisol levels down.”Prof Carey says sudden body changes should be checked by a medical professional to make sure there are no physical health problems.High levels of cortisol can cause weight gain around the face, upper back and stomach – which could indicate a very rare condition called Cushing’s Syndrome. The most common cause is taking high doses of steroid medicine for a long time.Sometimes, a small, non-cancerous growth in the pituitary gland (near the brain) or adrenal glands (near the kidneys) can also cause too much cortisol to be released. These glands help control the amount of certain hormones in your body, including cortisol.If you are stressed then there is “little point in just treating the symptoms”, Prof Carey says. “It’s all about the cause, and the cause could stem from a bad relationship, or financial worries or family problems. “Simple fixes on social media are not going to sort that.”Emma Lynch/BBCJasleen has a new job at a large digital marketing company. Despite being warned she might not be able to conceive, she gave birth to a baby girl eight months ago.She’s determined not to repeat the burnout she experienced in the past so every morning without fail, she says, she carries out several exercises. Each claims to stimulate the nervous system, which helps her relax and reduce her levels of stress.”I gently tap my body, grounding myself,” Jasleen explains. “I hold an imaginary ball between my hands, and I dry brush my body, stroking my skin, visualising the blood flowing to my heart.”Jasleen has a busy life, a successful career, and a baby girl to look after, but she says, she’s much more aware of her limits. On the whole she stays clear of socials, and her life is now “calmer”.”There are still elements that stress me out,” Jasleen says. “But now I have a toolbox of ways to help manage it and I can embrace the chaos!”