A recent study led by the Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine of the University of Hong Kong (HKUMed), in collaboration with the University of Hong Kong-Shenzhen Hospital, has demonstrated that combining an innovative coronary imaging technology known as the caFFR system, with diabetes drug SGLT2 inhibitors can significantly reduce the risks of major adverse cardiovascular events (MACE), heart failure and death among patients with type 2 diabetes mellitus (T2DM) and coronary artery disease. This dual-pronged strategy provides a precise measurement of coronary blood flow while lowering glucose levels, offering an effective approach to treating exceptionally high-risk patients. The findings were published in the Diabetes and Metabolism Journal link to the publication.
caFFR images access coronary blood flow
Patients with T2DM commonly develop more complex and severe forms of coronary artery disease, often involving multiple narrowed or blocked arteries. This complexity makes it challenging for cardiologists to achieve 'complete revascularisation', where all significantly blocked arteries are fully opened to restore blood flow. Without detailed functional assessment, some blockages that appear mild on imaging but are functionally important may be overlooked. If these high-risk blockages are not identified, patients may be at risk of 'incomplete revascularisation' and experience persistent ischaemia despite treatment, ultimately increasing their long-term cardiac risk.
To address this challenge, Professor Yiu Kai-hang, Clinical Professor in the Department of Medicine, School of Clinical Medicine, HKUMed, led a research team to evaluate the use of the caFFR system, an innovative imaging technology that allows accurate measurement of coronary blood flow from standard angiogram images. This technique enables cardiologists to identify which arterial blockages are truly responsible for ischaemia, thus supporting more precise decision-making and the development of more effective interventional treatment strategies for high-risk patients.
Professor Yiu Kai-hang explains that the functional assessment using the caFFR system is crucial for achieving optimal revascularisation in diabetic patients. SGLT2 inhibitors offer robust cardiovascular protection and significantly improve survival outcomes, even in cases of incomplete revascularisation.
SGLT2 inhibitors provide powerful cardiac protection
The study analysed data from 671 patients with both T2DM and coronary artery disease who underwent angiogram imaging in public hospitals between 2014 and 2016. While complete revascularisation was achieved in some patients, many still had residual stenosis after undergoing the revascularisation procedure due to diffuse and complex diabetic atherosclerosis. Remarkably, for those with incomplete revascularisation, the use of SGLT2 inhibitors provided powerful vascular protecton. The three-year incidence of MACE was markedly reduced from 17.8% to 8.3%, while all-cause mortality dropped sharply from 16.3% to 6.3% over the same period.
HKUMed reveals that combining novel caFFR imaging technology with glucose lowering drug effectively protects the heart of diabetic patients. In the photo are Professor Yiu Kai-hang (left), who led the research, and his team member Dr Xuan Haochen.
'Our findings show that functional assessment using the caFFR system allows clinicians to accurately identify blockages that truly cause ischemia, which is crucial for achieving optimal revascularisation in diabetic patients,' said Professor Yiu Kai-hang. 'Moreover, even when complete revascularisation cannot be achieved, SGLT2 inhibitors offer robust cardiovascular protection, significantly improving survival outcomes. This dual approach represents a major step forward in managing heart disease among individuals with diabetes.'
The study underscores the complementary roles of precision interventional imaging and pharmacological therapy in improving outcomes for diabetic patients with coronary artery disease. By integrating caFFR-guided vascular reconstruction procedures with SGLT2 inhibitor therapy, clinicians can better tailor treatment to each patient's needs, offering both anatomical and metabolic protection for the heart.
Professor Yiu added, 'This study has importance implications for clinical practice. It demonstrates that even when structural risks in the blood vessels may persist, SGLT2 inhibitors provide a vital safety net, reducing future cardiovascular risks. The findings reinforce HKUMed's ongoing commitment to translating clinical innovation into better patient care.'
The study was led by Professor Yiu Kai-hang, Clinical Professor, Department of Medicine, School of Clinical Medicine, HKUMed, and conducted in collaboration with the University of Hong Kong–Shenzhen Hospital.
A research team from the Department of Surgery and the Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, the University of Hong Kong (HKUMed), has demonstrated that prostate-specific antigen (PSA) screening for men aged 45 and above can significantly reduce the incidence of advanced-stage prostate cancer from 39% to approximately 1%, and lower the mortality rate from 6.14% to 2.85%. The study highlights that implementing risk-stratified screening in Hong Kong is highly cost-effective, providing robust evidence to support the formulation of future cancer prevention and control policies in the city. The study findings were published in The Lancet Regional Health – Western Pacific.
A study from HKUMed demonstrates that prostate-specific antigen (PSA) screening can significantly reduce the incidence of advanced-stage prostate cancer and mortality rate. The research is led by Dr Na Rong (left) from the Department of Surgery, and Professor Li Xue from the Department of Medicine, both under the School of Clinical Medicine at HKUMed. Photo source: HKUMed
PSA screening helps reduce incidence of advanced prostate cancer and mortality
According to the latest data from the Health Bureau, prostate cancer is now the third most prevalent cancer among men in Hong Kong, with its incidence rising in tandem with the ageing population. Dr Na Rong, Clinical Assistant Professor in the Department of Surgery, School of Clinical Medicine, HKUMed, explained that early symptoms of prostate cancer are often subtle, leading to delayed treatment. PSA screening, a blood test used to detect PSA levels in the blood, helps identify high-risk or metastatic prostate cancer at an early stage. However, the city's current health policy does not include a targeted screening programme for prostate cancer, and there is insufficient scientific evidence to support the implementation of universal screening.
The research team evaluated 56 distinct PSA screening strategies, including annual PSA screening for men aged 45 to 75. The team found that this strategy could significantly reduce the proportion of patients diagnosed with advanced-stage cancer at initial diagnosis from approximately 39% to 1%, while also slashing the annual prostate cancer mortality rate from 6.14% to 2.85%.
Cost-effectiveness of city-wide PSA screening
The team also evaluated the cost-effectiveness of implementing city-wide PSA screening to reduce pressure on the public healthcare system. The results indicated that assuming annual PSA screening for the 45 to 75 age group, the costs for screening and subsequent treatments would be far below the 'cost-effective' threshold defined by the World Health Organisation (WHO). Specifically, the estimated annual incremental cost per person would be approximately US$4,950 (HK$38,500). This is far below the value generated by the intervention, especially when compared to Hong Kong's GDP per capita of approximately US$55,000 (HK$420,000), confirming that periodic PSA screening is 'highly cost-effective'.
'From a health economics perspective, if a medical intervention is proven to be “cost-effective” in regions with lower GDP per capita, its feasibility and economic benefits are even more significant in a high-income economy like that of Hong Kong. With more abundant medical resources and higher purchasing power, Hong Kong is well-positioned to implement proactive early screening to reduce the societal burden of advanced cancer,' emphasised Dr Na.
Optimising resource allocation through 'precision screening'
To avoid overdiagnosis and strain on the public healthcare system, the research team suggests 'precision stratification' of population risk. The study introduced polygenic risk scores (PRS) for prostate cancer prediction to tailor screening strategies based on individual risk levels. While high-risk groups would undergo more frequent monitoring, the screening starting age could be delayed or testing frequency reduced for low-to-medium risk groups (comprising two-thirds of the population). This stratified approach would improve cost-effectiveness without compromising overall survival rates.
'We hope this health economics study, which combines clinical data from Hong Kong and the Chinese Mainland, will promote a review of prostate cancer screening guidelines in the city. In the long term, this will help achieve "early detection, early treatment”, improve the healthy life expectancy of men in Hong Kong, and alleviate societal and medical costs,' concluded Dr Na.
Research based on big data from Hong Kong and the Chinese Mainland
The research utilised 20 years of clinical follow-up data from Hong Kong, screening cohorts from Guangzhou, and diagnostic data from Shanghai. Leveraging this real-world evidence, HKUMed and the Mainland teams accurately modeled the natural history and prognosis of prostate cancer in the region. These results are highly applicable to the local population for predicting disease burden and intervention outcomes.
About the research team
The study was led by Dr Na Rong, Clinical Assistant Professor, Department of Surgery; Professor Li Xue, Assistant Professor, Department of Medicine, both under the School of Clinical Medicine at HKUMed; in collaboration with Professor Gu Di, First Affiliated Hospital of Guangzhou Medical University. The first authors are Dr Liu Jiacheng, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine; Dr Jiao Yuanshi, Department of Medicine, School of Clinical Medicine, HKUMed, and Dr Huang Yueting, First Affiliated Hospital of Guangzhou Medical University.
The research team hopes this health economics study will promote a review of prostate cancer screening guidelines in the city, ultimately improving the healthy life expectancy of men in Hong Kong in the long term while alleviating societal and medical costs. Photo source: HKUMed
