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Horne BD, Anderson JL, May HT, Le VT, Bair TL, Bennett ST, Knowlton KU, Muhlestein JB. Intermittent fasting and changes in clinical risk scores: Secondary analysis of a randomized controlled trial. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 19:200209. [PMID: 37727698 PMCID: PMC10505676 DOI: 10.1016/j.ijcrp.2023.200209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/28/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
Background Intermittent fasting may increase longevity and lower cardiometabolic risk. This study evaluated whether fasting modifies clinical risk scores for mortality [i.e., Intermountain Mortality Risk Score (IMRS)] or chronic diseases [e.g., Pooled Cohort Risk Equations (PCRE), Intermountain Chronic Disease score (ICHRON)]. Methods and results Subjects (N = 71) completing the WONDERFUL trial were aged 21-70 years, had ≥1 metabolic syndrome criteria, elevated cholesterol, and no anti-diabetes medications, statins, or chronic diseases. The intermittent fasting arm underwent 24-h water-only fasting twice-per-week for 4 weeks and once-per-week for 22 weeks (26 weeks total). Analyses examined the IMRS change score at 26 weeks vs. baseline between intermittent fasting (n = 38) and ad libitum controls (n = 33), and change scores for PCRE, ICHRON, HOMA-IR, and a metabolic syndrome score (MSS). Age averaged 49 years; 65% were female. Intermittent fasting increased IMRS (0.78 ± 2.14 vs. controls: -0.61 ± 2.56; p = 0.010) but interacted with baseline IMRS (p-interaction = 0.010) to reduce HOMA-IR (but not MSS) more in subjects with higher baseline IMRS (median HOMA-IR change: fasters, -0.95; controls, +0.05) vs. lower baseline IMRS (-0.29 vs. -0.32, respectively). Intermittent fasting reduced ICHRON (-0.92 ± 2.96 vs. 0.58 ± 3.07; p = 0.035) and tended to reduce PCRE (-0.20 ± 0.22 vs. -0.14 ± 0.21; p = 0.054). Conclusions Intermittent fasting increased 1-year IMRS mortality risk, but decreased 10-year chronic disease risk (PCRE and ICHRON). It also reduced HOMA-IR more in subjects with higher baseline IMRS. Increased IMRS suggests fasting may elevate short-term mortality risk as a central trigger for myriad physiological responses that elicit long-term health improvements. Increased IMRS may also reveal short-term fasting-induced safety concerns.
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Affiliation(s)
- Benjamin D. Horne
- Intermountain Medical Center Heart Institute, Salt Lake City, UT, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Jeffrey L. Anderson
- Intermountain Medical Center Heart Institute, Salt Lake City, UT, USA
- Cardiology Division, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Heidi T. May
- Intermountain Medical Center Heart Institute, Salt Lake City, UT, USA
| | - Viet T. Le
- Intermountain Medical Center Heart Institute, Salt Lake City, UT, USA
- Rocky Mountain University of Health Professions, Provo, UT, USA
| | - Tami L. Bair
- Intermountain Medical Center Heart Institute, Salt Lake City, UT, USA
| | - Sterling T. Bennett
- Intermountain Central Laboratory, Intermountain Medical Center, Salt Lake City, UT, USA
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Kirk U. Knowlton
- Intermountain Medical Center Heart Institute, Salt Lake City, UT, USA
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Joseph B. Muhlestein
- Intermountain Medical Center Heart Institute, Salt Lake City, UT, USA
- Cardiology Division, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
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Toprak K, Kaplangoray M, Memioğlu T, İnanır M, Ermiş MF, Toprak İH, Acar O, Taşcanov MB, Biçer A, Demirbağ R. Comparative Evaluation of Intermountain Risk Score With Mehran Risk Score for Risk Estimation of Contrast-Induced Nephropathy and Short-Term Mortality in ST-Segment Elevation Myocardial Infarction Patients. Angiology 2023:33197231201931. [PMID: 37672723 DOI: 10.1177/00033197231201931] [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: 09/08/2023]
Abstract
Contrast-induced nephropathy (CIN) has become one of the most important causes of in-hospital acute renal failure with the increasing use of contrast-mediated imaging tools. This significantly increases the morbidity and mortality of the affected subjects and causes a financial burden on the health system. In this context, prediction of CIN is important and some risk scores have been developed to predict CIN. The most frequently used and popular among these is the Mehran Score (MS), which is based on a number of hemodynamic and metabolic parameters. The Intermountain Risk Score (IMRS) is a recently developed risk score that highly predicts short-term mortality based on common laboratory parameters, and many parameters of this risk score have been found to be closely associated with CIN. In this context, we aimed to compare MS and IMRS in terms of CIN and short-term mortality estimation. The study included 931 patients who underwent percutaneous coronary intervention. CIN developed in 21.5% of patients. Both MS and IMRS independently predicted CIN. In receiver operating characteristic analysis, IMRS was found to be non-inferior to MS in predicting CIN and IMRS was superior to MS in predicting short-term mortality. IMRS and MS were independently associated with short-term mortality.
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Affiliation(s)
- Kenan Toprak
- Department of Cardiology, Harran University, Faculty of Medicine, Sanliurfa, Turkey
| | - Mustafa Kaplangoray
- Cardiology Department, Medical Faculty, Şeyh Edebali University, Bilecik, Turkey
| | - Tolga Memioğlu
- Cardiology Department, Medical Faculty, Abant Izzet Baysal University, Bolu, Turkey
| | - Mehmet İnanır
- Cardiology Department, Medical Faculty, Abant Izzet Baysal University, Bolu, Turkey
| | - Mehmet Fatih Ermiş
- Department of Cardiology, Harran University, Faculty of Medicine, Sanliurfa, Turkey
| | - İbrahim Halil Toprak
- Department of Cardiology, Harran University, Faculty of Medicine, Sanliurfa, Turkey
| | - Osman Acar
- Department of Cardiology, Harran University, Faculty of Medicine, Sanliurfa, Turkey
| | | | - Asuman Biçer
- Department of Cardiology, Harran University, Faculty of Medicine, Sanliurfa, Turkey
| | - Recep Demirbağ
- Department of Cardiology, Harran University, Faculty of Medicine, Sanliurfa, Turkey
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Çınar T, Şaylık F, Akbulut T, Korkmaz Y, Çiçek V, Asal S, Erdem A, Selçuk M, Hayıroğlu Mİ. Evaluation of Intermountain Risk Score for Short- and Long-Term Mortality in ST Elevation Myocardial Infarction Patients. Angiology 2023; 74:357-364. [PMID: 35635200 DOI: 10.1177/00033197221105753] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The aim of this study was to examine the Intermountain Risk Score (IMRS) for short- and long-term mortality in ST elevation myocardial infarction (STEMI) patients and compare it with the well-known risk scores, such as the Thrombolysis in Myocardial Infarction (TIMI) and the Global Registry of Acute Coronary Events (GRACE). In this retrospective and cross-sectional study, 1057 consecutive patients with STEMI were evaluated. The end-points of the study were short- and long-term mortality. The overall mortality rate was 16% (n = 170 patients). The IMRS was significantly higher in STEMI patients who did not survive compared with those who survived. According to multivariable COX proportional regression analysis, the IMRS was independently related to both short- (HR: 1.482, 95% CI: 1.325-1.675, p < .001) and long-term mortality (HR: 1.915, 95% CI: 1.711-2.180, p < .001). The comparison of receiver operating characteristic curves revealed that the IMRS had non-inferior predictive capability for short- and long-term mortality than the TIMI and GRACE risk scores. To the best of our knowledge, this is the first study to show that the IMRS can predict short- and long-term prognosis of patients with STEMI. Further, the IMRS' predictive value for overall mortality was non-inferior compared with TIMI and GRACE scores.
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Affiliation(s)
- Tufan Çınar
- Department of Cardiology, 546642Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Faysal Şaylık
- Department of Cardiology, 64259Van Training and Research Hospital, Van, Turkey
| | - Tayyar Akbulut
- Department of Cardiology, 64259Van Training and Research Hospital, Van, Turkey
| | - Yetkin Korkmaz
- Department of Cardiology, 546642Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Vedat Çiçek
- Department of Cardiology, 546642Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Suha Asal
- Department of Cardiology, 546642Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Almina Erdem
- Department of Cardiology, 546642Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Murat Selçuk
- Department of Cardiology, 546642Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Mert İlker Hayıroğlu
- Department of Cardiology, 111319Dr. Siyami Ersek Training and Research Hospital, Istanbul, Turkey
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Mert İlker H, Faysal S, Ahmet Çağdaş Y, Murat S, Tufan Ç. Prognostic value of Intermountain Risk Score for short- and long-term mortality in patients with cardiogenic shock. Coron Artery Dis 2023; 34:154-159. [PMID: 36720024 DOI: 10.1097/mca.0000000000001219] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is a lack of current research examining the predictive value of the Intermountain Risk Score (IMRS) in patients with ST-segment elevation myocardial infarction (STEMI) caused by cardiogenic shock. Therefore, the purpose of this research was to investigate the ability of IMRS to predict short- and long-term mortality in patients with cardiogenic shock triggered by STEMI. METHODS The participants included 492 consecutive cardiogenic shock patients who underwent primary percutaneous coronary intervention following STEMI. The patients were separated into two groups depending on their survival status. The groups' baseline characteristics, laboratory data, echocardiographic variables, and risk assessments were then compared. Next, the IMRS score was tested for its ability to predict both short- and long-term mortality. In order to assess its accuracy, the prognostic value of the IMRS was also compared that of the SYNTAX score II (SSII). RESULTS After adjustment for the characteristics in the univariable study, multivariable Cox regression analysis indicated that the IMRS and SSII were both independently associated with short- and long-term mortality in STEMI patients with cardiogenic shock. However, the receiver operating characteristic curves indicated that the IMRS outperformed the SSII in terms of predicting both short- and long-term mortality. CONCLUSION This preliminary investigation showed that IMRS can predict both short- and long-term mortality in individuals with STEMI accompanied by cardiogenic shock.
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Affiliation(s)
- Hayiroğlu Mert İlker
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul
| | - Saylik Faysal
- Department of Cardiology, Van Training and Research Hospital, Van
| | - Yumurtaş Ahmet Çağdaş
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul
| | - Selçuk Murat
- Department of Cardiology, Haydarpasa Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Çinar Tufan
- Department of Cardiology, Haydarpasa Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
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Horne BD, Bledsoe JR, Muhlestein JB, May HT, Peltan ID, Webb BJ, Carlquist JF, Bennett ST, Rea S, Bair TL, Grissom CK, Knight S, Ronnow BS, Le VT, Stenehjem E, Woller SC, Knowlton KU, Anderson JL. Association of the Intermountain Risk Score with major adverse health events in patients positive for COVID-19: an observational evaluation of a US cohort. BMJ Open 2022; 12:e053864. [PMID: 35332038 PMCID: PMC8948080 DOI: 10.1136/bmjopen-2021-053864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The Intermountain Risk Score (IMRS), composed using published sex-specific weightings of parameters in the complete blood count (CBC) and basic metabolic profile (BMP), is a validated predictor of mortality. We hypothesised that IMRS calculated from prepandemic CBC and BMP predicts COVID-19 outcomes and that IMRS using laboratory results tested at COVID-19 diagnosis is also predictive. DESIGN Prospective observational cohort study. SETTING Primary, secondary, urgent and emergent care, and drive-through testing locations across Utah and in sections of adjacent US states. Viral RNA testing for SARS-CoV-2 was conducted from 3 March to 2 November 2020. PARTICIPANTS Patients aged ≥18 years were evaluated if they had CBC and BMP measured in 2019 and tested positive for COVID-19 in 2020. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was a composite of hospitalisation or mortality, with secondary outcomes being hospitalisation and mortality separately. RESULTS Among 3883 patients, 8.2% were hospitalised and 1.6% died. Subjects with low, mild, moderate and high-risk IMRS had the composite endpoint in 3.5% (52/1502), 8.6% (108/1256), 15.5% (152/979) and 28.1% (41/146) of patients, respectively. Compared with low-risk, subjects in mild-risk, moderate-risk and high-risk groups had HR=2.33 (95% CI 1.67 to 3.24), HR=4.01 (95% CI 2.93 to 5.50) and HR=8.34 (95% CI 5.54 to 12.57), respectively. Subjects aged <60 years had HR=3.06 (95% CI 2.01 to 4.65) and HR=7.38 (95% CI 3.14 to 17.34) for moderate and high risks versus low risk, respectively; those ≥60 years had HR=1.95 (95% CI 0.99 to 3.86) and HR=3.40 (95% CI 1.63 to 7.07). In multivariable analyses, IMRS was independently predictive and was shown to capture substantial risk variation of comorbidities. CONCLUSIONS IMRS, a simple risk score using very basic laboratory results, predicted COVID-19 hospitalisation and mortality. This included important abilities to identify risk in younger adults with few diagnosed comorbidities and to predict risk prior to SARS-CoV-2 infection.
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Affiliation(s)
- Benjamin D Horne
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Joseph R Bledsoe
- Department of Emergency Medicine, Intermountain Medical Center, Salt Lake City, UT, USA
- Department of Emergency Medicine, Stanford University, Stanford, CA, USA
| | - Joseph B Muhlestein
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA
- Cardiology Division, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Heidi T May
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA
| | - Ithan D Peltan
- Pulmonary and Critical Care, Intermountain Medical Center, Salt Lake City, Utah, USA
- Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Brandon J Webb
- Division of Infectious Diseases and Clinical Epidemiology, Department of Medicine, Intermountain Medical Center, Salt Lake City, Utah, USA
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - John F Carlquist
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA
- Cardiology Division, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Sterling T Bennett
- Intermountain Central Laboratory, Intermountain Medical Center, Salt Lake City, UT, USA
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Susan Rea
- Care Transformation Information Systems, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Tami L Bair
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA
| | - Colin K Grissom
- Pulmonary and Critical Care, Intermountain Medical Center, Salt Lake City, Utah, USA
- Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Stacey Knight
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA
| | - Brianna S Ronnow
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA
| | - Viet T Le
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA
| | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Department of Medicine, Intermountain Medical Center, Salt Lake City, Utah, USA
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Scott C Woller
- Department of Medicine, Intermountain Medical Center, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Kirk U Knowlton
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Jeffrey L Anderson
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA
- Cardiology Division, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
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