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Wang X, Chen W, Qiu X, Guo J, You C, Ma L. Hematocrit drift and outcomes in surgical patients with aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 2024; 166:202. [PMID: 38703244 DOI: 10.1007/s00701-024-06097-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND There is a paucity of conclusive evidence regarding the impact of downward drift in hematocrit levels among patients who have undergone surgical clipping for aneurysmal subarachnoid hemorrhage (aSAH). This study endeavors to explore the potential association between hematocrit drift and mortality in this specific patient population. METHODS A cohort study was conducted, encompassing adult patients diagnosed with aSAH at a university hospital. The primary endpoint was follow-up mortality. Propensity score matching was employed to align patients based on their baseline characteristics. Discrimination capacity across various models was assessed and compared using net reclassification improvement (NRI). RESULTS Among the 671 patients with aSAH in the study period, 118 patients (17.6%) experienced an in-hospital hematocrit drift of more than 25%. Following adjustment with multivariate regression analysis, patients with elevated hematocrit drift demonstrated significantly increased odds of mortality (aOR: 2.12, 95% CI: 1.14 to 3.97; P = 0.019). Matching analysis yielded similar results (aOR: 2.07, 95% CI: 1.05 to 4.10; P = 0.036). The inclusion of hematocrit drift significantly improved the NRI (P < 0.0001) for mortality prediction. When in-hospital hematocrit drift was served as a continuous variable, each 10% increase in hematocrit drift corresponded to an adjusted odds ratio of 1.31 (95% CI 1.08-1.61; P = 0.008) for mortality. CONCLUSIONS In conclusion, the findings from this comprehensive cohort study indicate that a downward hematocrit drift exceeding 25% independently predicts mortality in surgical patients with aSAH. These findings underscore the significance of monitoring hematocrit and managing anemia in this patient population.
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Affiliation(s)
- Xing Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Wuqian Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Xingyu Qiu
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Jiulin Guo
- Information Center, West China Hospital, Sichuan University, Chengdu, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Lu Ma
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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Krishnamurthy N, Slack DJ, Kyweluk M, Cullen O, Kirkley J, Safer JD. Erythrocytosis Is Rare With Exogenous Testosterone in Gender-Affirming Hormone Therapy. J Clin Endocrinol Metab 2024; 109:1285-1290. [PMID: 38011684 DOI: 10.1210/clinem/dgad651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Indexed: 11/29/2023]
Abstract
CONTEXT Studies have found a variable incidence of erythrocytosis among people using testosterone as part of gender-affirming hormone therapy (GAHT). OBJECTIVE To examine the effect of using exogenous testosterone as GAHT on hematocrit in a large North American cohort. METHODS We conducted a cross-sectional analysis of testosterone and hematocrit laboratory values in 6670 patients who were prescribed testosterone through Plume, a national provider of GAHT. The prevalence of erythrocytosis, the mean hematocrit at predetermined testosterone thresholds and with varying routes of testosterone administration were assessed. RESULTS Among 6670 individuals, 560 (8.4%) had a hematocrit ≥50%, 182 ≥ 52% (2.7%), and 60 ≥ 54% (0.9%). There was significant variation (P < .001) in hematocrit between different clinically relevant testosterone thresholds (T < 50 vs T 50-299 vs T 300-999 vs T ≥ 1000 ng/dL) and when comparing serum testosterone in increments of 50 ng/dL within the target range for males (300-1000 ng/dL) (P < .001). Mean hematocrit ranged from 41.84% (T < 50 ng/dL) to 45.68% (T 900-949 ng/dL). Patients on intramuscular testosterone had a higher mean hematocrit than those on transdermal testosterone (44.96% vs 43.41%, P < .001). Both route of administration (P < .001) and testosterone level (P < .001) had statistically significant associations with hematocrit when controlling for each other. CONCLUSION While the magnitude of change in hematocrit with serum level and route of administration of testosterone was statistically significant, the absolute levels were within the normal range, unlikely to be clinically meaningful. These findings, along with the low prevalence of erythrocytosis, should help allay concerns about the use of testosterone as GAHT.
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Affiliation(s)
| | - Daniel J Slack
- Division of Endocrinology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
| | - Moira Kyweluk
- Clinical Research Division, Plume Health, Denver, CO 80209, USA
| | - Olivia Cullen
- Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
| | - Jerrica Kirkley
- Clinical Research Division, Plume Health, Denver, CO 80209, USA
| | - Joshua D Safer
- Center for Transgender Medicine and Surgery, Mount Sinai Health System, New York, NY 10029-6574, USA
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Yang Z, He H, He G, Zeng C, Hu Q. Investigating Causal Effects of Hematologic Traits on Lung Cancer: A Mendelian Randomization Study. Cancer Epidemiol Biomarkers Prev 2024; 33:96-105. [PMID: 37909945 DOI: 10.1158/1055-9965.epi-23-0725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/24/2023] [Accepted: 10/30/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Observational studies have suggested blood cell counts may act as predictors of cancer. It is not known whether these hematologic traits are causally associated with lung cancer. METHODS Two-sample bidirectional univariable Mendelian randomization (MR) and multivariable MR (MVMR) were performed to investigate the causal association between hematologic traits and the overall risk of lung cancer and three histologic subtypes [lung adenocarcinoma, squamous cell lung cancer, and small cell lung cancer (SCLC)]. The instrumental variables of 23 hematologic traits were strictly selected from large-scale genome-wide association studies. Inverse-variance weighted method and five extra methods were used to obtain robust causal estimates. RESULTS We found evidence that genetically influenced higher hematocrit [OR, 0.845; 95% confidence interval (CI), 0.783-0.913; P = 1.68 × 10-5] and hemoglobin concentration (OR, 0.868; 95% CI, 0.804-0.938; P = 3.20 × 10-4) and reticulocyte count (OR, 0.923; 95% CI, 0.872-0.976; P = 5.19 × 10-3) decreased lung carcinoma risk, especially in ever smokers. MVMR further identified hematocrit independently of smoking as an independent predictor. Subgroup analysis showed that a higher plateletcrit level increased the risk of small cell lung carcinoma (OR, 1.288; 95% CI, 1.126-1.474; P = 2.25 × 10-4). CONCLUSIONS Genetically driven higher levels of reticulocyte count and hematocrit decreased lung cancer risk. Higher plateletcrit had an adverse effect on SCLC. Hematologic traits may act as low-cost factors for lung cancer risk stratification. IMPACT Further studies are required to elucidate the potential mechanisms underlying the dysregulation of homeostasis related to hematologic traits, such as subclinical inflammation.
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Affiliation(s)
- Zhanghuan Yang
- Department of Oncology, Xiangya Cancer Center, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Molecular Radiation Oncology Hunan Province, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Hao He
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Guangxu He
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chudai Zeng
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Qian Hu
- Center for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, China
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Xiao Y, Cheng X, Jia L, Tian Y, He J, He M, Chen L, Hao P, Li T, Chong W, Hai Y, You C, Peng L, Fang F, Zhang Y. Preoperative hematocrit levels and postoperative mortality in patients undergoing craniotomy for brain tumors. Front Oncol 2023; 13:1246220. [PMID: 37916178 PMCID: PMC10616849 DOI: 10.3389/fonc.2023.1246220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 10/02/2023] [Indexed: 11/03/2023] Open
Abstract
Background Abnormal hematocrit values, including anemia and polycythemia, are common in patients undergoing craniotomy, but the extent to which preoperative anemia or polycythemia independently increases the risk of mortality is unclear. This retrospective cohort study aimed to examine the association between preoperative anemia and polycythemia and postoperative mortality in patients who underwent craniotomy for brain tumor resection. Methods We retrospectively analyzed data from 12,170 patients diagnosed with a brain tumor who underwent cranial surgery at West China Hospital between January 2011 and March 2021. The preoperative hematocrit value was defined as the last hematocrit value within 7 days before the operation, and patients were grouped according to the severity of their anemia or polycythemia. We assessed the primary outcome of 30-day postoperative mortality using logistic regression analysis adjusted for potential confounding factors. Results Multivariable logistic regression analysis reported that the 30-day mortality risk was raised with increasing severity of both anemia and polycythemia. Odds ratios for mild, moderate, and severe anemia were 1.12 (95% CI: 0.79-1.60), 1.66 (95% CI: 1.06-2.58), and 2.24 (95% CI: 0.99-5.06), respectively. Odds ratios for mild, moderate, and severe polycythemia were 1.40 (95% CI: 0.95-2.07), 2.81 (95% CI: 1.32-5.99), and 14.32 (95% CI: 3.84-53.44), respectively. Conclusions This study demonstrated that moderate to severe anemia and polycythemia are independently associated with increased postoperative mortality in patients undergoing craniotomy for brain tumor resection. These findings underscore the importance of identifying and managing abnormal hematocrit values before craniotomy surgery.
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Affiliation(s)
- Yangchun Xiao
- Department of Neurosurgery, Clinical Medical College and Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Xin Cheng
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lu Jia
- Department of Neurosurgery, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi, China
| | - Yixin Tian
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jialing He
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Miao He
- Department of Anesthesia, Clinical Medical College and Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Lvlin Chen
- Department of Critical Care Medicine, Clinical Medical College and Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Pengfei Hao
- Department of Neurosurgery, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi, China
| | - Tiangui Li
- Department of Neurosurgery, Longquan Hospital, Chengdu, Sichuan, China
| | - Weelic Chong
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Yang Hai
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Liyuan Peng
- Department of Critical Care Medicine, Clinical Medical College and Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Fang Fang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu Zhang
- Center for Evidence Based Medical, Clinical Medical College and Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
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Ide H, Akehi Y, Fukuhara S, Ohira S, Ogawa S, Kataoka T, Kumagai H, Kobayashi K, Komiya A, Shigehara K, Syuto T, Soh J, Tanabe M, Taniguchi H, Chiba K, Matsushita K, Mitsui Y, Yoneyama T, Shirakawa T, Fujii Y, Kumano H, Ueshiba H, Amano T, Sasaki H, Maeda S, Mizokami A, Suzuki K, Horie S. Summary of the clinical practice manual for late-onset hypogonadism. Int J Urol 2023; 30:422-430. [PMID: 36757880 DOI: 10.1111/iju.15160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/15/2023] [Indexed: 02/10/2023]
Abstract
Testosterone plays an important role in maintaining both physical and mental function. Age-related testosterone depletion contributes to the development of angina, arteriosclerosis, obesity, metabolic syndrome, dementia, frailty, and a range of other conditions. A condition involving age-related testosterone depletion and the associated clinical symptoms is defined as late-onset hypogonadism (LOH). LOH is treated by testosterone replacement therapy. Indications for testosterone replacement therapy are determined by evaluating symptoms and signs.
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Affiliation(s)
- Hisamitsu Ide
- Department of Urology, Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
| | - Yuko Akehi
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan
| | - Shinichiro Fukuhara
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shin Ohira
- Department of Urology, Kawasaki Medical School, Okayama, Japan
| | - Sumito Ogawa
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomoya Kataoka
- Department of Clinical Pharmaceutics, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan
| | - Hiroshi Kumagai
- The Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Ko Kobayashi
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Akira Komiya
- Department of Urology, Kameda Medical Center, Chiba, Japan
| | - Kazuyoshi Shigehara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Takahiro Syuto
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Jintetu Soh
- Department of Urology, Japanese Red Cross Society Kyoto Daini, Kyoto, Japan
| | - Makito Tanabe
- Department of Endocrinology and Diabetes Mellitus, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hisanori Taniguchi
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Koji Chiba
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kazuhito Matsushita
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Yozo Mitsui
- Department of Urology, Toho University School of Medicine, Tokyo, Japan
| | - Takahiro Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Tomoya Shirakawa
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroaki Kumano
- Faculty of Human Sciences, Waseda University, Saitama, Japan
| | - Hajime Ueshiba
- Division of Diabetes, Metabolism and Endocrinology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Toshiyasu Amano
- Department of Urology, Nagano Red Cross Hospital, Nagano, Japan
| | - Haruaki Sasaki
- Department of Urology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Seiji Maeda
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Kazuhiro Suzuki
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
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Luo M, Chen Y, Cheng Y, Li N, Qing H. Association between hematocrit and the 30-day mortality of patients with sepsis: A retrospective analysis based on the large-scale clinical database MIMIC-IV. PLoS One 2022; 17:e0265758. [PMID: 35324947 PMCID: PMC8947025 DOI: 10.1371/journal.pone.0265758] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/07/2022] [Indexed: 11/23/2022] Open
Abstract
This research sought to ascertain the relationship between hematocrit (HCT) and mortality in patients with sepsis. Methods: A retrospective analysis was conducted on the clinical data of septic patients who were hospitalized between 2008 and 2019 in an advanced academic medical center in Boston, Massachusetts, registered in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, We analyzed basic information including gender, age, race, and types of the first admission, laboratory indicators including HCT, platelets, white blood cells, albumin, bilirubin, hemoglobin, and serum creatinine, and 30-day mortality. A Cox proportional hazards regression model was utilized to analyze the relationship between HCT and 30-day mortality in patients with sepsis. Results: This research recruited 2057 patients who met the research requirements from 2008 to 2019. According to the HCT level, it was classified into the low HCT level, the regular HCT level, and the high HCT level. The 30-day mortality rate was 62.6%, 27.5%, and 9.9% for patients with the low HCT level, the regular HCT level, and the high HCT level, respectively (p < 0.05). The multivariate Cox proportional hazard regression model analysis displayed that compared with patients with the regular HCT level, the 30-day mortality of patients with the low HCT level increased by 58.9% (hazard ratio = 1.589, 95% confidence interval (CI) = 1.009–2.979, p < 0.05). Conclusion: The low HCT level is an independent risk factor for the increase of the 30-day mortality in patients with sepsis and can be used as a significant predictor of the clinical outcome of sepsis.
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Affiliation(s)
- Mengdi Luo
- ICU, Affiliated Hospital of Southwest Jiaotong University, The Third People’s Hospital of Chengdu, Chengdu, Sichuan, China
| | - Yang Chen
- ICU, Affiliated Hospital of Southwest Jiaotong University, The Third People’s Hospital of Chengdu, Chengdu, Sichuan, China
| | - Yuan Cheng
- ICU, Affiliated Hospital of Southwest Jiaotong University, The Third People’s Hospital of Chengdu, Chengdu, Sichuan, China
| | - Na Li
- Southwest Jiaotong University, Chengdu, Sichuan, China
| | - He Qing
- ICU, Affiliated Hospital of Southwest Jiaotong University, The Third People’s Hospital of Chengdu, Chengdu, Sichuan, China
- * E-mail:
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Brown TJ, Hammers M, Taylor M, Dugdale HL, Komdeur J, Richardson DS. Hematocrit, age, and survival in a wild vertebrate population. Ecol Evol 2021; 11:214-226. [PMID: 33437424 PMCID: PMC7790625 DOI: 10.1002/ece3.7015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/23/2020] [Indexed: 12/18/2022] Open
Abstract
Understanding trade-offs in wild populations is difficult, but important if we are to understand the evolution of life histories and the impact of ecological variables upon them. Markers that reflect physiological state and predict future survival would be of considerable benefit to unraveling such trade-offs and could provide insight into individual variation in senescence. However, currently used markers often yield inconsistent results. One underutilized measure is hematocrit, the proportion of blood comprising erythrocytes, which relates to the blood's oxygen-carrying capacity and viscosity, and to individual endurance. Hematocrit has been shown to decline with age in cross-sectional studies (which may be confounded by selective appearance/disappearance). However, few studies have tested whether hematocrit declines within individuals or whether low hematocrit impacts survival in wild taxa. Using longitudinal data from the Seychelles warbler (Acrocephalus sechellensis), we demonstrated that hematocrit increases with age in young individuals (<1.5 years) but decreases with age in older individuals (1.5-13 years). In breeders, hematocrit was higher in males than females and varied relative to breeding stage. High hematocrit was associated with lower survival in young individuals, but not older individuals. Thus, while we did not find support for hematocrit as a marker of senescence, high hematocrit is indicative of poor condition in younger individuals. Possible explanations are that these individuals were experiencing dehydration and/or high endurance demands prior to capture, which warrants further investigation. Our study demonstrates that hematocrit can be an informative metric for life-history studies investigating trade-offs between survival, longevity, and reproduction.
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Affiliation(s)
- Thomas J. Brown
- School of Biological SciencesUniversity of East AngliaNorwichUK
| | - Martijn Hammers
- Groningen Institute for Evolutionary Life SciencesUniversity of GroningenGroningenThe Netherlands
| | - Martin Taylor
- School of Biological SciencesUniversity of East AngliaNorwichUK
| | - Hannah L. Dugdale
- School of BiologyFaculty of Biological SciencesUniversity of LeedsLeedsUK
| | - Jan Komdeur
- Groningen Institute for Evolutionary Life SciencesUniversity of GroningenGroningenThe Netherlands
| | - David S. Richardson
- School of Biological SciencesUniversity of East AngliaNorwichUK
- Nature SeychellesVictoriaMahéSeychelles
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Lind L, Zanetti D, Högman M, Sundman L, Ingelsson E. Commonly used clinical chemistry tests as mortality predictors: Results from two large cohort studies. PLoS One 2020; 15:e0241558. [PMID: 33152050 PMCID: PMC7644047 DOI: 10.1371/journal.pone.0241558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/18/2020] [Indexed: 12/01/2022] Open
Abstract
Background The normal ranges for clinical chemistry tests are usually defined by cut-offs given by the distribution in healthy individuals. This approach does however not indicate if individuals outside the normal range are more prone to disease. Methods We studied the associations and risk prediction of 11 plasma and serum biomarkers with all-cause mortality in two population-based cohorts: a Swedish cohort (X69) initiated in 1969, and the UK Biobank (UKB) initiated in 2006–2010, with up to 48- and 9-years follow-up, respectively. Results In X69 and in UKB, 18,529 and 425,264 individuals were investigated, respectively. During the follow-up time, 14,475 deaths occurred in X69 and 17,116 in UKB. All evaluated tests were associated with mortality in X69 (P<0.0001, except bilirubin P<0.005). For calcium, blood urea nitrogen, bilirubin, hematocrit, uric acid, and iron, U-shaped associations were seen (P<0.0001). For leukocyte count, gamma-glutamyl transferase, alkaline phosphatases and lactate dehydrogenase, linear positive associations were seen, while for albumin the association was negative. Similar associations were seen in UKB. Addition of all biomarkers to a model with classical risk factors improved mortality prediction (delta C-statistics: +0.009 in X69 and +0.023 in UKB, P<0.00001 in both cohorts). Conclusions Commonly used clinical chemistry tests were associated with all-cause mortality both in the medium- and long-term perspective, and improved mortality prediction beyond classical risk factors. Since both linear and U-shaped relationships were found, we propose to define the normal range of a clinical chemistry test based on its association with mortality, rather than from the distribution.
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Affiliation(s)
- Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Daniela Zanetti
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
- Stanford Cardiovascular Institute, Stanford, CA, United States of America
- Stanford Diabetes Research Center, Stanford, CA, United States of America
| | - Marieann Högman
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Lars Sundman
- Department of Public Health Medicine, County Council of Gävleborg, Gävle, Sweden
| | - Erik Ingelsson
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
- Stanford Cardiovascular Institute, Stanford, CA, United States of America
- Stanford Diabetes Research Center, Stanford, CA, United States of America
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
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9
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Wang Q, Guo R, Nair S, Smith D, Bisha B, Nair AS, Nair R, Downs BW, Kushner S, Bagchi M. Safety and Efficacy of N-SORB ®, a Proprietary KD120 MEC Metabolically Activated Enzyme Formulation: A Randomized, Double-Blind, Placebo-Controlled Study. J Am Coll Nutr 2019; 38:577-585. [PMID: 30971174 DOI: 10.1080/07315724.2019.1586591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Enzymes are crucial for all aspects of metabolic function. Digestive enzymes from natural sources have been credited with beneficial effects in the digestion and absorption of food. N-SORB is a novel KD120 multienzyme complex (MEC) of metabolically activated enzymes composed of proteases, amylases, lipases, alpha-galactosidase, and glucoamylase from natural sources. These enzymes are encapsulated in a SK713 SLP (non-GMO soy lecithin phospholipid) absorption technology (Prodosome®). Objective: This randomized, double-blind placebo-controlled investigation assessed the safety and efficacy of N-SORB KD120 MEC in healthy male and female volunteers on various parameters of the blood, immunity, body composition, physical health, and quality of life following a 90-day intervention. Methods: Forty-six male and female (mean age: 25.8 ± 12.1 years) healthy volunteers were randomly assigned to receive either N-SORB (1 mL, twice daily) or placebo for 90 consecutive days. Complete blood count, as well as blood glucose, liver enzymes, and lipid profile were assessed pre- and post-intervention. Serum cytokine levels were determined by using a Bio-Plex Pro Human Cytokine 8-plex assay and enzyme linked immunosorbent assay (ELISA). Whole body composition analysis was performed by dual-energy x-ray absorptiometry (DEXA) to determine body fat mass, lean mass, and android and gynoid fat. Body weight, blood pressure, and physical health were assessed. Changes in quality of life were examined using the World Health Organization Quality of Life-abbreviated version and sleep quality was assessed using the 24-item Pittsburgh Sleep Quality Index (PSQI) questionnaire. Adverse events were monitored before, during, and after completion of the study. Results: Of the 46 subjects enrolled, a total of 40 subjects successfully completed the study. Compared to placebo, changes in blood cell counts including hematocrit, hemoglobin, mean corpuscular volume, platelets, and lymphocytes provide evidence of some improvement. Quality of life (QOL) parameters showed a small but significant improvement in the N-SORB group. A significant increase was observed in aspartate aminotransferase level in the placebo group at the end of 90 days of treatment; however, no increase was observed in the N-SORB group. No significant changes in blood urea nitrogen, serum creatinine, alkaline phosphatase, alanine aminotransferase, and lipid profile were observed between the placebo and treatment groups before and following intervention. No adverse effects were reported. Conclusions: This randomized, double blind, placebo-controlled clinical study demonstrates that short-term intervention with N-SORB improves the QOL and PSQI in healthy volunteers and did not significantly alter cardiometabolic parameters, lipid profile, or body composition.
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Affiliation(s)
- Qiurong Wang
- School of Pharmacy, University of Wyoming , Laramie , Wyoming , USA
| | - Rui Guo
- School of Pharmacy, University of Wyoming , Laramie , Wyoming , USA
| | - Sreejayan Nair
- School of Pharmacy, University of Wyoming , Laramie , Wyoming , USA
| | - Derek Smith
- Department of Kinesiology and Health, University of Wyoming , Laramie , Wyoming , USA
| | - Bledar Bisha
- Department of Animal Sciences and Molecular Biology , Laramie , Wyoming , USA
| | | | - Rama Nair
- Nutriwyo LLC , Laramie , Wyoming , USA
| | - Bernard W Downs
- Department of R&D, Victory Nutrition International, Inc , Lederach , Pennsylvania , USA
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König CS, Balabani S, Hackett GI, Strange RC, Ramachandran S. Testosterone Therapy: An Assessment of the Clinical Consequences of Changes in Hematocrit and Blood Flow Characteristics. Sex Med Rev 2019; 7:650-660. [PMID: 30926458 DOI: 10.1016/j.sxmr.2019.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/19/2019] [Accepted: 01/23/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Clinical guidelines indicate that hematocrit should be monitored during testosterone replacement therapy (TTh), with action taken if a level of 0.54 is exceeded. AIM To consider the extent of changes in hematocrit and putative effects on viscosity, blood flow, and mortality rates after TTh. METHODS We focused on literature describing benefits and possible pitfalls of TTh, including increased hematocrit. We used data from the BLAST RCT to determine change in hematocrit after 30 weeks of TTh and describe a clinical case showing the need for monitoring. We consider the validity of the current hematocrit cutoff value at which TTh may be modified. Ways in which hematocrit alters blood flow in the micro- and macro-vasculature are also considered. MAIN OUTCOME MEASURES The following measures were assessed: (i) change in hematocrit, (ii) corresponding actions taken in clinical practice, and (iii) possible blood flow changes following change in hematocrit. RESULTS Analysis of data from the BLAST RCT showed a significant increase in mean hematocrit of 0.01, the increase greater in men with lower baseline values. Although 0 of 61 men given TTh breached the suggested cutoff of 0.54 after 30 weeks, a clinical case demonstrates the need to monitor hematocrit. An association between hematocrit and morbidity and mortality appears likely but not proven and may be evident only in patient subgroups. The consequences of an increased hematocrit may be mediated by alterations in blood viscosity, oxygen delivery, and flow. Their relative impact may vary in different vascular beds. CONCLUSIONS TTh can effect an increased hematocrit via poorly understood mechanisms and may have harmful effects on blood flow that differ in patient subgroups. At present, there appears no scientific basis for using a hematocrit of 0.54 to modify TTh; other values may be more appropriate in particular patient groups. König CS, Balabani S, Hackett GI, et al. Testosterone Therapy: An Assessment of the Clinical Consequences of Changes in Hematocrit and Blood Flow Characteristics. Sex Med Rev 2019;7:650-660.
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Affiliation(s)
- Carola S König
- College of Engineering, Design & Physical Sciences, Brunel University, London, England, United Kingdom
| | - Stavroula Balabani
- Faculty of Engineering Sciences, University College London, London, United Kingdom
| | - Geoffrey I Hackett
- Department of Urology, University Hospitals Birmingham NHS Foundation Trust, West Midlands, England, United Kingdom
| | - Richard C Strange
- Institute for Science and Technology in Medicine, Keele University, Staffordshire, England, United Kingdom
| | - Sudarshan Ramachandran
- College of Engineering, Design & Physical Sciences, Brunel University, London, England, United Kingdom; Department of Clinical Biochemistry, University Hospitals Birmingham NHS Foundation Trust, West Midlands, England, United Kingdom; Department of Clinical Biochemistry, University Hospitals of North Midlands / Faculty of Health Sciences, Staffordshire University, Staffordshire, England, United Kingdom.
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11
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Hematological parameters and all-cause mortality: a prospective study of older people. Aging Clin Exp Res 2018; 30:517-526. [PMID: 28664457 PMCID: PMC5911276 DOI: 10.1007/s40520-017-0791-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 06/17/2017] [Indexed: 11/28/2022]
Abstract
Background The effect of low and high concentration of some hematological parameters in the blood can have a negative impact on health. Aim Therefore, we investigated the associations between hematological parameters and all-cause mortality among older people living in Poland. Methods The study was carried out among 75–80-year-old participants (n = 403) from Warsaw and Olsztyn regions, Poland. Information on lifestyle factors and food consumption were obtained at baseline (June 1, 1999) using a self-administered questionnaire. Red blood cell, haemoglobin, hematocrit, mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), and mean corpuscular haemoglobin concentration (MCHC) were determined. The data on deaths from all-causes were collected from the baseline until October 31, 2006. During an average of 7.4 years of follow-up, we ascertained 154 cases of death from all-causes. Results Compared with men in the lowest tertile of MCV, MCH, and MCHC, the multivariable hazard ratios (HRs) of all-cause mortality in those in the highest tertile were 0.35 (95% CI, 0.17–0.73), 0.32 (95% CI, 0.16–0.67), and 0.44 (95% CI, 0.22–0.88), respectively. In contrast, among women after combining the second and the third tertiles of MCV, MCH, and MCHC, the HRs were 2.01 (95% CI, 1.01–3.99), 1.71 (95% CI, 0.85–3.43), and 1.09 (95% CI, 0.62–1.94), respectively. Discussion/conclusion We observed inverse associations between some hematological parameters and all-cause mortality among men, but not among women. This may be explained by a difference in iron metabolism, iron status, hormone regulations, or the occurrence of some diseases.
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12
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Elements of the complete blood count associated with cardiovascular disease incidence: Findings from the EPIC-NL cohort study. Sci Rep 2018; 8:3290. [PMID: 29459661 PMCID: PMC5818488 DOI: 10.1038/s41598-018-21661-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 02/08/2018] [Indexed: 12/31/2022] Open
Abstract
All blood cells (white blood cells [WBC], red blood cells [RBC] and platelets) can play a role in atherosclerosis. Complete blood count (CBC) is widely available in clinical practice but utility as potential risk factors for cardiovascular disease (CVD) is uncertain. Our aim was to assess the associations of pre-diagnostic CBC with incidence of CVD in 14,362 adults free of CVD and aged 47.8 (±11.7) years at baseline, followed-up for 11.4 years (992 incident cases). Cox proportional hazards regressions were used to estimate HRs and 95%CI. Comparing the top (T3) to bottom (T1) tertile, increased total WBC, lymphocyte, monocyte and neutrophil counts were associated with higher CVD risk: 1.31 (1.10; 1.55), 1.20 (1.02; 1.41), 1.21 (1.03; 1.41) and 1.24 (1.05; 1.47), as well as mean corpuscular volume (MCV: 1.23 [1.04; 1.46]) and red cell distribution width (RDW: 1.22 [1.03; 1.44]). Platelets displayed an association for count values above the clinically normal range: 1.49 (1.00; 2.22). To conclude, total and differential WBC count, MCV, RDW and platelet count likely play a role in the aetiology of CVD but only WBC provide a modest improvement for the prediction of 10-year CVD risk over traditional CVD risk factors in a general population.
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Zhou W, Yao G, Chen L, Hu X, Ye C. Pretreatment hematocrit is negatively associated with response to neoadjuvant chemotherapy in breast cancer. Biomark Med 2017; 11:713-720. [PMID: 30669855 DOI: 10.2217/bmm-2017-0054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To explore the correlation between hematocrit (Hct) and response to neoadjuvant chemotherapy in breast cancer. METHODS The baseline clinicopathologic variables of included patients were retrospectively reviewed. Binary logistic regression analysis was performed to assess the predictive value of Hct on objective response. RESULTS Patients in Hct <0.396 group showed higher objective response rate (ORR) compared with patients in Hct ≥0.396 group (55.8 vs 39.3%; p = 0.049), especially in human epidermal growth factor receptor 2 (HER2) overexpression subtype (p = 0.045), premenopausal patients (p = 0.019) and HER2-positve patients (p = 0.021), respectively. And Hct (OR: 0.43; 95% CI: 0.20-0.90; p = 0.024) was independently associated with ORR in breast cancer patients. CONCLUSION Hct was negatively associated with ORR, and may serve as an independent predictive factor for ORR in breast cancer patients underwent neoadjuvant chemotherapy.
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Affiliation(s)
- Wenqi Zhou
- Breast Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, PR China
| | - Guangyu Yao
- Breast Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, PR China
| | - Lujia Chen
- Breast Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, PR China
| | - Xiaolei Hu
- Breast Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, PR China
| | - Changsheng Ye
- Breast Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, PR China
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Shouval R, Katz S, Nagler A, Merkel D, Ben-Zvi I, Segev S, Sidi Y, Goldenberg I, Kivity S, Maor E. Gender disparities in the functional significance of anemia among apparently healthy adults. Eur J Haematol 2017; 98:435-442. [PMID: 28122139 DOI: 10.1111/ejh.12849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Data on the functional impact of anemia on cardiorespiratory fitness (CRF) and survival in healthy individuals are limited. Our aim was to evaluate the association between anemia thresholds, low CRF, and survival in otherwise healthy adults. METHODS Study population included 16 334 apparently healthy subjects attending annual periodic health screening examinations (71 200 annual visits), including exercise stress testing (EST). Anemia was defined by the World Health Organization (WHO) or Beutler and Waalens' (BW) criteria. Low CRF was defined as the lowest fitness quintile according to the Bruce protocol. RESULTS The mean age was 46±10 years, and 70% were men. Mean Hb levels were 13±1 and 15±1 among women and men, respectively, with higher proportion of anemia among women. The majority of anemic subjects had mild anemia. When analyzing repeated annual visits, anemia was associated with a significant 39% and 64% increased risk of low CRF according the WHO and BW criteria only in women (n=18 672). Baseline anemia at first visit was associated with 2.6- and 1.9-fold increased risk of all-cause mortality using the WHO and BW criteria, exclusively in men (n=11 511). CONCLUSIONS Overall, the functional and prognostic impact of anemia is gender dependent, based on the WHO and BW arbitrary criteria, suggesting differing mechanism and responses.
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Affiliation(s)
- Roni Shouval
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,The Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sharon Katz
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Internal Medicine "F" Department, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Arnon Nagler
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Drorit Merkel
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ilan Ben-Zvi
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Internal Medicine "F" Department, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Shlomo Segev
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Institute for Medical Screening, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Yechezkel Sidi
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Internal Medicine "C" Department, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Ilan Goldenberg
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Shaye Kivity
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Internal Medicine "C" Department, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Elad Maor
- The Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Israel
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Chin-Yee B, Lazo-Langner A, Butler-Foster T, Hsia C, Chin-Yee I. Blood donation and testosterone replacement therapy. Transfusion 2017; 57:578-581. [PMID: 28150363 DOI: 10.1111/trf.13970] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 10/22/2016] [Accepted: 10/24/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Polycythemia is the most common adverse effect of testosterone replacement therapy (TRT) and may predispose patients to adverse vascular events. Current Canadian guidelines recommend regular laboratory monitoring and discontinuing TRT or reducing the dose if the hematocrit exceeds 54% (hemoglobin ≥180 g/L). This threshold has been interpreted by some physicians and patients to indicate the need for phlebotomy or blood donation while on TRT. STUDY DESIGN AND METHODS We reviewed all male blood donors in Southwestern Ontario at Canadian Blood Services from December 2013 to March 2016 who self-identified or were found on donor screening to be on TRT. Hemoglobin concentration was measured at the time of donation or clinic visit and with each subsequent appointment in repeat donors. RESULTS We identified 39 patients on TRT who presented for blood donation over a 2-year period. The mean hemoglobin level at all clinic visits was 173 g/L (range, 134-205 g/L; n = 108). Hemoglobin concentrations of 180 g/L or more (calculated hematocrit, ≥54%) were measured at 25% of appointments. Of the 27 repeat donors, 12 (44%) had persistently elevated hemoglobin levels (≥180 g/L) at subsequent donations. CONCLUSION Hemoglobin concentrations were elevated in donors on TRT, and significant numbers had hemoglobin levels above those recommended by current guidelines. These data also suggest that repeat blood donation was insufficient to maintain a hematocrit below 54%. Our findings raise concerns about the persistent risk of vascular events in these donors, particularly when coupled with the misperception by patients and health care providers that donation has reduced or eliminated the risks of TRT-induced polycythemia.
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Affiliation(s)
- Benjamin Chin-Yee
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alejandro Lazo-Langner
- Division of Hematology, Department of Medicine, Schulich School of Medicine, Western University.,Department of Epidemiology, Schulich School of Medicine, Western University
| | | | - Cyrus Hsia
- Division of Hematology, Department of Medicine, Schulich School of Medicine, Western University
| | - Ian Chin-Yee
- Division of Hematology, Department of Medicine, Schulich School of Medicine, Western University.,Canadian Blood Services, London, Ontario, Canada
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Peter RS, Mayer B, Concin H, Nagel G. The effect of age on the shape of the BMI-mortality relation and BMI associated with minimum all-cause mortality in a large Austrian cohort. Int J Obes (Lond) 2014; 39:530-4. [PMID: 25214148 DOI: 10.1038/ijo.2014.168] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 08/26/2014] [Accepted: 09/06/2014] [Indexed: 01/14/2023]
Abstract
BACKGROUND It is unclear if the body mass index (BMI) associated with minimum all-cause mortality is constant throughout adult life or increasing with age. METHODS We applied multivariable fractional polynomials to the data of the Vorarlberg Health Monitoring and Prevention Program to quantify the BMI associated with minimum mortality over age. The analysis included data of 129,904 never-smoking women and men (mean age: 45.4 years) who were followed for a median of 18.6 years. RESULTS Optimum BMI in women increased with age, lying within the normal BMI category (according to the World Health Organization definition) from the age of 20 years (23.3 kg m(-2), 95% confidence interval (CI): 22.2-24.3) to the age of 54 years and in the lower half of the overweight category from the age of 55 years onwards, reaching 26.2 kg m(-2) (95% CI: 25.1-27.3) at the age of 69 years. In men, optimum BMI increased slightly from 23.7 kg m(-2) (95% CI: 22.1-25.2) at the age of 20 years until the age of 59 years, reaching a BMI of 25.4 kg m(-2) (95% CI: 24.8-26.0) and decreased afterwards to 22.7 kg m(-2) (95% CI: 20.9-24.6) at the age of 80 years. CONCLUSIONS Our results indicate that BMI associated with minimum all-cause mortality changes with age and that patterns differ by sex. Sex- and age-independent BMI recommendations might therefore be inappropriate. Further studies using flexible methods instead of predefined categories are necessary to revise BMI recommendations.
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Affiliation(s)
- R S Peter
- 1] Agency for Preventive and Social Medicine, Bregenz, Austria [2] Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - B Mayer
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - H Concin
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - G Nagel
- 1] Agency for Preventive and Social Medicine, Bregenz, Austria [2] Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
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Abstract
PURPOSE OF REVIEW Use of testosterone among men is increasing rapidly. Low serum testosterone is positively associated with cardiovascular disease and its risk factors. No large randomized controlled trial (RCT) has assessed the effects of testosterone on cardiovascular outcomes. Here recent evidence accumulating from other sources - pharmacoepidemiology, Mendelian randomization studies and meta-analysis of small RCTs - is reviewed to inform current testosterone usage. RECENT FINDINGS In a large, well conducted pharmacoepidemiology study specifically testosterone prescription was associated with myocardial infarction. Two Mendelian randomization studies did not corroborate beneficial effects of higher endogenous testosterone on cardiovascular risk factors, but suggested higher endogenous testosterone raised LDL cholesterol and lowered HDL cholesterol. A comprehensive meta-analysis of RCTs summarizing 27 trials including 2994 men found increased risk of cardiovascular-related events on testosterone (odds ratio 1.54, 95% confidence interval 1.09-2.18). SUMMARY Contrary to expectations from observational studies, current indications suggest testosterone causes ischemic cardiovascular disease with corresponding implications for practice. A large RCT would undoubtedly settle the issue definitively. Given mounting evidence of harm and the urgency of the situation assembling all the evidence from completed RCTs of testosterone or androgen deprivation therapy and use of Mendelian randomization might generate a definitive answer most quickly.
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Affiliation(s)
- C Mary Schooling
- aCity University New York School of Public Health and Hunter College, New York, USA bSchool of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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