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2 Minute Medicine Rewind March 2, 2026
1. In this cohort study, the quadrivalent human papillomavirus (HPV) vaccine provides strong, long-lasting protection against invasive cervical cancer, with the greatest benefit if vaccination occurs before age 17.
Evidence Rating Level: 2 (Good)
Persistent risk with high-risk human papillomavirus (HPV) types is the main cause of invasive cervical cancer, and HPV vaccination is highly preventative and reduces cervical cancer risk. Sweden introduced the quadrivalent HPV vaccine in 2006, first through paid-access, then through subsidized programs, and eventually through school-based programs. Eventually, the program expanded to include catch-up vaccination and later transitioned from a three-dose to a two-dose schedule, before switching to the nonavalent vaccine in 2019. Previous studies have shown reductions in cervical cancer following HPV vaccination; however, there is limited clinical evidence on how durable this protection is long-term. This study seeks to evaluate how long protection lasts and how cervical cancer incidence has changed at the population level since the introduction of vaccination programs. The primary outcome was the diagnosis of invasive cervical cancer, assessed via the Swedish Cancer Registry. The study included 926,362 individuals, of whom 365,502 (39.5%) received at least one quadrivalent HPV vaccine dose. There were 930 invasive cervical cancer cases, with 97 in vaccinated women and 833 in unvaccinated women. Vaccination before the age of 17 was associated with an incidence rate ratio (IRR) of 0.21 (95% CI, 0.13-0.31), with protection sustained for 13-15 years after vaccination (IRR 0.23, 95% CI, 0.11-0.46). Those vaccinated at 17 or older had an overall IRR of 0.63 (95% CI, 0.49-0.81), with significant reductions during years 10-12 (IRR 0.54, 95% CI 0.33-0.86) and years 13-15 (IRR 0.23, 95% CI, 0.08-0.60). Overall, this study reinforced that the HPV vaccination is highly effective, durable, and most impactful when delivered early.
Antepartum Exposure to Greenness, Air Pollution, and Temperature and Outcomes of Preterm Infants
1. In this cohort of very preterm infants, maternal exposure to low levels of greenness, high levels of ozone, and low temperatures was associated with decreased odds of infant survival without major morbidity (SWMM).
Evidence Rating Level: 2 (Good)
Exposure to modifiable environmental factors during pregnancy is linked to important perinatal and infant outcomes. Air pollution, extreme temperatures, and less access to green space increase the risk of stillbirth, low birth weight, and preterm birth, while also being associated with worse neonatal respiratory, infectious, and neurodevelopmental outcomes in term infants. Early preterm infants are at high risk for major complications; however, little is known about how antepartum environmental exposures affect outcomes. To address this gap, this retrospective cohort study aims to determine whether preterm infants born before 29 weeks have different neonatal outcomes based on their mothers’ exposure to air pollution, temperature extremes, and greenness during pregnancy. A total of 14,748 infants (mean [SD] gestational age, 26.1 [1.6] weeks) were included, with 6,845 (46.4%) born between 27 and 28 weeks of gestation, and 7,903 (53.6%) born before 27 weeks of gestation. Among the total population, 4,737 infants (32.1%) survived without major morbidity. High ozone levels were associated with decreased odds of infant survival without major morbidity (SWMM), with the highest vs. lowest tertile showing an adjusted odds ratio (AOR) of 0.83 (95% CI, 0.74-0.95; P=.007) and the moderate vs. lowest tertile having an AOR of 0.89 (95% CI, 0.82-0.97; P=.01). In contrast, temperature showed a weak relationship. The only significant difference was moderate vs. lowest temperature, with an AOR of 1.18 (95% CI, 1.07-1.31; P=.001). Low temperature combined with specific environmental conditions was associated with SWMM, including low temperature and low greenness (SWMM 29.1%; AOR 0.77, 95% CI 0.60-0.99; P=.04), low temperature and high ozone (SWMM 31.5%; AOR 0.76, 95% CI 0.60-0.95; P=.02), and the combination of low temperature, high ozone, and low greenness (SWMM 24.6%; AOR 0.58, 95% CI 0.43-0.77; P<.001). In summary, this cohort study found that antepartum exposure to certain environmental stressors is associated with poorer neonatal outcomes in very preterm infants.
Sleep Apnea-Specific Hypoxic Burden and Postoperative Outcomes of Major Noncardiothoracic Surgery
1. In this cohort of patients with Obstructive sleep apnea (OSA), a higher sleep apnea-specific hypoxic burden (SASHB) was associated with a significantly greater risk of 30-day postoperative cardiovascular events and mortality.
Evidence Rating Level: 2 (Good)
Obstructive sleep apnea (OSA) is common and increases vulnerability to postoperative complications as a result of the relaxation effect of anesthesia and sedatives. Traditional measures such as the apnea-hypopnea index (AHI) do not adequately capture the physiological stress of OSA or predict future cardiovascular risk. The sleep apnea-specific hypoxic burden (SASHB) is a newer metric that quantifies how often breathing events occur and how deep and long the oxygen drops are. This study evaluated whether SASHB measured before surgery can identify OSA patients at higher risk of death or cardiovascular events within 30 days of major noncardiothoracic surgery. Of the 7,717 patients included in the study, 2,286 had confirmed OSA (AHI ≥ 5 events/hour) and underwent major noncardiothoracic surgery after diagnosis. The primary composite outcome, which included stroke, atrial fibrillation, heart failure, myocardial infarction, venous thromboembolism, and all-cause mortality, occurred in 80 patients (3.5%) within 30 days of surgery. Patients with higher SASHB had a significantly greater risk, with event rates rising from 1.6% (12 events) in the low-SASHB group to 5.8% (44 events) in those with high SASHB at diagnosis. The patients with higher SASHB values at diagnosis also had greater odds of experiencing the primary outcomes (adjusted odds ratio [AOR], 1.76; 95% CI, 0.86-3.59 for SASHB 32 to <80% min/h and 2.79; 95% CI, 1.42-5.49 for SASHB ≥ 80% min/h). This study found that SASHB is a strong and clinically meaningful predictor of postoperative cardiovascular complications and mortality in patients with OSA.
Modifiable Lifestyle Factors, Left Atrial Indices, and Atrial Fibrillation
1. In this prospective cohort study, lifestyle behaviours, especially higher body mass index (BMI) and smoking, are associated with measurable changes in left-atrial size and function.
Evidence Rating Level: 1 (Excellent)
Left atrial size and function are strong predictors of atrial fibrillation (AF), stroke, and mortality, and even subtle changes in these measures signal higher vulnerability. Several modifiable lifestyle factors, such as obesity, alcohol use, smoking, physical activity, and coffee consumption, may influence left atrial remodelling and contribute to AF development. However, the mechanisms underlying this are not well understood. To address this gap, this prospective cohort study evaluates the associations between modifiable lifestyle behaviours and left atrial structures, and whether these atrial differences help explain lifestyle-associated AF risk. The cohort included 37,701 participants, and the median time between the lifestyle questionnaires and the MRI was 8.9 years (IQR 7.4-10). A higher body mass index (BMI), more vigorous physical activity, and greater alcohol consumption were each associated with larger left atrial volumes and lower left atrial emptying fractions. In contrast, greater cumulative smoking exposure was associated with smaller atrial volumes and reduced emptying fraction, while coffee intake showed no meaningful relationship with any left atrial measure. Larger left atrial volumes were associated with a progressively higher risk of developing AF, while a lower left atrial emptying fraction also predicted a greater risk. About 25% of the link between higher BMI and future AF was explained by changes in the left atrium, specifically, larger maximal volume (25%), larger minimal volume (28%), and lower emptying fraction (26%). These findings suggest that common lifestyle behaviours contribute to adverse left-atrial remodelling, which in turn accounts for a substantial portion of the increased AF risk associated with obesity and smoking.
1. In this prospective cohort, individuals with greater periods of sedentary time have increased risks of all-cause mortality and mortality from cancer, cardiovascular disease, and respiratory disease.
2. Replacing sedentary behaviour with physical activity substantially lowers these risks.
Evidence Rating Level: 1 (Excellent)
Sedentary behaviour (SB), defined as low-energy acivities have become increasingly common and is strongly associated with a higher risk of chronic disease and premature death. Previous studies have shown that sitting more than 6-8 hours per day raises all‑cause and cardiovascular mortality, while greater physical activity can offset part of this risk. Also suggested was that swapping sedentary time for moderate‑to‑vigorous activity lowers risks of sarcopenia and mortality, but far less is known about which specific, everyday activities offer the greatest benefit. This study examined how sedentary time relates to all-cause and cause‑specific mortality and to identify which types of physical activity most effectively reduce these risks. The cohort included eligible individuals from the UK Biobank and the National Health and Nutrition Examination Survey (NHANES). Sedentary time was assessed through participant surveys, providing an average amount of hours they spent each week watching TV, using a computer, or driving. During the follow-up period, more time spent sitting daily was associated with higher risks of all-cause mortality, as well as mortality from cancer, cardiovascular disease, and respiratory disease, compared with sitting less than 5 hours per day. In the UK Biobank, 36,109 deaths occurred over 13.5 years, while in NHANES, 3,057 deaths occurred over 6.7 years. Replacing sedentary time with physical activity lowered all-cause mortality risk by 3.5% (hazard ratio [HR] 0.965, 95% CI 0.954-0.977). Cause‑specific mortality also fell: 1.6% for cancer (HR 0.984, 95% CI 0.968–1.000), 4.4% for cardiovascular disease (HR 0.956, 95% CI 0.930–0.982), and 15.5% for respiratory disease (HR 0.845, 95% CI 0.795–0.899). The benefits increased with more intense activity or longer replacement periods. These findings indicate that prolonged SBis significantly associated with higher all-cause and cause-specific mortality, and even modest everyday physical activity can meaningfully counteract this.
Image: PD
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