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Di Angelantonio E, Kaptoge S, Wormser D, Willeit P, Butterworth AS, Bansal N, O'Keeffe LM, Gao P, Wood AM, Burgess S, Freitag DF, Pennells L, Peters SA, Hart CL, Håheim LL, Gillum RF, Nordestgaard BG, Psaty BM, Yeap BB, Knuiman MW, Nietert PJ, Kauhanen J, Salonen JT, Kuller LH, Simons LA, van der Schouw YT, Barrett-Connor E, Selmer R, Crespo CJ, Rodriguez B, Verschuren WMM, Salomaa V, Svärdsudd K, van der Harst P, Björkelund C, Wilhelmsen L, Wallace RB, Brenner H, Amouyel P, Barr ELM, Iso H, Onat A, Trevisan M, D'Agostino RB, Cooper C, Kavousi M, Welin L, Roussel R, Hu FB, Sato S, Davidson KW, Howard BV, Leening MJG, Leening M, Rosengren A, Dörr M, Deeg DJH, Kiechl S, Stehouwer CDA, Nissinen A, Giampaoli S, Donfrancesco C, Kromhout D, Price JF, Peters A, Meade TW, Casiglia E, Lawlor DA, Gallacher J, Nagel D, Franco OH, Assmann G, Dagenais GR, Jukema JW, Sundström J, Woodward M, Brunner EJ, Khaw KT, Wareham NJ, Whitsel EA, Njølstad I, Hedblad B, Wassertheil-Smoller S, Engström G, Rosamond WD, Selvin E, Sattar N, Thompson SG, Danesh J. Association of Cardiometabolic Multimorbidity With Mortality. JAMA 2015; 314:52-60. [PMID: 26151266 PMCID: PMC4664176 DOI: 10.1001/jama.2015.7008] [Citation(s) in RCA: 538] [Impact Index Per Article: 59.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
IMPORTANCE The prevalence of cardiometabolic multimorbidity is increasing. OBJECTIVE To estimate reductions in life expectancy associated with cardiometabolic multimorbidity. DESIGN, SETTING, AND PARTICIPANTS Age- and sex-adjusted mortality rates and hazard ratios (HRs) were calculated using individual participant data from the Emerging Risk Factors Collaboration (689,300 participants; 91 cohorts; years of baseline surveys: 1960-2007; latest mortality follow-up: April 2013; 128,843 deaths). The HRs from the Emerging Risk Factors Collaboration were compared with those from the UK Biobank (499,808 participants; years of baseline surveys: 2006-2010; latest mortality follow-up: November 2013; 7995 deaths). Cumulative survival was estimated by applying calculated age-specific HRs for mortality to contemporary US age-specific death rates. EXPOSURES A history of 2 or more of the following: diabetes mellitus, stroke, myocardial infarction (MI). MAIN OUTCOMES AND MEASURES All-cause mortality and estimated reductions in life expectancy. RESULTS In participants in the Emerging Risk Factors Collaboration without a history of diabetes, stroke, or MI at baseline (reference group), the all-cause mortality rate adjusted to the age of 60 years was 6.8 per 1000 person-years. Mortality rates per 1000 person-years were 15.6 in participants with a history of diabetes, 16.1 in those with stroke, 16.8 in those with MI, 32.0 in those with both diabetes and MI, 32.5 in those with both diabetes and stroke, 32.8 in those with both stroke and MI, and 59.5 in those with diabetes, stroke, and MI. Compared with the reference group, the HRs for all-cause mortality were 1.9 (95% CI, 1.8-2.0) in participants with a history of diabetes, 2.1 (95% CI, 2.0-2.2) in those with stroke, 2.0 (95% CI, 1.9-2.2) in those with MI, 3.7 (95% CI, 3.3-4.1) in those with both diabetes and MI, 3.8 (95% CI, 3.5-4.2) in those with both diabetes and stroke, 3.5 (95% CI, 3.1-4.0) in those with both stroke and MI, and 6.9 (95% CI, 5.7-8.3) in those with diabetes, stroke, and MI. The HRs from the Emerging Risk Factors Collaboration were similar to those from the more recently recruited UK Biobank. The HRs were little changed after further adjustment for markers of established intermediate pathways (eg, levels of lipids and blood pressure) and lifestyle factors (eg, smoking, diet). At the age of 60 years, a history of any 2 of these conditions was associated with 12 years of reduced life expectancy and a history of all 3 of these conditions was associated with 15 years of reduced life expectancy. CONCLUSIONS AND RELEVANCE Mortality associated with a history of diabetes, stroke, or MI was similar for each condition. Because any combination of these conditions was associated with multiplicative mortality risk, life expectancy was substantially lower in people with multimorbidity.
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Affiliation(s)
| | | | | | | | | | | | | | - Pei Gao
- University of Cambridge, Cambridge, England
| | | | | | | | | | - Sanne A Peters
- University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | | | | | | | - Bu B Yeap
- University of Western Australia, Perth
| | | | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | | | | | | | - Leon A Simons
- University of New South Wales, New South Wales, Australia
| | | | | | - Randi Selmer
- Norwegian Institute of Public Health, Oslo, Norway
| | | | | | | | - Veikko Salomaa
- National Institute for Health and Welfare, Helsinki, Finland
| | | | - Pim van der Harst
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | | | | | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | | | | | | | | | | | | | - Cyrus Cooper
- University of Southampton, Southampton, England32University of Oxford, Oxford, England
| | | | | | - Ronan Roussel
- INSERM, Centre de Recherche des Cordeliers, Paris, France36Université Paris Diderot, Paris, France37Diabétologie, AP-HP, Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Paris, France
| | - Frank B Hu
- Harvard School of Public Health, Boston, Massachusetts
| | - Shinichi Sato
- Osaka Medical Center for Health Science and Promotion/Chiba Prefectural Institute of Public Health, Suita, Japan
| | | | | | | | | | - Annika Rosengren
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marcus Dörr
- University Medicine Greifswald, Greifswald, Germany44DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Dorly J H Deeg
- Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | | | | | | | | | | | | | - Jackie F Price
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany52German Research Center for Cardiovascular Research (DZHK eV), Partner-Site Munich, Munich, Germany
| | - Tom W Meade
- London School of Hygiene and Tropical Medicine, London, England
| | | | | | | | | | | | - Gerd Assmann
- Assmann-Stiftung für Prävention, Munster, Germany
| | - Gilles R Dagenais
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec, Canada
| | | | | | | | | | | | | | - Eric A Whitsel
- Department of Medicine, University of North Carolina, Chapel Hill65Department of Epidemiology, University of North Carolina, Chapel Hill
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155
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Fukuoka Y, Choi J, S Bender M, Gonzalez P, Arai S. Family history and body mass index predict perceived risks of diabetes and heart attack among community-dwelling Caucasian, Filipino, Korean, and Latino Americans--DiLH Survey. Diabetes Res Clin Pract 2015; 109:157-63. [PMID: 25931282 PMCID: PMC4470846 DOI: 10.1016/j.diabres.2015.04.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 02/11/2015] [Accepted: 04/12/2015] [Indexed: 01/10/2023]
Abstract
AIM The purpose of the study was to explore the perceived risk for diabetes and heart attack and associated health status of Caucasian, Filipino, Korean, and Latino Americans without diabetes. METHODS A cross-sectional survey was conducted with 904 urban adults (mean age 44.3±16.1 years; 64.3% female) in English, Spanish or Korean between August and December 2013. RESULTS Perceived risk for developing diabetes was indicated by 46.5% (n=421), and 14.3% (n=129) perceived themselves to be at risk for having a heart attack in their lifetime. Significant predictors of pessimistic diabetes risk perceptions: Filipino (adjusted odds ratio [AOR]=1.7; 95% CI: 1.04-2.86) and Korean (AOR=2.4; 1.33-4.48) ethnicity, family history of diabetes (AOR=1.4; 1.00-1.84), female gender (AOR=1.4; 1.04-1.96), high cholesterol (AOR= 1.6; 1.09-2.37) and higher body mass index (BMI) (AOR=1.1; 1.08-1.15). Predictors of pessimistic heart attack risk perceptions were family history of an early heart attack (AOR=2.9; 1.69-5.02), high blood pressure (AOR=2.4; 1.45-3.84), and higher BMI (AOR=1.1; 1.04-1.12) after controlling for socio-demographic factors. Older age, physical inactivity, smoking, and low HDL levels were not associated with risk perceptions. CONCLUSION Multiple risk factors were predictive of greater perceived diabetes risk, whereas, only family history of heart attack, high blood pressure and increases in BMI significantly contributed to perceived risk of heart attack among ethnically diverse at risk middle-aged adults. It is important that healthcare providers address the discordance between an individual's risk perceptions and the presence of actual risk factors.
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Affiliation(s)
- Yoshimi Fukuoka
- University of California, Institute for Health & Aging/Department of Social & Behavioral Sciences, School of Nursing, 3333 California Street, BOX0646, San Francisco, CA 94118, United States.
| | - JiWon Choi
- University of California, Institute for Health & Aging/Department of Social & Behavioral Sciences, School of Nursing, 3333 California Street, BOX0646, San Francisco, CA 94118, United States
| | - Melinda S Bender
- University of California, Institute for Health & Aging/Department of Social & Behavioral Sciences, School of Nursing, 3333 California Street, BOX0646, San Francisco, CA 94118, United States
| | - Prisila Gonzalez
- University of California, Institute for Health & Aging/Department of Social & Behavioral Sciences, School of Nursing, 3333 California Street, BOX0646, San Francisco, CA 94118, United States
| | - Shoshana Arai
- University of California, Institute for Health & Aging/Department of Social & Behavioral Sciences, School of Nursing, 3333 California Street, BOX0646, San Francisco, CA 94118, United States
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Kim YJ, Choi NK, Kim MS, Lee J, Chang Y, Seong JM, Jung SY, Shin JY, Park JE, Park BJ. Evaluation of low-dose aspirin for primary prevention of ischemic stroke among patients with diabetes: a retrospective cohort study. Diabetol Metab Syndr 2015; 7:8. [PMID: 25733983 PMCID: PMC4346109 DOI: 10.1186/s13098-015-0002-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 01/22/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Low-dose aspirin is recommended to reduce the risk of cardiovascular disease. However, the questions with regard to primary prevention have been raised among patients with diabetes. We evaluated low-dose aspirin use for preventing ischemic stroke in patients with diabetes using a national health insurance database. METHODS Using data from the Korean Health Insurance Review and Assessment Service database from January 1, 2005, through December 31, 2009, a population-based retrospective cohort study was conducted with incident patients with diabetes aged 40 to 99 years old with the initial use of low-dose aspirin during the index period from January 1, 2006 to December 31, 2007. We matched each low-dose aspirin user to one non-user using a propensity score. The Cox proportional hazards model was used to compare the risk of hospitalization for ischemic stroke in users and nonusers of low-dose aspirin until December 31, 2009. RESULTS Out of 261,065 incident patients with diabetes, 15,849 (6.2%) were low-dose aspirin users. Compared to non-users, the adjusted hazard ratio (95% confidence interval) of low-dose aspirin users for hospitalization due to ischemic stroke was 1.73 (95% CI; 1.41-2.12). In a sensitivity analysis of study subjects with more than 1 year follow-up periods, slightly higher adjusted hazard ratio (1.97, 95% CI; 1.51-2.62) was observed. In the subgroup analyses, there were no significant changes in the risk of hospitalization for ischemic stroke irrespective of gender, age, or comorbidity. CONCLUSIONS In this study of patients with diabetes, the use of low-dose aspirin showed an increased risk of hospitalization for ischemic stroke. These results suggest that low-dose aspirin use for the primary prevention of ischemic stroke should be reconsidered in patients with diabetes.
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Affiliation(s)
- Ye-Jee Kim
- />Korea Institute of Drug Safety and Risk Management, Seoul, Republic of Korea
| | - Nam-Kyong Choi
- />Medical Research Collaborating Center, Seoul National University College of Medicine/Seoul National University Hospital, Seoul, Republic of Korea
- />Institute of Environmental Medicine, Seoul National University Medical Research Center, , Seoul, Republic of Korea
| | - Mi-Sook Kim
- />Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Joongyub Lee
- />Medical Research Collaborating Center, Seoul National University College of Medicine/Seoul National University Hospital, Seoul, Republic of Korea
| | - Yoosoo Chang
- />Center for Cohort Studies, Total Healthcare Screening Center, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
| | - Jong-Mi Seong
- />Korea Institute of Drug Safety and Risk Management, Seoul, Republic of Korea
| | - Sun-Young Jung
- />Korea Institute of Drug Safety and Risk Management, Seoul, Republic of Korea
| | - Ju-Young Shin
- />Korea Institute of Drug Safety and Risk Management, Seoul, Republic of Korea
| | - Ji-Eun Park
- />National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea
- />Department of Health Care Management and Policy, School of Public Health, National University, Seoul, Republic of Korea
| | - Byung-Joo Park
- />Korea Institute of Drug Safety and Risk Management, Seoul, Republic of Korea
- />Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
- />National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea
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167
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Quek RGW, Fox KM, Wang L, Li L, Gandra SR, Wong ND. Lipid-lowering treatment patterns among patients with type 2 diabetes mellitus with high cardiovascular disease risk. BMJ Open Diabetes Res Care 2015; 3:e000132. [PMID: 26435839 PMCID: PMC4586941 DOI: 10.1136/bmjdrc-2015-000132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/19/2015] [Accepted: 08/28/2015] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To examine real-world treatment patterns of lipid-lowering treatment and their possible associated intolerance and/or ineffectiveness among patients with type 2 diabetes mellitus initiating statins and/or ezetimibe. RESEARCH DESIGN AND METHODS Adult (aged ≥18 years) patients diagnosed with type 2 diabetes who initiated statins and/or ezetimibe from January 1, 2007 to June 30, 2011 were retrospectively identified from the IMS LifeLink Pharmetrics Plus commercial claims database. Patients were further classified into 3 high-risk cohorts: (1) history of cardiovascular event (CVE); (2) two risk factors (age and hypertension); (3) aged ≥40 years. Patients had continuous health plan enrolment ≥1 year preindex and postindex date (statin and/or ezetimibe initiation date). Primary outcomes were index statin intensity, treatment modification(s), possible associated statin/non-statin intolerance and/or ineffectiveness issues (based on treatment modification type), and time-to-treatment modification(s). Analyses for each cohort were stratified by age groups (<65 and ≥65 years). RESULTS A total of 9823 (history of CVE), 62 049 (2 risk factors), and 128 691 (aged ≥40 years) patients were included. Among patients aged <65 years, 81.4% and 51.8% of those with history of CVE, 75.6% and 44.4% of those with 2 risk factors, and 77.9% and 47.1% of those aged ≥40 years had ≥1 and 2 treatment modification(s), respectively. Among all patients, 23.2-28.4% had possible statin intolerance and/or ineffectiveness issues after accounting for second treatment modification (if any). CONCLUSIONS Among patients with type 2 diabetes with high cardiovascular disease risk, index statin treatment modifications that potentially imply possible statin intolerance and/or ineffectiveness were frequent.
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Affiliation(s)
| | - Kathleen M Fox
- Strategic Healthcare Solutions, LLC, Aiken, South Carolina, USA
| | - Li Wang
- STATinMED Research, Plano, Texas, USA
| | - Lu Li
- STATinMED Research, Plano, Texas, USA
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