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Hou X, Xu W, Zhang C, Song Z, Zhu M, Guo Q, Wang J. L-Shaped Association of Serum Chloride Level With All-Cause and Cause-Specific Mortality in American Adults: Population-Based Prospective Cohort Study. JMIR Public Health Surveill 2023; 9:e49291. [PMID: 37955964 PMCID: PMC10682926 DOI: 10.2196/49291] [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: 05/29/2023] [Revised: 08/31/2023] [Accepted: 10/17/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Chloride is the most abundant anion in the human extracellular fluid and plays a crucial role in maintaining homeostasis. Previous studies have demonstrated that hypochloremia can act as an independent risk factor for adverse outcomes in various clinical settings. However, the association of variances of serum chloride with long-term mortality risk in general populations has been rarely investigated. OBJECTIVE This study aims to assess the association of serum chloride with all-cause and cause-specific mortality in the general American adult population. METHODS Data were collected from 10 survey cycles (1999-2018) of the National Health and Nutrition Examination Survey. All-cause mortality, cardiovascular disease (CVD) mortality, cancer mortality, and respiratory disease mortality data were obtained by linkage to the National Death Index through December 31, 2019. After adjusting for demographic factors and relevant lifestyle, laboratory items, and comorbid factors, weighted Cox proportional risk models were constructed to estimate hazard ratios and 95% CIs for all-cause and cause-specific mortality. RESULTS A total of 51,060 adult participants were included, and during a median follow-up of 111 months, 7582 deaths were documented, 2388 of CVD, 1639 of cancer, and 567 of respiratory disease. The weighted Kaplan-Meier survival analyses showed consistent highest mortality risk in individuals with the lowest quartiles of serum chloride. The multivariate-adjusted hazard ratios from lowest to highest quartiles of serum chloride (≤101.2, 101.3-103.2, 103.2-105.0, and ≥105.1 mmol/L) were 1.00 (95% CI reference), 0.77 (95% CI 0.67-0.89), 0.72 (95% CI 0.63-0.82), and 0.77 (95% CI 0.65-0.90), respectively, for all-cause mortality (P for linear trend<.001); 1.00 (95% CI reference), 0.63 (95% CI 0.51-0.79), 0.56 (95% CI 0.43-0.73), and 0.67 (95% CI 0.50-0.89) for CVD mortality (P for linear trend=.004); 1.00 (95% CI reference), 0.67 (95% CI 0.54-0.84), 0.65 (95% CI 0.50-0.85), and 0.65 (95% CI 0.48-0.87) for cancer mortality (P for linear trend=.004); and 1.00 (95% CI reference), 0.68 (95% CI 0.41-1.13), 0.59 (95% CI 0.40-0.88), and 0.51 (95% CI 0.31-0.84) for respiratory disease mortality (P for linear trend=.004). The restricted cubic spline analyses revealed the nonlinear and L-shaped associations of serum chloride with all-cause and cause-specific mortality (all P for nonlinearity<.05), in which lower serum chloride was prominently associated with higher mortality risk. The associations of serum chloride with mortality risk were robust, and no significant additional interaction effect was detected for all-cause mortality and CVD mortality (P for interaction>.05). CONCLUSIONS In American adults, decreased serum chloride concentrations were independently associated with increased all-cause mortality, CVD mortality, cancer mortality, and respiratory disease mortality. Our findings suggested that serum chloride may serve as a promising cost-effective health indicator in the general adult population. Further studies are warranted to explore the potential pathophysiological mechanisms underlying the association between serum chloride and mortality.
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Affiliation(s)
- Xinran Hou
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Wei Xu
- Department of Anesthesiology, Hunan Provincial Maternal and Child Health Care Hospital, University of South China, Changsha, China
| | - Chengliang Zhang
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Zongbin Song
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Maoen Zhu
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Qulian Guo
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jian Wang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Shafat T, Novack V, Barski L, Haviv YS. Community-based serum chloride abnormalities predict mortality risk. PLoS One 2023; 18:e0279837. [PMID: 36809243 PMCID: PMC9942956 DOI: 10.1371/journal.pone.0279837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/15/2022] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION This population-based study aimed to investigate the prognostic value of ambulatory serum chloride abnormalities, often ignored by physicians. METHODS The study population included all non-hospitalized adult patients, insured by "Clalit" Health Services in Israel's southern district, who underwent at least 3 serum chloride tests in community-based clinics during 2005-2016. For each patient, each period with low (≤97 mmol/l), high (≥107 mmol/l) or normal chloride levels were recorded. A Cox proportional hazards model was used to estimate the mortality risk of hypochloremia and hyperchloremia periods. RESULTS 664,253 serum chloride tests from 105,655 subjects were analyzed. During a median follow up of 10.8 years, 11,694 patients died. Hypochloremia (≤ 97 mmol/l) was independently associated with elevated all-cause mortality risk after adjusting for age, co-morbidities, hyponatremia and eGFR (HR 2.41, 95%CI 2.16-2.69, p<0.001). Crude hyperchloremia (≥107 mmol/L) was not associated with all-cause mortality (HR 1.03, 95%CI 0.98-1.09 p = 0.231); as opposed to hyperchloremia ≥108 mmol/l (HR 1.14, 95%CI 1.06-1.21 p<0.001). Secondary analysis revealed a dose-dependent elevated mortality risk for chloride levels of 105 mmol/l and below, well within the "normal" range. CONCLUSION In the outpatient setting, hypochloremia is independently associated with an increased mortality risk. This risk is dose-dependent where the lower the chloride level, the higher is the risk.
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Affiliation(s)
- Tali Shafat
- Clinical Research Center, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
- Department of Internal Medicine F, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Leonid Barski
- Department of Internal Medicine F, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Yosef S. Haviv
- Nephrology Department, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
- * E-mail:
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Florian M, Li B, Patry D, Truong J, Caldwell D, Coughlan MC, Woodworth R, Yan J, Chen Q, Petrov I, Mahemuti L, Lalande M, Li N, Chan LHM, Willmore WG, Jin X. Interplay of Obesity, Ethanol, and Contaminant Mixture on Clinical Profiles of Cardiovascular and Metabolic Diseases: Evidence from an Animal Study. Cardiovasc Toxicol 2022; 22:558-578. [PMID: 35429258 PMCID: PMC9107407 DOI: 10.1007/s12012-022-09738-6] [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] [Received: 10/20/2021] [Accepted: 03/28/2022] [Indexed: 11/05/2022]
Abstract
Obesity, ethanol, and contaminants are known risk factors of cardiovascular and metabolic diseases (CMD). However, their interplay on clinical profiles of these diseases remains unclear, and thus were investigated in this study. Male lean or obese JCR rats were given water or 10% ethanol and orally treated with or without a contaminant mixture (CM) dissolved in corn oil and loaded on two cookies at 0, 1.6, or 16 mg/kg BW/day dose levels for 4 weeks. The CM consisted 22 environmental contaminants found in human blood or serum of Northern populations. Over 60 parameters related to CMD were examined. The results revealed that obesity in JCR rats resembles the clinical profiles of non-alcoholic fatty liver disease in humans. Obesity was also associated with increased serum and organ retention of mercury, one of the chemical components of CM. Exposure to ethanol lightened hyperlipidemia, increased liver retention of mercury, and increased risk for hypertension in the obese rats. CM lessened hyperlipidemia and hyperenzymemia, worsened systemic inflammation and increased the risk for hypertension in the obese rats. CM markedly increased serum ethanol levels with or without ethanol exposure. Tissue total mercury contents significantly correlated with clinical parameters with altered profiles by both ethanol and obesity. These results suggest that obese individuals may be more prone to contaminant accumulation. Ethanol and CM exposure can alter clinical profiles associated with obesity, which may lead to misdiagnosis of CMD associated with obesity. CM can alter endogenous production and/or metabolism of ethanol, further complicating disease progression, diagnosis, and treatment.
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Affiliation(s)
- Maria Florian
- Regulatory Toxicology Research Division, Bureau of Chemical Safety, Food Directorate, HPFB, Health Canada, Ottawa, ON, Canada
- Departments of Biology and Chemistry, Institute of Biochemistry, Carleton University, Ottawa, ON, Canada
| | - Bai Li
- Regulatory Toxicology Research Division, Bureau of Chemical Safety, Food Directorate, HPFB, Health Canada, Ottawa, ON, Canada
- Department of Biology, University of Ottawa, Ottawa, ON, Canada
| | - Dominique Patry
- Scientific Services Division, Bureau of Chemical Safety, Food Directorate, HPFB, Health Canada, Ottawa, ON, Canada
| | - Jocelyn Truong
- Department of Biology, University of Ottawa, Ottawa, ON, Canada
| | - Don Caldwell
- Scientific Services Division, Bureau of Chemical Safety, Food Directorate, HPFB, Health Canada, Ottawa, ON, Canada
| | - Melanie C Coughlan
- Regulatory Toxicology Research Division, Bureau of Chemical Safety, Food Directorate, HPFB, Health Canada, Ottawa, ON, Canada
| | - Robert Woodworth
- Regulatory Toxicology Research Division, Bureau of Chemical Safety, Food Directorate, HPFB, Health Canada, Ottawa, ON, Canada
| | - Jin Yan
- Regulatory Toxicology Research Division, Bureau of Chemical Safety, Food Directorate, HPFB, Health Canada, Ottawa, ON, Canada
| | - Qixuan Chen
- Regulatory Toxicology Research Division, Bureau of Chemical Safety, Food Directorate, HPFB, Health Canada, Ottawa, ON, Canada
| | - Ivan Petrov
- Regulatory Toxicology Research Division, Bureau of Chemical Safety, Food Directorate, HPFB, Health Canada, Ottawa, ON, Canada
| | - Laziyan Mahemuti
- Regulatory Toxicology Research Division, Bureau of Chemical Safety, Food Directorate, HPFB, Health Canada, Ottawa, ON, Canada
- Departments of Biology and Chemistry, Institute of Biochemistry, Carleton University, Ottawa, ON, Canada
| | - Michelle Lalande
- Scientific Services Division, Bureau of Chemical Safety, Food Directorate, HPFB, Health Canada, Ottawa, ON, Canada
| | - Nanqin Li
- Hazard Identification Division, Environmental Health Science and Research Bureau, HECSB, Health Canada, Ottawa, ON, Canada
| | - Laurie H M Chan
- Department of Biology, University of Ottawa, Ottawa, ON, Canada
| | - William G Willmore
- Departments of Biology and Chemistry, Institute of Biochemistry, Carleton University, Ottawa, ON, Canada
| | - Xiaolei Jin
- Regulatory Toxicology Research Division, Bureau of Chemical Safety, Food Directorate, HPFB, Health Canada, Ottawa, ON, Canada.
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Eggimann L, Blum S, Aeschbacher S, Reusser A, Ammann P, Erne P, Moschovitis G, Di Valentino M, Shah D, Schläpfer J, Mondet N, Kühne M, Sticherling C, Osswald S, Conen D. Risk factors for heart failure hospitalizations among patients with atrial fibrillation. PLoS One 2018; 13:e0191736. [PMID: 29394253 PMCID: PMC5823079 DOI: 10.1371/journal.pone.0191736] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/10/2018] [Indexed: 01/06/2023] Open
Abstract
Background Patients with atrial fibrillation (AF) have an increased risk for the
development of heart failure (HF). In this study, we aimed to detect
predictors of HF hospitalizations in an unselected AF population. Methods The Basel Atrial Fibrillation Cohort Study is an ongoing observational
multicenter cohort study in Switzerland. For this analysis, 1193 patients
with documented AF underwent clinical examination, venous blood sampling and
resting 12-lead ECG at baseline. Questionnaires about lifestyle and medical
history were obtained in person at baseline and during yearly follow-up
phone calls. HF hospitalizations were validated by two independent
physicians. Cox regression analyses were performed using a forward selection
strategy. Results Overall, 29.8% of all patients were female and mean age was 69 ±12 years.
Mean follow-up time was 3.7 ±1.5 years. Hospitalization for HF occurred in
110 patients, corresponding to an incidence of 2.5 events per 100 person
years of follow-up. Independent predictors for HF were body mass index (HR
1.40 [95%CI 1.17; 1.66], p = 0.0002), chronic kidney disease (2.27 [1.49;
3.45], p = 0.0001), diabetes mellitus (2.13 [1.41; 3.24], p = 0.0004), QTc
interval (1.25 [1.04; 1.49], p = 0.02), brain natriuretic peptide (2.19
[1.73; 2.77], p<0.0001), diastolic blood pressure (0.79 [0.65; 0.96], p =
0.02), history of pulmonary vein isolation or electrical cardioversion (0.54
[0.36; 0.80], p = 0.003) and serum chloride (0.82 [0.70; 0.96], p =
0.02). Conclusions In this unselected AF population, several traditional cardiovascular risk
factors and arrhythmia interventions predicted HF hospitalizations,
providing potential opportunities for the implementation of strategies to
reduce HF among AF patients.
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Affiliation(s)
- Lucien Eggimann
- Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Steffen Blum
- Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.,Division of Internal Medicine, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefanie Aeschbacher
- Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andreas Reusser
- Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Peter Ammann
- Division of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Paul Erne
- Laboratory for Signal Transduction, Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | | | | | - Dipen Shah
- Division of Cardiology, University Hospital Geneva, Geneva, Switzerland
| | - Jürg Schläpfer
- Service of Cardiology, University Hospital Lausanne, Lausanne, Switzerland
| | - Nadine Mondet
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael Kühne
- Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Sticherling
- Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Osswald
- Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - David Conen
- Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.,Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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Association of serum chloride level with mortality and cardiovascular events in chronic kidney disease: the CKD-ROUTE study. Clin Exp Nephrol 2016; 21:104-111. [DOI: 10.1007/s10157-016-1261-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 03/14/2016] [Indexed: 12/17/2022]
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