Microplastics in brains … and other research
BMJ 2025; 388 doi: https://doi.org/10.1136/bmj.r296 (Published 20 February 2025) Cite this as: BMJ 2025;388:r296
Plastic people
Microplastics and nanoplastics (MNPs) are being found just about everywhere we look, and they have now been found in our brains. A report in Nature Medicine describes their appearance as “shards or flakes,” neither of which I really want to imagine being deposited around my grey matter. They found higher levels of MNPs in brain samples from 2024 than from 2016 and in those who had been diagnosed with dementia. The authors are careful to point out that their study doesn’t establish a causal role for microplastics and dementia and other neurological disease but urges more research to explore this possibility.
Nat Med doi:10.1038/s41591-024-03453-1
Make some noise for blood pressure screening in public spaces
Investigators of a randomised crossover trial examining differences in blood pressure measured in loud versus quiet places were in a win-win situation: find higher blood pressures in loud public places, and they could warn of the health harms of noise; find no difference between blood pressure measured in loud and quiet environments, and they sound the claxon for blood pressure screening interventions in busy environments. It turned out to be the latter, so grab your sphig and a megaphone and get out there: “Get your free blood pressure check, roll up, roll up (your sleeves).”
Ann Intern Med doi:10.7326/ANNALS-24-00873
Age and sex differences with newer diabetes drugs
SGLT-2 inhibitors seem to be more effective at reducing major adverse cardiovascular events and HbA1c in older people with diabetes than younger people. Meanwhile, the opposite effect has been found for GLP-1 receptor agonists, which seem less effective at reducing major adverse cardiovascular events and HbA1c in older people. These are the findings of a network meta-analysis that looked at individual participant data from 103 trials. The study also found no difference in outcomes according to sex with SGLT-2 inhibitors and GLP-1 receptor agonists.
JAMA doi:10.1001/jama.2024.27402
Stopping indication creep in endovascular treatment for acute stroke
There’s been a growing literature exploring the possible benefits of endovascular treatment for acute ischaemic stroke caused by medium or distal vessel occlusion. However, the first randomised control trials of thrombectomy for medium and distal vessel occlusion, DISTAL and ESCAPE MeVO, have just been published and found that endovascular treatment did not lead to any added clinical benefit compared with medical management alone. An editorial concludes that “performance of thrombectomy for medium- or distal-vessel occlusion in a manner consistent with these trials is not evidence-based.”
N Engl J Med doi:10.1056/NEJMoa2408954, doi:10.1056/NEJMoa2411668
Is the exenatide going out for Parkinson’s disease?
Epidemiological and laboratory studies have suggested that GLP-1 receptor agonists could have a role in prevention and treatment of Parkinson’s disease. But once again, evidence from clinical trials seems to be lacking. A new study, published in the Lancet, is the largest and longest trial so far of a GLP-1 receptor agonist as treatment for Parkinson’s disease: 194 people with moderate severity Parkinson’s disease received exenatide or placebo and were followed up for 96 weeks. There was no benefit with exenatide on any measures of disease severity. This may not be the end, though: the authors suggest higher doses may be required to achieve therapeutic concentrations of the drug in the central nervous system.
Lancet doi:10.1016/S0140-6736(24)02808-3
Footnotes
Competing interests: None declared.
Provenance and peer review: Not commissioned; not peer reviewed.