Glucagonlike peptide‐1 receptor agonists versus dipeptidyl peptidase‐4 inhibitors in ischemic strokes with diabetes 2

Background and purpose Cardiovascular outcome trials demonstrate that glucagonlike peptide‐1 receptor agonists (GLP‐1RAs) reduce the risk of major adverse cardiovascular events in patients with type 2 diabetes (T2D), whereas dipeptidyl peptidase‐4 inhibitors (DPP‐4is) have not shown cardiovascular b...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:European journal of neurology 2024-08, Vol.31 (8), p.e16329-n/a
Hauptverfasser: Hastrup, Sidsel, Hedegaard, Jakob Nebeling, Andersen, Grethe, Rungby, Jørgen, Johnsen, Soren Paaske
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page n/a
container_issue 8
container_start_page e16329
container_title European journal of neurology
container_volume 31
creator Hastrup, Sidsel
Hedegaard, Jakob Nebeling
Andersen, Grethe
Rungby, Jørgen
Johnsen, Soren Paaske
description Background and purpose Cardiovascular outcome trials demonstrate that glucagonlike peptide‐1 receptor agonists (GLP‐1RAs) reduce the risk of major adverse cardiovascular events in patients with type 2 diabetes (T2D), whereas dipeptidyl peptidase‐4 inhibitors (DPP‐4is) have not shown cardiovascular benefits. We compared acute ischemic stroke (AIS) with T2D treated with either a GLP‐1RA or DPP‐4i prior to the index stroke. Methods This national cohort study included AIS patients with T2D from 2017 to 2020 in Denmark who were users of a GLP‐1RA or DPP‐4i. To be categorized as a user, we required at least 12 months of exposure and no concurrent treatment with another newer glucose‐lowering medication during the last 3 months prior to the index stroke. GLP‐1RA users were compared to users of DPP‐4i while adjusting for the calendar year of index stroke, age, sex, comorbidity, and socioeconomic factors. Results The study included 1567 AIS events with T2D; 593 were users of GLP‐1RA and 974 of DPP‐4i. The absolute risk of a very severe stroke was 2.4% (95% confidence interval [CI] = 1.2–3.7) in GLP‐1RA users and 6.1% (95% CI = 4.6–7.7) in DPP‐4i users. The corresponding adjusted risk ratio (aRR) of GLP‐1RA versus DPP‐4i was 0.49 (95% CI = 0.24–1.00). The aRRs of 30‐day and 365‐day mortality were 0.55 (95% CI = 0.32–0.94) and 0.72 (95% CI = 0.53–0.98), respectively. Conclusions The risk of a very severe stroke as well as the 30‐day and 365‐day poststroke mortality rates were lower among the AIS patients with comorbid T2D receiving GLP‐1RA prior to the index stroke compared to those receiving DPP‐4i. Hence, GLP‐1RA may improve stroke outcomes in comparison with DPP‐4i.
doi_str_mv 10.1111/ene.16329
format Article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3052592145</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3052592145</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3489-23663583e2c2a3e26383b3a4bd2fcde97cd73b735fc87e05455e22e8bceba6323</originalsourceid><addsrcrecordid>eNp1kbtOxDAQRS0E4l3wA8gSDRQB2xPnUaLV8pAQNFBHjjPLGrLJYieg7fgEvpEvYZYsFEi4sGfkc69Gcxk7kOJU0jnDBk9lAipfY9syTrJIAsh1qkHLSEsht9hOCE9CCJUqscm2IEulhizfZovLurfmsW1q94x8jvPOVfj5_iG5R0td6_ny14Uu8Ff0oQ-8cgO2qFe8CUtFzF0zdaUjSaCSu2CnOHOWh863zxj4m-umJDYldtSpPbYxMXXA_dW7yx4uxvejq-jm7vJ6dH4TWYizPFKQJKAzQGWVoTuBDEowcVmpia0wT22VQpmCntgsRaFjrVEpzEqLpaGdwC47Hnznvn3pMXTFjEbDujYNtn0oQGilcyVjTejRH_Sp7X1D0xGVJjKWUiREnQyU9W0IHifF3LuZ8YtCimKZR0F5FN95EHu4cuzLGVa_5E8ABJwNwJurcfG_UzG-HQ-WXxAgl2s</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3076141106</pqid></control><display><type>article</type><title>Glucagonlike peptide‐1 receptor agonists versus dipeptidyl peptidase‐4 inhibitors in ischemic strokes with diabetes 2</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><source>Wiley Online Library (Open Access Collection)</source><source>PubMed Central</source><creator>Hastrup, Sidsel ; Hedegaard, Jakob Nebeling ; Andersen, Grethe ; Rungby, Jørgen ; Johnsen, Soren Paaske</creator><creatorcontrib>Hastrup, Sidsel ; Hedegaard, Jakob Nebeling ; Andersen, Grethe ; Rungby, Jørgen ; Johnsen, Soren Paaske</creatorcontrib><description>Background and purpose Cardiovascular outcome trials demonstrate that glucagonlike peptide‐1 receptor agonists (GLP‐1RAs) reduce the risk of major adverse cardiovascular events in patients with type 2 diabetes (T2D), whereas dipeptidyl peptidase‐4 inhibitors (DPP‐4is) have not shown cardiovascular benefits. We compared acute ischemic stroke (AIS) with T2D treated with either a GLP‐1RA or DPP‐4i prior to the index stroke. Methods This national cohort study included AIS patients with T2D from 2017 to 2020 in Denmark who were users of a GLP‐1RA or DPP‐4i. To be categorized as a user, we required at least 12 months of exposure and no concurrent treatment with another newer glucose‐lowering medication during the last 3 months prior to the index stroke. GLP‐1RA users were compared to users of DPP‐4i while adjusting for the calendar year of index stroke, age, sex, comorbidity, and socioeconomic factors. Results The study included 1567 AIS events with T2D; 593 were users of GLP‐1RA and 974 of DPP‐4i. The absolute risk of a very severe stroke was 2.4% (95% confidence interval [CI] = 1.2–3.7) in GLP‐1RA users and 6.1% (95% CI = 4.6–7.7) in DPP‐4i users. The corresponding adjusted risk ratio (aRR) of GLP‐1RA versus DPP‐4i was 0.49 (95% CI = 0.24–1.00). The aRRs of 30‐day and 365‐day mortality were 0.55 (95% CI = 0.32–0.94) and 0.72 (95% CI = 0.53–0.98), respectively. Conclusions The risk of a very severe stroke as well as the 30‐day and 365‐day poststroke mortality rates were lower among the AIS patients with comorbid T2D receiving GLP‐1RA prior to the index stroke compared to those receiving DPP‐4i. Hence, GLP‐1RA may improve stroke outcomes in comparison with DPP‐4i.</description><identifier>ISSN: 1351-5101</identifier><identifier>ISSN: 1468-1331</identifier><identifier>EISSN: 1468-1331</identifier><identifier>DOI: 10.1111/ene.16329</identifier><identifier>PMID: 38715389</identifier><language>eng</language><publisher>England: John Wiley &amp; Sons, Inc</publisher><subject>Aged ; Aged, 80 and over ; Agonists ; Cardiovascular diseases ; cerebrovascular disease/stroke ; Clinical trials ; Cohort Studies ; Comorbidity ; Denmark - epidemiology ; Diabetes ; Diabetes mellitus (non-insulin dependent) ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - drug therapy ; Dipeptidyl-Peptidase IV Inhibitors - therapeutic use ; Female ; Glucagon-Like Peptide-1 Receptor - agonists ; Humans ; Hypoglycemic Agents - therapeutic use ; Inhibitors ; Ischemia ; Ischemic Stroke - drug therapy ; Ischemic Stroke - epidemiology ; Male ; Middle Aged ; Mortality ; outcome research ; Peptidases ; Peptides ; Receptors ; Risk ; Socioeconomic factors ; Socioeconomics ; Stroke</subject><ispartof>European journal of neurology, 2024-08, Vol.31 (8), p.e16329-n/a</ispartof><rights>2024 The Authors. published by John Wiley &amp; Sons Ltd on behalf of European Academy of Neurology.</rights><rights>2024 The Authors. European Journal of Neurology published by John Wiley &amp; Sons Ltd on behalf of European Academy of Neurology.</rights><rights>2024. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3489-23663583e2c2a3e26383b3a4bd2fcde97cd73b735fc87e05455e22e8bceba6323</cites><orcidid>0000-0002-5232-8409</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fene.16329$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fene.16329$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>315,782,786,1419,11569,27931,27932,45581,45582,46059,46483</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38715389$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hastrup, Sidsel</creatorcontrib><creatorcontrib>Hedegaard, Jakob Nebeling</creatorcontrib><creatorcontrib>Andersen, Grethe</creatorcontrib><creatorcontrib>Rungby, Jørgen</creatorcontrib><creatorcontrib>Johnsen, Soren Paaske</creatorcontrib><title>Glucagonlike peptide‐1 receptor agonists versus dipeptidyl peptidase‐4 inhibitors in ischemic strokes with diabetes 2</title><title>European journal of neurology</title><addtitle>Eur J Neurol</addtitle><description>Background and purpose Cardiovascular outcome trials demonstrate that glucagonlike peptide‐1 receptor agonists (GLP‐1RAs) reduce the risk of major adverse cardiovascular events in patients with type 2 diabetes (T2D), whereas dipeptidyl peptidase‐4 inhibitors (DPP‐4is) have not shown cardiovascular benefits. We compared acute ischemic stroke (AIS) with T2D treated with either a GLP‐1RA or DPP‐4i prior to the index stroke. Methods This national cohort study included AIS patients with T2D from 2017 to 2020 in Denmark who were users of a GLP‐1RA or DPP‐4i. To be categorized as a user, we required at least 12 months of exposure and no concurrent treatment with another newer glucose‐lowering medication during the last 3 months prior to the index stroke. GLP‐1RA users were compared to users of DPP‐4i while adjusting for the calendar year of index stroke, age, sex, comorbidity, and socioeconomic factors. Results The study included 1567 AIS events with T2D; 593 were users of GLP‐1RA and 974 of DPP‐4i. The absolute risk of a very severe stroke was 2.4% (95% confidence interval [CI] = 1.2–3.7) in GLP‐1RA users and 6.1% (95% CI = 4.6–7.7) in DPP‐4i users. The corresponding adjusted risk ratio (aRR) of GLP‐1RA versus DPP‐4i was 0.49 (95% CI = 0.24–1.00). The aRRs of 30‐day and 365‐day mortality were 0.55 (95% CI = 0.32–0.94) and 0.72 (95% CI = 0.53–0.98), respectively. Conclusions The risk of a very severe stroke as well as the 30‐day and 365‐day poststroke mortality rates were lower among the AIS patients with comorbid T2D receiving GLP‐1RA prior to the index stroke compared to those receiving DPP‐4i. Hence, GLP‐1RA may improve stroke outcomes in comparison with DPP‐4i.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Agonists</subject><subject>Cardiovascular diseases</subject><subject>cerebrovascular disease/stroke</subject><subject>Clinical trials</subject><subject>Cohort Studies</subject><subject>Comorbidity</subject><subject>Denmark - epidemiology</subject><subject>Diabetes</subject><subject>Diabetes mellitus (non-insulin dependent)</subject><subject>Diabetes Mellitus, Type 2 - complications</subject><subject>Diabetes Mellitus, Type 2 - drug therapy</subject><subject>Dipeptidyl-Peptidase IV Inhibitors - therapeutic use</subject><subject>Female</subject><subject>Glucagon-Like Peptide-1 Receptor - agonists</subject><subject>Humans</subject><subject>Hypoglycemic Agents - therapeutic use</subject><subject>Inhibitors</subject><subject>Ischemia</subject><subject>Ischemic Stroke - drug therapy</subject><subject>Ischemic Stroke - epidemiology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>outcome research</subject><subject>Peptidases</subject><subject>Peptides</subject><subject>Receptors</subject><subject>Risk</subject><subject>Socioeconomic factors</subject><subject>Socioeconomics</subject><subject>Stroke</subject><issn>1351-5101</issn><issn>1468-1331</issn><issn>1468-1331</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp1kbtOxDAQRS0E4l3wA8gSDRQB2xPnUaLV8pAQNFBHjjPLGrLJYieg7fgEvpEvYZYsFEi4sGfkc69Gcxk7kOJU0jnDBk9lAipfY9syTrJIAsh1qkHLSEsht9hOCE9CCJUqscm2IEulhizfZovLurfmsW1q94x8jvPOVfj5_iG5R0td6_ny14Uu8Ff0oQ-8cgO2qFe8CUtFzF0zdaUjSaCSu2CnOHOWh863zxj4m-umJDYldtSpPbYxMXXA_dW7yx4uxvejq-jm7vJ6dH4TWYizPFKQJKAzQGWVoTuBDEowcVmpia0wT22VQpmCntgsRaFjrVEpzEqLpaGdwC47Hnznvn3pMXTFjEbDujYNtn0oQGilcyVjTejRH_Sp7X1D0xGVJjKWUiREnQyU9W0IHifF3LuZ8YtCimKZR0F5FN95EHu4cuzLGVa_5E8ABJwNwJurcfG_UzG-HQ-WXxAgl2s</recordid><startdate>202408</startdate><enddate>202408</enddate><creator>Hastrup, Sidsel</creator><creator>Hedegaard, Jakob Nebeling</creator><creator>Andersen, Grethe</creator><creator>Rungby, Jørgen</creator><creator>Johnsen, Soren Paaske</creator><general>John Wiley &amp; Sons, Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7U7</scope><scope>C1K</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5232-8409</orcidid></search><sort><creationdate>202408</creationdate><title>Glucagonlike peptide‐1 receptor agonists versus dipeptidyl peptidase‐4 inhibitors in ischemic strokes with diabetes 2</title><author>Hastrup, Sidsel ; Hedegaard, Jakob Nebeling ; Andersen, Grethe ; Rungby, Jørgen ; Johnsen, Soren Paaske</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3489-23663583e2c2a3e26383b3a4bd2fcde97cd73b735fc87e05455e22e8bceba6323</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Agonists</topic><topic>Cardiovascular diseases</topic><topic>cerebrovascular disease/stroke</topic><topic>Clinical trials</topic><topic>Cohort Studies</topic><topic>Comorbidity</topic><topic>Denmark - epidemiology</topic><topic>Diabetes</topic><topic>Diabetes mellitus (non-insulin dependent)</topic><topic>Diabetes Mellitus, Type 2 - complications</topic><topic>Diabetes Mellitus, Type 2 - drug therapy</topic><topic>Dipeptidyl-Peptidase IV Inhibitors - therapeutic use</topic><topic>Female</topic><topic>Glucagon-Like Peptide-1 Receptor - agonists</topic><topic>Humans</topic><topic>Hypoglycemic Agents - therapeutic use</topic><topic>Inhibitors</topic><topic>Ischemia</topic><topic>Ischemic Stroke - drug therapy</topic><topic>Ischemic Stroke - epidemiology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>outcome research</topic><topic>Peptidases</topic><topic>Peptides</topic><topic>Receptors</topic><topic>Risk</topic><topic>Socioeconomic factors</topic><topic>Socioeconomics</topic><topic>Stroke</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hastrup, Sidsel</creatorcontrib><creatorcontrib>Hedegaard, Jakob Nebeling</creatorcontrib><creatorcontrib>Andersen, Grethe</creatorcontrib><creatorcontrib>Rungby, Jørgen</creatorcontrib><creatorcontrib>Johnsen, Soren Paaske</creatorcontrib><collection>Wiley Online Library (Open Access Collection)</collection><collection>Wiley Online Library (Open Access Collection)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hastrup, Sidsel</au><au>Hedegaard, Jakob Nebeling</au><au>Andersen, Grethe</au><au>Rungby, Jørgen</au><au>Johnsen, Soren Paaske</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Glucagonlike peptide‐1 receptor agonists versus dipeptidyl peptidase‐4 inhibitors in ischemic strokes with diabetes 2</atitle><jtitle>European journal of neurology</jtitle><addtitle>Eur J Neurol</addtitle><date>2024-08</date><risdate>2024</risdate><volume>31</volume><issue>8</issue><spage>e16329</spage><epage>n/a</epage><pages>e16329-n/a</pages><issn>1351-5101</issn><issn>1468-1331</issn><eissn>1468-1331</eissn><abstract>Background and purpose Cardiovascular outcome trials demonstrate that glucagonlike peptide‐1 receptor agonists (GLP‐1RAs) reduce the risk of major adverse cardiovascular events in patients with type 2 diabetes (T2D), whereas dipeptidyl peptidase‐4 inhibitors (DPP‐4is) have not shown cardiovascular benefits. We compared acute ischemic stroke (AIS) with T2D treated with either a GLP‐1RA or DPP‐4i prior to the index stroke. Methods This national cohort study included AIS patients with T2D from 2017 to 2020 in Denmark who were users of a GLP‐1RA or DPP‐4i. To be categorized as a user, we required at least 12 months of exposure and no concurrent treatment with another newer glucose‐lowering medication during the last 3 months prior to the index stroke. GLP‐1RA users were compared to users of DPP‐4i while adjusting for the calendar year of index stroke, age, sex, comorbidity, and socioeconomic factors. Results The study included 1567 AIS events with T2D; 593 were users of GLP‐1RA and 974 of DPP‐4i. The absolute risk of a very severe stroke was 2.4% (95% confidence interval [CI] = 1.2–3.7) in GLP‐1RA users and 6.1% (95% CI = 4.6–7.7) in DPP‐4i users. The corresponding adjusted risk ratio (aRR) of GLP‐1RA versus DPP‐4i was 0.49 (95% CI = 0.24–1.00). The aRRs of 30‐day and 365‐day mortality were 0.55 (95% CI = 0.32–0.94) and 0.72 (95% CI = 0.53–0.98), respectively. Conclusions The risk of a very severe stroke as well as the 30‐day and 365‐day poststroke mortality rates were lower among the AIS patients with comorbid T2D receiving GLP‐1RA prior to the index stroke compared to those receiving DPP‐4i. Hence, GLP‐1RA may improve stroke outcomes in comparison with DPP‐4i.</abstract><cop>England</cop><pub>John Wiley &amp; Sons, Inc</pub><pmid>38715389</pmid><doi>10.1111/ene.16329</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-5232-8409</orcidid><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 1351-5101
ispartof European journal of neurology, 2024-08, Vol.31 (8), p.e16329-n/a
issn 1351-5101
1468-1331
1468-1331
language eng
recordid cdi_proquest_miscellaneous_3052592145
source MEDLINE; Access via Wiley Online Library; Wiley Online Library (Open Access Collection); PubMed Central
subjects Aged
Aged, 80 and over
Agonists
Cardiovascular diseases
cerebrovascular disease/stroke
Clinical trials
Cohort Studies
Comorbidity
Denmark - epidemiology
Diabetes
Diabetes mellitus (non-insulin dependent)
Diabetes Mellitus, Type 2 - complications
Diabetes Mellitus, Type 2 - drug therapy
Dipeptidyl-Peptidase IV Inhibitors - therapeutic use
Female
Glucagon-Like Peptide-1 Receptor - agonists
Humans
Hypoglycemic Agents - therapeutic use
Inhibitors
Ischemia
Ischemic Stroke - drug therapy
Ischemic Stroke - epidemiology
Male
Middle Aged
Mortality
outcome research
Peptidases
Peptides
Receptors
Risk
Socioeconomic factors
Socioeconomics
Stroke
title Glucagonlike peptide‐1 receptor agonists versus dipeptidyl peptidase‐4 inhibitors in ischemic strokes with diabetes 2
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-05T15%3A23%3A56IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Glucagonlike%20peptide%E2%80%901%20receptor%20agonists%20versus%20dipeptidyl%20peptidase%E2%80%904%20inhibitors%20in%20ischemic%20strokes%20with%20diabetes%202&rft.jtitle=European%20journal%20of%20neurology&rft.au=Hastrup,%20Sidsel&rft.date=2024-08&rft.volume=31&rft.issue=8&rft.spage=e16329&rft.epage=n/a&rft.pages=e16329-n/a&rft.issn=1351-5101&rft.eissn=1468-1331&rft_id=info:doi/10.1111/ene.16329&rft_dat=%3Cproquest_cross%3E3052592145%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3076141106&rft_id=info:pmid/38715389&rfr_iscdi=true